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25th EPICOH Conference- Occupational Health: Think Globally, Act Locally – Barcelona, Spain – Sept 5-7, 2016

5-7 September 2016 – Universitat Pompeu Fabra, Campus de la Ciutadella, Barcelona, Spain

25th EPICOH Conference- Occupational Health: Think Globally, Act Locally

Organized by: EPICOH Supported by ICOH SC: ICOH, CREA, Universitat Pompeu Fabra, Universiteit Utrecht

Topics: The scientific program will cover all major topics of current epidemiologic research in occupational health. We have chosen the theme to promote the connection between local research and action with research and action in occupational health at the global level. The programme will include pre/post conference workshops and special care will be taken to promote participation of young researchers.

Contact Information Address: Salvador Espriu, 77, local 10 – 08005 Barcelona, Spain E-mail: epicoh2016@mondial-congress.com Website: http://www.epicoh2016.org/

To download the first announcement, please click here.

New Documentary Film Announcement

Many jobs in America today are making people sick.

From the lowest to the highest-paying jobs, workers are suffering from a variety of illnesses stemming from exposure to stressful work environments.

Job stressors of many kinds such as insecure contracts, lack of respect, lack of control, long hours, shortened or skipped breaks, fear of layoff, unpaid time, diminished benefits including health insurance and pension, all contribute significantly to mental health problems such as burnout and depression and to chronic illnesses such as diabetes, hypertension, and coronary artery disease. Many of these illnesses could be prevented if we acknowledge their causes and act now.

Workers sometimes have a sense that their jobs are making them sick though the serious and life- threatening nature of these health consequences may only become apparent after years of exposure. Job-related health problems are also frequently dismissed as being individual problems or personal weakness rather than as predictable outcomes of the way work is organized. The medical profession frequently contributes to this misunderstanding by ignoring working conditions as it sees most illness as the result of individual differences and/or unhealthy behaviors.

We need to change all this.

Working on Empty Documentary Team Bios

Dr. Peter Schnall MD, MPH, the Executive Producer for WOE and Director of the Center for Social Epidemiology, is a Clinical Professor of Medicine at the University of California at Irvine, Center for Occupational and Environmental Medicine where he directs the Center’s program in Work organization and Cardiovascular Disease. Peter has studied the impact of working condition on the development of hypertension among workers for over 30 years; and his major professional goal is to increase awareness among students, colleagues and the public as to the important role that work stress plays in the etiology of chronic mental and physical illnesses. (LinkedIn, Twitter)

Donald Goldmacher, MD, WOE Producer, is a longtime filmmaker, labor advocate, activist, and community psychiatrist with decades of experience observing, documenting and participating in social change. His most recent documentary film, HEIST: Who Stole the American Dream, has received a great deal of critical reviewer support, and serves as one of many reasons Donald is a key advisor to WOE Executive Producer Peter Schnall. (LinkedIn, Twitter)

Marnie Dobson Zimmerman, PhD, WOE Associate Producer of Research and Associate Director of the Center for Social Epidemiology, is a medical sociologist and a work stress researcher for more than 15 years, studying the effects of work organization on worker stress and health. She has worked to give voice to many worker populations, interviewing and conducting focus groups with firefighters, bus drivers, hotel room cleaners, communication workers, publishing academic research articles and co-editing the book Unhealthy Work: Causes, Consequences, Cures. (Baywood, 2009) (LinkedIn,Twitter)

Dr. Ellen Rosskam, PhD, MPH, WOE Contributing Researcher and Blog Writer and Research Associate with the Center for Social Epidemiology, is a global public health and social protection specialist, as well as the author of numerous books and scientific publications. She is the author of Excess Baggage: Leveling the Load and Changing the Workplace (Baywood, 2007), and co-editor of Unhealthy Work: Causes, Consequences, Cures (Baywood, 2009). (LinkedIn, Twitter)

Paul Landsbergis, PhD, MPH, EdD, WOE Contributing Researcher and Blog Writer, has been a Research Associate with the Center for Social Epidemiology since its foundation in 1987. He is an Associate Professor in the Department of Environmental and Occupational Health Sciences of the State University of New York (SUNY)-Downstate School of Public Health and is Deputy Editor of the American Journal of Industrial Medicine. (LinkedIn, Twitter, SUNY Downstate Faculty)

Cass Ben-Levi, MA, WOE Grant Writer and Associate Producer, has been the Director of Continuing Education and Outreach for the Southern California NIOSH (National Institute for Occupational Safety and Health) Education and Research Center located at UCLA for 13 years, providing courses on workplace safety and health to occupational health and safety professionals and workers. In these capacities and others, she works to improve the lives of working people and the underserved, as she has tried to do throughout her career. (LinkedIn, Twitter, UCLA SCERC Facebook and UCLA SCERC Twitter)

Maria Doctor, BA, serves as WOE’s managing Associate Producer, including the content, website, crowdfunding campaign and documentary feature film in progress. From a working class family in Indiana, Maria earned her B.A. in Cinema-TV Production from USC’s School of Cinematic Arts in 2008 and has since developed both her creative and business acumen to illuminate true stories and inspire all people. (LinkedIn, Twitter)

The Celestial Group, a meditation on creative strategies focused on impact, engagement, audience building, and outreach. CELESTIAL where audience engagement is not an afterthought but something inherent to the experience. (Twitter, Facebook)

Working on Empty Documentary Announcement

Dear Colleagues,

Many jobs in America today are making people sick.

From the lowest to the highest-paying jobs, workers are suffering from a variety of illnesses stemming from exposure to stressful work environments.

Job stressors of many kinds such as insecure contracts, lack of respect, lack of control, long hours, shortened or skipped breaks, fear of layoff, unpaid time, diminished benefits including health insurance and pension, all contribute significantly to mental health problems such as burnout and depression and to chronic illnesses such as diabetes, hypertension, and coronary artery disease. Many of these illnesses could be prevented if we acknowledge their causes and act now.

Workers sometimes have a sense that their jobs are making them sick though the serious and life- threatening nature of these health consequences may only become apparent after years of exposure. Job-related health problems are also frequently dismissed as being individual problems or personal weakness rather than as predictable outcomes of the way work is organized. The medical profession frequently contributes to this misunderstanding by ignoring working conditions as it sees most illness as the result of individual differences and/or unhealthy behaviors.

We need to change all this.

We want to make workers aware of this major threat to their health and quality life. Workers need to know that stressful jobs are making them sick but also that the jobs are becoming more and more stressful in recent years.

It doesn’t have to be this way. Individually and collectively, people can bring about positive change – for working people, and for the organizations they work for.

We are making a full-length documentary film and a companion book that will expose this mostly hidden threat to the wellbeing of working people from all walks of life. We will show how working people are negatively impacted by today’s conditions of work. We will explain the role of globalization and companies’ need for ever-increasing profits and how this contributes to creating unhealthy working conditions worldwide that facilitate the exploitation of working people from all walks of life in what is actually a race to the bottom. We will do this, in part, by telling the stories of real working people, nurses, hotel housekeepers, assembly line workers, bus drivers, software developers and technology workers as well as cashiers.

We are asking for your help getting out this important message. Here are some things you can do:

• We are looking for people to be interviewed in the film. If you are or know of a worker who may be interested in discussing his/her personal work story, please ask them to contact us.

• We are looking for forums where we can spread our message. If your organization has meetings where we can make a presentation, please let us know.

• We are looking for examples of organizations that are actively working to better the lives, and particularly the health, of working people. Fight of 15 is one such example. If your organization has upcoming activities that we can film which address these concerns, please contact us.

• We are also looking for funding as film-making is expensive. Any help would be appreciated. We are a 501(c) 3 – a non-profit charitable organization – and therefore, contributions are tax deductible.

Who are we? This effort begins with the Center for Social Epidemiology and includes researchers, activists, and veteran filmmakers.

We hope you will join us in this important, difficult, and yet very hopeful project that has the intention and promise of improving the lives of millions of people suffering or who will be suffering from preventable work-related illness unless a major change takes place.

Work, Stress, and Health 2015 – Atlanta, GA – May 6-9, 2015

Sustainable Work, Sustainable Health, Sustainable Organizations

May 6-9, 2015

The Westin Peachtree Plaza, Atlanta, Georgia

Sponsored by:

The Call for Proposals (including online submissions) is available now, and can be found at the official conference website: http://www.apa.org/wsh/.

The submission deadline is October 6, 2014.

2015 UCLA Work and Health Course Syllabus

Syllabus

2015 UCLA Work and Health Course Slides

Session 1

Session 2

Session 3

Session 4

Session 5

Session 6 

Session 7 

Session 8 

Session 9

Session 10

2016 UCLA Work and Health Course Readings

Session 1

The Changing Nature of Work. In Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009. Pp 17-20.

Economic Globalization and Its Effects on Labor. (Chapter 2) Moutsatsos, C. In Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.

Session 2

Beyond the Individual: Connecting Work Environment and Health. (Chapter 1) Gordon, D, Schnall, P., In Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.

Health, Productivity and Work Life in Karasek RA, Theorell T. Healthy Work: Stress, productivity and the reconstruction of working life. New York. Basic Books, Inc., 1990. pp 1-31.

Session 3

Kasl, S. The Influence of the Work Environment on Cardiovascular Health: A Historical, Conceptual, and Metholodical Perspective. Journal of Occupational Health Psychology 1996; 1(1): 42-56.

Siegrist, J. Social Reciprocity and Health: New Scientific Evidence and Policy Implications. Psychoneuroendocrinology 2005; 30; 1033-1038

Session 4

Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease.The Central Nervous System: Bridge Between the External Milieu and the Cardiovascular System, 107-115

Principles of allostasis: optimal design, predictive regulation, pathophysiology and rational therapeutics. Sterling, P. In Schulkin, J. Allostasis, Homeostasis, and the Costs of Adaptation, Cambridge University Press, 2004. pp 1-36.

Session 5

Schulte PA, Wagner GR, Downes A, Miller DB. A framework for the concurrent consideration of occupational hazards and obesity. Ann Occup Hyg. 2008 Oct;52(7):555-66. Epub  2008 Sep 2.

Verweij LM, Coffeng J, van Mechelen W, Proper KI. Meta-analyses of workplace physical activity and dietary behaviour interventions on weight outcomes. Obes Rev. 2011;12(6):406-29.

Suggested Readings:

Obesity in US workers: The National Health Interview Survey, 1986 to 2002. Caban AJ, Lee DJ, Fleming LE, Gómez-Marín O, LeBlanc W, Pitman T. Am J Public Health. 2005 Sep;95(9):1614-22. Epub 2005 Jul 28. pp. 1-9.

Choi B, Schnall PL, Yang H, et al. Psychosocial Working Conditions and Active-Leisure-Time Physical Activity in Middle-Aged Workers. International Journal of Occupational Medicine and Environmental Health Volume 23, Number 3, 2010. pp. 239-253.

Choi B, Schnall P, Yang H, et al. Sedentary Work, Low Physical Job Demand, and Obesity in US Workers. American Journal of Industrial Medicine Volume 53, Number 11, 2010. pp. 1088-1101.

Session 6

From Stress to Distress: The Impact of Work on Mental Health. (Chapter 7) Dobson, M., Schnall, P., In Schnall PL, Dobson M, Rosskam E., Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009. pp. 113 – 127.

Theorell T., et al. A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health 07/2015; 15(1)

Suggested Reading:

Namie G. The Challenge of Workplace Bullying. Employment Relations Today Volume 34 (2) Summer 2007, p.43-51

Session 7

The Workplace and Cardiovascular Disease. (Chapter 6) Landsbergis, P., Schnall, P., Dobson, M., In Schnall PL, Dobson M, Rosskam E., Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009. pp. 89 – 101.

Kivimäki M, Nyberg ST, Batty GD, et al. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. Lancet 2012; 380: 1491–97.   

Lancet letter to the editor and author’s reply: Job strain and coronary heart disease

Session 8

The Health and Economic Costs of “Unhealthy” Work, In Schnall PL, Dobson M, Rosskam E., Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009. pp. 87 – 88

Work, Psychosocial Stressors and the Bottom Line. (Chapter 9) Jauregui, M, Schnall P, In Schnall PL, Dobson M, Rosskam E., Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009. pp.153 – 165.

Stakeholder Perspectives on Work and Stress: Seeking Common Ground. (Chapter 10) Gordon, D, Jauregui, M, Schnall, P., In Schnall PL, Dobson M, Rosskam E., Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009. pp. 173 – 190.

Presentation Readings:

1) Using participatory action research methodology to improve worker health (Chapter 12). Rosskam E. In Schnall PL, Dobson M, Rosskam E., Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009, pp. 211-228.

2) The MUNI Health and Safety Project: A 26-year Union-Management Research Collaboration (Chapter 13). Antonio R, Fisher J, Rosskam E. In Schnall PL, Dobson M, Rosskam E., Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009, pp. 229-247.

3) Organizing and collaborating to reduce hotel workers injuries (Chapter 14). Casey M, Rosskam E. In Schnall PL, Dobson M, Rosskam E., Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009, pp. 249-266

4) Bourbonnais R, Brisson C, Vezina M. Long-term effects of an intervention on psychosocial work factors among healthcare professionals in a hospital setting. Occupational and Environmental Medicine 2011;68:479-486

5) Restaurant Opportunities Center efforts to improve health and safety, working conditions and wages for restaurant workers

http://rocunited.org/

http://rocunited.org/our-work/workplace-justice/

Burned: High Risks and Low Benefits for Workers in the New York City Restaurant Industry. Restaurant Opportunities Center, New York, 2009. 

ROC Worker Ergonomics Manual, 2010

6) State and local laws related to working time: paid family leave, sick leave, limits on mandatory overtime, and prohibiting misclassification as “independent contractors”.

http://familyvaluesatwork.org/

http://www.iwpr.org/initiatives/family-leave-paid-sick-days

http://prospect.org/article/fair-work-schedules-next-new-human-right

http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/MandatoryOvertime/Mandatory-Overtime-Summary-of-State-Approaches.html

http://www.massnurses.org/unionizing/mna-and-collective-bargaining

http://www.dir.ca.gov/dlse/faq_independentcontractor.htm

http://www.thenation.com/article/205145/have-we-seen-end-8-hour-day

Session 9

Interventions. In Schnall PL, Dobson M, Rosskam E., Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009. pp. 169-172

Interventions to reduce job stress and improve work organization and worker health. (Chapter 11) Landsbergis, P.A., In Schnall PL, Dobson M, Rosskam E., Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009, pp. 193-209

Plus an article to be selected for presentation.

Session 10

Curing Unhealthy Work. (Chapter 19) Schnall, PL, Dobson, M, Rosskam, E, Landsbergis, P., In Schnall PL, Dobson M, Rosskam E., Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.

Gardell B. Worker participation and autonomy: a multilevel approach to democracy at the workplace. In: Johnson JV, Johansson G. (Eds.) The Psychosocial Work Environment: Work Organization, Democratization and Health. Essays in Memory of Bertil Gardell. Baywood Publishing Co., Inc., Amityville, 1991, pp. 193-223

Cardiovascular Health and Disease: Occupational and Environmental Factors and Updates in Occupational and Environmental Medicine – San Francisco, CA – March 12-14

This course, presented by the Division of Occupational and Environmental Medicine in the Department of Medicine at the University of California, San Francisco, is designed to provide occupational and environmental health professionals and persons from other health-related disciplines with a review and update of current data in occupational and environmental medicine. The first day of the curriculum will focus on Cardiovascular Health and Disease. A poster session the evening before will supplement the cardiovascular course content. The second day and final half-day of the course will cover a multi-topic theme: Updates in Occupational and Environmental Health.

This course is approved for American Board of Preventive Medicine Maintenance of Certification credit and is a comprehensive update for occupational medicine specialists. California Qualified Medical Examiner credit approval is anticipated.

This course is also designed to meet the needs of primary care providers and others engaged in occupational health practice and research including physicians (family physicians, general practitioners, internists, emergency medicine specialists), nurse practitioners and other nursing professionals, as well as physician’s assistants, industrial hygienists, and health researchers and policy makers.

For more information or to register online visit our website at www.cme.ucsf.edu.

You may also call the Office of Continuing Medical Education (415) 476-4251 or email info@ocme.ucsf.edu

Brochure is attached here.

*The Center for Social Epidemiology’s Director, Peter Schnall, MD, MPH will be giving his presentation, “Work Organization and Stress as a Risk Factor for Cardiovascular Disease – Time for Intervention?” on March 12 at 11:00 a.m.

A Day in the Life of a Bus Driver

(This vignette is an edited version of Karen Belkic and Peter Schnall’s article, On a San Francisco public transport line: Burden and consequences upon the human operator, Job Stress Network, 2000)

Operating a motor vehicle in a city is an activity familiar to most people. Yet the toll this activity takes on the human nervous system and target organs is under-appreciated. Imagine transporting thousands of people each day via narrow, hilly streets, facing innumerable obstacles under inexorable pressure to keep to a strict schedule, knowing that the slightest accident could result in injury to a passenger and jeopardize your job. And imagine that this activity consumed 8 or more hours a day, 5 or more days in a row. These and many other stressors comprise the everyday experience of the San Francisco urban transport operators, who encounter problems specific to their city, but who also in many ways, exemplify the difficulties faced by transit operators in most metropolitan centers.

Getting started

The traveling public never witnesses a transit operator’s daily “start-up” procedure. Before beginning on the transit line, the operator must sign in and meet a dispatcher to receive the schedule, learn about any detours, etc. The dispatcher could be a source of support and encouragement. However, given the pressures of urban transport life faced by both dispatchers and operators, interaction with the dispatcher can be an additional stressor even before the day’s driving work begins. The operator then locates the assigned vehicle and has a mere 10 minutes to make a detailed safety check on the vehicle, set up its destination sign, adjust the seat and mirrors, and program the radio and fare boxes. A working radio is the operator’s “lifeline” – the communication system without which s/he cannot proceed. Incessant pressure to turn to the right side means that drivers’ seats often are completely worn out. In fact, bus drivers’ equipment is often old and worn. If any of these elements is not functioning properly, the allotted time becomes inadequate. If another bus is blocking the way out, a further delay and increased stress may result. The first few minutes of operating the vehicle are the most precarious with regard to accident risk.

Drivers are responsible for the safety of their passengers and vehicle. Mass transit vehicles often handle poorly, brake slowly and, in the case of electric trolley cars, must be stopped only in locations where they will not lose contact with the overhead grid. Traffic is often heavy. Pedestrians have the right of way and may demand it under dangerous circumstances. There are often too many passengers and not enough buses. Drivers are frequently behind schedule and trying to catch up, and as a consequence, may not be able to take the prescribed breaks. This may result in excessive fatigue, leading to frayed nerves, poorer driving and more conflict with passengers.

Getting going

San Francisco’s hills present a major difficulty for bus drivers, affecting visibility and creating difficulty in maneuvering. Significant muscle strength is required to hold the brakes on the downhill. San Francisco also has many narrow streets, not designed for heavy traffic. A double-parked car on a narrow street can be sufficient to cause a major traffic blockage. Having to make sharp turns with a large vehicle on these streets is challenging, slowing the driver down as well as presenting an accident risk.

A number of San Francisco’s mass transit lines are equipped with trolley buses, connected to a power line by a pole, which can be displaced. When this happens along a narrow street traffic can become totally blocked. In the midst of the jam, the operator must get out of the vehicle and try to put the connecting pole back in place using a tension cable, a procedure requiring considerable physical strength. When the driver tries to put the pole back in place quickly while standing in the midst of congested traffic, arm and shoulder injuries can easily occur.

The magnificent panoramas that dominate San Francisco’s landscape mean that transit operators must shut off part of their visual attention system in order to continuously monitor the traffic situation. A natural way for drivers to recover at the end of the line would be to step out of their vehicle and have a chance to enjoy San Francisco’s unique panoramas. This kind of pause accompanied by a brisk walk could be incorporated into “recovery time”, or guaranteed rest breaks, coherent with what is known about healthy work practices. Indeed, it has been recommended that city bus drivers have at least a 20-minute break after each 2 hours behind the wheel.[i] Yet, transit operators often are unable to take even the short break that is scheduled at the end of each driving tour. When the driver reaches the end of the tour behind schedule, back-up is seldom, if ever, available. Knowing that passengers for the next tour are waiting, getting more impatient by the moment, most drivers opt to skip or at least shorten their break, an attempt to ameliorate passengers’ impatience, and to try to get back on schedule. This means that the driver sacrifices his/her own comfort, and in the long run health and well being to compensate for the city’s traffic congestion and the lack of adequate numbers of drivers and vehicles.

…and not going

Minimum conditions for hygiene are frequently lacking at rest sites. Restrooms for drivers, often ill-maintained, are mainly found along the route itself, requiring an unscheduled stop. In addition to the discomfort and inconvenience of this situation, there are potential health consequences for the drivers, such as risk of urinary tract infection, from insufficient toilet breaks, and dehydration from not drinking enough fluid because of the insufficient toilet breaks.

Time squeeze

San Franciscans rely on public transportation and expect punctuality. Passengers may enter the bus already upset by long waits and being late for their appointments, etc. A transit operator can be cited if a passenger complains. The city’s urban transit operators have received bad press, not unusual for transit operators around the world. The hard work of these drivers rarely, if ever, makes the front page.

Simply getting people on and off at each stop is a time-consuming challenge for drivers. Passengers often fail to realize how important it is for them to move to the rear to keep the driver’s view clear. No one wants to be left behind because the bus is over-crowded, and invariably it is the driver who bears the brunt of passengers’ anger when this situation arises. Asking people to move back in the bus and explaining why no more passengers can come on costs the driver time and energy. As well, unruly passengers may congregate in the back of the vehicle. Thus, while following the traffic situation the driver must also keep an eye on behavior at the rear of the bus, a difficult task that can compromise passenger safety.

Inexorable time pressure is a fact of daily life for the urban transport operator, whose life becomes governed by the clock and is measured in time units of minutes. Waking for morning rush hour passengers often means rising at very early hours – sometimes 2 or 3 AM. Scrupulously punctual drivers, fearful of not hearing the alarm, report sleeping lightly or not at all in anticipation of this early, strictly defined wakening time. Running late – often not the fault of the driver – will compromise or eliminate the already short rest break usually scheduled at the end of the line. If the schedule is more severely compromised, punitive measures may be taken. The driver is continuously pressing to catch-up with the schedule.

Research shows that objective barriers consume at least 30 extra minutes for nearly half of 4-hour work segments, [ii] and that there is a fundamental conflict faced by urban mass transit operators: keeping on schedule versus providing for the immediate, specific needs of the public. This means not only answering questions, but also many other services, most notably, taking the extra time to accommodate the disabled and elderly.[iii]

In typical urban settings passengers also are exposed to numerous difficulties in using public transportation, starting with frequent long waits for tardy vehicles, often in inclement weather. They enter the bus late for their destination, tired and perhaps ill or infirm, frequently to find standing room only. Buses are unsteady, stop suddenly and lurch, making it difficult to remain stable on one’s feet. Vehicles may be cold or overheated, and one may be pressed tightly against others. A single rowdy, or violent passenger can be frightening; the elderly and the otherwise frail are particularly vulnerable.

Violence on the job

Varying in degree from one urban center to another, the threat of violence is a common and major stressor for transit operators, who are vulnerable to violent attack at any moment. Drivers being robbed at knife or gunpoint are not uncommon events. The social problems of urban society are often manifested in hostile acts directed against the transit operator; carrying cash and transfers increases their vulnerability. Besides physical danger, frustrated persons often verbally vent their rage at the transport operator. They may complain about the bad conditions in the vehicle itself, about which the driver is well aware but which s/he cannot control. The urban mass transit operator has to be a pseudo psychologist to anticipate and handle all kinds of people and their troubles, and to devise coping strategies to minimize disruption from these complaints.

However, interaction with the public is also a source of satisfaction and gratification, explaining why suggestions for constructing compartments to separate the operator from the public in numerous settings, including San Francisco, have met with nearly universal opposition. Drivers expressed that this would create a sense of isolation and alienation. Suggestions for requiring 2 transport operators on high-risk transport lines have been resisted by the companies, based on cost.

Constant vigilance

Vigilance and avoiding accidents is doubly burdensome for professional drivers. Even under ideal circumstances, professional driving requires a high degree of vigilance to avoid accidents. The driver must continuously follow a barrage of incoming signals, to which s/he must be prepared to rapidly respond. A momentary lapse of attention, or even a seemingly slight error or delayed response could have potentially disastrous consequences. For the urban transit operator this burden is much greater than for an amateur driver. For example, s/he must watch right-left-right-left before making any move, whereas the amateur driver usually makes just three visual direction shifts. An eye must be kept open for oncoming and exiting passengers and anyone at the side of the curb. There is a need to watch on the right far more than for amateur drivers. This can be one of the factors contributing to the high rate of neck and other spinal pain among bus drivers, which is associated with number of years in the occupation. Furthermore, in situations where an amateur driver would brake (or quickly change lanes or make another rapid maneuver), the urban mass transit operator must think about the fact that people are standing, including frail passengers and people unsteady on their feet, and must try to maneuver accordingly. These dilemmas are not always resolvable. If someone falls inside the vehicle, the transit operator is held liable. It should be noted that anyone could stagger onto the bus, unstable on his feet, etc. requiring yet additional vigilance for the transit operator. The biggest worry is always about an accident, whether big or small. Even a seemingly trivial accident may result in injuries to passengers.

One may think that with experience and time on the job, a city transit operator will adapt to these conditions, difficult as they may be. Indeed, the acquired coping skills and knowledge of a seasoned professional driver are irreplaceably valuable assets, without which it would be practically impossible to continue in this line of work. There is a high turnover rate among urban mass transit operators. Those remaining on the job for 10 or more years are a highly select group.

Your health or your job

However, a heavy price is paid for years on the job. The very skills that get the driver through a working day serve to quietly displace the burden onto his/her target organs: the heart, blood vessels, gastrointestinal tract, and musculoskeletal system. Laboratory simulation and field studies demonstrate that the experienced drivers who cope silently and who appear to handle with ease the continuous barrage of potential dangers and who toughly deny how difficult this work is, are those who show the most dramatic blood pressure and electrocardiographic responses to the threatening stimuli of the traffic environment. Research shows that professional drivers are second to none as an occupational group at risk for hypertension and ischemic heart disease, and that these diseases occur at a relatively young age. Studies of heart attack patients under the age of 40 report a marked overrepresentation of professional drivers – up to 40% in some studies. Studies from Europe, the U.S., Latin America, East Asia and India show a high risk among this occupational group for cardiovascular and cerebrovascular disease, musculoskeletal disorders and/or peptic ulcer disease. Many of these studies found a strong relation between number of years on the job and/or number of daily hours behind the wheel linked with illness.

The human toll from these diseases, coming at an early adult age, also translates into enormous economic costs: absenteeism, disability and early retirement. It is unusual for a mass transit operator to retire at term in any city. In the Netherlands, for example, 48 is the average age of retirement for city bus drivers and is usually disability-based, with only 12% working until the normal retirement age of 60.

Much can be done

Public transportation is under-funded. Everyone is being forced to make due with less, thus for both the driver and the passengers, a bus ride may be a difficult experience. Passengers and drivers may take out their frustration on each other, instead of directing these urgent concerns towards those who are in a position to implement the needed changes.

We have discussed only a few of the many stressful, noxious conditions in the urban transport operator’s work environment. Quantitative analysis shows that the total burden of occupational stressors faced by the city bus driver is over twice that of construction workers and other trades known to be quite tough. The scientific community has called for urgent interventions to reduce occupational stress among urban transport operators,[iv] and various strategies to prevent bus drivers’ stress have been published.[v] Experts in this area agree that limiting the number of hours behind the wheel, guaranteed rest breaks, and diminishing time pressure are essential minimal requirements for all urban transit operators. More attention to the special health needs of professional drivers, and primary prevention programs are also necessary.

Innovations to improve the bus drivers’ working conditions have been made in Sweden, focusing on the toughest bus route in Stockholm. Streets were widened on some parts of the route, a special bus lane was created for a large portion of the route, and a number of other changes were implemented. The changes have resulted in some improvements to blood pressure and other physiologic measures among a small group of drivers who were examined before and after the changes were made. San Francisco’s specific characteristics, such as its narrow, hilly streets, however, necessitate a different approach. One such innovation for improvement is the “Ambassador Program”, which is discussed at the end of this chapter. This program has provided hope for both operators and passengers, and once again highlights the benefits that can be achieved through study, reflection, and action designed jointly with workers, management and researchers.

________________________________________
[i] Kompier MA, Di Martino V. Review of bus drivers’ occupational stress and stress prevention. Stress Med 1995; 11: 253-262.
[ii] Greiner BA, Ragland DR, Krause N, Syme SL, Fisher JM. Objective measurement of occupational stress factors–An example with San Francisco urban transit operators. J Occup Health Psychol. 1997; 2: 325-342.
[iii] Gardell B, Aronsson G, Barklof K. The working environment for local public transport personnel. Stockholm: The Swedish Work Environment Fund, 1983.
[iv] Michaels, D., Zoloth, S.R. Mortality among urban bus drivers. Int J Epidemiol 1991; 20: 399-404.
[v] Kompier and DiMartino, ibid, Stress Med, 1995

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