Global strategies and trends in
Well-being at work in focus
During the past decades work life has undergone
great changes. Not only the work itself has changed,
but also our opinion on work has changed. Now we
know that a good work environment should not only
be healthy and safe. It should also encourage
personal and professional development, job
satisfaction and personal fulfilment, which all
contribute to improved work quality and productivity.
BENGT KNAVE,
ICOH PRESIDENT
W
e know that the way work is organised
politically acceptable low levels. However, the latest
is of importance, and that the situation
statistics of reported work-related injuries and dis-
in the labour market affects the work,
eases show a marked increase. Among the work-
the worker and the worker’s health and well-being.
related diseases those indicated as caused by organi-
So, there are different aspects of this development
sational and social factors increased the most, and
of work life. One of the most important and com-
considerably more than half of these cases were
mon occupational health problems today is: stress.
diagnosed to be related to stress.
STRESS, DOWNSIZING OF COMPANIES AND
LESSONS FROM THE PAST – CHALLENGES FOR
UNEMPLOYMENT
TOMORROW
In a recent study on stress symptoms ‘a feeling of
It is interesting to note the observation of an histo-
general irritation’ was found to be most common, fol-
rian of ideas (Johannisson: Nostalgia, 2001). She
lowed by headaches, depression and sleep difficulties.
points at the similarities in symptoms that we see
On a question on which were the eliciting stress fac-
today among employees suffering from stress and
tors ‘high work load’ was most common, followed by
those that were observed one hundred years ago in
‘short delivery times’, ‘no influence at work’, ‘no sup-
the transition phase between the farming and indus-
port from manager’, ‘bad working hours’, and ‘worry
trial societies. Today we live in another transition
for employment’. During the nineties, especially the
phase; the one between the industrial society and
first part of it, the general welfare in many countries
the ICT society. In both transitions, large population
was influenced by a severe, world-wide economic
groups have to adopt to quite new work life skills and
recession. Many companies had to downsize, and
experiences, which may be difficult for many, with-
unemployment rates increased dramatically.
out proper education and training, and which may
It is well-known that it is traumatic to be unem-
6
result in stress reactions.
ployed. However, workers still at work also feel the
So, what is the remedy today for the stress at
high unemployment rates. So, as a consequence of
work? Let me quote a former Director General of the
the recession, enterprises downsized and work pace
Swedish Social Insurance Board (Sherman, 2002).
and work stress increased. Nobody complained be-
“...the increased stress and sick leave absentee-
cause of risk of losing their job. As a paradox, sick
ism are a reaction to what happened in the ’90s when
leave absenteeism diminished – when ill, employees
companies were ‘slimmed’, and work intensities in-
nevertheless went to work because of the fear of los-
creased. There are 325 000 more employees on sick
ing their position. During the late nineties the labour
leave today than five years ago. Nobody could expect
market in many countries recovered, and the rate of
me to believe that the additional numbers are sick in
unemployment dropped steadily. It has now reached
an objective sense. This does not mean that they
JANUARY/FEBRUARY 2003
OCCUPATIONAL HEALTH SA
s in occupational health
should be sent back to work, unless we change the
and welfare, under duress, in the cause of commer-
work itself. Burn-out and stress are symptoms of a
cial gain for others, or simply for their own and their
diseased society, where people have been pressed
families’ survival.
over their capacities.”
An example could be taken from Bangladesh,
I agree with Sherman and hope that society will
where child labour is a rapidly growing phenomenon
take prompt measures to start recovering from this
of concern (Rahman, June 2002, Institute of Child
disease.
and Mother Health, Bangladesh), the total number of
children in labour approaches seven million, ie 20%
MEN AND WOMEN AT WORK
of the total child population between 5 and 14 years,
We know today that it is a fact that women – more
out of which 96% are in informal sectors. Most of the
than men – are more frequently affected by injuries
children are compelled to engage themselves in dan-
and sickness caused by a poor work environment.
gerous and hazardous occupations, and many of the
Especially in recent years, the prevalence of stress-
children suffer from injuries. In the Bangladesh study
related health problems in women has increased
(covering the transport sector and small metal manu-
markedly. This gender difference is linked to the
facturing enterprises) the prevalence of morbidity in
changing roles of women and greater participation in
one month was almost 40%, and the proportional
the paid workforce, without a corresponding reduc-
morbidity from injuries was almost 50%. Cuts of the
tion in unpaid work (household work, child care, etc).
finger or hand constituted 52% of the injuries, frac-
Furthermore, regardless of country and continent
tures (8%), sprains (9%), and bruises (14%). Forty
women are paid between five and fifty percent less
percent of these injured children did not receive any
than men for the same work. The situation was sum-
kind of treatment, 23% consulted doctors, and 13%
marised at the Work, Women and Health Conference
were sent to hospital.
last June as follows (Lundby Wedin, 2002): “Every-
This study is detailed in order to show the magni-
where you turn in the world you will find that it is the
tude of the problem, and to show how self-evident it
women who are the poorest, who have the lowest
must be for all international occupational health or-
wages, who have the worst working environment and
ganisations to engage themselves in the challenge
who get the worst pension deals”.
against child labour. It is easy to understand, fur-
We need more data to describe women’s and men’s
thermore, how different the meaning must be of the
working conditions. Women often have a mixture of
word ‘well-being’ – depending upon if one is born in a
illnesses and so-called vague symptoms like fatigue,
rich or in a poor country.
reduced vitality, feelings of insufficiency, different
pains and discomfort. These symptoms are associ-
THE INTEGRATED OCCUPATIONAL HEALTH CONCEPT
ated with psychological causes and up till now,
Going back to the beginning of the 20th century, oc-
according to some researchers, not looked upon as
cupational health was a matter for physicians.
serious as other somatic symptoms. In turn, this
Gradually however, new groups came in: nurses, en-
means that women’s health problems at work are
gineers, and hygienists. Today, topics within
not as visible as those of men, resulting in being
ergonomics and work organisation are included, and
neglected both in research and practice.
the ‘integrated’ occupational health area even borders
on labour market issues.
CHILD LABOUR
It is easy to realise the interrelationships between
Child labour has been, and still is a worldwide prob-
medicine, hygiene and ergonomics. Work organisa-
lem. The involuntary underage workers typically forfeit
tion defines the contents of the work and how it is
the chances of developing knowledge and obtaining
distributed among the employees (‘right person for
education as do other children, and risk their health
Continued on page 8
OCCUPATIONAL HEALTH SA
JANUARY/FEBRUARY 2003
7
Continued from page 7
Africa, East Europe and South-East Asia) the epidemic
the right work’). ‘Theoretical’ work organisation dis-
is still increasing. The consequences of the epidemic
cusses, for instance, where and when the employee
in the most affected countries are devastating; the
comes in the decision hierarchy; it is given the possi-
workforce is dying, the national production dimin-
bilities for life-long learning; and may evaluate work
ishes, the level of education goes down, and the pov-
loads and risks for ill-health. More practical ‘projects’
erty increases. It is quite clear that the occupational
may include ‘stress and health’, ‘conditions for hu-
health world society has to include the prevention of
man service work’, ‘industry and the human resource’,
this epidemic as one of its main missions. Promising
‘gender and work’, ‘life-long learning’ and ‘work and
workplace interventions have been made in some of
culture’.
the Sub-Saharan Africa countries as to education
Labour market issues are somewhat more
about preventing transmission, and providing serv-
peripheral, however important for the employee. Ex-
ices to the wider community, but more has to be done.
amples on practical projects are ‘job creation’, ‘labour
law’ and ‘social economics’. Some of the labour market
‘NEW’ AREAS COMING INTO FOCUS
topics overlap with work organisation, which in turn
As said, work life is in a continuous change. New ‘prob-
overlap with ergonomics, which in turn overlap with
lem’ areas will call for attention. Some of these may
medicine, and so on.
have been there forever, but society has ignored them
There are reasons to believe that the integrated
for different reasons, not because of an evil mind,
occupational health concept will be a leading star for
but perhaps because of ignorance. Three such areas
the future. The development in work life matters
are sexual harassment, physical violence, and bullying
within the European Union (EU) points in this direc-
– all in some way or the other related to each other.
tion. Employability, entrepreneurship, adaptability and
Recent studies by the European Foundation for the
equal opportunities are the four ‘pillars’ in the EU 1998
Improvement of Living and Working Conditions (un-
Guidelines.
der the European Commission) have shown these
problem to be relatively common; the first two with
DON’T FORGET THE ‘OLD’ AND WELL-KNOWN HAZARD
prevalences between 5–10%, and the third one (bul-
It is easy to understand from what is said above that
lying) between 10–15%.
occupational health is a growing field today, covering
8
a broad panorama of different topics, where research,
OCCUPATIONAL HEALTH TODAY – AND PROSPECTS
practice and prevention go hand in hand. Overall,
FOR TOMORROW
and in addition to stress, musculo-skeletal diseases
Since the mid-nineties there has been a decline of
and asthma and other allergies, as the most preva-
occupational health activities in many of the ‘devel-
lent work-related diseases, occupational fatal
oped’ countries in the world. The main reason has
accidents still feature extensively each year world-
been a worldwide economic recession leading to
wide.
‘slimmed’ national budgets and increasing unemploy-
However, we must not forget that there are one
ment rates, and occupational health services (OHS)
million different chemical compounds in our immedi-
have been among the first areas to suffer. A contrib-
ate environment; several hundred new chemicals are
uting factor could be the increasing age among those
introduced each year into the environment; the long-
who work within OHS, and consequently the increas-
term toxicity of extremely low concentrations of these
ing number of retirements due to age, without any
chemicals are unknown. New work technologies mean
replacements of younger people. Still another factor
exposure to ‘new’ physical factors, such as electro-
of possible importance is ‘the changing world of work’
magnetic fields (EMF), the full effects of which we do
with a transfer from the industrial society to the ICT
not know. Recent assessments by the International
society, with the OHS’s main activities still within
Agency for Research on Cancer (IARC) now classify
industry.
the low-frequency EMFs as possible risk factors for
There are, however, signs pointing in the right di-
childhood leukemia, and the health risks of using
rection. In many countries, for instance, there is a
mobile phones are under evaluation.
political revival of positive interest in OHS.
Infections constitute another important health
Furthermore, in an organisation such as ICOH
area, and for self-evident reasons special emphasis
(International Commission for Occupational Health)
is directed towards the HIV/AIDS epideic. Forty mil-
we can now see an increase of new, young members
lion people are now infected in the world (“..what we
from different parts of the world. With what we have
now witness is a world historic epidemic larger than
today, there are reasons to be positive about the fu-
the Black Death and the Spanish Flu” (Kallings, July
ture. Worklife is constantly changing, which is noth-
2002, Secretary General, International AIDS Soci-
ing but a challenge for OHS working for health and
ety)), and in some parts of the world (Sub-Saharan
well-being at work.
JANUARY/FEBRUARY 2003
OCCUPATIONAL HEALTH SA