Work more than lifestyle cause of differences in self-rated health between rich and poor

Gerben Hulsegge Gerben Hulsegge

In the Netherlands, people with low socioeconomic positions live 18 years less in good health than people with high socioeconomic positions. Physical and psychological work demands, such as heavy lifting and lack of autonomy, explains approximately one-third of the lower self-rated health of people with low socioeconomic positions. Lifestyle factors, such as nutrition, physical exercise and smoking, appear to explain a smaller proportion of these experienced differences. These results were found in studies defining low socioeconomic position as low education, and in studies defining it as low income or low-skilled jobs. This was shown in a large literature study of Amsterdam UMC, location VUmc. Researcher Gerben Hulsegge: “These findings highlight the importance of making policy that improves the working conditions for employees with demanding jobs.” The study, performed in collaboration with the Vrije Universiteit, Erasmus MC and RIVM, was published on the 30th of October in the Scandinavian Journal of Work, Environment & Health.

To what extent do working conditions and lifestyle contribute to socioeconomic differences in self-rated health? This question has been answered by summarizing 27 scientific articles. Unfavorable physical and psychosocial working conditions explained approximately one-third of the differences in self-rated health between employees with low and high socioeconomic positions. Not all psychosocial working conditions contributed to the differences in health. Job resources such as autonomy and reward contributed to health inequalities, while working overtime and job overload did not. Lifestyle factors explained roughly one-fifth of the differences in self-rated health. It is striking that lifestyle factors seemingly explain a smaller proportion compared to work-related factors.


This study shows that working conditions play a key role in the limited self-rated health of employees with low socioeconomic positions. The issue at hand involves millions of the Dutch population. This emphasizes the importance of developing interventions that not only target lifestyle, but also improve working conditions among people with low socioeconomic positions.

Side note

The researchers found that only six studies followed individuals over time. As a result, the observed average contribution of both work and lifestyle factors to socioeconomic differences in self-rated health might be an overestimation. Previous research identified other factors that also contribute to health differences, such as accessibility and quality of healthcare, and housing and living conditions.