251 General discussion thinking and doing abilities (denk- en doenvermogen in Dutch) (24). Hence, thinking and doing abilities are important as they influence the extent to which individual persons can self-manage and adapt (i.e. self-control). For instance, workers with a lower SEP may have less cognitive skills (i.e. fewer thinking abilities) and may find it more difficult to act and therefore, use more passive coping styles (i.e. fewer doing abilities). Furthermore, workers with problems on multiple life domains more often experience chronic stress (25), which also affects people’s thinking and doing abilities. Problems on multiple life domains are interrelated and may enforce each other, leading to a vicious cycle (25). Moreover, the time and energy that workers with problems on multiple life domains need, to deal with problems in their daily life, may compete with the time and energy for solving problems, which could improve their health on the longer term. McKee et al. (2017), argues that we as society must focus more on the relation between health and social circumstances (26). There is a large group of people whose lives could be characterized as precarious, due to factors related to employment, such as low skills, low wages, and harsh working conditions, but also economic insecurity, inadequate housing, health problems and a lack of social networks. This means that the philosophy of the Dutch government which focuses in general on individual responsibility and self-control of individuals does not account for everyone and may even increase socioeconomic health inequalities. Solving problems on multiple life domains may also be challenging for workers as help and solutions for their problems may lay within different domains, such as occupational health care, curative health care, the social and/or the private domain. As a result, they may come in contact with different (health) professionals who are employed in different kind of institutions, such as health care services, social, labor and/or welfare services (loketten in Dutch). Moreover, these professionals may also provide workers with different solutions for different kinds of problems, and there is no coordinator for a comprehensive approach to address their problems. As a result, workers can easily loose overview and may face difficulties in finding their way in this complex system of different professionals across institutions and domains, in which workers are mainly left to their own responsibility to coordinate solutions and actions which are set by different professionals. The difficulties lower SEP workers face with solving problems on multiple life domains that are described in this paragraph were also found in the process evaluation of Grip on Health. Based on this information, researchers argue that we should make a shift from the individual responsibility to a society which focuses more on the collective; a society in which we protect and support the most disadvantaged and enable them to increase their ability to adapt and self-manage their health. 8
RkJQdWJsaXNoZXIy MTk4NDMw