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CSE Education Activities for 2010

CSE Staff and Consultants teach a Work and Health Course at UCLA one semester each year and have, over the last ten years, provided over 100 students with skills on conducting surveillance at the workplace and measurement of exposures and outcomes such as blood pressure.

The CSE sponsors a number of education activities including 1) a course at UCLA (Work and Health), 2) a course at UCI of Occupational Cardiology, 3) conferences and workshops in international settings, and 4) regular meetings of the  California Work and Health Study Group (last held this past May 2010 in Berkeley).

The Center is involved in the preparation and publication of scientific articles and books. CSE is proud to have had two books published during the past decade each with over 30 internationally recognized authors; the first, The Workplace and Cardiovascular Disease published by Hanley and Belfus in 2000 and the second, Unhealthy Work: Causes, Consequences, Cures published by Baywood in 2009. In 2010 book parties were held in Los Angeles and Berkeley to promote Unhealthy Work at which several of the books editors gave presentations.

The Center is excited to have just had Unhealthy Work translated by colleagues into Korean and Spanish. The Korean version was published in September 2010, Seoul, Korea by GyeChuk Mun Wha Sa (Publisher) while the University de Los Andes in Bogota, Colombia is publishing the Spanish version edited by Dr. Viviola Gomez, Department of Psychology.

During 2010, CSE consultants have prepared multiple abstracts, some based on a pilot web survey of Orange County Fire Authority (OCFA) firefighters conducted with colleagues at the UCI COEH. Several abstracts were accepted as oral presentations, a few others as poster presentations at the 4th International Conference of Occupational Health (ICOH) Work Organization and Psychosocial Stressors (WOPS) conference in Amsterdam in June 2010.

Paul Landsbergis, consultant to the CSE, with Peter Schnall, recently published a book chapter on job strain and cardiovascular disease for the second edition of the Handbook of Occupational Health Psychology. He is in the process of working on several new manuscripts, including a meta-analysis of job strain and ambulatory blood pressure (in collaboration with Marnie Dobson and Peter Schnall of the CSE) and a study of job strain and masked hypertension. Additionally, Paul authored papers for the 2010 Global Obesity Summit recently held in Jackson, Mississippi.

BongKyoo Choi, consultant to the CSE, published papers on work and obesity during 2010 in the American Journal of Industrial Medicine and the International Journal of Occupational Medicine and Environmental Health.. His other research on work and obesity using a US national dataset was well received at the 2010 ICOH-WOPS conference in Amsterdam, the Netherlands (Best Abstract Award and 2010 Global Obesity Summit, Jackson, MS (New Investigator Travel Award). In addition, he submitted a critical commentary to NIH on their draft strategies for research into obesity.

The Center also considers the education of the public one of its main goals. To support this aim, the Center’s Informations Systems Manager (ISM), Erin Wigger, moderates a network of health professionals through several listservs and manages a website using web design software (Dreamweaver).

Expansion of the ISM’s role at the Center includes broadening the Center’s fundraising efforts, the redesign of the Center’s Job Stress Network website as well as the creation and development of a blog and new website based on the Center’s recently published book, Unhealthy Work: Causes, Consequences, Cures, Baywood, 2009. This website represents the first of the Center’s efforts to begin presenting information on work and health to the lay-public.

March 5, 2008 Woodrow Wilson Presentation given by Dr. Peter Schnall

On March 5, 2008, participants from health, economic, academic, labor, and other sectors gathered at the Woodrow Wilson Center to discuss work’s contribution to public health and national economic costs. Research shows that employees facing high demands at their job, combined with low control over the work process or little reward, are more likely to die of heart disease and suffer from mental health problems than workers without such job stressors. The panelists of this event presented data on the relationship between work and health in order to illustrate its global impact. 

To watch Dr. Peter Schnall’s presentation visit the Woodrow Wilson Center page here.

The Physical Manifestations of Unhealthy Work

Dr. Peter Schnall, director of the Center for Social Epidemiology, opened the event by stating that “global epidemics are not natural”. Rather, they are products of globalization, the labor-intensive work organization it fosters, and increasing social inequality. “Globalization is contributing to a changing nature of work . . . which is contributing to poorer health of many peoples worldwide,” said Schnall. He described stress as a social process related to societal and occupational organization. The physical manifestations of stress and musculoskeletal disorders are caused by the high demands, long hours, job strain, effort-reward imbalance, and hazardous conditions of many work environments. Thus, the culpability of poor health outcomes, such as cardiovascular disease and mental health conditions, should not be placed on genes or individuals, but rather unhealthy working conditions. 

Schnall also noted that cardiovascular disease is currently the leading cause of death worldwide and its prevalence rate continues to rise in both developed and developing countries. According to the American Heart Association, cardiovascular disease causes around 40 percent of all U.S. deaths. Globally, 900 million people suffer from hypertension; approximately 60-80 million of them live in the United States. Schnall used his own research to demonstrate the relationship between job strain and cardiovascular disease, showing that blood pressure is elevated during work hours and sharply rises when demanding or stressful activities are performed. 

The Global Impact of Unhealthy Work Organization

Paul Landsbergis, associate professor of Community and Preventive Medicine at the Mount Sinai School of Medicine, continued the discussion by outlining the global impact of unhealthy work conditions. He focused on recent trends in work organization including, privatization, de-regulation, lean production techniques, income inequality, increasing contingent work, and longer work hours. “These overriding pressures force workers to work harder and longer,” said Landsbergis, as well as weaken job control and security, deteriorate social support, and elevate stress levels. He also explained that as developed countries strive to attract foreign capital, many businesses have adopted longer hours and more deadline pressures, often emphasizing quantity and speed over quality and safety. These conditions, along with forced and child labor, have made job conditions detrimental to workers’ health and family dynamics. 



The Mental Health Consequences of Work
Marnie Dobson, associate director of the Center for Social Epidemiology, addressed the mental health consequences of work, which are increasing along with health care and productivity costs. Currently, 9.6 percent of U.S. adults suffer from depression within a 12 month period. “Changes resulting from globalization and from work are key

contributing factors to depression and mental disorders,” stated Dobson. She also linked effort-reward imbalance and occupational position to depression and exposure to work stressors to mental fatigue, psychological distress, and sleep disorders. Dobson emphasized the importance of addressing the role that work plays, especially since the World Health Organization projects depression to be the second greatest contributor to the global disease burden by 2020. 

Finally, Dobson described how work-related illnesses have direct and indirect economic consequences including, high health insurance premiums, worker’s compensation costs, production losses due to sick and disability leave, and employee turnover. The top contributors to these costs include hypertension, heart attacks, and depression. She referred to one study that found that depression cost U.S. employers $44 billion in one year. Nevertheless, “business has really yet to focus on the deleterious effects of the workplace as a way to deter productivity losses and heath problems in their employees,” said Dobson.

Adopting Systematic Reform

Ellen Rosskam, public policy scholar at the Woodrow Wilson Center, called for the re-organization of work to protect employee health, and offered legislative strategies to reverse the grave trends outlined by the panelists before her. The presented solutions included more participatory action research, job re-design centered on reducing job strain, collective bargaining based on workplace democracy, and collaborative interventions that increased employee job control. Rosskam noted t

hat, “collaborative approaches in interventions have led to improved co-worker relations, better employment security, and stronger social support, which is an important buffer against job strain”. She also advocated for establishing a universal floor for basic social protection to promote health within the workplace. For the United States, this floor would include minimum staffing levels, bans on mandatory overtime, limits on work hours, and guaranteed paid family, vacation, and sick leave. 



When John Froines proposed a statewide conference of “The Future of Psychosocial Stress Research” he opened the door to a dialog about what we as psychosocial stress researchers in California should be doing next. It seems to me there are a number of possibilities (not necessarily mutually exclusive).

1. Continue what we are doing now, with periodic discussions such as those held by the CWHSG
2. Reexamine our current research efforts to identify positives and negatives with the goal of redirecting our future research to answer new questions.
3. Begin research/prevention projects aimed at utilizing our new knowledge about the workplace and various health outcomes to improve work and health conditions (prevention and intervention activities). The SF Muni bus driver project would be a good example.
4. Begin sharing our knowledge with various stake holders who would normally have a vested interest in what we believe we know (such as health care providers, unions, etc.)
i. Educational courses such as our recent UCLA OHP course would be one example of this kind of activity while
ii. A “white paper” might be another. Here I am assuming that one of the purposes of a white paper is to contribute to a public consensus on the issues and potential solutions.

To target stakeholders implies we have a common knowledge base which generate an agreed upon agenda for the future. It is not clear to me (us) that this is the case. One way to go about exploring this issue is to attempt to write a “white paper” which would be a consensus statement on a wide range of relevant issues. A “white paper” probably should go beyond the “Tokyo Declaration” which was mainly a policy statement. The Tokyo Declaration assumed a shared set of research findings and conclusions. A “white paper” might include state of the art reviews of various topics (e.g., identified workplace risk factors, health outcomes affected by them, summaries of intervention findings, training needs, etc.). Key question for readers of this letter – How do we kick start this dialog? Do we start with another conference to discuss these issues in detail or hold a discussion utilizing email with a goal of trying to find a consensus prior to another general meeting. If the latter then one path would be to comment on the proposed white paper with the idea of identifying areas we might wish to contribute to. In looking at the proposed “White Paper” outline below it occurs to me that since we have an OM:STAR already on this topic that the first section – what do we know – be quite short and in the form of a summary. Another approach would be a document along the lines of the Tokyo Declaration – updated to include new materials and goals as reflected in our current work in California. This would result in a much shorter document.

A proposed outline for a “White Paper”

Paul Landsbergis has suggested the following outline as the basis for a “white paper” on psychosocial stressors.

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