Occupational class differences in CHD incidence: which indications for promoting the social capital at the workplace?

Occupational class (OC) differences have been observed for cardiovascular diseases, cancers, mental health, musculoskeletal disorders as well as hazardous life styles and environmental conditions have been evidenced in most studies. Over time, the relative differences among social classes persisted, despite the absolute gap is decreasing. In addition the aging of the working populations increases the prevalence of all these disorders during the working life-time.   We found higher CHD incidence rates among manual workers, professionals and administrators, and self-employed, compared to non-manual workers in a large Italian working population-based sample. When the entire spectrum of job categories is considered, traditional risk factors and job strain helped to explain the CHD excess risk in manual workers, but not in other occupational classes. There is the need to better assess the risk in these occupational groups which are spreading in most post-industrialized societies, but at the same time to address health intervention to group at higher risk.  A comprehensive review on the efficacy of workplace health promotion (WHP) has recently been published. Evidences of outcome benefits have been shown for AHRF Plus interventions only, when health risk assessments are combined with counselling, interventions and follow-up. Smoking restriction policies, high blood pressure and cholesterol control programmes, screenings of alcohol and drug abuse and risk-specific oriented interventions, increase healthy physical activity in the worktime, have shown positive effects of different health outcomes.   In conclusion, in addition to occupational risk assessment and prevention, to preserve social capital at the workplace WHP programmes are mandatory. Occupational physicians need to be trained to be able to identify and deliver priority interventions in different work settings.