Kompier editorial on work-related stress and health

Scand J Work Environ Health 2006;32(6):413-419

Work-related stress and health—risks, mechanisms and countermeasures

by Härmä M, Kompier MAJ, Vahtera J

Profound changes occurring in the economic, political, technological, and social landscape have transformed the world. And because the world has changed, also the world of work has changed (1). The most striking development is the changing nature of work itself—from physical to mental. Another major development is that the significance of time and time-related activities in work has increased. Furthermore, due to the systematic intensification of work, the psychosocial workload has increased. Accordingly, today, for many employees, work poses primarily mental and emotional demands. At the same time, job and work security have decreased. Moreover, work and family life have become blended. It is now generally recognized that, as a result of these developments, work-related stress has become a major public health problem with serious consequences for the individual, companies, and society.

Although the concept of stress is very popular, both in the academic world and in the everyday world, it has been difficult to agree on the exact scientific definition. According to Kristensen et al (2) stress is an individual, psychophysiological, and subjective state, characterized by a combination of high arousal and displeasure. In this issue of the Scandinavian Journal of Work, Environment & Health, in line with this definition, Siegrist & Rödel (3) specify stress as a latent construct that indicates a state of elevated activation of the autonomic nervous system with coordinated manifestations at the affective, cognitive, and behavioral levels. To study the health aspects of stressful work characteristics, general theoretical work-stress models, like those for job strain (4) and effort–reward imbalance (5), have been developed and tested. Also in this issue of the Scandinavian Journal of Work Environment & Health, several papers (3, 6, 7, 8) have used these models and more-recent conceptualizations, such as organizational injustice, to explore the association between work stress and health. Work stress thus refers to the aspects of work design, organization, and management, and their social and organizational contexts, that have the potential to cause harm to employee health. This paradigm, in addition to the conventional physicochemical approach, forms an essential part of contemporary occupational health research (6).

The aim of this special issue of the Scandinavian Journal of Work, Environment & Health is to clarify the knowledge and understanding of the risks and mechanisms of work-related stress and to review current challenges and some approaches for the prevention of work-related stress.

21 Workplace Benefits that are Rapidly Disappearing

Traditional pension plans, paid family leave, and even the company picnic are all on the decline. Employers have significantly cut many of the benefits they offer to workers over the past five years. Some 77 percent of companies report that benefits offerings have been negatively affected by the slow pace of recovery, according to a Society for Human Resource Management survey of 600 human resources professionals. “The two biggest areas where cuts have come have been in health care and retirement because that’s where costs have increased the most,” says Mark Schmit, research director of the Society for Human Resource Management in Alexandria, Va. Here is a look at the workplace perks that have significantly declined since 2007.

Trabajo No Saludable: Causas, Consecuencias, Curas

Review of Unhealthy Work, by Robert Forrant featured in New Solutions

Reviews Unhealthy Work: Causes, Consequences, Cures, edited by Peter L. Schnall,

Marnie Dobson, and Ellen Rosskam, Amityville, NY: Baywood, 2009.

Reviewed by Robert Forrant MAKING NOXIOUS WORK HISTORY

Unhealthy Work, a rigorous interdisciplinary examination of the evidence linking the conditions of work with illness, labels “unhealthy work” a serious problem of public well-being. Pulling no punches, the authors of the book’s first chapter state:

Work, so fundamental to basic survival and health, as well as to wealth, well-being, and positive social identity, has its darker and more costly side too. Work can negatively affect our health, an impact that goes well beyond the usual counts of injuries, accidents, and illness from exposure to toxic chemicals [1, p. 1].

Peter Schnall, a clinical professor of medicine at the University of California, Irvine, Division of Occupational and Environmental Medicine (where he directs the program in work organization and cardiovascular disease), Marnie Dobson, a medical sociologist and a research associate at the Center for Occupational and Environmental Health at the University of California, Irvine, and Ellen Rosskam, policy scholar at the Woodrow Wilson International Center for Scholars, and public health and social protection specialist, have crafted a book that anyone interested in the health and well-being of working people ought to take a careful look at.

Unhealthy Work addresses the topic of unhealthy work in three parts: The Changing Nature of Work (Part I) discusses the important changes taking place in the world of work in the context of the global economy; The Health and Economic Costs of “Unhealthy” Work (Part II) considers the growing body of scientific evidence on the effects of particular forms of work organization and work stressors on employees’ health and discusses how unhealthy work has become a major public health problem; and Interventions (Part III) takes a look at actions and approaches that can be taken to improve working conditions, prevent disease, and improve health. Authors present well researched, highly readable accounts of the epidemiological science supporting their conclusions that a lousy work environment leads to poor health. Thanks to a skillful job by the book’s editors, the reader comes away with a sobering understanding of the depth of human suffering caused by a poor work environment.

In the introductory chapter the premise is offered that a good society “must have as a moral basis the well-being of its working people” [1, p. 3]. This view is tested in detailed articles from an extraordinarily able group of researchers. How work is organized, they suggest—its pace and intensity, workers’ degree of control over the work process, workers’ sense of justice, and the degree of employment security, among other things—can be as important to the health of workers as the chemicals in the air they breathe on the job. In other words, the less job security one has, the less say one has over the ways his or her work day is organized, and the greater the pace of work, the more likely a worker is to suffer what the book’s editors call the “hazards” of the “psychosocial” work environment. And, because the “transformations in work and work organiza- tion that began 200 years ago are now accelerating so much” [1, p. 5] because of globalization, these stresses are intensifying with every downsizing, plant closing, and off-shoring of work.

CLUELESS ON THE SHOP FLOOR

As a former machinist, someone who dunked his arm up to his elbow in a bucket of trichloroethylene numerous times a day for several years, another of the book’s premises resonated. We think of disease and illness in terms of risk factors or health habits or lifestyles or genes of an individual; we think of prevention as directed toward changing the individual—for example, through stress management techniques, more exercise, or healthy eating habits—rather than toward changing the workplace, the community, or economic or political systems [1, p. 11].

Never once when I had a physical during my “machining years” did any doctor ask me what I did for a living beyond the very basic chit-chat of did I have a job. What I breathed, how my work was paced, and what I dunked exposed skin into were not conversation topics. Only years later when I ran across the work of Peter Schnall and others and learned about the Japanese term karoshi, which literally means a person working himself to death, did I become deeply concerned with the questions with which Unhealthy Work wrestles.

SPREADING STRESS

Unhealthy Work is a valuable summary of existing knowledge regarding working conditions that impair the health of millions of employees. While its focus is mainly a North American one, there is an important international perspective contained in the argument that globalization has spread unhealthy work through the resulting international division of labor. Notes Chrisy Moutsatsos, Assistant Professor of Anthropology and Women’s Studies at Iowa State University:

In addition to the increase of global economic inequality and the steady replacement of secure employment with insecure and flexible labor, neo- liberal economic and political policies and the global economic restructuring that has resulted from them have dangerously challenged workers’ repre- sentational politics and voice worldwide [2, p. 24].

Paradoxically, while globalization has undermined wages and workers’ well-being, it has sparked very intense labor protests against harsh work regimes in several countries, including China, where in the spring and summer of 2010 workers protested in several high-tech plants against the pace and pressure of their required labor.

THE GRIM TRUTH

In the midst of the “Great Global Recession of 2008,” working conditions are worsening and, as the case studies in Unhealthy Work reveal, the impact on physical illness (mainly cardiovascular disease, hypertension, and diabetes) and mental illness (mainly depression) as well as lost productivity, is staggering. Summarizing the case studies in the book, Schnall, Dobson, Rosskam and Landsbergis report that by the age of 50, most members of the U.S. workforce suffer from at least one work-related illness and sometimes more, including injuries (e.g., back, neck, and repetitive strain injuries); work-related mental health conditions (including burnout, depression, and anxiety-related disorders); or cardiovascular heart disease of one form or another, including hypertension and coronary artery disease [3, pp. 331-332].

What’s disturbing here is the fact that for the most part we now do poorly addressing even many of the workplace’s more obvious and easily seen dangers, as evidenced by such things as oil rigs blowing up, coal mines caving in, and high-tech workers being exposed to highly toxic cleaning agents. So, how do we move forward the important arguments that are raised in Unhealthy Work? The book should be read by anyone who cares about public health, workplace health, and the skyrocketing costs of health care. Don’t let the science scare you; even a historian like me got the message loud and clear. “Chronic illnesses, such as depression, hypertension, and coronary artery disease appear to be ‘modern epidemics,’ the consequences of excessive environmental load (such as chronic stressors at work) on the human organism over prolonged periods of time” [3, p. 334]. Now, just like the Happy Meal, we are exporting this workplace harm to unsuspecting workers in the ever-expanding global supply chain. There oughta be a law!

Note: A video recording of the seminar Global Epidemics: The Contribution of Work held by the editors of Unhealthy Work at The Woodrow Wilson International Center for Scholars, as well as a PDF presentation, are available at:

http://www.wilsoncenter.org/ondemand/index.cfm?fuseaction=home.play& mediaid=0324B5D4-D7ED-552C-1BEF9291E0C9FAD0

NOTES

1. Deborah R. Gordon and Peter L. Schnall, “Introduction,” in Unhealthy Work: Causes, Consequences, Cures, eds. Debora R. Gordon and Peter L. Schnall (Amityville, NY: Baywood, 2009), 1-15.

2. Chrisy Moutsatsos, “Economic Globalization and Its Effects on Labor,” in Unhealthy Work: Causes, Consequences, Cures, eds. Debora R. Gordon and Peter L. Schnall (Amityville, NY: Baywood, 2009), 21-36.

3. Peter L. Schnall et al., “Curing Unhealthy Work,” in Unhealthy Work: Causes, Consequences, Cures, eds. Debora R. Gordon and Peter L. Schnall (Amityville, NY: Baywood, 2009), 331-350.

Related Websites

1. American Heart Association (AHA)
2. American Public Health Association (APHA)
3. American College of Occupational & Environmental Medicine
4. California Department of Health Services (DHS): Occupational Health Branch
5. California Nurses Association
6. Centers for Disease Control (CDC)
7. Danish National Institute of Occupational Health (AMI)
8. European Foundation for the Improvement of Living and Working Conditions
9. European Network for Workplace Health Promotion (ENWHP)
10. Finnish Institute of Occupational Health
11. Firefighter Obesity Research: Workplace Assessment to Reduce Disease (FORWARD)
12. Framingham Heart Study
13. International Commission on Occupational Health (ICOH)
14. International Labour Organization
15. John D. and Catherine T. MacArthur Research Network on Socioeconomic Status and Health
16. The Job Content Questionnaire (JCQ) / Robert Karasek
17. The Karolinska Institute
18. LaborNet
19. National Heart, Lung, and Blood Institute (NHLBI)
20. National Institute of Health (NIH)
21. National Institute of Occupational Safety and Health (NIOSH)
22. National Library of Medicine (PubMed)
23. National Network of Committees on Occupational Safety and Health
24. National Safety Council
25. NIOSH: Stress at Work
26. SafeWorkers.co.uk
27. Social Medicine Portal
28. Swedish National Institute for Working Life
29. UC Irvine Center for Occupational and Environmental Health
30. UC Irvine Health Promotion Center
31. UC Irvine Heart Disease Prevention Program
32. UC Los Angeles Center for Occupational and Environmental Health
33. University of Pittsburg Epidmiology Supercourse
34. UK National Work-Stress Network
35. WorkStress.Net
36. World Health Organization (WHO)
37. WHO Ocuupational Safety & Health

Additional Websites

Press

• American Heart Association
• National Instutute of Occupational Safety and Health
• Department of Health and Human Services
• Occupational Safety and Health Administration
• World Health Organization

Events

• National Institute of Health
• American Heart Association
• National Instutute of Occupational Safety and Health
• World Health Organization

Funding Sources

• The California Wellness Foundation
• Center For Disease Control
• The Foundation Center
• The John Randolph Haynes and Dora Haynes Foundation
• The Robert Wood Johnson Foundation
• The Kellogg Foundation
• National Institute of Occupational Safety and Health
• National Institute of Health

A Prospective Cohort Study of Shift Work and Risk of Ischemic Heart Disease in Japanese Male Workers

San Francisco Hotel Worker Study Summary

BACKROUND AND SIGNIFICANCE

This is a pilot study designed to help in the development of a large-scale research project on the future of work in the hospitality industry. The hospitality industry has experienced a wave of restructuring, consolidation, and new practices to cut costs including lean staffing and greater performance demands on the workforce. The study will explore the impact of these and related changes on the health and quality of life the largest occupational group within the hospitality industry, room cleaners. Jobs in housekeeping (and food and beverage) operations of the hospitality industry represent the future of work in this growing service sector with jobs characterized by increasing repetitive physical workloads, low income, low skill utilization, low job control, and virtually no prospects for training and career advancement. There is compelling evidence that this kind of low-income jobs result in a disproportionate high burden of illness, injury, and disability. Unlike other services, businesses in the hospitality industry, cannot be moved across the borders but will remain a fast growing sector in industrialized countries, creating increasing societal costs including disproportionate workers’ compensation and health care utilization costs. Working conditions in the hospitality industry are representative for a growing number of workers of color, working women, and former welfare recipients. The hospitality industry has become a major target for welfare-to-work and job training programs in cities throughout the country. An aging workforce is faced with increasing job demands in a competitive industry constantly upgrading services. Few studies have been done on this growing workforce and little is known about their specific working conditions and health risks and how they could be addressed.

This study will take a broad view at physical and psychosocial job factors, health, including general self-rated health, musculoskeletal disorders, work-related injury, and health-related quality of life. Further, this study will investigate which innovative organizational strategies can help to reduce the burden of illness and disability in the service sector by comparing hotels in different market segments, different degrees of unionization, and hotels with innovative joint labor management health and safety programs, negotiated child care/elder care benefits, and a multi-employer worker training project.

San Francisco Bus Drivers Study

The Ambassador/Friends of the Muni Program is up and runnin. The overall pupose of the program is to improve service, to improve working conditions, and to improve relationships between operators and their riders.

The program was established in the 1996 Memorandum of Understanding, articles 5 and 6. The MOU sets up the “Muni Improvement Fund (MIF)” as the governing body for the Ambassador/Friends of Muni program. The MIF trustees are the same as for the TWU-Muni Trust Fund.

The Ambassador Program is a pilot. We are going to focus on twelve lines. Once we succeed on those lines we’ll move the program through the system, so that every single line will become an Ambassador line.

Here’s the heart of the program.

• STAFFING: The number of operators must be brought up to full strength.
• SCHEDULES: We must have realistic scheduling, increased running time and consistent recovery time.
• EQUIPMENT: There’s no point talking about improved schedulilng if we don’t have the working vehicles.
• TRAINING: The Ambassador program will provide improved training. The operators’ job should be upgraded, focusing on providing transportation-service rather than just moving a vehicle from one place to the other. Operators should have increased reponsibility for the full job-controlling headways, keeping to schedules to the fullest extent possible, safety, and improving passenger relations. Other Muni staff should also be trained to work in this improved environment.
• RIDER INVOLVEMENT: Operators have more contact with the public than anyone else in the system. Operators are in the best position to educate riders about how the system works and what kind of service they can expect. The Ambassador program will give operators the tools, the materials, and the training they need to reach out to the riders.

The program has already begun on the 22-Filmore. All of us working together identified problem areas such as scheduling, passenger load, safety, and stress. In order to address these problems, and to create a better working environment, we agreed to put three more buses on the 22 line. We have taken other steps to improve services on the line, and by all account operators are pleased. The next step is to meet late this month with 22-Filmore line operators and others to discuss training needs and ideas.

The program has hired a coordinator, Danny Beagle, who is meeting with operators, union leaders and Muni staff in order to put together all of the elements of the program.