Global Challenges in Work, Stress, and Health
The global challenges related to work, stress, and health are being addressed through various initiatives and reports. Lennart Levi, an expert in psychosocial occupational medicine, highlights the importance of recognizing, compensating, and preventing occupational diseases. The International Labour Organization (ILO) emphasizes the need for addressing psychosocial hazards at work, evaluating risks, and implementing preventive measures. The UN Development Group's 2013 report stresses the importance of creating more and better jobs, reducing unemployment, and promoting social protection systems. Various data and images illustrate issues such as vulnerable employment, productivity levels, and the person-environment fit in the workplace.
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WORK, STRESS AND HEALTH A GLOBAL CHALLENGE Lennart Levi, MD, PhD Emeritus Professor of Psychosocial Occupational Medicine, Karolinska institutet, Stockholm, Sweden; Member of the Swedish Parliament 2006-2010. ILO International Safety and Health Conference, Duesseldorf, November 6-7, 2013: Make it visible: Occupational Diseases Recognition, Compensation, and Prevention.
ILO APPROACH TO MENTAL HEALTH AND WELLBEING AT WORK Broaden enterprise policy on OSH to include psychosocial hazards in risk assessment measures; Evaluate workplace psychosocial risks through risk assessment; Identify specific needs, and measures to be taken; Implement workplace action through preventive/promotive measures. (Forastieri, SafeWork, 2011)
UN DEVELOPMENT GROUPS REPORT (2013): The international community must give a strong and visible response to the pressing demand for more and better jobs , said the ILO Director-General Guy Ryder. 202 million are unemployed; 470 new jobs will be needed globally 2016-30; 900 million are working poor. Key recommendations: (1) adapting a stand-alone goal on employment; (2) shifting from quantity to quality of growth; (3) combining economic growh with creation of decent jobs for the poor and most vulnerable; (4) addressing the structural causes of unemployment; Governments to be more pro-active; (6) Expanding social protection systems; (7) Social protection systems combined with employment generation; (8) strengthening social dialogue; (9) reform in international trade, finance and technology transfer. (ILO, 2013)
VULNERABLE EMPLOYMENT AS A SHARE OF TOTAL EMPLOYMENT, 2011
OUTPUT PER WORKER Table 1: Labour productivity (output per worker) by region, as a proportion of productivity levels in developed economies, 1991 and 2011 (per cent) Regions 1991 2011 Middle East CSEE (non-EU) & CIS Latin America & the Caribbean North Africa East Asia South-East Asia & Pacific South Asia Sub-Saharan Africa 64 38 37 27 6 10 6 9 53 35 32 25 20 14 11 8 (ILO, 2011; World Bank 2011)
FRAGMENTED OR HOLISTIC APPROACH?
WORKPLACE HEALTH PROMOTION AND WELLBEING Promotion of health among all workers and their families through preventive and assistence programmes in the area of drug and alcohol abuse, HIV/AIDS, workplace stress and the promotion of tobacco-free workplaces. With the aim of integrating workplace health promotion into OSH policies. SOLVE focuses on the prevention of psychosocial risks and the promotion of health and well-being at work through policy design and action. (ILO, 2013)
60th SESSION, INTERNATIONAL LABOUR CONFERENCE: The improvement of working conditions and the protection of the physical and mental health of workers constitute an essential and permanent mission of the International Labour Organization.
THEORETICAL MODELS FOR OCCUPATIONAL MENTAL HEALTH ACTION: Person-Environment Fit Life changes Demand-control-support (iso-strain) Effort-reward imbalance Person-Environment Fit Recovery Justice
GLOBALIZATION + CRISIS + MIGRATION + AGING + INNOVATION = CHALLENGE! Adequate knowledge on traditional OSH Great need for close and sustainable collaboration between the social partners and Academia Uncertainty how to cope with informal sector, SME, allocation of responsibilty regarding mobile workplaces, sub-contractors, foreign cultures, rapidly expanding service sector.
Investments into Mental Health challenges and benefits: In any one year, the proportion of the EU s population suffering from a mental disorder is 38.2 % (Wittchen et al., 2011). Most common are anxiety disorders (14%), insomnia (7%), depression (6.9%), somatoform disorders (6.3%) and alcohol and drug dependence (>4%). Remains significantly and persistently high. Accounts for 26.6% of total ill-health. All EU countries provide prevention of mental illness and promotion of mental health, mostly school-based but also work-based. Cost savings have been demonstrated (McDaid & Park, 2011; Knapp et al., 2011). (EU-OSHA, 2011; European Commission, 2013)
CSR AND DEVELOPING COUNTRIES: The overall contribution of business to sustainable development. CSR offers real opportunities for governments of middle and low-income countries to change the terms on which they interact with business. (United Nations, 2007)
MOTIVES FOR INTERVENTION? A humanistic quest for The Good Working Life ; A wish to improve the health and wellbeing of the working population; Promotion of autonomy and democratic values; Concern for company profit and competitiveness. (Gardell, 1980)
PSYCHOSOCIAL FACTORS AT WORK RECOGNITION AND CONTROL (1984): Report of the Joint ILO/WHO Committee on Occupational Health, Ninth Session. Endorsed by ILO s Governing Body and WHO s Executive Board. Occupational Safety and Health Series No. 56. ILO: The importance of the psychosocial environment of workplaces was increasing. Economic growth, economic progress, increased productivity and social stability depend also on working and living conditions and the health and wellbeing of workers and their families. (Psychosocial factors) have a considerable influence on the physical and mental wellbeing of workers. WHO: Concern for psychosocial factors at work was reflected in Making work more human , and in the proposed conclusions with a view to a Convention and to a Recommendation on Occupational Health Services adopted in 1984. A vast quantity of litterature has demonstrated that psychosocial factors at work contribute to a wide range of workers health disorders. Positive psychosocial factors can act as health-maintaining and health-enhancing agents. In developing countries, the determinants of special vulnerability in newly urbanized job recruits may include psychological aspects like unfamiliarity with the work-leisure dichotomy (ex-nomads) and separation of the end-product from labour (ex-peasants and rural craftsmen). Somatic ill health resulting from infectious diseases, poverty, malnutrition, overcrowding, lack of education, sanitation and health care probably render individuals more susceptible to environmental psychosocial hazards at the workplace.
OPTIONS FOR INTERVENTIONS: 1. Job redesign; 2. Organisational measures, e.g., greater autonomy; 3. Ergonomic measures; 4. Working space, working time; 5. Work process; 6. Workers participation; 7. Helping workers to cope. (ILO & WHO, 1986)
OPTIONS FOR INTERVENTIONS: Strengthen information and training; Implement existing knowledge Monitor and survey Raise knowledge and competence. Support by regulations and laws, inspections; Empower the workers.
SHIFT OF INDUSTRY AND SERVICES TO DEVELOPING COUNTRIES: Absence of (or presence of weak) regulatory systems; Many of these jobs are hazardous to workers health; 80% of the world s GDP is produced in industrialized countries; only 20% in developing countries (where 80% of the world s workforce resides); It follows that wealth and prosperity are extremely unequally shared. (Kortum et al., 2010)
WHY IS THERE LITTLE IMPROVEMENT? Inadequate funding; Other health issues compete; Psychosocial hazards are not included in the definition of easily preventable issues; Come on top of poverty, economic insecurity, gigh exposure and vulnerability; Poor data collection; Lack of data on exposure or causality; Struggle with other well-known and traditional occupational risks. (Kortum et al., 2010)
INTERVIEWS OF EXPERTS AND DELPHI SURVEY ON WORK-RELATED STRESS IN DEVELOPING COUNTRIES It can be concluded that the health impact from psychosocial risks and work-related stress is considerable in developing countries and should be regarded as a theat to public health. (Kortum et al., 2010) It could be expected that the incidence of such workplace stress is higher in developing countries. (Chopra, 2009)
MANY WORK-RELATED DISEASES HAVE MULTIFACTORIAL ETIOLOGY: Occupational diseases, have a specific or strong relation to occupation; Work-related diseases, with multiple causal agents, where factors in the work environment may play a role; Diseases affecting working populations, without causal relationship with work but which may be aggravated by occupational hazards to health. (Lesage, 2011)
QUESTIONS TO BE CONSIDERED: Strength of association; Consistency; Specificity; Appropriate time relationship; Biological gradient; Coherence. (Lesage, 2011)
GLOBAL WELLNESS SURVEY 2009: 1,103 organizations from more than 45 countries representing more than 10 million employees have responded to a survey from Buck Consultants (2012). But not a random sample Stress is cited as the top health risk driving wellness programs in most areas of the world. Strong growth is predicted for programs designed to improve the psychosocial work environment.
HEALTHY WORKPLACES CONSIDER: Health and safety concerns in the physical work environment; Health, safety and wellbeing in the psychosocial work environment; Health promotion opprtunities in the workplace; Ways of participating i the community to improve the health of workers, their families and other members of the community. (WHO, 2010)
WORKERS HAVE TO DEAL WITH Increased demands of learning new skills; The need to adopt new ways of working; Demands for higher productivity; Demands for increased quality of work; Increased time pressure and hectic jobs; Higher job competition; Increased job insecurity and less benefits; Less time for co-workers and socializing. (TNO and WHO, 2007)
RISKS FOR WORK-RELATED STRESS AND ILL HEALTH Mental health problems(depression, anxiety); Musculo-skelettal problems (neck, shoulder, back pain); Cardio-vascular problems (IHD, hypertension, metabolic syndrome). (TNO and WHO, 2007)
WORKERSHEALTH: GLOBAL PLAN OF ACTION (WHO, 2008-17): Workers represent half the world s population and are the major contributors to economic and social development; The growing informal economy is often associated with hazardous working conditions And involves vulnerable group as children, pregnant women, older, disabled and migrant workers; All workers shoulde be able to enjoy the highest attainable standard of physical and mental health and favourable working conditions. The workplace should not be detrimental to health and well-being. Primary prevention of occupational hazards should be given priority. The workplace can also serve as a setting for health promotion.
WORKERSHEALTH: GLOBAL PLAN OF ACTION (WHO, 2008-17): 1. Devise and implement policy instruments on workers health; 2. Protect and promote health at the workplace; 3. Improve the performance of and access to occupational healtyh services; 4. Provid and communicate evidence for action and practice; 5. Incorporate workers health into other policies.
WORK CAN BE BOTH PATHOGENIC AND SALUTOGENIC: Work provides (1) goal and meaning in life; (2) structure and content of the working day, week, year and life; (3) identity and self-respect; (4) social networks and support; and (5) material rewards. On the other hand, dangerous exposures and loads are often several times greater in the workplace than in any other environment, with adverse consequences on health. A healthy, productive and well-motivated workforce is the key agent for overall socioeconomic development.
WORK-RELATED STRESS is a pattern of physiological, emotional cognitive and behavioural reactions to extremely taxing aspects of work content, organization and environment . The offer of labour in urban and suburban areas has increased enormously. Deregulation has also bee the requirement during the globalization process, which has led to less protection of workers m rights, particularly health and retirement benefits, as well asjob security. As a result, there is unemployment and under-employment, and people accept substandard jobs. WHO estimates that worldwide only 5-10 % of the workers in developing countries and 20-50% in industrialized countries have access to adequate occupational health services. Psychosocial issues are rarely dealt by these. (WHO and TNO, 2007)
WORK-RELATED IN DEVELOPING COUNTRIES is often made wore by gender inequalities, poor paths of participation and poor environmental management of industrial pollution and illiteracy, parasitic and infectious diseases, poor hygiene andsanitation, poor nutrition, poor living conditions, inadequate transportation systems and general poverty. Also dealing with increasing fragmentation of the labour market, the deand for flexible contracts, incrwased job insecurity, a high work pace, long and irregular working hours, low control over job content and process, and low pay, together with new occupational hazards accompanying the old and new industries and technologies.
GLOBALIZATION AND THE WORLD OF WORK Globalization has not benefitted all; The economic and jobs crisis presents an enormous global challenge; ILO is responding through a Decent Work Agenda for all. (Pascual-Teesa, 2011)
IS THERE A PROBLEM? More than 2 million people die every year from work-related diseases; 160 million annual non-fatal cases cause immense human suffering; This also causes major economic losses 4% of the world s gross domestic product; 205 million people are unemployed; Young people are nearly three times as likely to be unemployed; An estimated 1.5 billion are in vulnerable employment; 630 million live in extreme poverty; Much of this is preventable. (ILO, 2013)
HOW IS DECENT WORK REALIZED? DECENT WORK COUNTRY PROGRAMMES (DWCP): Mean ehicle for delivering ILO support to countries; Distinct ILO contributio to UN country programmes; More than 70 DWCPs world wide. (Pascual-Teresa, 2011)
DECENT WORK FOR ALL IN ACTION: Better Factories (Cambodia); Employment-Intensive Rebuilding (Liberia); Eradicating Child Labour from Mining Industry (Peru). (Pascual-Teresa, 2011)
EMPLOYMENT-INTENSIVE REBUILDING. THE CHALLENGE: After many years of devastating conflict, Liberia has 80 percent under-employment; The country lacks basic infrastructure, such as roads, electricity, running water; Young adults are largely unskilled; The challenge: To rebuild the country and help create a skilled employment bvaswe to carry the nation forward. (Pascual-Teresa, 2011)
PSYCHOSOCIAL OCCUPATIONAL FACTORS AND HEALTH: Emotional reactions (anxiety, depression, hopelessness, helplessness, interpretation of extrinsic and intrinsic perceptions); Cognitive reactions (recollection, concentration, creativity, learning, decision making); Behavioral reactions (smoking, alcohol, overeating, drugs, agressiveness, suicide); Physiological reactions (cardio-vascular, genito-urinary, skeletto-muscular, gastro-intestinal: dysfunction possibly leading to structural damage; Can to some degree influence virtually every disease, its course, treatment and rehabilitation.
SWEDISH WORK ENVIRONMENT ACT 1990/91:140 (Summary): Adapt jobs to employees abilities and needs; Allow employee participation n job design and change; Humanize piece work and shift work; Avoid strictly controlled and tied work; Promote task variety and continuity; and collaboration; Promote personal development, self- determinantion and occupational responsibility.
WORDS DO NOT COOK RICE!
MONITORING AND ASSESSING PROGRESS ON DECENT WORK (MAP) Ongoing processes in, among others: Bangla Desh, Brazil, Cambodia, Indonesia, Niger, Peru, Philippines, Ukraine, Zambia (ILO, 2013)
DECENT WORK COUNTRY PROFILE INDONESIA (2011) Employment opportunities: mixed; difficulties related to gender, youth, informal employment. Adequate earnings and productive work: modest progress. Decent working time: no progress. Combining work, family and personal life: improvements, but lessso in informal work. Work that should be abolished: Notable progress regarding child work, but many problems remain. Stability and security of work: increasing part in precarious or casual work. Equal opportunity and treatment in employment: increased women s participation in management, falling gender wage gap. Safe work environments: some progress. Fall in fatal and non-fatal occupational injury rates. Social security: Universal coverage aimed at but not yet achieved. Social dialogue: Mixed progress. (ILO, 2011)
DECENT WORK (ILO) has been defined as productive work for women and men in conditions of freedom, equity, security and human dignity; It involves opportunities for work that is productive and delivers a fair income; It provides security in the workplace and social protection for workers and their families; It offers better prospects for personal development and encourages ocial integration; It gives people the freedom to express their concerns, to organize and to participate in decisions that affect their lives; and It guarantees equal opportunities and equal treatment for all.
COMMON OBSTACLES: Lack of commitment; Ambitious legislation, not implemented; Lack of monitoring; Lack of awareness and competence; Lack of empowerment.
PREVENTION/PROMOTION STRATEGIES: Exposure and/or disease specific prevention; Generic prevention (multiple morbidity); Promotion of health and wellbeing.
SOCIAL CAPITAL: The processes between people wich establish networks, norms and social trust, and facilitate co-ordination and co-operation for mutual benefit.
BIGGEST OVERALL CAUSE: Mental health problems and stress-related disorders are the biggest overall cause of early death in Europe.
A RENEWED WORK ENVIRONMENT POLICY 2010 2015 (SWEDEN): Work environment policy shall concern, as up till now, to counteract stamping out from working life, and improve opportunities for re- entry, and to diminish the risk for exposure to accidents and diseases, but also to a higher degree than before concern work environment as developing and contributing to health. (Communication from the Swedish Government to the Swedish Parliament No. 2009/10:248).
EUROPEAN PACT FOR MENTAL HEALTH AND WELL-BEING: Mental health is a human right; It enables to enjoy welolbeing, quality of life and health; It promotes learning, working and participation in society; It is a key resource for the success of the EU as a knowledge-based society and economy; There is a need for decisive political steps to make mental health and well-being a key priority. (WHO and EU, 2008)
OPTIONS FOR INTERVENTIONS: Legislation, ordinances; Supervisory control; Regulations of working hours; Education and training; Inspections, surveys; Occupational health services; Horisontal and vertical cooperatiom/integration; Development of health promotion skills; Promotion of collective agreements; Research and development.
EUROPEAN PACT FOR MENTAL HEALTH AND WELLBEING: We call for action in five priority areas: Prevention of depression and suicide; Mental health in Youth and Education; Mental Health in Workplace Settings; Mental Health of Older People; Combating Stigma and Social Exclusion. (WHO and EU, 2008)
