The Worksome
: Developing and Empirically Supporting a Theoretical Framework for Examining the Work-health Relationship

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)


Inequalities in health outcomes have received increasing attention both in the research landscape and in policy environments. Social determinants of health, especially those which are modifiable, have been examined thoroughly. One such determinant, occupation - in terms of the jobs and places people work - has been received less attention and scrutiny than the others, and it is often operationalised as social class. This lack of attention is further complicated because research into work and health has often been fairly heterogeneous in terms of contexts used, data deployed, and methodological approaches adopted and therefore conclusions are hard to reconcile. There have been calls for a theoretical framework to help link these disparate pieces of current and future research. Therefore, this thesis develops ’the worksome’ out of the biological exposome, an epidemiologic life-course approach to exposure. The empirical portion of the thesis explores and supports the concept of the worksome, which emphasises the importance of context (geographical, temporal, and so on) and varying scales. This is done by employing two robust datasets: the European Working Conditions Survey (EWCS) and the British Household Panel Survey (BHPS), to examine a selected set of working conditions in the context of a variety of health outcomes using logistic regression techniques. The final set of
models uses multilevel logistic regression. The various health outcomes, such as backache or anxiety, are characterised by differences in the effect of the working conditions, such as flexible time arrangements. The individual level accounts for a large part of the variance, and, with the
BHPS, the observations over individuals through time were most relevant for general health. However, for specific health outcomes, the differences between individuals were most pertinent, meaning the conditions under which people live, and therefore work, are highly relevant. The
contexts and scales within which the individuals are situated also have reasonably strong impacts on whether they report specific health outcomes. The heterogeneity of factors which promote and are of detriment to work has been clarified: feelings of control, certainty and security, and tasks which match skills can make two jobs with the same characteristics have different health impacts. The worksome emphasises the importance of examining the interactions between and within all of the elements in which an individual is situated. The concept of the worksome
provides an empirically supported, solid theoretical framework for future research into work and health.
Date of Award24 Jun 2021
Original languageEnglish
Awarding Institution
  • University of Bristol
SupervisorDavid J Manley (Supervisor) & Levi J Wolf (Supervisor)


  • work
  • health
  • worksome
  • exposome
  • working conditions
  • EWCS
  • BHPS
  • work-health relationship
  • health inequalities

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