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Chapter 7

Chapter 7 social determinants of health .docx

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Health Sciences
Health Sciences 1002A/B
Anita Cramp

Chapter 7- The Unhealthy Canadian Workplace -The purpose of this chapter is to provide a broad overview of the impact of employment, working conditions, and the work environment on health. The focus is on the quality of work -Since higher-income people are in better health and live longer than middle-income people suggests that the health gradient is linked to relative position on the income scale rather than to absolute deprivation or poverty -the experience of work dominates the lives of most working-age people -those at the lower end of the income spectrum are most likely to experience stress from job insecurity and from stress in workplace itself, and they are also most likely to face workplace hazards to physical health -there is strong links b/w unemployment/precarious employment and poor health outcome -also strong link b/w poor working conditions and poor physical and mental health -Poor employment conditions: →dirty and dangerous jobs, exposure to harmful substances that pose risks to physical health in terms of injuries and occupational disease →jobs that are stressful by virtue of the pace, demands, or repetitive content of the labour process →jobs that are stressful b/c of the exercise of arbitrary power in the workplace and lack social support →jobs that are stressful b/c they do not meet human developmental needs →jobs that are stressful b/c they are a source of conflict w/ the lives of workers in the home and in the community Work and Health -there is a link b/w work stress and physical and mental health -stress comes from many sources: →job insecurity, physical demands of the work, the extent of support from supervisors and co-workers, work-life conflict, and job strain -High job-strain =combination of high psychological demands at work combined w/ a low degree of control over work process = is linked to an increased risk of physical injuries at work, high blood pressure, cardiovascular disease, depression and other mental health conditions, and increased risks to health -Work is a major source of psychosocial stress, which has been identified as one major cause of increased morbidity and mortality -feeling depressed, bitter, cheated, vulnerable, frightened about debts or job or housing insecurity, feel useless, helpless, uncared for, hopeless, isolated, and anxious→ these feeling can dominate a person's whole life What is a Good Job? -non-wage benefits, job security, and opportunities for advancement are as important as wages -a large majority of workers place a high value on having interesting and personally rewarding work, enjoying some autonomy(one of the conditions) on the job, and having the ability to exercise and develop their skills and capacities -72% of worker say the "very important" criterion of a job is healthy and safe workplace. Followed closely by work-life balance which 63 % of workers say is important -the quality of jobs involve much more than just the amount of money you get -Work is seen as a potential sphere for the development of individual human capacities and potentials -Good workplaces= there are valued relationships w/ co-workers and some degree of active participation and democratic control of the work process -Bad workplaces= are alienating and authoritarian Forces Shaping Workplace Change in Canada -The most common forms of organizational change have been downsizing, contracting out of non-core functions, and securing greater flexibility of time worked through a combination of increased overtime and increased part-time and contract work -restructuring of work has been driven by employers and governments have been bystanders Dimensions of Job Quality •Job Security -the state of unemployment is bad for health for both material and psychological reasons -the transition from stable employment to long-term unemployment is less frequent today. Now people have short-term unemployment and precarious employment -Frequent short-term unemployment is a source of stress and anxiety due to lack of income, uncertain prospects for the future, and its potential to undermine social support networks -people who move b/w short-term jobs have less satisfaction and meaning from their jobs -To be counted as employed, one needs to only work for a few hours in a week, including temporary employees, part-time workers who want more hours, and people working in low-wage survival jobs while looking for regular jobs matching their skills -unemployed= person is unable to find any work at all and to have been actively seeking work even if he/she knew that no suitable jobs were available -Long-term unemployment in Canada is much lower than in other advanced industrial countries -Precarious work in Canada is widespread and is much more precarious than in many other countries -In the EU there are job-security laws regulations that limit employers' power to lay off long-tenure workers -in Canada the pay gap b/w precarious and core workers are more larger than in most EU countries -job insecurity in the precarious labour market is heightened by the lack of supports and services to promote access to better employment -to get employment insurance you need 700 hours or 20 weeks of full-time work, this means that people who work precarious jobs and part-time jobs won't be able to get employment insurance -"employment strain" →stress that has adverse implications for health arise from precarious jobs such as temporary and contract work →precarious jobs don't have support networks that are found in secure and stable jobs in larger workplaces →they have a higher risk of injury and illness →greater workload and greater exposure to dangerous substances among the self-employed and those who work for small contractors →higher risk of self-reported ill health and a greater incidence of working in pain compared to workers in similar jobs who are in more secure forms of employment -another key difference b/w relatively secure and more precarious employment w/ direct implications for health is access to employer-sponsored health benefits -the most important benefit for the working-age population is prescription drug coverage -having a low-wage job w/ no benefits can mean an inability to but medically necessary prescription drugs as well as needed dental and other health services not provided by medicare -non-union members have less coverage than union members. Small firms, part-time jobs, and temporary jobs have even less coverage -precariously employed workers face directly higher risks to health b/c of the quality of their employment -lack of employer-sponsored pension coverage for many precarious workers, combined w/ a relatively ungenerous public pension system, implies longer working lifetimes -Low-wage older workers are better off after they retire at 65 and qualify for the combined OldAge Security pension and Guaranteed Income Supplement, which at least provide an income close to the poverty line Box 7.1: Fear of job loss -the Personal Security Index(PSI) is used to track the proportion of people who think there is a good chance they could lose their job over the next 2 years -Fear of job loss is slightly higher among men than women, and much higher in lower-income households -PSI also tracks the proportion of workers who are confident they could find an equivalent job w/in 6 months if they lost their current job -the risk of job loss has been falling, however many workers still fear they would be unable to find as good a job as the one they have if they were to be laid off Box: 7.2 Five deaths a day: Workplace fatalities in Canada -workplace fatalities have been increasing from 1993 to 2004 so much that there are 5 work-related deaths per working day -the chances of a worker dying from a workplace-related accident of disease in Canada vary greatly by industry, occupation, gender, and age group. -most dangerous over the 1996-2005 is (order from the most dangerous to the least): 1)mining, quarrying, oil wells 2)logging and forestry 3)fishing and trapping 4)agriculture 5)construction 6)finance and insurance -men are much more likely than women to die on the job -men are 30 times higher to die than women at a workplace -workplace fatalities arise from both accident and occupational diseases →there is more deaths from occupational diseases than from accidents -in 2003, Canada ranks the 5th highest in workplace fatalities out of 29 countries Physical Conditions of Work -incidences of work-related accidents and injuries appears to be falling for both men and women. -But men still have a higher rate than women b/c they are more in the blue-collar industrial jobs. (these jobs have recently grown b/c of the resource boom in Western Canada and strong housing construction market -A lot of injuries don't get reported b/c workers feel they will be fired or treated as troublemakers -another reason is that employers have to pay a premium if there are accidents, so if there are higher accident rates this results in higher costs to them. This makes the employer persuade their own workers not to report injuries -also, some employers provide awards for days worked w/out injuries, increasing peer pressure on workers not to report injuries -larger workplaces are usually unionized so health and safety issues are usually taken more seriously -smaller jobs and precarious jobs are usually non-unionized like self-employment and employment w/ small subcontractors -self-employed workers are generally not covered by government health and safety legislation or by worker's compensation legislation and programs even though they may be working for large employers, so work-related accidents among them will not be report
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