Global Challenges in Work, Stress, and Health

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 GROUP´S 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 

                                               64 

                         53

•

CSEE (non-EU) & CIS 

                                 38 

                         35

•

Latin America & the Caribbean 

    37 

                         32

•

North Africa 

                                               27 

                         25

•

East Asia 

                                                 6 

                         20

•

South-East Asia & Pacific 

                  10 

                         14

•

South Asia 

                                                 6 

                         11

•

Sub-Saharan Africa 

                                   9 

                           8

•

                                   (ILO, 2011; World Bank 2011)

PERSON-ENVIRONMENT FIT?

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)

WORKERS´HEALTH: 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.

WORKERS´HEALTH: 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)

UNITED NATIONS GENERAL ASSEMBLY

RESOLUTION ON HAPPINESS (July 19, 2011)

•

”The pursuit of happiness is a fundamental human goal;

•

Happiness as a universal goal and aspiration embodies the

spirit of the Millenium Development Goals;

•

Recognizes the need for a more inclusive equitable, and

balanced approach  (than measures of GNP) to economic

growth that promotes sutainable development, poverty

eradication, happiness and well-being of all people;

•

Invites MS to pursue the elaboration of additional

measures that better capture the importance of happiness

and well-being in development with a view to guiding their

public policies.”

DEFINITION OF ”MENTAL HEALTH”:

”A state of well-being in which every individual

realizes his or her own potential, can cope with

the normal stresses of life, can work

productively and fruitfully, and is able to make a

contribution to her or his community.”

                                                      (WHO, 2011)

WHO GLOBAL COMMISSION ON

”SOCIAL DETERMINANTS OF HEALTH”:

Social determinants are the conditions in which people live and work.

They are ”the causes behind the causes” of ill health. Thet include

poverty, social exclusion, inappropriate housing, shortcomings in

safeguarding early childhood development. Unsafe employment

conditions, and lack of quality health systems.

The core of the Commission´s work will be to identify, evaluate. Adapt

and distribute effective strategies to address social determinants, with

the aim of supporting governments to scale up interventions. The six

main recommendations are: Giving every child the best start in life;

Enabling all children, young people and adults to maximize their

capabilities and have control over their lives; Creating fair employment

and good work for all; Ensuring a healthy standard of living for all;

Creating and developing sustainable places and communities;

Strengthening the role and impact of ill-health prevention.

TOTAL RETURNS ON INVESTMENTS:

PAYOFFS PER GB£ 1 EXPENDITURE:

•

Early intervention for conduct disorder      7.9

•

Early treatment of depression at work         5.0

•

Screening of alcohol misuse                          11.8

•

Suicide prevention training to all GPs          44.0

•

Workplace health promotion                          9.7

                                                                                   (Knapp, McDaid and Parsonage, 2011)

TREATY OF LISBON, ARTICLE 168:

•

”A high level of human protection shall be

ensured in the definition and implementation

of all Union policies and activities.”

”Science can only ascertain what

is, not what should be, and

outside of its domain, value

judgements of all kind remain

necessary”.

                                      (Albert Einstein)

THE ECONOMIC CRISIS IS LIKELY TO:

•

Increase inequality, poverty, homelessness, and

social exclusion;

•

Increase work intensity, and  job insecurity;

•

Increase morbidity and mortality;

•

Inspire 

austerity

 policies that may - but need not -

further increase such risks, e.g.,  by decreasing

access to social and health services;

•

Have strongly negative effects on productivity,

economic performance - and recovery.

”PANTA RHEI – EVERYTING FLOWS”

•

Globalization, technical development, recession, and

recession-related adaptive work restructuring – all

involve 

change

.

•

Closure, downsizing, outsourcing, sub-contracting,

layoff, merging, acquisitions – all may, but need not,

lead to unemployment and over employment.

•

Their causes, mechanisms and outcomes may all be

powerful 

stressors

 - increasing the risk for work- or

unemployment related morbidity and mortality.

GLOBAL EMPLOYMENT TRENDS (ILO, 2013)

•

More jobs are destroyed - and fewer created;

•

Labour force participation - has fallen drastically;

•

Unemployment is increasing: 202 million in 2013, + 39 million who have

dropped out;

•

73.8 million young people are unemployed globally;

•

12.7 young Europeans are 

N

either 

E

mployed nor in 

E

ducation or 

T

raining

(NEETs).  - A ”lost generation”?

•

Many of the employed experience - vulnerable employment and working

poverty. 397 million workers are ”extremely poor”, and an additional 472

million cannot address their basic needs on a regular basis.

•

There is, often, an incoherence between monetary and fiscal policies,

piece-meal approaches, uncertainty about future conditions;

•

Skill and occupational mismatches;

•

Austerity measures and uncoordinated attempts to promote

competitiveness increase the risk of a deflationary spiral of lower wages,

weaker consumption and faltering global demands.

PSYCHOSOCIAL HAZARDS AT WORK:

•

”The interactions among job content, work

organization and management, and other

environmental and organizational conditions, on

the one hand, and the employee´s competence

and needs on the other” (ILO, 1986).

•

”Aspects of the design and management of work

and its social and organizational contexts that

have the potential for causing psychological or

physical harm” (Cox & Griffiths, 2005).

WORLD HAPPINESS REPORT 2013

Three types of measures: (1) positive emotions, (2)

negative emotions, and (3) evaluations of life as a

whole. ”Happiness” appears twice, once as an

emotional report, and once as part of a life

evaluation.

•

10% of the world´s population suffers from

clinical depression or crippling anxiety disorders.

•

There was an obvious detrimental happiness

impact of the 2007-2008 financial crisis.

                      (Helliwell, Layard & Sachs, eds., 2013)

OCCUPATIONAL HEALTH IN

DEVELOPING COUNTRIES:

•

Much emphasis on industrialization.

•

Industrial workers now face not only endemic

diseases but also occupational ailments.

•

Data from Nigersteel Clinic show that 75% of

all care is spent on endemic rather than

occupational diseases.

•

This needs to be considered in training

occupational physicians to practice in Third

World Countries.             (Asogwa, 1981)

UNITED NATIONS DEVELOPMENT

GROUP MESSAGE (2013):

1.

respect for rights, justice and reducing

inequalities;

2.

One-size-fits-all policies should not be

promoted;

3.

Recognize the need for structural transformation

toward more energy-efficient and less carbon-

emitting sectors;

4.

Greater role for the State;

5.

The international community should play a key

role.

A 

GLOBAL

 CHALLENGE?

•

Psychosocial factors 

include: design and

management of work, and its social and

organisational contexts - with a potential for

causing psychological or physical harm;

•

Work-related stress and workplace violence are

associated with cardiovascular, depressive and

musculoskeletal disease;

•

Weak epidemiological, but solid circumstantial

evidence at the 

global

 level.

                                                        (Leka et al., 2010)

ECONOMY, STRESS AND HEALTH

•

Numbers do not have any

emotions. Data do not cry.

Economic statistics do not bleed.

•

But human beings feel pain. They

get sick. They suffer. They die.

FIFTH EUROPEAN WORKING CONDITIONS SURVEY (EU27)

•

Psychosocial dimensions are a 

decisive

 factor, and not only in

cases of anxiety or depression.

•

 High ‘

psychological demand

’ increases musculoskeletal

diseases among white-collar workers; high ‘

skill discretion

’

decreases them among all workers, while ‘

decision authority

’

increases them for both blue-collar and white-collar workers.

•

The positive role of 

rewards

 emerges as a protective factor

for all health outcomes considered, and also decreases work

accidents among all groups of workers.

•

 Work accidents – together with musculoskeletal disease –

also show clear associations with many physical hazards, such

as environmental hazards, and awkward working postures.

Lennart Levi

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T

C

O

N

T

R

O

L

l

o

w

D

E

M

A

N

D

h

i

g

h

low

high

high

low

relaxed

active

passive

(

K

a

r

a

s

e

k

,

T

h

e

o

r

e

l

l

&

J

o

h

n

s

o

n

)

high

strain

Lennart Levi

”

E

f

f

o

r

t

-

R

e

w

a

r

d

-

I

m

b

a

l

a

n

c

e

”

-

m

o

d

e

l

(

E

R

I

)

Overinvolvement

High

effort

Low

reward

Intrinsic

Extrinsic

Demands

Salary

Appreciation

Security

Career opportunities

(

J

o

h

a

n

n

e

s

S

i

e

g

r

i

s

t

)

FAIRNESS AT WORK

•

Social determinants exercise a strong

influence on health and wellbeing;

•

Poverty kills;

•

So does socio-economic inequality;

•

These may be ”the causes of the causes”.

                                      (Marmot, 2013)

ILO CHECKPOINTS FOR DECENT JOBS

:

•

Leadership and justice at work;

•

Job demands and workload;

•

Job control;

•

Social support;

•

Physical environment;

•

Work-life balance and working time;

•

Recognition at work;

•

Protection from offensive behavior;

•

Job security;

•

Information and communication.

)

SANTIAGO DECLARATION (2013):

•

Consider 

health

, in addition to other impacts, of 

all

 policies;

•

Coordinate their efforts 

across sectors

, by pro-active,

synergistic strategies;

•

Maintain, or even invest in, 

social welfare

, and active labour

market policies;

•

Recognise the 

economic

 benefits of investment in ”more

and better jobs”;

•

Prioritise these investment according to

 need

;

•

Ensure access to high quality 

health 

services;

•

Support relevant 

research

 on the human dimensions of the

economic and financial crisis.