Background: As with income and education level, there's a health gradient in society tied to the jobs and work we do. Our position in the pecking order, the nature and stability of our work conditions and employment situation, and our access to power, control and resources all have an impact on our health.

Everyone knows that work can be stressful. But how does job stress get under the skin, and what can be done about it?

The Gradient. Contrary to popular wisdom, it's not CEOs dying of heart attacks, it's their subordinates. In general, those at the top of the job ladder live longer, healthier lives than those in the middle, who in turn fare better than those at the bottom. While much of this advantage is tied to wealth, it's also affected by how much power and autonomy people have at work, their job security, job design, safety of work conditions, and the respect their occupational status commands.

Although we all face pressure, we don't all have the same power over the demands we face or the same resources. Executives and top managers have decision-making authority, they control budgets and their schedules, and they can use their knowledge, leverage and clout to get what they want or need. As top earners, they are also more likely to live in the best neighborhoods, enjoy job perks and benefits, and have the resources to hire help or get away when the stress becomes too great.

Middle managers and supervisors may not be as well off as their superiors, but their position still affords them many advantages, which typically include: employment benefits like group health insurance and access to a retirement plan, sick time and paid vacation, some flexibility or stability with tasks and schedule, training opportunities, money for entertainment or the occasional escape, and a home in a secure neighborhood with decent schools.

Those lowest on the totem pole not only receive the smallest paycheck, they are likely to have less control over their tasks or schedule, less job security, less say in the workplace, less supervisor support, few or no benefits, more hazardous work conditions, more debt, more worries about their child's safety and future, more trouble balancing the demands of work and home, and less access to healthy avenues for stress relief.

Growing Inequality. Since the 1980s, an emphasis on short-term profit, the decline of unions and increased global competition have resulted in an unprecedented transfer of wealth and power to corporate shareholders and executives at the expense of the lives and health of the average worker. The growing wealth gap in the U.S. has corresponded to a decline in our international ranking for life expectancy, infant mortality, child poverty, and other health-related indicators.

Americans are working longer hours than ever before, yet they have less job security, fewer benefits and in some cases are earning lower pay. Companies looking to maximize profits and cut costs are not only moving overseas for cheaper labor, they are quietly undermining hard-won gains in the American workplace, by replacing permanent full-time positions with part-time workers and non-standard contractors and voiding collective bargaining agreements through legal loopholes. This allows corporations to pay less, deny benefits, exert more control over hiring and firing, and avoid accountability - sometimes skirting legal responsibility altogether.

These new work arrangements produce a cascade of direct and indirect health disruptions: everything from food and housing insecurity to increased family strife, anxiety, job strain, depression, substance abuse, and higher levels of disease risk. They also increase social costs that we all must bear: higher health care costs, increased disability, crime, divorce, and increased costs to the welfare system.

In fact, studies by Dr. Harvey Brenner indicate that unemployment can be measured by increased rates of mortality, domestic abuse, alcoholism, drug use and heart disease.

Other countries have passed legislation to protect workers, lessen inequality and help families. For example, European Union countries guarantee paid sick leave, paid vacation, government or industry-wide pensions, and severance pay following layoffs. Many of these countries also provide paid parental leave, universal preschool, universal health care, new parent support, and social protections for families in poverty. Scandinavian countries have even outlawed job strain.