文章基本信息

标题：Work as an Inclusive Part of Population Health Inequities Research and Prevention
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作者：Emily Quinn Ahonen ; Kaori Fujishiro ; Thomas Cunningham 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2018
卷号：108
期号：3
页码：306-311
DOI：10.2105/AJPH.2017.304214
语种：English
出版社：American Public Health Association
摘要：Despite its inclusion in models of social and ecological determinants of health, work has not been explored in most health inequity research in the United States. Leaving work out of public health inequities research creates a blind spot in our understanding of how inequities are created and impedes our progress toward health equity. We first describe why work is vital to our understanding of observed societal-level health inequities. Next, we outline challenges to incorporating work in the study of health inequities, including (1) the complexity of work as a concept; (2) work’s overlap with socioeconomic position, race, ethnicity, and gender; (3) the development of a parallel line of inquiry into occupational health inequities; and (4) the dearth of precise data with which to explore the relationships between work and health status. Finally, we summarize opportunities for advancing health equity and monitoring progress that could be achieved if researchers and practitioners more robustly include work in their efforts to understand and address health inequities. More than a decade ago, Lipscomb et al. 1 argued that excluding the analysis of work in health disparities research in the United States limits comprehensive understanding and our ability to intervene in persistent health inequities. A few researchers since have incorporated work into analyses of health inequities in general 2 and health inequities observed by socioeconomic status or position. 3 On the whole, though, and despite its inclusion in socioecological models and its centrality in the lives of most adults, work remains remarkably absent from examinations of health inequities in the United States. Several factors may explain this absence. These include the complexity of work as a concept for study; how work is intertwined with other concepts such as race, ethnicity, educational attainment, immigration status, gender, and socioeconomic position; and the development of a separate, parallel line of inquiry into occupational health disparities and inequities in isolation from the population health inequities agenda. Leaving work out of a broader health inequities inquiry has important consequences for research and practice, namely fragmentation of thinking and resources, incomplete understanding of inequitable patterns, and less effective strategies to intervene in them. We discuss these factors in detail, outlining concrete advances in understanding that we could make by including work along with other important factors in the study of the social production and patterning of disease and health. We argue that a careful consideration of work in public health research and practice can advance health equity. To clarify our discussion, we briefly explain our use of terms. References for readers who wish to engage more deeply with these ideas may be found in the online supplemental information (available as a supplement to the online version of this article at http://www.ajph.org ). Employment refers to the legal relationship that buyers of labor have to sellers of labor. This relationship determines the obligations, responsibilities, and expectations of employers and employees in that relationship. Occupation is applied to socially defined groups of workers with the assumption of shared skills, knowledge, and tasks. We use it for organizational purposes in the job market and in research. Working conditions are circumstances under which people perform their jobs and can include how work is organized; location and hours worked; and the physical, chemical, biological, and social factors present. We call factors that are close to the job tasks (e.g., ergonomic demands) job characteristics . Throughout, we use the words work and job to generally refer to the package of employment relationship, occupation, working conditions, and job characteristics; to refer to a more specific idea, we use the more specific term. Likewise, disparity , inequality , and inequity are not synonyms. Inequity implies a state that results from a lack of fairness and is the most relevant to our discussion of pursing health equity. However, we use the terms disparity and inequality when they are in keeping with the referenced research.