Intended for healthcare professionals

Analysis Health inequalities

The importance of government policies in reducing employment related health inequalities

BMJ 2010; 340 doi: (Published 21 June 2010) Cite this as: BMJ 2010;340:c2154

This article has a correction. Please see:

  1. Joan Benach, director of the Health Inequalities Research Group (GREDS). Employment Conditions Knowledge Network (EMCONET)12,
  2. Carles Muntaner, professor of nursing13,
  3. Haejoo Chung, assistant professor134,
  4. Orielle Solar, undersecretary for public health156,
  5. Vilma Santana, associate professor7,
  6. Sharon Friel, associate professor8,
  7. Tanja AJ Houweling, senior research fellow 8,
  8. Michael Marmot, professor8
  1. 1Health Inequalities Research Group (GREDS), Employment Conditions Knowledge Network (EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
  2. 2CIBER Epidemiología y Salud Pública (CIBERESP), Spain
  3. 3Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, University of Toronto, Canada
  4. 4Department of Healthcare Management, College of Health Sciences, Korea University, Republic of Korea
  5. 5Ministry of Health, Chile
  6. 6School of Public Heath. Universidad Mayor, Chile
  7. 7Institute of Collective Health, Federal University of Bahia, Brazil
  8. 8Department of Epidemiology and Public Health, University College London, United Kingdom
  1. joan.benach{at}
  • Accepted 14 March 2010

Efficient and fair employment and welfare state policies are needed to reduce employment related health inequalities explain Joan Benach and colleagues.

The current economic recession has caused striking levels of unemployment, underemployment, and job insecurity globally. The International Labour Organization (ILO) estimated that the number of unemployed people was 212 million in 2009, and projects the global unemployment rate in 2010 to be 6.5%, with a confidence interval ranging from 6.1% to 7%. In rich countries in the Organization for Economic Co-operation and Development more than 57 million people, or 10%, are unemployed in 2010,1 the current unemployment rate in Spain is 20%, and in the United States the rate is around 10% using conservative estimates. The ILO has predicted that the impact of the economic crisis on vulnerable employment is likely to have increased the number of working poor—those living on $1.25 (£0.8; €0.9) a day—by 215 million workers between 2008 and 2009, and that in 2009 there were between 1.48 and 1.59 billion vulnerable workers worldwide.2 These developments will increase global health inequalities, and inequalities between social classes within countries because unemployment and underemployment cluster among lower income countries and workers.3 In this article we explore the relation between unemployment, poor working conditions, and health, and argue that governments and public health agencies should recognise that fair employment conditions should be regarded as a human right.

Globalisation increasing inequality in working conditions

Globalisation has increased the inequality in working conditions across regions, countries, social groups, and occupations. It has also generated substantial social inequalities in health. Worldwide, about 1000 workers, mainly located in poor regions and countries, die every day because of unsafe working conditions, and an additional 5000 people die from work related diseases.4 5 In rich regions, such as the European Union, long established hazards at work—for example, …

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