Hierarchical cluster analysis of labour market regulations and population health: a taxonomy of low- and middle-income countries

<p>Abstract</p> <p>Background</p> <p>An important contribution of the social determinants of health perspective has been to inquire about non-medical determinants of population health. Among these, labour market regulations are of vital significance. In this study, we investigate the labour market regulations among low- and middle-income countries (LMICs) and propose a labour market taxonomy to further understand population health in a global context.</p> <p>Methods</p> <p>Using Gross National Product per capita, we classify 113 countries into either low-income (n = 71) or middle-income (n = 42) strata. Principal component analysis of three standardized indicators of labour market inequality and poverty is used to construct 2 factor scores. Factor score reliability is evaluated with Cronbach's alpha. Using these scores, we conduct a hierarchical cluster analysis to produce a labour market taxonomy, conduct zero-order correlations, and create box plots to test their associations with adult mortality, healthy life expectancy, infant mortality, maternal mortality, neonatal mortality, under-5 mortality, and years of life lost to communicable and non-communicable diseases. Labour market and health data are retrieved from the International Labour Organization's Key Indicators of Labour Markets and World Health Organization's Statistical Information System.</p> <p>Results</p> <p>Six labour market clusters emerged: Residual (n = 16), Emerging (n = 16), Informal (n = 10), Post-Communist (n = 18), Less Successful Informal (n = 22), and Insecure (n = 31). Primary findings indicate: (i) labour market poverty and population health is correlated in both LMICs; (ii) association between labour market inequality and health indicators is significant only in low-income countries; (iii) Emerging (e.g., East Asian and Eastern European countries) and Insecure (e.g., sub-Saharan African nations) clusters are the most advantaged and disadvantaged, respectively, with the remaining clusters experiencing levels of population health consistent with their labour market characteristics.</p> <p>Conclusions</p> <p>The labour market regulations of LMICs appear to be important social determinant of population health. This study demonstrates the heuristic value of understanding the labour markets of LMICs and their health effects using exploratory taxonomy approaches.</p

The solution space: developing research and policy agendas to eliminate employment-related health inequalities.

As in many other areas of social determinants of health, policy recommendations on employment conditions and health inequalities need to be implemented and evaluated. Case studies at the country level can provide a flavor of "what works," but they remain essentially subjective. Employment conditions research should provide policies that actually reduce health inequalities among workers. Workplace trials showing some desired effect on the intervention group are insufficient for such a broad policy research area. To provide a positive heuristic, the authors propose a set of new policy research priorities, including placing more focus on "solving" and less on "problematizing" the health effects of employment conditions; developing policy-oriented theoretical frameworks to reduce employment-related inequalities in health; developing research on methods to test the effects of labor market policies; generalizing labor market interventions; engaging, reaching out to, and holding onto workers exposed to multiple forms of unhealthy employment conditions; measuring labor market inequalities in health; planning, early on, for sustainability in labor market interventions; studying intersectoral effects across multiple interventions to reduce health inequalities; and looking for evidence in a global context

The solution space: developing research and policy agendas to eliminate employment-related health inequalities.

As in many other areas of social determinants of health, policy recommendations on employment conditions and health inequalities need to be implemented and evaluated. Case studies at the country level can provide a flavor of "what works," but they remain essentially subjective. Employment conditions research should provide policies that actually reduce health inequalities among workers. Workplace trials showing some desired effect on the intervention group are insufficient for such a broad policy research area. To provide a positive heuristic, the authors propose a set of new policy research priorities, including placing more focus on "solving" and less on "problematizing" the health effects of employment conditions; developing policy-oriented theoretical frameworks to reduce employment-related inequalities in health; developing research on methods to test the effects of labor market policies; generalizing labor market interventions; engaging, reaching out to, and holding onto workers exposed to multiple forms of unhealthy employment conditions; measuring labor market inequalities in health; planning, early on, for sustainability in labor market interventions; studying intersectoral effects across multiple interventions to reduce health inequalities; and looking for evidence in a global context

Policies and interventions on employment relations and health inequalities.

The association between certain increasingly pervasive employment conditions and serious health inequalities presents a significant policy challenge. A critical starting point is the recognition that these problems have not arisen in a policy vacuum. Rather, policy frameworks implemented by governments over the past 35 years, in conjunction with corporate globalization (itself facilitated by neoliberal policies), have undermined preexisting social protection policies and encouraged the growth of health-damaging forms of work organization. After a brief description of the context in which recent developments should be viewed, this article describes how policies can be reconfigured to address health-damaging employment conditions. A number of key policy objectives and entry points are identified, with a summary of policies for each entry point, relating to particular employment conditions relevant to rich and poor countries. Rather than trying to elaborate these policy interventions in detail, the authors point to several critical issues in relation to these interventions, linking these to illustrative examples