The occupational determinants of health: A labor market segmentation analysis

The thesis contains two major theoretical strains, one critical, the other constructive. The critical strain concerns the theory of wage compensating differentials for differential workplace risk in the labor market. Under the theory, workers choose health outcomes by choosing from among the portfolio of jobs available to them. It is maintained, however, that the theory relies on a model of health risk--a "labor market risk" model--that is incomplete; it emphasizes isolable and external events that are purportedly confined within the labor market to the exclusion of structural determinants of health embedded in the occupational class structure. The constructive strain of the thesis forwards an alternative, "occupational determinants" model of health that focuses on structural determinants arising from labor market segmentation. Health risk is posited to increase the lower one is situated on the occupational hierarchy due to higher levels of competing physical hazards and higher levels of stress. The existence of structural determinants of health does not preclude the possibility that workers face options in the labor market over health outcomes. The issue lends itself to empirical analysis. The Cox proportional hazards model is applied to the mortality and morbidity experience of the National Longitudinal Survey's mature male cohort studied from 1966 to 1981. In addition to risk measures associated with wage differentials in various studies, variables assessing class location and other control variables associated with health status are entered into the analysis. The variables assessing class location are found to be powerful determinants of health outcomes. Individual job risk measures, on the other hand, are often found to be wrong-signed and insignificant. The empirical results from the thesis discredit the notion that efficient labor market conditions assure worker choice over health outcomes. Health and safety regulatory policy should address, in addition to individuated risks, the regimentation and routinization of work--as well as other sources of occupational stress--that tend to characterize jobs at the lower end of the occupational structure. In addition, macroeconomic policy directed at full employment as well as labor law reform directed at strengthening labor unions, are implicated as important occupational health policies.