Linking credentialed skills, social class, working conditions and self-reported health: a focus on health inequality-generating mechanisms

In this study, focus is on the mechanisms linking credentialed skills and social
class relations to five dimensions of occupational stressors and three self-reported
health outcomes: persistent fatigue, musculoskeletal complaints and emotional
wellbeing. We test for direct health associations of skills ? class. Moreover, indirect
health associations of skills ? class, through differential exposure to occupational
stressors and effect modifications of the occupational stressors, are tested. A
modified LISREL analysis is applied to a representative cross-sectional sample of
11,099 Flemish wage-earners. The direct health effects of credentialed skills ? class
are limited, but they are clearly indirectly related to the self-reported health
outcomes through differential exposure to occupational stressors. The indirect
mechanisms point to both reinforcing and moderating effects on socio-economic
health inequalities. Two cases of effect modification are also observed: social class
modifying the association between control and persistent fatigue; and skills
affecting the association between the quality of social relations and emotional
wellbeing. Differential exposure to occupational stressors is a crucial mechanism
linking skills ? class to socio-economic health inequalities. Direct effects and effect
modification of class ? skills are relevant, but of limited importance. One of the
effect modifications found suggests that a specific focus on contradictory class
positions might be warranted in future research.