- The poor have worse health and lower life expectancy than the more affluent, something referred to as the social gradient. The reason for this is that workers in lower status jobs are exposed to more stressors which in turn increase the risk of mental illness, gastro-intestinal conditions and coronary heart disease (this has also been shown to be true when controlling for poor housing or other negative social factors associated with poorer classes).
- The steepness of the social gradient varies across different countries and reflects the degree of income inequality in a society – which is why the egalitarian Swedes live longer and enjoy better health than the less equal but richer Americans. This is one of the reasons to try and reduce income inequality in a society.
- Marmot and colleagues' research on social hierarchy and status has shown that autonomy, and a person’s opportunities for full social engagement and participation directly impact on their health, well-being and, quite literally, their life expectancy. In societies where basic needs are fulfilled criteria like these and the distribution of resources matter, rather then the absolute availability of resources. It is inequality in these factors that determines the steepness of the social gradient in health.
- The task for employers comes in at this point because a range of workplace factors (see above characteristics for good vs. bad jobs) can be identified that shape status and the experience of it and influence health outcomes for lower status groups. According to the authors, stress and job control as well as access to social support networks (e.g. collective voice at work) seem to be particularly important.
Summing up, this means that in order to work for the well-being agenda in the realms of the working world we need to take a holistic approach and focus on several levels. Workers, employers and the public authorities need to be educated and know about the impact of work on people`s lives, the characteristics of good work vs. bad work and the interdepencence of work and employment with other areas. All of the players should work together in order to solve issues and change structures that create low well-being for individuals or certain groups of people (professions, social classes). This will involve the individual taking responsibility for a healthy lifestyle, for education and employability, for voicing his or her needs at the workplace and for creating a good and supportive environment at work. It will involve employers taking responsibility for their biggest capital, the social capital, and creating good jobs (and all that it involves – fair pay, control, good communication, support, etc.) as well as educating their staff, especially those in management functions. And it involves the government passing relevant legislation and supporting structures that improve workplace characteristics and relations and foster an equal society.