**4.1 Social determinants of health**

Social determinants of health include all the major non-genetic and non-biological factors that influence human health. In other words, they are the socioeconomic factors operating in the society that ultimately lead to poor health outcomes. The field of the social determinants of health is perhaps the most complex and challenging of all [9–12]. As reported on the official website of the WHO [9], social determinants of health are defined as follows:

*"The conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems*" [9].

Several "conceptual models" have been developed to describe the complex process by which social hierarchies are associated to health. The models try to illustrate how health inequalities are created through the effects of social stratification [11, 31, 32]. Generally, the classifying of individuals into groups with different relative social positions is based on characteristics such as education, income, labor market position, ethnicity, and gender. All together, they are also named social determinant of health. The uneven distribution of opportunities and resources (coupled with social positions) is associated to systematic differences in living conditions and to differential vulnerability. It is important to emphasize that although the "conceptual models" differ in style and complexity, most of these represent health as the outcome of a chain of events or social influences, including both proximal and distal determinants of health. Proximal factors act directly or almost directly to cause disease, (e.g., individual lifestyle factors, housing, water and sanitation, and social and community networks), and distal determinants act indirectly (including social resources like education, employment opportunities, political influence, income, and property). The most significant distal factor is the social structure of society, which is the upstream in the causal chain and acts via a number of intermediate causes establishing person's position in the social hierarchies. Numerous studies have shown that a "dose-response" association with health [17, 26] characterizes education and income. As stated by the WHO and by experts in the field of health inequalities, six main areas of interventions are identified for good health condition:


**57**

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

determinants of health.

1.Employment

3.Unemployment

5.Child labor

2.Precarious employment

6.Slavery/bonded labor

**5. Employment and working conditions**

types of employment into six "dimensions" of global scope:

4.Informal employment and informal jobs

5.Create and develop healthy and sustainable places and communities.

In the last few years, new and stronger scientific evidence and several conceptual models on the levels of causation of health inequalities have been developed [31, 32]. A detailed description of the six areas as well as deeper conceptual models on the levels of causation (by which social hierarchies are created) goes beyond the scope of the present chapter and interested readers can refer to more focused reviews [9, 11, 14, 26, 31, 32]. Here, we like to emphasize that the importance of employment and the quality of work is recognized as one of the most important key

To analyze how the working world can affect the health of populations, we need first to clarify three occupational aspects: employment relations, employment conditions, and working conditions. The former concerns the various relationships between the employer and employee. In the developed countries, "employment relations" are often subject to the enforcement of specific law or a contract of hire. In the developing and under-developing countries, most employment agreements are not explicitly subject to any formal law or contract. Considering that the "employment relations" varies both within and between countries, the term "employment conditions" was introduced by the WHO [33], classifying different

Finally, "working conditions" are related to the tasks carried out by workers, the physical and chemical work environment, ergonomics, the way the work is organized, the social work environment, and the technology being used. Several occupational studies have shown that the relationship between employment condition and work conditions reflect and reinforce the social gradient of health [22]. Thus, people with lower education and lower occupational positions have been associated with dangerous work and with worse work-related exposure [13, 17, 23, 24]. Generally, they were subjected to poorer health than those in higher positions [23, 24]. However, the inequality of exposure does not seem to be sufficiently recognized by all countries in the world. For example, in developing countries, there is a great lack of research, as well as data about risk factors and exposure levels for specific jobs [25]. Nevertheless, in this section, we will try to identify common features and trends among and between economically different countries. Our analysis on occupational conditions starts with the most disadvantaged "dimensions" as registered

6.Strengthen the role and impact of ill-health prevention.


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

root causes of health inequalities.

**4.1 Social determinants of health**

*and political systems*" [9].

determinants of health are defined as follows:

of interventions are identified for good health condition:

3.Create fair employment and good work for all.

4.Ensure a healthy standard of living for all.

1.Give every child the best start in life.

and have control over their lives.

could be a response to social breakdown and a mirage to escape from social adversity and stress. Several studies have shown that alcohol dependence, illicit drug use, and cigarette smoking are all closely associated with markers of social and economic disadvantage [28, 29]. The WHO introduced a new approach for public health intervention that recommended more concern toward social policies and social determinants of health. According to the suggestions of the WHO [10, 30], different countries in the world (especially European countries) are focusing their health policy interventions both on promoting better lifestyles and addressing the

Social determinants of health include all the major non-genetic and non-biological factors that influence human health. In other words, they are the socioeconomic factors operating in the society that ultimately lead to poor health outcomes. The field of the social determinants of health is perhaps the most complex and challenging of all [9–12]. As reported on the official website of the WHO [9], social

*"The conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies* 

Several "conceptual models" have been developed to describe the complex process by which social hierarchies are associated to health. The models try to illustrate how health inequalities are created through the effects of social stratification [11, 31, 32]. Generally, the classifying of individuals into groups with different relative social positions is based on characteristics such as education, income, labor market position, ethnicity, and gender. All together, they are also named social determinant of health. The uneven distribution of opportunities and resources (coupled with social positions) is associated to systematic differences in living conditions and to differential vulnerability. It is important to emphasize that although the "conceptual models" differ in style and complexity, most of these represent health as the outcome of a chain of events or social influences, including both proximal and distal determinants of health. Proximal factors act directly or almost directly to cause disease, (e.g., individual lifestyle factors, housing, water and sanitation, and social and community networks), and distal determinants act indirectly (including social resources like education, employment opportunities, political influence, income, and property). The most significant distal factor is the social structure of society, which is the upstream in the causal chain and acts via a number of intermediate causes establishing person's position in the social hierarchies. Numerous studies have shown that a "dose-response" association with health [17, 26] characterizes education and income. As stated by the WHO and by experts in the field of health inequalities, six main areas

2.Enable all children, young people, and adults to maximize their capabilities

**56**


In the last few years, new and stronger scientific evidence and several conceptual models on the levels of causation of health inequalities have been developed [31, 32]. A detailed description of the six areas as well as deeper conceptual models on the levels of causation (by which social hierarchies are created) goes beyond the scope of the present chapter and interested readers can refer to more focused reviews [9, 11, 14, 26, 31, 32]. Here, we like to emphasize that the importance of employment and the quality of work is recognized as one of the most important key determinants of health.
