KeywordsOccupational Health Sickness Absence Behavioral Medicine Psychosocial Work Environment Worksite Health Promotion
“Occupational health” is defined as the field of research and intervention that deals with work- and employment-related influences on people’s health and health-related behaviors and their modification. The field of occupational health is broader than the academic discipline of occupational medicine as it includes organizational, psychosocial, and behavioral aspects in addition to the more traditional physical and chemical hazards, thus incorporating research and expertise from social and behavioral sciences.
Generally, behavioral medicine is interested in two approaches toward occupational health. The first approach considers the organizations, companies, and businesses where large population groups can be met recurrently and simultaneously as an ideal setting of implementing programs of behavioral modification. In these programs, health-adverse behaviors such as smoking, unhealthy diet, or lack of physical exercise are targeted with the aim of promoting a healthy lifestyle. These individual- or group-based interventions are often supported by employers and health insurance organizations as they were shown to produce benefits to both employees and employers. The second approach focuses on those aspects of work and employment that directly affect the health of working people. Here, scientific analyses of these associations and interventions based on respective evidence are of central interest.
As the nature of employment and work has changed significantly over the last half century, psychological and socio-emotional demands and threats evolving from an adverse psychosocial environment have become more widespread in all advanced societies (Schnall et al. 2009). Technological progress and economic growth in the context of globalized markets and trades result in new types of tasks (e.g., information and communication technologies, person-based services) and in an increase of chronic psychosocial stress at work. This increase is mainly due to work pressure under growing competition, often in combination with threats to job continuity and security. Although the quality of work and employment follows a social gradient leaving those in lower socioeconomic positions at higher risk, stressful work in advanced societies has become common in more privileged parts of the workforce as well (Eurofound 2015). Chronic exposure to a stressful psychosocial work environment affects the health of working people by triggering negative emotions and by eliciting recurrent psychobiological stress responses in the organism that compromise different bodily systems in the long run, promoting the development of distinct physical and mental disorders (McEwen 2007).
To identify and measure a health-adverse psychosocial work environment, a theoretical model is needed that delineates specific “toxic” components within complex and diverse work settings at a level of high generalization. Several such models were proposed, but the following concepts are considered most established up to now as they have been supported by a substantial body of empirical research. First, the “demand-control model” posits that a specific job task profile characterized by high quantitative demands in combination with a low degree of decision latitude or control elicits recurrent stress reactions. These effects are moderated by the presence or absence of social support at work (Karasek and Theorell 1990). Second, the “effort-reward imbalance model” is based on the basic principle of reciprocity of contractual social exchange. High efforts spent at work that are not reciprocated by adequate rewards trigger recurrent stressful experience. Rewards include salary or wage, promotion prospects and job security, and esteem or appreciation from significant others. Effort-reward imbalance is frequent among employees who have no alternative choice in the labor market or who work in highly competitive jobs. Stressful experience is reinforced among those who are overcommitted to their work (Siegrist 1996). Third, the “organizational justice model” claims that unfair procedures within organizations and inappropriate interpersonal relationships, in particular within the hierarchies of organizations, are experienced as stressful (Greenberg 2010).
Health-adverse effects of these complementary models of stressful psychosocial work environments have been demonstrated by a series of prospective epidemiological cohort studies, supplemented by findings on psychobiological pathways from experimental and “naturalistic” investigations. Evidence is particularly robust in case of cardiovascular risk and disease and in case of affective disorders (Steptoe and Kivimaki 2012; Siegrist and Wahrendorf 2016). This information can be used to identify targets (e.g., particular businesses and/or groups of employees) for health-promoting interventions that are commonly implemented at one or several of the following levels. At the personal level, the individual workers’ coping resources are strengthened by different approaches of stress management (e.g., relaxation and meditation techniques, cognitive-behavioral interventions). At the interpersonal or group level, social relationships at work are improved (e.g., communication, leadership, esteem, social support). At the organizational or structural level, interventions target changes in the division of work, work time, work load, task content, promotion prospects, or monetary and nonmonetary rewards. Evidence indicates that interventions which combine these levels produce stronger and more sustainable effects than single-level interventions (Semmer 2008). Moreover, integrating health-promoting behavioral change into programs of stress management and organizational change seems particularly promising in an attempt of reducing social inequalities in health where those in lower socioeconomic positions suffer from a higher work-related burden of disease.
Behavioral interventions in occupational health are commonly located at the level of primary prevention where they are directed either at the workforce as a whole or at specific vulnerable subgroups. However, behavioral interventions at the level of secondary prevention are becoming more important as working populations are aging. Improving return to work in chronically ill and disabled people is considered a major challenge of occupational health, particularly with regard to mental health and well-being. There is a strong business case in terms of sickness absence reduction and productivity gain for introducing such secondary prevention measures where behavioral medicine expertise can be successfully implemented (e.g., individual placement and support models) (Black 2008).
Despite these promises, occupational health from a behavioral medicine perspective still has to face substantial challenges (Eurofound 2015; Siegrist & Wahrendorf 2016). So far, only a minority of companies and organizations is committed to promote healthy work. There is a lack of resources, information, and personnel and management incentives. In view of the afflictions of economic crises and of rapid transformation of work and employment, basic material and psychosocial needs of working people need to be maintained by sustainable social and labor policies at national and international levels. Against this background, promoting awareness, solid evidence, and models of good practice in the field of behavioral occupational health and prioritizing investments into good quality of work and employment at different policy levels are important measures to strengthen healthy work locally and globally.
References and Further Reading
- Black, C. (2008). Working for a healthier tomorrow. London: TSO.Google Scholar
- Eurofound. (2015). Convergence and divergence of job quality in Europe 1995–2010. Luxembourg: Publications Office of the European Union.Google Scholar
- Karasek, R. A., & Theorell, T. (1990). Healthy work stress, productivity, and the reconstruction of working life. New York: Basic Books.Google Scholar
- Schnall, P. L., Dobson, M., & Rosskam, E. (Eds.). (2009). Unhealthy work: Causes, consequences cures. Amityville: Baywood Press.Google Scholar
- Semmer, N. (2008). Stress management and well-being interventions in the workplace. State of science review: SR-C6, Report by the Foresight Project. London: Government Office for Science.Google Scholar
- Siegrist, J., & Wahrendorf, M. (Eds.). (2016). Work stress and health in a globalized economy: The model of effort-reward imbalance. Dordrecht: Springer. (in press).Google Scholar