10 Chapter 1 impact on health (24). A lower health literacy may be more prevalent among certain groups in the population, such as workers with a lower SEP and workers with an intellectual disability (25, 26). Poor social and economic conditions which are more prevalent among workers in a vulnerable position are associated with a lower health literacy and may result in poor health outcomes (27). Therefore, strengthening health literacy of people in vulnerable positions could reduce health disparities. For this, workers need an enabling environment. In the next paragraph, we describe which factors in the personal and work environment play a role in the sustainable employability of workers in a vulnerable position. Factors in the work and personal environment for sustainable employment Accumulated evidence found that factors in the work environment play a key role in the sustainable employability of workers. The job demand-job resources model (JD-R model) provides an overarching framework to explain how the work environment can affect sustainable employability (28). According to this model psychosocial factors, which can be divided into job demands and job resources, are linked to a range of outcomes such as workers’ well-being, health, and productivity (29-32). For instance, autonomy and social support have a positive impact on well-being and performance (31), and psychological job demands, and low decision latitude have a negative impact on health (30, 32). Furthermore, psychosocial factors in the work environment are often less favorable among workers in a vulnerable position and may partially explain socioeconomic health inequalities (33, 34). Considering this information, it is important for organizations to safeguard work environments that facilitate sustainable employment. Beyond the work environment, factors in the personal environment, such as the circumstances in which people live, social networks or access to (financial) resources also tend to play a role in the health and thereby sustainable employability of workers. For instance, social networks can provide relevant health related information to perform healthy behaviors and provide mental support (35). However, access to and the number of resources is more limited among workers in a vulnerable position, which may lead to poorer health outcomes (36). According to the World Health Organization, factors in the personal environment, besides health care and a healthy lifestyle, can be summarized into social determinants of health (SDH). The WHO states that “SDH are the non-medical factors that influence health and consist of the conditions in which people are born, grow, live and age, and the wider set of forces and systems shaping the conditions of daily life” (37). In summary, the environment of workers strongly influences the ability of people (i.e., individual skills) to deal with (health) problems, which is in line with the definition of sustainable employability and SDH. Therefore, to improve the health and sustainable employability of workers, and especially of those in a vulnerable
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