8 Chapter 1 General Introduction The health and sustainable employability of workers in a vulnerable position I would like to start this thesis with the well-known phrase ‘work is healthy.’ People with a job are healthier than people without a job. Work provides income, social contacts, and is often a source of personal identity, which results in good health (1). In contrast, work can also negatively affect health or vice versa; unemployment has negative health consequences (2, 3) and poor health is associated with job loss and disability benefits (4-6). However, some workers face more difficulties to remain sustainably employed. This group consists for a large part of workers with a lower socioeconomic position (SEP) (6, 7). Workers with a lower SEP can include people with a lower education or income level and/or with a lower educated or blue-collar occupation. Workers with a lower SEP are in a more vulnerable position as they not only face more difficulties to (re-)enter the labor market (8) and remain sustainably employed, but also are more likely to exit paid employment (4). Previous research identified why workers with a lower SEP face more difficulties to remain sustainably employed. They more often have unhealthy working conditions, such as physically active jobs, irregular working hours, low job control, high job insecurity and low paid work (9-11). Unhealthy living conditions are also more prevalent among this group of workers, such as smoking, physical inactivity and unhealthy housing conditions (12). Unhealthy working and living conditions may increase the chance of physical and/or mental health problems, and therefore make a significant contribution to socioeconomic health inequalities (10, 12). Furthermore, workers with a lower SEP often have problems on multiple life domains (9, 13). This means that they face a combination of health problems and other problems in- and outside the workplace, such as unhealthy working and living conditions, financial problems or other private or social issues. Problems on multiple life domains are often strongly intertwined (10, 12, 14, 15), making it even more complex for the individual worker to solve these problems and remain sustainably employed. To improve their health and sustainable employability, we should simultaneously focus on factors in multiple life domains. This asks for a more holistic approach, which is in line with the definition of the Positive Health approach ‘the ability to adapt and manage oneself in the light of the physical, emotional and social challenges of life’ (16). Workers who face more difficulties to remain sustainably employed, also consist for a large part of workers with a work disability (7). Next to workers with a lower SEP, workers with a work disability also face more difficulties to enter the labor market and remain sustainably employed due to an illness, disorder, or disability (17). Workers with a work disability can include people with a (mild) intellectual disability, psychological disability, physical disability, and/or learning delay.
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