The study explores the pathways and mechanisms of the relation between employment conditions and health inequalities. A significant amount of published research has proved that workers in several risky types of labor--precarious employment, unemployment, informal labor, child and bonded labor--are exposed to behavioral, psychosocial, and physio-pathological pathways leading to physical and mental health problems. Other pathways, linking employment to health inequalities, are closely connected to hazardous working conditions (material and social deprivation, lack of social protection, and job insecurity), excessive demands, and unattainable work effort, with little power and few rewards (in salaries, fringe benefits, or job stability). Differences across countries in the social contexts and types of jobs result in varying pathways, but the general conceptual model suggests that formal and informal power relations between employees and employers can determine health conditions. In addition, welfare state regimes (unionization and employment protection) can increase or decrease the risk of mortality, morbidity, and occupational injury. In a multilevel context, however, these micro- and macro-level pathways have yet to be fully studied, especially in middle- and low-income countries. The authors recommend some future areas of study on the pathways leading to employment-related health inequalities, using worldwide standard definitions of the different forms of labor, authentic data, and a theoretical framework.

The synergistic effect of smoking, noise exposure and age on hearing loss, found in this study, is consistent with the biological interaction. Furthermore, it is possible that distinct ototoxic substances in the chemical composition of mainstream smoke may synergistically affect hearing when in combination with noise exposure, which needs to be examined in future studies.

Although the conditions and power relations of employment are known to be crucial health determinants for workers and their families, the nature of these relations and their effects on health have yet to be fully researched. Several types of employment--precarious employment in developed countries; informal sectors, child labor, slavery, and bonded labor in developing countries--expose workers to risky working conditions. Hazardous work and occupation-related diseases kill approximately 1,500 workers, globally, every day. Growing scientific evidence suggests that particular employment conditions, such as job insecurity and precarious employment, create adverse health effects; yet the limited number of studies and the poor quality of their methods prevent our understanding, globally, the complexity of employer-employee power relations, working conditions, levels of social protections, and the reality of employment-related health inequalities. This article introduces a special section on employment-related health inequalities, derived from the EMCONET approach, which focuses on (1) describing major methods and sources of information; (2) presenting theoretical models at the micro and macro levels; (3) presenting a typology of labor markets and welfare states worldwide; (4) describing the main findings in employment policies, including four key points for implementing strategies; and (5) suggesting new research developments, a policy agenda, and recommendations. This introduction includes a glossary of terms in the emerging area of employment conditions and health inequalities.

OBJECTIVE:To estimate the validity of three single questions used to assess self-reported hearing loss as compared to pure-tone audiometry in an adult population. METHODS:A validity study was performed with a random sub-sample of 188 subjects aged 30 to 65 years, drawn from the fourth wave of a populationbased cohort study carried out in Salvador, Northeastern Brazil. Data were collected in household visits using questionnaires. Three questions were used to separately assess self-reported hearing loss: Q1, "Do you feel you have a hearing loss?"; Q2, "In general, would you say your hearing is 'excellent,' 'very good,' 'good,' 'fair,' 'poor'?"; Q3, "Currently, do you think you can hear 'the same as before', 'less than before only in the right ear', 'less than before only in the left ear', 'less than before in both ears'?". Measures of accuracy were estimated through seven measures including Youden index. Responses to each question were compared to the results of pure-tone audiometry to estimate accuracy measures. RESULTS:The estimated sensitivity and specifi city were 79.6%, 77.4% for Q1; 66.9%, 85.1% for Q2; and 81.5%, 76.4% for Q3, respectively. The Youden index ranged from 51.9% (Q2) to 57.0% (Q1) and 57.9% (Q3). CONCLUSIONS:Each of all three questions provides responses accurate enough to support their use to assess self-reported hearing loss in epidemiological studies with adult populations when pure-tone audiometry is not feasible.

OBJECTIVE:To estimate the proportion of occupational accident benefits granted within the total for health-related social security benefits, viewing the costs according to benefit type and the impact on productivity according to work days lost. METHODS:Records of benefit decisions from the National Benefits System of the National Social Security Institute for the State of Bahia in 2000 were utilized. Occupational accidents were defined in accordance with the clinical diagnoses of External Causes, Injuries and Poisoning (SS-00 to T99) of the International Classification of Diseases, 10 th Revision, and with the benefit type, which distinguishes between occupational and non-occupational health problems. RESULTS:A total of 31,096 benefits granted due to illnesses or health problems were studied. Of these, 2,857 (7.3%) were caused by work accidents. Greater proportions were found among workers in the manufacturing, construction, electricity and gas industries, accounting for 18% of the total benefits. The costs of occupational accident benefits were estimated to be R$8.5 million, with around half a million work days lost during the year studied. CONCLUSIONS:Despite the fact that these data are under-reported and are restricted to workers who were able to receive health-related benefits, the findings reveal that avoidable health problems have a major impact on productivity and on the budget of the National Social Security Institute, thereby reinforcing the need for their prevention. KEYWORDS

Neste estudo sintetizam-se achados epidemiológicos sobre acidentes de trabalho fatais e não-fatais para populações brasileiras, entre 1994 e 2004, período pós II Conferência Nacional de Saúde do Trabalhador. Os estudos foram identificados em pesquisa nas bases Scielo e Medline, limitando-se a trabalhos completos disponíveis. Verificou-se que embora o coeficiente de mortalidade por acidentes de trabalho seja elevado, entre 1990 e 2003 caiu 56,5%. Todavia, a letalidade aumentou (0,18% em 1970 para 1,07%) até 1999, quando passou a declinar (0,70% em 2003). A incidência cumulativa anual de acidentes de trabalho não-fatais também vem reduzindo, mas discretamente, em especial, para os menos graves. Não houve alteração para os acidentes incapacitantes. Pesquisas populacionais mostram que a incidência cumulativa anual varia entre 3% e 6%. Trabalhadores rurais têm o dobro do risco do que os de área urbana. A construção civil, indústria da celulose, serviços domésticos estão entre os grupos de maior risco para acidentes não-fatais. A subnotificação de óbitos se concentrou entre 70% e 90%. Indica-se a necessidade de uma redefinição das políticas de proteção ao trabalhador tomando como base o conhecimento produzido sobre este evitável problema de saúde.

The authors develop a macro-social theoretical framework to explain how employment and working conditions affect health inequalities. The theoretical framework represents the social origins and health consequences of various forms of employment conditions. The emphasis is thus on determinants and consequences of employment conditions, not on social determinants of health in general. The framework tries to make sense of the complex link between macro-social power relations among employers, government, and workers' organizations, labor market and social policies, employment and working conditions, and the health of workers. It also suggests further testing of hypothetical causal pathways not covered in the literature. This macro-social theoretical framework might help identify the main "entry points" through which to implement policies and interventions to reduce employment-related health inequalities. The theoretical framework should be approached from a historical perspective.

Standard full-time permanent employment-providing a minimal degree of stability, income sustainability, workers' empowerment, and social protection-has declined in the high-income countries, while it was never the norm in the rest of the world. Consequently, work is increasingly affecting population health and health inequalities, not only as a consequence of harmful working conditions, but also because of employment conditions. Nevertheless, the health consequences of employment conditions are largely neglected in research. The authors describe five types of employment conditions that deviate from standard full-time permanent employment--precarious employment, unemployment, informal employment, forced employment or slavery, and child labor--and their health consequences, from a worldwide perspective. Despite obvious problems of measurement and international comparability, the findings show that, certainly in the low-income countries, these conditions are largely situated in informality, denying any possible standard of safety, protection, sustainability, and workers' rights. Considerable numbers of the world's working people are affected in geographically and socioeconomically unequal ways. This clearly relates nonstandard employment conditions to health equity consequences. In the future, governments and health agencies should establish more adequate surveillance systems, research programs, and policy awareness regarding the health effects of these nonstandard employment conditions.