title: A conceptual model of work and health disparities in the United States.
abstract: Recent research in medicine and public health highlights differences in health related to race, ethnicity, socioeconomic status, and gender. These inequalities, often labeled "disparities," are pervasive and pertain to the major causes of morbidity, mortality, and lost life years. Often ignored in discussions of health disparities is the complex role of work, including not only occupational exposures and working conditions, but also benefits associated with work, effects of work on families and communities, and policies that determine where and how people work. The authors argue that work should be considered explicitly as a determinant of health disparities. Their conceptual model and empirical evidence, built on previous contributions, describe how work contributes to disparities in health on multiple levels. The examples focus on the United States, but many of the key conceptual features can also be applied to other countries. The model emphasizes behaviors and characteristics of institutions rather than individual workers. This approach avoids a focus on individual responsibility alone, which may lead to victim blaming and failure to emphasize policies and institutional factors that affect large populations and systematically create and maintain racial, gender, and socioeconomic disparities in health.
authors.affiliation: Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, NC 27705, USA. hester.lipscomb@duke.edu
authors.forename: Hester J
authors.initials: HJ
authors.lastname: Lipscomb
authors.forename: Dana
authors.initials: D
authors.lastname: Loomis
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: McDonald
authors.forename: Robin A
authors.initials: RA
authors.lastname: Argue
authors.forename: Steve
authors.initials: S
authors.lastname: Wing
mesh_terms: D015984:Causality; D004651:Employment / Q000191:economics; D005006:Ethnicity; D005260:Female; D033161:Government Regulation; D006264:Health Benefit Plans, Employee; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D016273:Occupational Exposure / Q000009:adverse effects* / Q000191:economics / Q000331:legislation & jurisprudence; D016134:Organizational Policy; D011287:Prejudice; D011640:Public Policy; D012111:Residence Characteristics; D012456:Salaries and Fringe Benefits; D012923:Social Class; D014481:United States / Q000453:epidemiology; D014489:United States Occupational Safety and Health Administration; D014942:Workers' Compensation