In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

The organization of work in the United States has changed dramatically over the last four decades as a result of globalization, industrial shifts, and technological innovation (Burgard et al., 2009; Seigrist & Marmot, 2005; Sverke & Hellgren, 2002). Long-term, stable employment relationships have increasingly been replaced with work arrangements characterized by shorter job tenure and fewer worker protections, leading to an increase in perceived job insecurity (Standing, 2011). Perceived job insecurity is defined as an anticipatory stressor related to the threat of losing a job, or important features of a job, and a sense of powerlessness to overcome this threat (Greenhalgh & Rosenblatt, 2010; De Witte, 2005). The Employment Conditions Knowledge Network of the World Health Organization (WHO) Commission on Social Determinants of Health (Benach et al., 2007) suggests that the effects of perceived job insecurity on health may be even more harmful than job loss itself. Although evidence for a causal relationship between perceived job insecurity and health is growing, little is known about mechanisms and group differences in this relationship. This dissertation investigates the relationship between perceived job insecurity and quality of life. Quality of life is defined in this study as a general state of health, well-being, and satisfaction across multiple dimensions of life (Drotar, 2014; Kobau et al., 2010; Bowling, 1991). Although the WHO defines health very broadly as a "complete state of physical, mental, and social well-being," health is usually assessed in studies of perceived job insecurity in very narrow terms based on the presence or absence of disease (CDC, 2011). In contrast to this deficit perspective on health, quality of life is an overall state of wellness. This dissertation makes an important contribution to the literature on perceived job insecurity and quality of life by achieving three aims: 1) identifying determinants of perceived job insecurity among adults in the United States; 2) testing causal pathways linking perceived job insecurity and perceived inequality at work to quality of life; and 3) estimating group differences in the effect of perceived job insecurity and perceived inequality at work on quality of life based on social status, social resources, and demographic characteristics. Data for this research were drawn from a U.S. sample of non-institutionalized, English-speaking adults in the 1995-1996 and 2004-2006 waves of the National Survey of Midlife Development in the United States (MIDUS). Multivariate generalized ordinal structural equation modeling was used to test hypotheses for the first aim (N=5,424). Multivariate linear structural equation modeling with full information maximum likelihood estimation was used to test hypotheses for the second and third aims (N=5,113). This study was informed by Pearlin and colleagues' (1981) stress process model, which posits that unequal exposure to stressors and access to resources for coping with stressors contributes to health disparities. Key findings from this study add to existing knowledge on job stressors and health. First, for determinants, perceived job insecurity is influenced by objective job insecurity over and above the effects of psychosocial job stressors and demographic characteristics. Effort-reward imbalance also significantly increases perceived job insecurity, but job strain does not. High effort may improve security, but not in the absence of control. People of color report significantly higher perceived job insecurity than non-Hispanic white people, but there is no association between gender and perceived job insecurity, all other factors held constant. Perceived inequality at work is a strong determinant of perceived job insecurity. Second, for consequences, perceived job insecurity is associated with quality of life net of controls for demographic and health characteristics, but not when controlling for other job stressors. Perceived inequality at work confounds the relationship between perceived job insecurity and quality of life. Negative work to family spillover of stress and social support outside of work from family, friends, and spouse/partner significantly mediate the relationship between perceived inequality at work and quality of life. Third, for conditioning factors, the effect of perceived inequality at work on quality of life is conditional on household income, social support at work, age, and wave of interview. No significant group differences were found by education, gender, or race. The findings demonstrate that perceived job insecurity is associated with other psychosocial stressors from established job stress models but that inequality may be even more threatening to health and well-being than insecurity. Stress proliferation from work to family life partially explains the relationship between perceived inequality at work and quality of life. Programs to enhance social support at work and home may help to contain the negative health effects of inequality and insecurity on quality of life.

The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.

This book covers a wide range of topics relating to the health and wellbeing of the construction workforce. Based on more than two decades of work examining various aspects of workers’ health and wellbeing, the book addresses a key topic in construction management: how the design of work environments, construction processes and organisation of work impact upon construction workers’ physical and psychological health. Occupational health is a significant problem for the construction industry. However, the subject of health does not receive as much attention in occupational health and safety research or practice as the subject of safety. Traditional management approaches (focused on the prevention of accidents and injuries) are arguably ill-suited to addressing issues of workers’ health and wellbeing. This book seeks to explain how workers' health and wellbeing are impacted by working in the construction sector, and suggest ways in which organisations (and decision makers within them) can positively shape workplaces and practices in ways that better support construction workers to maintain healthy and productive working lives. Including chapter summaries and discussion questions to encourage student readers to reflect on and formulate their own viewpoints about the issues raised in each chapter, the book has the potential to be used as a textbook in undergraduate or postgraduate occupational health and safety, or construction management courses dealing with occupational health and safety. It could also be used as supplementary recommended reading in undergraduate or postgraduate programmes in architecture, engineering or management.

The Social Determinants of Mental Health aims to fill the gap that exists in the psychiatric, scholarly, and policy-related literature on the social determinants of mental health: those factors stemming from where we learn, play, live, work, and age that impact our overall mental health and well-being. The editors and an impressive roster of chapter authors from diverse scholarly backgrounds provide detailed information on topics such as discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underemployment, and job insecurity; income inequality, poverty, and neighborhood deprivation; food insecurity; poor housing quality and housing instability; adverse features of the built environment; and poor access to mental health care. This thought-provoking book offers many beneficial features for clinicians and public health professionals: Clinical vignettes are included, designed to make the content accessible to readers who are primarily clinicians and also to demonstrate the practical, individual-level applicability of the subject matter for those who typically work at the public health, population, and/or policy level. Policy implications are discussed throughout, designed to make the content accessible to readers who work primarily at the public health or population level and also to demonstrate the policy relevance of the subject matter for those who typically work at the clinical level. All chapters include five to six key points that focus on the most important content, helping to both prepare the reader with a brief overview of the chapter's main points and reinforce the "take-away" messages afterward. In addition to the main body of the book, which focuses on selected individual social determinants of mental health, the volume includes an in-depth overview that summarizes the editors' and their colleagues' conceptualization, as well as a final chapter coauthored by Dr. David Satcher, 16th Surgeon General of the United States, that serves as a "Call to Action," offering specific actions that can be taken by both clinicians and policymakers to address the social determinants of mental health. The editors have succeeded in the difficult task of balancing the individual/clinical/patient perspective and the population/public health/community point of view, while underscoring the need for both groups to work in a unified way to address the inequities in twenty-first century America. The Social Determinants of Mental Health gives readers the tools to understand and act to improve mental health and reduce risk for mental illnesses for individuals and communities. Students preparing for the Medical College Admission Test (MCAT) will also benefit from this book, as the MCAT in 2015 will test applicants' knowledge of social determinants of health. The social determinants of mental health are not distinct from the social determinants of physical health, although they deserve special emphasis given the prevalence and burden of poor mental health.