Global Epidemics: The Contribution of Work

Peter Schnall, Professor of Medicine, University of California at Irvine, and Director, Center for Social Epidemiology
Paul Landsbergis, Associate Professor of Community and Preventive Medicine, Mount Sinai School of Medicine
Marnie Dobson, Associate Director, Center for Social Epidemiology, and Research Associate, Center for Occupational and Environmental Health at University of California, Irvine
Ellen Rosskam, Southeast Europe Policy Scholar, Woodrow Wilson Center
Josh Bivens, Economist, Economic Policy Institute

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.

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 that, "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.

How Does the U.S. Compare to its Peers?

Josh Bivens, economist for the Economic Policy Institute, offered commentary on the event's presentations, comparing U.S. work organization and health outcomes to other industrialized nations. He acknowledged that the United States has a productivity and per capita income advantage over other developed nations due to its longer work hours (The United States is ranked number one for the average number of hours worked per year.) and high labor utilization. Yet, "it is hard to find a health outcome measure on which the U.S. looks great compared to its industrialized peers," despite its prosperity and high health care spending, argued Bivens. He noted that the United States was one of the only developed countries without a legal minimum for paid vacation days, possibly contributing to high stress levels and poor health.

Shifting the Focus to Find a Solution

The panelists of this event described how unhealthy work conditions and poor social organization has contributed to the rise of chronic diseases worldwide. Most importantly, they argued that because these epidemics are socially created, they are therefore preventable. However, efforts to reduce them must shift from models based on individual behavior and responsibility to grander schemes of work re-organization and social reform. Such reform would benefit public health through creating healthier work environments and employees, but also curb productivity losses. As the welfare of workers improves, losses due to sick and disability leave, and employee turnover are expected to follow.

By Kai Carter