1. Work stressors: effects on health and sickness absence Findings from Whitehall II and other studies
Jane E. Ferrie
Department of Epidemiology and Public Health
University College London

2. Labour market stressors
Moves to private sector practice
Job insecurity
Temporary employment
Need to keep in mind as consider fairness, fairness of distribution of work itself
Marker - degree job attached
Bar chart – Will Hutton, chief exec of The Work Foundation
30% periphery, 30% intermediate
Only 40% core…. Most research on latter 2

3. Moves to private sector practice (transfer to an executive agency) effects on health and sickness absence (men)
% excess ill-health compared to men
not transferred to agencies*
relative increase in cardiovascular risk factors
compared to men not transferred to agencies*
* adjusted for age, employment grade, marital status & health at the beginning of the follow-up period 3
Ferrie et al. J Occup. Health Psychology 2001

4. Job insecurity and health in women
*adjusted for age, employment grade & health at the beginning of follow-up 4
Ferrie et al. J. Epidemiology Community Health 2002

5. Job insecurity and coronary artery disease
*adjusted for age, grade and CAD before the threat of privatisation 5
Ferrie et al. Am. J. Public Health 1998

6. Job insecurity and sickness absence
Odds Ratios*
*adjusted for age, employment grade and health status 6
Ferrie et al 2001 J. Occup. Health Psychol

7. Temporary employment and sickness absence
Rate Ratios*
*adjusted for age, sex, income, and number of contracted days 7
Virtanen et al 2003 Occup Environ Med

8. Temporary employment and early death
Hazard Ratios*
*adjusted for age, occupational status and income 8
Virtanen et al 2003 Am. J. Epidemiol

9. Conceptualising Work Stress Major work stress models (questionnaire based measures)
Job strain (Demand-Control) model
Effort-Reward Imbalance model
Organisational Justice model (fair treatment) 9

10. Conceptualising Work Stress Major work stress models
Job strain (Demand-Control) model
Effort-Reward Imbalance model
Organisational Justice model (fair treatment) 10

11. Job strain (Demand-Control) model
in 1979 Robert Karasek argued that work stress results "from the joint effects
of the demands of a work situation and the range of decision-making freedom
available to the worker facing those demands……….” Job strain occurs when psychological job demands are high and job control is low"
Example question on job demands:-
Do you have enough time to do everything?
Example question on job control:-
Do you have a say in your own work speed? 11

12. Psychological job demands
Job Strain Model
LOW HIGH
passive
high
strain
active
low
Psychological job demands
job strain
Job control
LOW HIGH 12
Karasek and Theorell 1990

13. Job strain and new coronary heart disease
Meta-analysis of prospective studies
>50-VUOTIAAT KESKIM. 3 KERTAA 4 VUODESSA.
<30-VUOTIAAT 2 KERTAA 4 VUODESSA. 13
Kivimäki et al 2006 Scan J Work Environ Health

14. Job strain and sickness absence Meta-analysis
*adjusted for age, demographic factors, behaviour,
health status, occupation and baseline sickness absence
Odds Ratios 14
Duijts et al 2007 J. Clin Epidemiol

15. Influence of change in job strain on sickness absence
Hazard ratio for long spells of sickness absence, stable = reference
Work demands Job control 15
Head et al. J Epidemiol Community Health 2006

16. Conceptualising Work Stress Major work stress models (questionnaire based measures)
Job strain (Demand-Control) model
Effort-Reward Imbalance model
Organisational Justice model (fair treatment) 16

17. Effort-Reward Imbalance (ERI)
Reciprocal exchange underlies all transactions in society
Digression from this reciprocity produces stress
In the workplace reciprocity depends on a balance between perceived efforts spent and rewards received
Efforts: Responsibility
Time pressure
Work load
Rewards: Esteem
Career opportunities
Pay 17

18. Effort-Reward Imbalance at work and coronary heart disease
Likelihood of CHD (Hazard Ratio)*
*adjusted for age, sex and employment grade 18
Kuper et al. Occup. Environ. Med. 2002

19. Effort-Reward Imbalance and sickness absence
Odds Ratios*
*adjusted for age, employment grade and health status 19
Head et al 2007 J. Psychosomatic Research

20. Conceptualising Work Stress Major work stress models
Job strain (Demand-Control) model
Effort-Reward Imbalance model
Organisational Justice model (fair treatment) 20

21. Organisational Justice
refers to the extent to which employees are treated with fairness and justice at their workplace
Procedural component decision-making procedures include input from affected parties, are consistently applied, open and ethical
Relational component respectful and considerate treatment of employees by supervisors
TYÖYKSIKÖT VAIHTELEVAT SIINÄ, KUINKA PALJON SUORITTEITA SAMALLA KUSTANNUKSELLA TUOTETAAN.
MITEN HLÖSTÖ VOI TEHOKKAIMMISSA (TUOTTAVIMMISSA) YKSIKÖISSÄ JA MITEN VÄHEMMÄN TUOTTAVISSA? 21

22. Organisational Justice and health
Odds ratio*
*adjusted for demographic and behavioural risk factors 22
Elovainio et al. (2001) Am J Public Health

23. Organisational Justice (relational component) and sickness absence in women
Odds Ratios*
*adjusted for age, employment grade and health status 23
Head et al 2007 J. Psychosomatic Research

24. Does a change in organisational justice lead to a change in health?24

25. Change in Organisational Justice
Odds of new-onset common mental disorders
Ferrie et al. Occup Environ Med 2006 25

26. Summary
Changes in the labour market have adverse effects job security and other aspects of the psychosocial work environment, such as job demands, the ratio of effort to reward, etc
Psychosocial stressors in the work environment have adverse effects on health and well-being
Reductions in levels of work stress result in health improvements and healthy levels of sickness absence 26

27. Sickness Absence Research Collaboration
SARC: Four-country collaboration - Finland, France, Sweden and the UK
Studies: 10-town study (Finland), GAZEL study (France), Östergötland and SLOSH studies (Sweden), and the Whitehall II study (UK)
Researchers : Mika Kivimäki and Jussi Vahtera (10-town), Maria Melchior and Archana Singh-Manoux (GAZEL), Kristina Alexanderson (Östergötland) and Hugo Westerlund (SLOSH) and Jane Ferrie and Jenny Head (Whitehall II)
SARC meetings are supported by a grant from the ESRC 27