**2. Materials and methods**

A non-systematic literature review was conducted, based on a selection of current and high-quality articles. Search strategy was set up on the main keywords utilized both in the field of occupational health and health inequalities. The search covered PubMed, Science Direct, and Google Scholar databases. Articles and reports that are considered milestones in the field of health inequalities have also been added to the list of references. Reports from World Health Organization (WHO) and Occupational Safety and Health (OSH) were downloaded from the official websites, and web addresses have been reported in the references. Data relevant to the objectives of this chapter have been synthesized using interpretive analysis.

### **3. Health inequalities**

Health inequalities are well documented in a large number of studies from a broad range of industrialized countries (seen in low-, middle-, and high-income

**55**

*Working Conditions and Health Inequalities DOI: http://dx.doi.org/10.5772/intechopen.89518*

social groups rather than between individuals.

**4. What are the factors that influence people's health status?**

Scientific work on health inequalities has exponentially increased over the last five decades and particularly since the establishment of the World Health Organization (WHO)'s Commission on Social Determinants of Health (CSDH) in 2005. The CSDH approach has focused on the Social Determinants of Health (SDH) perspective, providing an alternative for the approaches limited only to the medical-health aspect and individual behaviors [26]. As a matter of fact, the medical-health approach had always focused on improving health care quality and addressing unhealthy behaviors (e.g., incorrect life style) to achieve greater health equality. Thus, individuals have been considered as responsible for their own health, and the main strategy for preventing disease has been focused on the promotion of correct life style and on behavioral modifications (e.g., smoking cessation, decreasing salt and fat intake, and reducing sedentary lifestyle) [21, 27]. Encouraging better individual behavior is a well-established approach to health promotion, but the evidence suggests that these interventions may have limited effect without to tackle health inequalities [21]. Conversely, an incorrect lifestyle

countries) [9–12]. Among the most important scientific evidence of health inequalities, it is necessary to give particular emphasis to the famous Whitehall Studies (I and II) of British Civil Servants led by Michael Marmot [13, 14]. The Whitehall cohort study examined mortality rates of Civil Servants and was conducted over a period of 10 years, beginning in 1967. A long-term follow-up of people enrolled in the two studies is still ongoing [15, 16]. Why the impact of these studies so important? The Whitehall studies concentrate on one "working environment" (British Civil Servants) in which there is little heterogeneity in the social economic position within occupational levels and clear social divisions between levels [17]. Whitehall studies showed that people of lower hierarchical occupational levels had worse health and shorter life expectancy than those who were in higher occupational levels. Whitehall studies likewise showed a gap of 5 years in life expectancy between people at the top and at the bottom of the occupational levels. Whitehall studies have also demonstrated an inverse relationship between social economic position and health as well as mortality related to a wide range of diseases. Based on the results of Whitehall studies, Marmot identified "the social gradient in health" where people are positioned by degrees of affluence and deprivation [13, 18]. People near the top have poorer health than those at the very top but better than people behind them in the health gradient scale. Thus, the social gradient in health means that health inequalities affect everyone in a different manner. In addition to Whitehall research, other studies have provided overwhelming evidence for health inequalities and their distribution in the social gradient of health [19–25]. Health inequalities, within and between different countries, are influenced by an unequal distribution of economic, social, and environmental conditions. People with a lower level of education, a lower occupational class, or a lower level of income tend to die at a younger age and to have a higher prevalence of most types of health problems [11, 17]. It is interesting to note that the health gradient cannot be explained taking into account only the biological or genetic characteristics of people, but rather must be considered as the consequence of the socio-economic conditions in which people live and work. The social gradient in health is a term used to describe the phenomenon whereby people who are less advantaged in terms of socioeconomic position have worse health (and shorter lives) than those who are more advantaged. It is also important to highlight that social gradient of health considers differences between

#### *Working Conditions and Health Inequalities DOI: http://dx.doi.org/10.5772/intechopen.89518*

*Safety and Health for Workers - Research and Practical Perspective*

seem to be inherently dangerous [3–5].

masculinized jobs.

**2. Materials and methods**

**3. Health inequalities**

to be exposed to the " hazardous biological agent," for example, by working with biological samples infected with *Mycobacterium tuberculosis* or having close contact with someone with the disease TB. In this example, the probability (risk) of being exposed to TB will be very high for people working in the hospital infectious diseases department, but very low for people working in other workplaces, such as a library. Today, there are known many different types of hazards, which can cause adverse effects or harm in the workplace. Hazards can come from a wide range of sources and can be found in every workplace. Workplace risk awareness has grown over time, thus now it is possible to identify situations and processes that are inherently dangerous, such as those associated with chemical, physical, and biological procedures or ergonomic risk factors. Unfortunately, there is no cultural preparation to address risk assessment of new and emerging categories (e.g., the work organization) that do not

Before going into specific aspects of OSH, it should be emphasized that adverse health outcomes in the medical field can be considered as based on two different approaches: the first considers bad health as an inevitable result of individual behavior patterns; the second considers that poor social and economic circumstances affect health throughout life. These different approaches can be extrapolated into the occupational field. Unfortunately, the occupational safety and health management system has so far given little attention to aspects related to the social-economic organization in which people live and work. In recent years, several studies have shown that safety interventions may be more effective at preventing the incidence of work-related diseases by giving priority to the characteristics of organization structures [6–8]. What does this specifically refer to? Generally, when referring to social-economic organization, we consider some occupational and working conditions, type of organizational structure of companies, different types of contracts (such as atypical jobs), size of the production units, and feminized and

In this chapter, assuming that most aspects of common workplace hazards should have been dealt with extensively in other chapters of this book, we will not discuss them unless these can be modified by the specific characteristics of subgroups of workers. Our goal is to provide a point of reflection on the relationship that associates socioeconomic organization and safety interventions in the work-

A non-systematic literature review was conducted, based on a selection of current and high-quality articles. Search strategy was set up on the main keywords utilized both in the field of occupational health and health inequalities. The search covered PubMed, Science Direct, and Google Scholar databases. Articles and reports that are considered milestones in the field of health inequalities have also been added to the list of references. Reports from World Health Organization (WHO) and Occupational Safety and Health (OSH) were downloaded from the official websites, and web addresses have been reported in the references. Data relevant to the objec-

Health inequalities are well documented in a large number of studies from a broad range of industrialized countries (seen in low-, middle-, and high-income

place with social inequalities in health also named health inequalities.

tives of this chapter have been synthesized using interpretive analysis.

**54**

countries) [9–12]. Among the most important scientific evidence of health inequalities, it is necessary to give particular emphasis to the famous Whitehall Studies (I and II) of British Civil Servants led by Michael Marmot [13, 14]. The Whitehall cohort study examined mortality rates of Civil Servants and was conducted over a period of 10 years, beginning in 1967. A long-term follow-up of people enrolled in the two studies is still ongoing [15, 16]. Why the impact of these studies so important? The Whitehall studies concentrate on one "working environment" (British Civil Servants) in which there is little heterogeneity in the social economic position within occupational levels and clear social divisions between levels [17]. Whitehall studies showed that people of lower hierarchical occupational levels had worse health and shorter life expectancy than those who were in higher occupational levels. Whitehall studies likewise showed a gap of 5 years in life expectancy between people at the top and at the bottom of the occupational levels. Whitehall studies have also demonstrated an inverse relationship between social economic position and health as well as mortality related to a wide range of diseases. Based on the results of Whitehall studies, Marmot identified "the social gradient in health" where people are positioned by degrees of affluence and deprivation [13, 18]. People near the top have poorer health than those at the very top but better than people behind them in the health gradient scale. Thus, the social gradient in health means that health inequalities affect everyone in a different manner. In addition to Whitehall research, other studies have provided overwhelming evidence for health inequalities and their distribution in the social gradient of health [19–25]. Health inequalities, within and between different countries, are influenced by an unequal distribution of economic, social, and environmental conditions. People with a lower level of education, a lower occupational class, or a lower level of income tend to die at a younger age and to have a higher prevalence of most types of health problems [11, 17]. It is interesting to note that the health gradient cannot be explained taking into account only the biological or genetic characteristics of people, but rather must be considered as the consequence of the socio-economic conditions in which people live and work. The social gradient in health is a term used to describe the phenomenon whereby people who are less advantaged in terms of socioeconomic position have worse health (and shorter lives) than those who are more advantaged. It is also important to highlight that social gradient of health considers differences between social groups rather than between individuals.
