Work can give structure and meaning to life. But working conditions can also trigger or accelerate the symptoms of ill health - physical and mental - that feed back into our productivity and earning capacity, as well as into our social and family relationships. In fact, an alarmingly large number of people appear to be at risk.
Of the EU's 160 million-strong labour force, 56% report working at very high speeds, and 60% to tight deadlines. More than a third have no influence on task order, and 40% perform monotonous tasks. This probably contributes to a host of health-related problems: 15% of the workforce complain of headaches, 33% of backache, 23% of fatigue, and 23% of neck and shoulder pains, plus a host of other illnesses, including life-threatening ones.
Sustained work-related stress is also an important determinant of depressive disorders - the fourth-largest cause of disease world-wide. They are expected to rank second by 2020, behind only heart disease. In the EU, the cost of these and related mental health problems is estimated to average 3-4% of GNP, amounting to approximately 265 billion euros annually.
Moreover, sustained work-related stress is likely to contribute to `metabolic syndrome,' a cluster of pathogenic mechanisms characterised by an accumulation of abdominal fat, a decrease in sensitivity to insulin, increased levels of cholesterol, and heightened blood pressure, all related to the onset of heart disease and diabetes.
Of course, working conditions may be experienced as threatening even when objectively they are not, or trivial symptoms may be interpreted as manifestations of serious illness. But stress is worrisome precisely because even misinterpretations can add to, or result in, a wide variety of health problems, including heart disease, stroke, cancer, musculoskeletal and gastrointestinal diseases, anxiety and depression, accidents, and suicides.
Briefly stress consists of a pattern of built-in processes preparing the human organism for physical activity in response to demands and influences that tax its capacity to adapt. Activation of our "fight or flight" mechanism is an appropriate adaptive response when facing a wolf pack, but not so when struggling to adjust to rotating shifts, monotonous and fragmented tasks, or over-demanding customers. If sustained, stress is often maladaptive and eventually disease provoking.
Stress-related paths to pathologies take a wide variety of forms. They can be emotional (anxiety, depression, hypochondria, and alienation), cognitive (loss of concentration or recall, inability to learn new things, be creative, make decisions), behavioural (abuse of drugs, alcohol, and tobacco, refusal to seek or accept treatment), or physiological (neuroendocrine and immunological dysfunction).
To identify, prevent, and counteract the causes and consequences of work-related stress, we need to monitor job content, working conditions, terms of employment, social relations at work, health, well-being and productivity. The first step is to identify the incidence, prevalence, severity, and trends of work-related stress and its causes and health consequences. Are they likely to contribute to stress-related ill health? Can they be changed? Are such changes acceptable to workers and employers?
Wherever the answers are affirmative, an integrated package of organisational changes should be considered. Such changes are likely to include the following areas:
Work schedule. Design labor time to avoid conflict with demands and responsibilities unrelated to the job;
Participation/control. Allow workers to take part in decisions or actions affecting their jobs;
Workload. Ensure that workers have enough time to complete assigned tasks, and allow for recovery from especially demanding physical or mental tasks;
Content. Design tasks to provide meaning, stimulation, a sense of completeness, and an opportunity to use skills;
Roles. Define work roles and responsibilities clearly;
Social environment. Ensure a working atmosphere free of all forms of invidious discrimination and harassment;
Future. Avoid ambiguity in matters of job security and career development; promote life-long learning and employability.
Although it is likely, the short- and long-term outcomes of such changes may not always suffice in the fight against work-related stress. They need therefore to be evaluated in terms of exposures and reactions to stress, the incidence and prevalence of ill health, and the quality and quantity of goods or services.
Many companies world-wide recognize that success requires satisfying the three elements of sustainable development: financial, environmental, and social. Failure to do so leads, over time, to terminal organizational weakness, owing to lost credibility amongst employees, shareholders, customers, and communities.
This has numerous implications for relations with employees. Ensuring long-term economic growth and social cohesion requires a commitment to health and safety, a better balance between work, family and leisure, lifelong learning, greater workforce diversity, gender-blind pay and career prospects, and profit-sharing and equity-ownership schemes.
These practices can have a positive impact on profits through increased productivity, lower staff turnover, greater amenability to change, more innovation, and better, more reliable output. Indeed, companies often have an interest in going beyond minimum legal requirements: peer respect and a good reputation as an employer are marketable assets.
The challenge for science is to find out what to do, for whom, and how. The challenge to workers, employers, governments, and communities is to translate what we now know into coordinated and sustainable programs.