Effort-Reward Imbalance
“The concept of effort-reward imbalance (ERI) was developed by Johannes Siegrist to study lack of reciprocity (low rewards relative to high effort) and its association over a sustained period of time with the development of stress-related disorders. The ERI model also encompasses the idea of having an “over-commitment” to work, meaning that some people may be more likely to expend a large amount of effort for low reward because of an “intrinsic” or personal over-commitment to their job.
In a review of longitudinal epidemiological studies, Siegrist found that “people who experience failed reciprocity at work are twice as likely to suffer from incident cardiovascular disease, depression, or alcohol dependence compared to those who are not exposed” [29, p. 1033].
Finnish factory workers with effort-reward imbalance were heavier than those without effort-reward imbalance in one study [70]. Another study showed that Finnish public employees with effort-reward imbalance were more likely to have several risk factors for heart disease: overweight, smoking, heavy alcohol use, and lack of exercise [125]. Male British civil servants with effort-reward imbalance had an increased risk of developing Type 2 diabetes, although this pattern was not seen among female civil servants [126]. Finally, several studies have shown that workers with effort-reward imbalance had higher levels of cholesterol [102, 127, 128].
Long Work Hours
Overtime work was associated with unhealthy weight gain in two studies, increased alcohol use in two of three studies, and increased smoking in one of two studies, but it was not related to exercise or drug abuse [43]. One [129] of two [129, 130] Japanese studies found a relationship between work hours and adult onset (Type 2) diabetes.
Job Strain
In a preliminary analysis of data from men in the New York City Work Site BP Study, job strain was 54% more common among men with masked hypertension (at entry into the study) and more than five times more common (at the 3-year follow-up measurement period), taking into account other risk factors for high blood pressure such as age, race, weight, education, smoking, and alcohol use.
Direct Costs
According to the Institute for Health and Productivity Studies, the top physical health conditions financially affecting large U.S. employers through direct costs were chronic maintenance of angina pectoris, essential hypertension, diabetes mellitus, mechanical low back pain, acute myocardial infarction, chronic obstructive pulmonary disease, back disorders other than low back, traumatic spine and spinal cord, sinusitis, and diseases of the ear, nose, throat, or mastoid processes [4]. Six of these 10 conditions have been associated with psychosocial stressors in past studies (see chapters 6 and 7). The top mental health conditions were: bipolar disorders; depression; neurotic, personality, and non-psychotic disorders; alcoholism; anxiety disorders; acute phase schizophrenia, and psychoses. Of these conditions, anxiety disorders, depression, and alcoholism have been shown to have some roots in workplace stressors.
Taken from: Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.
97. Schnall, P. L., J. E. Schwartz, P. A. Landsbergis, K. Warren, and T. G. Pickering, Relation between Job Strain, Alcohol, and Ambulatory Blood Pressure, Hypertension, 19, pp. 488-494, 1992.
11. Hasin, D. S., R. D. Goodwin, F. S. Stinson, and B. F. Grant, Epidemiology of Major Depressive Disorder: Results from the National Epidemiological Survey on Alcoholism and Related Conditions, Archives of General Psychiatry, 62:10, pp. 1097-1106, 2005.
Behavioral Risk Factors – Individual behaviors which put people at risk for the development of Cardiovascular Disease. Smoking, alcohol use, obesity and physical inactivity are examples.
Center for Social Epidemiology – The Center for Social Epidemiology is a private non-profit foundation established in 1988, whose purpose is to promote public awareness of the role of environmental and occupational stress in the etiology of psychological disorders and cardiovascular disease. See our About Us page for more information.
Cardiovascular Health Outcomes – Several negative effects on the Cardiovascular System have been found when Job Strain is present and chronic. These include heightened bood pressure, chronically heightened blood pressure or hypertension and heart disease.
Effort-Reward Imbalance – This model of work stress was pioneered by Johannes Siegrist and defines threatening job conditions as a “mismatch between high workload (high demand) and low control over long-term rewards.” More information about the Effort-Reward Model can be found here.
Emotional Labor – Defined by Muntaner et al, is a term which “describes jobs that require workers to induce or suppress feelings to sustain the outward countenance that produces the proper state of mind in others. For example, airline stewards are responsible for managing situations with customers to create a favourable experience for the customer.” More information about Emotional Labor can be found here
FORWARD Study – Firefighter Obesity Research: Workplace Assessment to Reduce Disease (FORWARD) is a 2-year project of the UCI-COEH, funded by the Center for Disease Control and Prevention/National Institute for Occupational Safety and Health (Award #: 1 R21 OH009911-01) and is supported by Research Associates of the Center for Social Epidemiology. The study will consider the unique working conditions and health behaviors of firefighters who work on a 24 hour-shift system.
Visit the FORWARD Study Website at: http://www.coeh.uci.edu/forward/
Globalization – In the Unhealthy Work website, globalization is explored in terms of its significance to the changing nature of work and its consequences on worker health. More can be found about it here.
Job Control – According to Muntaner et al, “this refers to employees’ sense of control over their tasks and performance during the workday. Job control is also called ‘‘decision latitude,’’ which is defined as the combination of decision-making authority and the worker’s opportunity to use and develop skills on the job.”
Job Strain – Karasek’s “job strain” model states that the greatest risk to physical and mental health from stress occurs to workers facing high psychological workload demands or pressures combined with low control or decision latitude in meeting those demands. More about the job strain model can be found here, including findings, scales and other job strain models.
Low Social Support – Social support refers to the various types of support that people receive from others and is usually separated into two distinct categories: emotional and instrumental support. Emotional support is characterized by things that people do for each other that makes them feel cared for and supports feelings of esteem and worthiness. Instrumental support refers to the various types of tangible help that others may provide (i.e. financial support, child-care, etc). More on low social support can be found here.
Mental Health Outcomes – When stress becomes a prolonged or chronic experience, it can result in psychological distress. A growing body of empirical evidence in the occupational health field is making connections between the way work is organized and burnout, as well as more long-term adverse psychological health outcomes such as chronic anxiety and clinical depression.
Musculoskeletal Disorders – Musculoskeletal disorders include a wide range of inflammatory and degenerative conditions affecting the muscles, tendons, ligaments, joints, peripheral nerves, and supporting blood vessels. Body regions most commonly involved are the low back, neck, shoulder, forearm, and hand, although recently the lower extremity has received more attention. Musculoskeletal disorders (MSDs) are widespread in many countries, with substantial costs and impact on quality of life. Although not uniquely caused by work, they constitute a major proportion of all registered and/or compensable work-related diseases in many countries. More can be found about MSDs here.
Organizational Justice – Defined by Muntaner et al, organizational justice refers to whether or not decision- making procedures are consistently applied, correctable, ethical, and include input from affected parties (procedural justice). It also refers to respectful, considerate and fair treatment of people by supervisors (relational justice). More can be found about organizational justice here.
Person–Environment Fit – According to Munaner et al, the “person–environment fit” model states that, “stress develops when the work environment fails to match the motives of the person, or when the person’s abilities fail to meet the job demands. The model emphasizes the ‘‘perceived’’ fit versus the ‘‘objective’’ fit.”
Psychological Demands – Psychological demands are part of the demands in the demand–control model and part of the effort in the effort–reward imbalance model. Demands refer to the psychological stressors associated with accomplishing work, unexpected tasks and job-related personal conflict. Typical questions about psychological demands measure the pressure of output on the job: ‘‘Does your job require you to work very fast, hard, or to accomplish large amounts of work? Are you short of time?’’
Psychological Risk Factors – Individual psychological characteristics which are particularly problematic when paired with Job Strain. Depression, anxiety, neuroticism (or negative affectivity) and anger are examples.
Social Class – Extensive research has documented that Cardiovascular Disease is more common not only among people facing work stressors, but also among people of lower social class or socioeconomic position (SEP), for example, lower levels of education, income, or occupational status. One possible explanation for the social class differences in CVD is greater exposure to unhealthy working conditions among lower SEP groups. More on social class can be found here.
Threat-Avoidant Vigilance – Work that involves continuously maintaining a high level of vigilance in order to avoid disaster, such as loss of human life. This is a feature of a number of occupations at high risk for CVD, e.g., truck drivers, air traffic controllers, and sea pilots. More on threat-avoidant vigilance can be found here.
Work–Family Conflict – According to Muntaner at al, work–family conflict is a form of inter-role conflict in which the role pressures from the work and family domains are mutually incompatible in some respect, causing considerable personal and organizational problems.
References:
Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.
Bloomberg reports in an article today that Apple’s margins have widened at the expense of its main supplier as Foxconn Technology Group cuts prices to retain orders for the iPhone and iPad.
See http://www.bloomberg.com/news/2012-01-04/apple-profit-margins-rise-at-foxconn-s-expense.html for more information.
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For the third time in little over a year an explosion has rocked a factory that supplies parts in the manufacturing of various Apple devices. The explosion injured 61, and sent 23 to the hospital. Fortunately, there were no fatalities.
1 “Apple supplier Pegatron hit by China plant blast” By Clare Jim and Argin Chang, Reuters.
Physical inactivity is a term used to identify people who do not get the recommended level of regular physical activity. The American Heart Association recommends 30-60 minutes of aerobic exercise three to four times peer week to promote cardiovascular fitness. In 1996 the Report of the Surgeon General on Physical Activity and Health recommended the minimum level of physical activity required to achieve health benefits was a daily expenditure of 150 kilocalories in moderate or vigorous activities. This recommendation is consistent with guidelines established by the Centers for Disease Control and Prevention, and American College of Sports Medicine. It also is consistent with the 1996 consensus statement from the National Institutes of Health, recommending adults to accumulate at least 30 minutes of moderate activity most days of the week. Moderate activities include pleasure walking, climbing stairs, gardening, yard work, moderate-to-heavy housework, dancing and home exercise. More vigorous aerobic activities, such as brisk walking running, swimming, bicycling, roller skating and jumping rope — done three or four times a week for 30-60 minutes — are best for improving the fitness of the heart and lungs.
Regular physical activity reduces the risk of dying prematurely from CVD. It also helps prevent the development of diabetes, helps maintain weight loss, and reduces hypertension, which are all independent risk factors for CVD. Less active, less fit persons have a 30-50 percent greater risk of developing high blood pressure. Physical inactivity is a significant risk factor for CVD itself. It ranks similarly to cigarette smoking, high blood pressure, and elevated cholesterol. One reason it has such a large affect on mortality is because of its prevalence. Twice as many adults in the United States are physically inactive than smoke cigarettes. Regular physical activity has been shown to help protect against first cardiac episode, help patients’ recovery from coronary surgeries, and will reduce the risk of recurrent cardiac events.
It is estimated that approximately 35% of coronary heart disease mortality is due to physical inactivity. The significance of this relationship lies in the fact that coronary heart disease is the leading cause of death in the United States with over 700,000 deaths annually. Approximately 60% of all Americans age 18 and older report that they are physically inactive. Physical inactivity has a major economic impact. It is felt through the loss of income and productivity when disabling diseases result. It was estimated that in 1989 physical inactivity cost the nation $5.7 billion due to hospitalizations and other related health care costs.
Only about 22 percent of Americans report regular sustained physical activity (activity of any intensity lasting 30 minutes or more 5 times a week). Fifteen percent of Americans report vigorous activity (activity intense enough to make the heart beat fast and hard breathing for at least 20 minutes or more 3 times a week). Thus, improvements in physical activity can be gained in all segments of society. Physical inactivity is more prevalent among women, blacks and Hispanics, older adults and the less affluent. People with less than a 12th grade education are also more likely to be sedentary. In addition, people who are physically disabled, people with injures that limit movement, adolescents, adults who are overweight, women, and people with low incomes all have elevated levels of sedentary behavior.
Sedentary Lifestyle: no reported activity or any physical activity or pair of activities done for less than 20 minutes or less than three times per week.
Regular and Sustained: any physical activity or pair of physical activities that are done for 30 minutes or more per session, five or more times per week, regardless of intensity.
Regular and Vigorous: any physical activity or pair of activities done for at least 20 minutes, at least three times per week, that requires rhythmic contraction of large muscle groups at 50% of functional capacity.
From: Centers For Disease Control and Prevention at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/
Smoking harms nearly every organ of the body. Smoking causes many diseases and reduces the health of smokers in general.1
Smoking causes death.
Compared with nonsmokers, smoking is estimated to increase the risk of—
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health
E-mail: tobaccoinfo@cdc.gov
Phone: 1-800-CDC-INFO