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Policy Statements Adopted by the Governing Council of the American Public Health Association, November 15, 2000

Policy Statements Adopted by the Governing Council of the American Public Health Association, November 15, 2000

200018: Public Health Impacts of Job Stress


The American Public Health Association,

Recognizing that workers in the United States are taking fewer and shorter vacations, and are working more hours over the course of a year, surpassing even Japan as the leader among major developed nations in annual hours worked per person (1), and

Recognizing that 20% of American workers saw his or her job disappear during the 1980s, and downsizing and layoffs have continued through the end of the 1990s, despite an unprecedented economic boom, with income disparities rising to their highest levels in over a century (2), and

Recognizing that in the US, many previously secure and well-paying jobs in diverse manufacturing industries have been exported oversees, leaving workers in the US to take lower wage non-unionized jobs (4), and

Recognizing that more people in the US feel stressed now than in 1985, because of time urgency and worries about gaining a sense of control over their lives (4); most with job stress rooted in heavy workloads and job insecurity combined with a lack of control over schedules and other factors (4); jobs which constrict learning and skill development; and they are characterized by a lack of free time and reduced energy, resulting in individual isolation, passive, destructive behavior, increased drug use, as well as a decline in participation in social and political institutions (5); and

For example, finding that health care workers, particularly those working in managed care institutions, are now finding that their job latitude and control which include their use of personal judgment is being undermined; yet these factors are critical to job satisfaction and to their own and their patients’ health; and

Recognizing that how much control a person has over his or her work is important because it affects how well he or she copes with the demands of his job (6); and that jobs that offer restricted opportunity to use skills combined with high job demands result in a high strain situation with heavy psychosocial costs in physical and mental health (7). The so-called job demand-control hypothesis that high decision latitude and low-to-moderate work demands are good for health and that high job demands and low decision latitude are bad; similarly, the effort-reward hypothesis postulates that the risk of ill-health is increased by an imbalance between efforts and rewards (8); such poorly-designed jobs are associated with negative health effects, including increased blood pressure (9); heart disease (10,14), fatigue and sleep disturbance (15,16) musculoskeletal disorders (17), absenteeism, job turnover, and increased acute injury rates (18,19) and adverse effects on family and social life outside the workplace (5); and

Realizing that additional types of job strain, such as lean production, in particular, cutting the number of workers while at the same time speeding up production, are associated with increased injury rates (20); many of these involve non-standard shifts associated in some studies with adverse health outcomes including heart disease (21); and

Whereas APHA has previously recognized the right to a healthful working environment (22) and the need to increase occupational disease prevention and increasing worker and union rights (23); there-fore urges that,

1. Reducing job strain and providing quality jobs are key to improving the health of workers; and
2. Improved job design depends on sustainable principles of social equity instead of short-term profitability and “lean production” (24).
3. That the Congress provide for additional occupational safety and health funding to:

  • convene employers and other professional organizations to develop research strategies and intervention methods to reduce job stress;
  • conduct further research on job stress and the mechanism of the observed increase in cardiovascular disease;
  • support investigation into job stress and its relationship to depression;
  • evaluate occupational differences and gender and ethnic differences in prevalence of job stress and resulting adverse health affects.

References

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2. Forrant R. Global flexibility-shop floor flexibility: What’s a worker to do? New Solutions. 1999;9:231-245.
3. World Labour Report: Industrial Relations, Democracy and Social Stability, 1997-1998. Geneva: International Labour Organization; 1997.
4. Fact Finding Report: Commission on the future of worker-management relations. Washington, DC: US Departments of Labor and Commerce; 1994.
5. Karasek R. The new work organization and conducive value. Sociolosche Gids [Dutch Sociological Journal]; 1999;5:310-330.
6. Bonn D, Bonn J. Work-related stress: Can it be a thing of the past? Lancet. 2000;355:125-128.
7. Karasek R, Theorell T. Healthy Work: Stress, Productivity and the Reconstruction of Working Life. New York, NY: Basic Books, 1990.
8. Siegrist J. Adverse health effects of high-effort/ low-reward conditions. J Occup Health Psychol. 1996;1:27-41.
9. Pieper C, Warren K, Pickering TG. A comparison of ambulatory blood pressure and heart rate at home and work on work and non-work days. J Hypertens. 1993;11:177-183.
10. Sokejima S, Kagamimori S. Working hours as a risk factor for acute myocardial infarction in Japan: Case-control study. BMJ. 1998;317:775-780.
11. Theorell T, Rahe RH. Behavior and life satisfactions of Swedish subjects with myocardial infarction. J Chron Dis. 1972;25:139-147.
12. Karasek R, Baker D, Marxer F, Ahlbom A, Theorell T. Job decision latitude, job demands and cardiovascular disease: A prospective study of Swedish men. Am J Public Health. 1981;71: 694-705.
13. Siegrist J, Peter R, Junge A, Cremer P, Seidel D. Low status control, high effort at work and ischemic heart disease: Prospective evidence from blue-collar men. Soc Sci Med. 1990;31: 1127-1134. American Journal of Public Health 27 March 2001, Vol. 91, No. 3
14. Appels A, Mulder P. Excess fatigue as a precursor of myocardial infarction. Eur Heart J. 1988;9:758-764.
15. Lauber JK, Kayten PI, Sleepiness, circa-dian dysththmia and fatigue and transportation system accidents. Sleep. 1988;11:503-512.
16. Brown ID. Driver fatigue. Human Factors. 1994;36:298-314.
17. Moon SD, Sauter SL. Beyond Biomech-anics: Psychosocial Aspects of MusculoskeletalDisorders in Office Work. London: Taylor and Francis, 1996.
18. Smith L, Folkard S, Poole CHM. Increased injuries on night shift. Lancet 1994; 344:1137-1139.
19. Mitler MM, Carskadon MA, Czeisler CA, et. al. Catastrophies, sleep and public policy. Consensus Report. Sleep. 1988;11:100-110.
20. Landsbergis PA, Cahill J, Schnall P. The impact of lean production and related new systems of work organization on worker health. J Occup Health Psychol. 1999; 4:108-130.
21. Kawachi I, Colditz G, Stampfer M, et al. Prospective study of shift work and risk of coronary heart disease in women. Circulation. 1995; 92:3178-3183.
22. APHA Public Policy Statement 7111: The right to a healthful work environment. APHA Policy Statements; 1948-present, cumulative. Washington, DC: American Public Health Association; current volume.
23. APHA Public Policy Statement 8509: Occupational Disease Prevention: Increase Worker and Union Rights. APHA Policy Statements; 1948-present, cumulative. Washington, DC: American Public Health Association; current volume.
24. Bartley M, Marmot M. Social class and power relations at the workplace. Occ Med: State
of the Art Reviews. 2000; 15:73-78.
25. Landsbergis PA, Cahill J. Labor union pro-grams to reduce or prevent occupational stress in the United States. In J Health Serv 1994; 24:105-129.
26. Kaminski M, Bertell D, Moye M, Yudken J (eds). Making change happen: Six cases of unions and companies transforming their work-places. Washington, DC: Work and Technology Institute, 1996, pp. 25-44.
27. Leslie D, Butz D. ‘GM Suicide’: Flexibility, space and the injured body. Economic Geography. 1998;74:360-378.

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