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.