Introduction to the Historical Origins of Modern Work Organization

“Cardiovascular disease (CVD), including heart disease and stroke, is the major cause of disease and death in the industrialized world and is projected to become the most common cause of death worldwide by the year 2020. CVD and hypertension (high blood pressure) appear to be epidemics of recent historical origin, developing along with industrialization and urbanization, and now increasing in the context of economic globalization. Modern medicine focuses on individual risk factors for hypertension and CVD, often ignoring the important role that social factors, such as social class, work organization, and work-related psychosocial stressors, play in the development of hypertension and CVD. Social factors need to be fully integrated into explanations of disease development.

Increased CVD risk has been associated with job characteristics such as long work hours, shift work, “job strain” (a combination of high psychological work demands and low job decision latitude, or job control), high job efforts combined with low job rewards, injustice, job insecurity, and work that involves maintaining a high level of vigilance in order to avoid disaster, such as loss of human life. Sources of stress on the job (job stressors), besides acting directly on the human nervous system, may increase the risk of hypertension and CVD through a variety of mechanisms, including inhibiting healthy behaviors such as smoking cessation and exercise, or by producing psychological distress, such as anxiety and depression. Public health strategies are needed to address the pandemic of CVD, including worksite surveil- lance, development of the field of occupational cardiology, integration of health promotion with occupational health approaches, and job redesign.


CVD, including heart disease and stroke, is the major cause of disease and death in the industrialized world, and is projected to become the most common cause of death worldwide by 2020 [1, 2]. In 2003, CVD caused 29.2% of all global deaths and 80% of all CVD deaths worldwide took place in developing, low- and middle- income countries [1].

Modern medical science has identified a number of individual risk factors for CVD including cigarette smoking, total and low density lipoprotein cholesterol, hypertension, fibrinogen, overweight, diabetes, and sedentary behavior (lack of exercise) [3]. However, essential hypertension, the leading cause of CVD world- wide [4], is considered by many to be an unexplained disease (hence the name “essential”). Essential hypertension, as well as smoking, sedentary behavior, and diabetes, have been linked to work stressors. Thus, much remains to be learned about the role of work in the development of CVD.

CVD and hypertension appear to be epidemics of recent historical origin [5, 6]. A major cross-cultural study found virtually no rise in blood pressure (BP) with age and no hypertension among hunter-gatherers, herders, or traditional family farmers [6]. In contrast, men and women in urban industrial societies have steady rises of blood pressure (BP) with age and hypertension is common [5, 6] (see Figure 1). This study also found large and significant correlations between BP and involvement in a money economy even after controlling for salt consumption and, for men, after controlling for body mass index (a measure of body weight) [6].

CVD, as a major cause of death, also developed at the same time as industrialization and urbanization [2, 7, 8], raising the question, what is it about industrializa- tion and urbanization that leads to hypertension and CVD? Evidence suggests that one important factor is the transformation of working life during the last 100-200 years in developed countries, away from agricultural work and relatively autonomous craft-based work toward machine-based (including computer-based) labor, based on the principles of the assembly line [9, 10]. Key features of the assembly-line approach to job design, whether in factories or offices, are high workload demands combined with low employee control or autonomy (known as “job strain”) [11], and, during periods of economic growth, long work hours.”

Taken from: Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.

1. World Health Organization, The Atlas of Heart Disease and Stroke, World Health Organization, Geneva, Switzerland, 2004.

2. Graziano, J., Global Burden of Cardiovascular Disease, in Heart Disease, Zipes, D., P. Libby, R. Bonow, and E. Braunwald (eds.), Elsevier, London, UK, pp. 1-19, 2004.

3. Kannel, W. B., The Framingham Experience, in Coronary Heart Disease Epidemi- ology, Marmot, M. and P. Elliott (eds.), Oxford University Press, Oxford, NY, pp. 67-82, 1992.102 / UNHEALTHY WORK

4. Lawes, C., S. Vander Hoorn, M. Law, P. Elliott, S. MacMahon, and A. Rodgers, Blood Pressure and the Burden of Coronary Heart Disease, in Coronary Heart Disease Epidemiology, Marmot, M. and P. Elliott (eds.), Oxford University Press, Oxford, NY, pp. 152-173, 2005.

5. Schnall, P. L. and R. Kern, Hypertension in American Society: An Introduction to Historical Materialist Epidemiology, in The Sociology of Health and Illness: Critical Perspectives, Conrad, P. and R. Kern (eds.), St. Martin’s Press, New York, pp. 97-122, 1981.

6. Waldron, I., M. Nowatarski, M. Freimer, J. P. Henry, N. Post, and C. Witten, Cross- Cultural Variation in Blood Pressure: A Qualitative Analysis of the Relationship of Blood Pressure to Cultural Characteristics, Salt Consumption and Body Weight, Social Science and Medicine, 16, pp. 419-430, 1982.

7. Mackinnin, A., The Origin of the Modern Epidemic of Coronary Artery Disease in England, Journal of the Royal College of General Practitioners, 37, pp. 174-176, 1987.

8. Faergeman, O., The Societal Context of Coronary Artery Disease, European Heart Journal, 7:Supplement A, pp. A5-A11, 2005.

9. Landsbergis, P., P. Schnall, K. Belkic, J. Schwartz, D. Baker, and T. Pickering, Working Conditions and Masked (Hidden) Hypertension: Insights into the Global Epidemic of Hypertension, Scandinavian Journal of Work Environment and Health, Suppl (6), pp. 41-51, 2008.

10. Schnall, P., K. Belkic, P. A. Landsbergis, and D. Baker, Why the Workplace and Cardiovascular Disease?, Occupational Medicine: State-of-the-Art Reviews, 15:1, pp. 1-5, 2000c.

11. Karasek,R.andT.Theorell,HealthyWork:Stress,Productivity,andtheReconstruction of Working Life, Basic Books, New York, 1990.

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