These findings held even when adjusting for factors such as occupation – meaning even those in the same job had reduced stress if they had attained a higher level of education. Importantly, integrative labour market policies, such as training for the unemployed, had a greater association with lower stress levels than more passive policies (those based around job loss compensation e.g. early retirement/unemployment benefits). This is possibly a result of integrative policies’ tendency to target disadvantaged groups, and having greater impact in terms of lowering overall labour market disadvantage. With work-related stress leading to reduced physical and mental health, this study provides evidence that policy makers should step up investments in protective and integrative labour market policies to reduce health inequalities.

The study: ‘The Association between Education and Work Stress: Does the Policy Context Matter?’ can be found here: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0121573.

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They gather the latest evidence from the project, provide a synopsis of the issue, solutions, and opportunities to advocate. The briefs have been informed by the findings of work on advocacy for health equity, and are meant for policy makers and practitioners at the European, national and sub-national levels. Translations of the policy briefs into several different European languages are under way, and will be made available from the Translations page.

Download links:

• Early Child Development - Universal, quality early childhood programmes that are responsive to need promote better and more equal outcomes in childhood and later life.
• Fair Employment - Improvements in quality of work, particularly for people in lower occupational groups, would contribute to a significantly healthier and more productive Europe.
• Income & Social Protection - Well-designed social protection systems can improve the lives of people and reduce health inequalities.

Slideshare links:

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The event, co-hosted by Julie Ward MEP (S&D, UK) and Eider Gardiazabal Rubial MEP (S&D, ES), brought together European and national policy-makers, civil society, industry and academics to discuss how DRIVERS’ latest evidence can be taken forward and integrated into existing and future policy initiatives.

For more than three years, scientists, civil society organisations, and representatives from public health and businesses have collaborated to explore how health equity can be improved across policy sectors, through action on three of the most important drivers of health: early childhood, employment & working conditions, and income & social protection.

As a result of their efforts, DRIVERS has identified four principles by which decision makers can design better and ‘healthier’ policies addressing the challenges of our time to help create a fairer Europe. These overarching principles can be applied to any policy context and can bring potential added value especially during times of crisis and cuts to public social spending.

Prof. Sir Michael Marmot in his keynote speech outlined how the principles of ensuring universality of access to services while addressing disadvantage, accounting for context and respecting rights of people concerned and ensuring that policies are evidence-based can guide the development and implementation of policies to improve health and reduce health inequalities. 

Application of these principles would enable children and families to live better and have adequate social protection coverage, enable workers to stay in the labour market for longer, improve productivity at work, reduce social exclusion and, hence, foster greater social cohesion. 

The importance of the life-course should be taken into account in the application of these principles as social inequalities start having an impact on individuals before birth, through early childhood and through life, influencing later life chances and outcomes. Moreover, the systematic deprivation of health for certain social groups, denying them the possibility to participate fully in economic and social life, results in even worse health.

The conference was composed of a scientific and a policy expert panel. During the first panel on taking stock of the evidence base advanced by DRIVERS, representatives from three DRIVERS’ partners (University of Dusseldorf, Centre for Health Equity Studies & University College London) explained how the DRIVERS project enabled them to gain new insights on employment, social protection and early child development & inequalities within and between different EU countries. 

Throughout the discussions, there was a general consensus that solutions to improve health equity solutions do not simply reside within the health sector and that public spending should strengthen sustainable employment and address health-adverse working conditions.

Moreover, other messages echoed that more spending on active labour market policies is correlated with better jobs and lower health inequalities in the same way that more spending on unemployment benefits is linked to a narrower social gradient in health.

In the panel dedicated to policy and how recommendations from DRIVERS can be taken forward to inform EU policy agendas, members of the European Parliament argued that the European Parliament's work can help improve health, but real moves towards health equity require action across sectors and at different levels of governance.

The DRIVERS policy recommendations received broad support and endorsement and several EU policy makers, including a member of the Social Protection Committee, and made concrete proposals and commitments to taking them forward.

Conference co-host Eider Gardiazabal Rubial MEP pledged to make efforts to ensure that the Commission and the Council boost investment in social and health needs and continue to tackle inequalities rather than allow a widening of existing disparities as a result of the crisis.

Ralf Jacob (DG EMPL, European Commission) stated that DRIVERS’ recommendations are in synergy with many of the Commissions priority areas. He also argued that the mid-term review of the Europe2020 Strategy represents a real opportunity for using new knowledge to inform the next phase of the Strategy.

All in all, the conference was an excellent opportunity to disseminate the latest pan-European evidence arising from the DRIVERS project and stimulate debate on how action to help reduce health inequalities across sectors can be maximized.

Reducing inequalities and enhancing social cohesion during this economic climate requires collective commitment and co-operation. DRIVERS and EuroHealthNet, a network of agencies and organisations dedicated to improving health equity across Europe, would like to thank all those who have supported us in the execution of our work within DRIVERS. Following the conference, interviews were conducted with several of our speakers. Video footage will be available soon.

“DRIVERS’ recommendations are impressive, very detailed, evidence-based, and integrated across the life course…” Rudi Van Dam (Social Protection Committee)

Did you miss the DRIVERS conference and want to know more? Please visit our Storify page (see below), which summarises the conference key messages that were produced via Twitter.

The news release issued following the conference can be found here.

The key note speech by Sir Michael Marmot can be found here.

The policy recommendations document 'Improving health equity through action across the life course' can be found here.

More information on DRIVERS publications (policy briefs, reports) can be found here.  The policy recommendations and policy briefs are currently being translated into several European languages and will be available shortly.

For more information, please contact us at [email protected]

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They detail the scientific work carried out by teams at University College London/UCL Institute of Health Equity, the Department of Medical Sociology at Universität Düsseldorf, and the Centre for Health Equity Studies (CHESS) at Stockholms Universitet, on (respectively) early child development, employment & working conditions, and income & social protection.

While numerous academic papers have been - and continue to be - published in leading peer-reviewed journals, these reports bring together the expanded evidence base, explaining how the different pieces of work fit together and provide a solid foundation for the development of evidence-based recommendations. These recommendations are detailed in separately published recommendations document and three policy briefs.

The three reports are:

• Social Inequalities in early childhood health and development, evidence and policy implications, by Hynek Pikhart, Milagros Ruiz, Joana Morrison, Peter Goldblatt & Michael Marmot. Also see the Appendices.
• Working conditions and health inequalities, evidence and policy implications, by Johannes Siegrist, Diego Montano & Hanno Hoven.
• The role of income and social protection for inequalities in health, evidence and policy implications, by Olle Lundberg, Monica Åberg Yngwe, Kersti Bergqvist & Ola Sjöberg.

The project's final recommendations will be presented tomorrow, 3 February 2015, at a conference held at the Residence Palace in Brussels. The final recommendations document and policy briefs are available from the publications section of the website.

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Using data from three longitudinal ageing studies (SHARE, HRS, ELSA), including 5650 men and women in 13 countries, they find significantly increased chances of depressive symptoms two years later among participants experiencing work-related stress in terms of effort-reward imbalance and low job control. In addition, they find that social and labour policies reduce the likelihood of depressive symptoms resulting from effort-reward imbalance. Explaining the results, they suggest that the health threatening stress response of effort-reward imbalance at work may be less pronounced in a 'protective policy context', because job insecurity may seem less threatening if social protection exists. Conversely, work-related stress and resultant depressive symptoms may be much more pronounced in a non-protective policy environment.

These results hold importance in the context of an ageing society and high levels of early labour market exit due to ill health, as they indicate that more ambitious social (protection) spending modifies the health threatening effect of effort-reward imbalance. Furthermore, they show that action is needed in two distinct areas: 1) action to tackle effort-reward and low work control in the workplace, 2) action to support and improve social protection policies.

DRIVERS is building on this knowledge base, and will publish a series of reports over the coming year to highlight specific actions that may be taken to improve health and reduce health inequalities in Europe.

To read the paper, click here.

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Claudia Marinetti presented on the project as a whole. Hynek Pikhart presented on the work on early childhood development on behalf of the UCL team. Next, Hanno Hoven presented the work on employment & working conditions for the University of Dusseldorf team. Then Olle Lundberg of CHESS presented an overview of what’s known and some of the findings of their research network. Finally, Linden Farrer presented on the advocacy work taking place within DRIVERS.

A lively question and answer session followed each presentation, and useful feedback will be incorporated into future work.

Furthermore, DRIVERS had the opportunity to present a rolling presentation of its work at the Third Annual Convention of the Platform against Poverty and Social Exclusion on 26-27 November 2013.

• European Public Health Conference - Introduction to DRIVERS (C. Marinetti)
• European Public Health Conference - Early Childhood Development (P. Pikhart)
• European Public Health Conference - Employment & Working Conditions (H. Hoven)
• European Public Health Conference - Income & Social Protection (O. Lundberg)
• European Public Health Conference - Advocacy for Health Equity (L. Farrer)
• Third Annual Poverty Convention - DRIVERS rolling presentation

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The review is divided into four main sections: 1) Context and background to the review with key principles underpinning the recommendations, 2) Summary of current evidence on the health divide between countries, 3) A focus on the life-course perspective, wider society, macro-level context, governance, delivery and monitoring systems, 4) Implementation, framework for action, reasons for failure, guidance on good practice.

Overall, the report calls for universal coverage of health care, a focus on health-adverse behaviours, and action on the conditions into which people are born, grow, live, work and age, and the inequalities in power, money and resources that give rise to them.

New themes in the report, compared with the CSDH, include:

• Emphasis on human rights as an approach to tackle the SDH and improve health but continued commitment to social justice.
• Emphasis on empowering communities and individuals to take action.
• Emphasis on the life-course approach, meaning that although early childhood is important every stage of life plays a subsequent part in determining health.
• Emphasis on protecting future generations from perpetuations of social and economic inequalities.

Click here to download.

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The declaration notes that Europe is only just beginning to emerge from the deepest recession in decades, but that the measures taken to tackle it have had dramatic and deleterious effects on the living and working conditions of many people in Europe. This is evidenced by the 26.4 million unemployed people and 9.9 million under-employed people in the EU, the fact that one in four workers in Europe is exposed to stressful work which increases relative risks of cardiovascular disease and depression by 40 and 80 per cent respectively, and that those facing job insecurity have double the risk of stress-related mental and health disorders compared to those in stable jobs.

In consequence, the declaration calls on political leaders across the EU, and in partnership with civil society, scientific, trade union and other stakeholders, to:

• consider health in all actions to tackle the economic crisis;
• maintain and increase spending on social protection;
• recognise the economic benefits of investing in better health-promoting work and employment conditions;
• prioritise investments according to need, with special emphasis on addressing social inequalities in health and reaching the socio-economically deprived, including young people, the long-term unemployed and people with disabilities;
• ensure access to high quality health services, including those concerning mental health;
• support research on the human dimensions of the economic and financial crisis and its management in order to strengthen knowledge and action towards improving population health and productivity.

DRIVERS aims to play a key role in developing policies and practices that promote health and reduce health inequalities not only in the workplace, but also in the early periods of the child's life and through the life course via social protection.

The full declaration is available to download here.

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This systematic review, by Hanno Hoven & Johannes Siegrist (Heinrich-Heine University Düsseldorf), produced as part of the DRIVERS project, looks at mediation and moderation effects in prospective studies.

Physical stressors and occupational hazards have traditionally been considered the major causes of work-related health risks. With the advent of economic globalisation stressful psychosocial work environments are no longer confined to low-skilled occupational groups and it is therefore important to know more about exactly how work affects the health of working people and to what extent these associations explain the social gradient of health.

Two hypotheses have been applied to tackle this challenge. The mediation hypothesis claims that the association between socio-economic position and health can partly be explained by the effects of work and employment. The moderation hypothesis claims that the effect of work characteristics on health varies according to socio-economic position. The finds moderate support in favour of both hypotheses. In addition, a series of recommendations for further research are set out:

1. Studies should test an explicit hypothesis, rather than exploring what variables may produce statistically significant results; this requires a priori definition of the core variable.
2. Studies should analyse separate and combined effects of the psychosocial and the physical work environment, and focus on appropriate tests of respective theoretical models.
3. Studies should focus on those employment and working conditions that are becoming more prevalent under current worldwide economic and financial conditions (e.g. high job insecurity, contract work, etc..
4. Results should be obtained from cohort studies that do not overemphasise the stable work and employment conditions that are more prevalent in large organisations.
5. It is important to analyse non-western countries and rapidly developing societies, in view of the dynamics of economic globalisation.
6. Despite obvious difficulties, intervention studies should be performed to improve scientific evidence.

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Younger workers across Europe are worst affected by casual employment:

• 50 per cent of employees aged under 25 are on permanent contracts (as opposed to 80 per cent for all age groups)
• 10 per cent of workers aged under 25 have no contract at all (compared to 5.6 for all employees)
• 25 per cent are on temporary contacts (as opposed to 12 per cent of all employees)
• 4 per cent are agency workers (1.5 per cent of all employees)

(Source: European Working Conditions Survey, 2010)

The report argues that casualisation fuels social inequalities, and that the phenomenon needs to be looked at in terms of social class: "young people from disadvantaged backgrounds may be more permanently casualised than young people from more affluent backgrounds. So casualisation is handed on down the generations". As a result, some authors posit the development of a “precariat” – an intergenerational class stripped of the protections that the labour movement managed to win for most workers throughout in the twentieth century.

A number of recommendations are put forward, including:

• Tackling the poverty risk through wage protection, minimum income schemes and access to credit.
• Reducing inequalities in employment opportunities and targeting job mobility support at very young and under-educated workers.
• Providing easier access to the education system for disadvantaged people, for example through scholarships and job placement schemes.
• Re-orientating production processes so that they are skill and innovation based, rather than continuing the cycle of de-skilling.

The report is available to download here.

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