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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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