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Public Health and Safety

The idea of the «welfare state» is related to the capability of a society to fulfill the fundamental wants of the individuals who compose it, similar to schooling, work or health, amongst others 1 . Public health, like social safety, has its institutional origin in actions that the state, as an organized expression of society, has been adopting to collectively face the fundamental wants of the inhabitants, whether or not these wants are associated to issues health or social safety mechanisms. Thus, specialization is the principle distinction between the 2 establishments, which share the truth that each have helped shape the trendy state.

It's vital to focus on that each establishments emerge on account of a disaster, both because of the look of epidemics that devastate the inhabitants 2 or to reply to the devastating results of industrialization 3. With out forgetting that in Spain, and after the creation of the Nationwide Welfare Institute in 1908 (initially to advertise protection in opposition to accidents at work and previous age), it's Social Safety that lays the foundations of our present Nationwide Health System , established in 1986, once we went from a system financed by Social Safety that supplied protection solely to associates and beneficiaries to a common one financed by taxes. Health and Social Safety have been so united that even at present the assumption persists within the creativeness of the inhabitants, together with some health professionals, that their physician continues to be "the one with the insurance coverage". The evolution of the health system, wherein public health is included, and of social safety, along with the general public schooling system, particularly because the Nineteen Fifties,4 .

Nonetheless, regardless of this shared origin, the present relationship between social safety and public health is scarce, if not non-existent. A scenario that ought to be corrected, on condition that social safety insurance policies (as a mechanism for revenue redistribution via pensions, unemployment, and illness and incapacity advantages) may be important interventions to scale back social inequalities in health: a basic purpose of public health.

Work and employment, as social determinants of health

The current report of the Fee on Social Determinants of the World Health Group 5 as soon as once more factors to work, and employment as an expression of paid work, as one of many important social determinants of health. Having fun with a good job, within the phrases outlined by the Worldwide Labor Group 6 , is a requirement to realize a suitable degree of health and well-being.

Many and assorted are the mechanisms by which work and employment situations have an effect on individuals's health, each positively and negatively. Accidents attributable to work accidents and occupational illnesses are the best-known direct results, though they don't seem to be all the time taken into consideration in public health 7 . We additionally know that job insecurity, psychosocial components and work stress have an effect on individuals's bodily and psychological health within the medium and long run 8. The employment and occupation scenario defines the social standing, social id, energy and buying energy, which decide the health of the employee himself or herself, in addition to that of dependent individuals. The comparability of a number of health indicators based on occupational social class exhibits this actuality time and time once more 9 .

The adjustments which were happening within the labor market, such because the rising flexibility of employment situations (days, wages, rights, and so on.), the incorporation of girls into productive work (double shifts, segregation, and so on.) and The arrival of individuals from different international locations (discrimination, irregular work, and so on.) are having a huge effect on health 10 and rising social inequalities in health 11 .

Social safety as a modulator of the connection between work and health

Spanish Social Safety, with a price range deliberate for 2011 of round 124,000 million euros, is likely one of the strongest devices accessible to the state to fight social inequalities in health. Most of this quantity (89%) is allotted to take care of the greater than 9 million pensioners, together with retirees (5.3 million individuals) and employees with a acknowledged everlasting incapacity (1 million individuals), collectively to the fee of subsidies for momentary incapacity (6.8%) 17 .

However as well as, in Spain, the social safety system has a health system parallel to the Nationwide Health System, at the moment managed via 20 Mutual Insurance coverage Corporations for Work Accidents and Occupational Illnesses of the Social Safety 18 , which give health care to some 14 million of employees after they endure an harm attributable to an accident at work (some 700,000 in 2009) or an occupational illness (17,000 acknowledged instances in 2009). To do that, the mutuals will spend some 1.6 billion euros on healthcare (main, specialised and pharmaceutical) in 2011. This healthcare system, which we will name occupational healthcare, is starting to coordinate with the Nationwide Health System, as proven by the current settlement signed between the health administration in Catalonia and the Social Safety19 , to share care assets, in addition to recognition of occupational illnesses handled within the public health system 20 .

In brief, from public health it shouldn't be forgotten, after all, that social safety performs an necessary position within the redistribution of wealth, and particularly in occasions of financial disaster like the present one, subsidizing people who find themselves left with out employment and sustaining pensions, amongst different social advantages, which undoubtedly considerably prevents poverty and reduces social inequalities 21 .

Likewise, employment and social safety insurance policies ought to consider, when getting ready and implementing mentioned insurance policies (together with the newest labor market reform or the one deliberate for pensions), their potential affect on health, as a result of as proven by the scientific proof, health is negatively affected by unemployment 12,13 and job insecurity 14 . Quite the opposite, current research have proven that the totally different unemployment protection and coaching insurance policies for the unemployed promoted by the social safety methods within the various kinds of welfare states cushion the affect of unemployment on health 15, and that the financing of energetic employment insurance policies considerably reduces suicide mortality related to unemployment 16 .

Occupational health as a hinge between public health and social safety

Occupational health, as a social response to the health issues of working individuals, is the hinge that may finest join public health and social safety. The incorporation into epidemiological surveillance, carried out in public health administrations, of the systematic evaluation of accidents attributable to work accidents, occupational illnesses and people associated to work, and work disabilities, can assist Social Safety to plan and consider their social safety insurance policies to make them more practical and environment friendly.

Likewise, the event of the Occupational Threat Prevention Regulation in 1995, which establishes the company accountability to stop occupational threat components, charged to its personal price range, has opened the door to behave sanitary inside corporations, the place an necessary a part of social inequalities in health is generated 22 . A big step on this route can be the authorized recognition of the health exercise carried out by occupational threat prevention providers as a part of the Nationwide Health System 23. The health exercise, together with security, hygiene, ergonomics and psychosociology that make up the prevention service, has as its basic goal to scale back the incidence of injury to health derived from work, be it accidents, sicknesses or disabilities. Occupational threat prevention providers, each exterior and company-specific, adequately coordinated by the occupational health items within the territory, and as a part of the general public health construction, represent an instrument, nonetheless little developed, to advertise extra past rhetorical discourses, health insurance policies in all insurance policies 24 .

Lastly, occupational health should incorporate into its agenda the analysis of the health affect of those insurance policies, as supplied for within the preliminary draft of the Common Public Health Regulation. Asking about what the constructive and unfavourable impacts on health shall be of the present labor reform or the extension of the retirement age, is a pending process that should be carried out earlier than the implementation of those insurance policies, in addition to to hold out their follow-up and correction, if vital. Now we have not too long ago been in a position to confirm that in 1984, coinciding with the labor reform of that yr and which began the pattern that has led us to the present momentary employment figures of 30%, there was an inflection within the pattern of the incidence of accident accidents of labor,25 . It might be good if one thing like this did not occur once more.

authorship contributions

This manuscript has been devised and ready by the only real signing writer.



Battle of pursuits



The concepts introduced are indebted to ongoing collaborative work with colleagues from the Occupational Health Analysis Heart (CISAL), the results of an settlement between Pompeu Fabra College, the Labor, Setting and Health Union Institute (ISTAS) and the Mutual Company, particularly with Fernando Rodrigo, Pere Boix, Ana M. García, Jordi Delclós, Consol Serra, José Miguel Martínez, Elena Ronda and David Gimeno. I'm additionally grateful for the continued mental stimulation of Carlos Álvarez-Dardet.