Socioeconomic gradients in health status are ubiquitous, persistent
and pervasive. Existing occupational studies have not convinced
observers that work-related psychosocial exposures constitute
key causal influences responsible for gradients in the health
of the adult population, especially in chronic disease. Largely
missing in the debate is high-quality evidence on gradients from
workplaces with a wide range of jobs, such as hospitals. Rich
insights into the genesis of such health gradients may be gained
by detailed study of a workplace that has a wide range of jobs,
and of employees from different social classes. In hospitals,
the major short-term occupational health problem is work-related
musculoskeletal disorders (WRMSDs). Psychosocial and physical-ergonomic
exposures at work are now thought to be joint determinants of
these problems. This study addresses the link between socioeconomic
and job-category disparities and the risk of WRMSDs and their
associated outcomes in 2 San Francisco hospitals, emphasizing
the multi-factorial etiology of such gradients.
Participants (150 cases, 450 matched controls) are interviewed
by telephone and their jobs assessed in detail by a work site
visit on 2 occasions 24 months apart to obtain comprehensive data
on occupational risk factors and health outcomes. An ethnographer
interviews key informants and reviews health and safety practices
to better understand working conditions and institutional culture.
A comprehensive labor-management collaborative work plan will
assist the hospitals to make optimal use of study findings.
Outcomes studied include lost-time WRMSD, allostatic load (including
salivary cortisol), overall health-related quality of life, injury-specific
functional status, mental health status, and sickness/injury absence.
The influence of directly observed physical-ergonomic factors
at work, psychosocial occupational exposures on socioeconomic
gradients, and socio-cultural contextual factors and their influence
on working conditions, is assessed. The study team will also work
with a labor-management team at each institution to develop interventions
for problems that are identified during the study.
CORRESPONDING AUTHOR: Jeffrey P. Braff, DrPH, Department of Medicine, University of California, San Francisco, 1600 Divisadero Street C-446, San Francisco, CA 94115 USA jpbraff@medicine.ucsf.edu