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Jobs Don't Kill People, But Stress in the Workplace Can

Adding to a growing body of evidence that workplace stress is harmful, researchers have linked job strain with higher rates of heart disease and other physical ailments, and are exploring the psychological effects of working long hours or being disenchanted with a job.

      In one of the most comprehensive US studies so far of hypertension and job strain defined as being in a job with high demands but low control over working conditions researchers followed nearly 200 men for three years, and found that those with the most job strain had significantly higher blood pressure than those with the least.

      Around the world, European and Japanese scientists have been looking at the influence of job strain on heart disease, gastrointestinal illness, immune system function, back and joint pain, and depression and absenteeism, as well as at ways to redesign the workplace to reduce stress.

      And University of Iowa researcher Cynthia A. Bonebright reported last week finding that ``workaholics'' people who work long hours, whether out of enthusiasm for the job or not have more conflicts between work and family, and less satisfaction and purpose in life. And Georgia State University professor Kenneth B. Matheny reported that workers who say they suffer the most ``burnout'' are less confident in general and more disinterested in their jobs.

      These and other findings not to mention downsizing, longer workdays, computerization and other changes that are increasingly affecting workers have made job stress a priority for US public health officials.

      ``One-quarter of the American working population feels their job is a highly stressful force in their life,'' said Dr. Linda Rosenstock, director of the National Institute for Occupational Safety and Health, or NIOSH.

      ``We see it as a major issue,'' she said. In fact, the average American work week is the longest in a generation, at about 47 hours, according to statistics she cited.

      Worldwide, the International Labor Organization has estimated that work stress costs employers more than $200 billion a year, and the World Health Organization has reported that about three-quarters of people who seek psychiatric help have symptoms that relate either to lack of job satisfaction or the inability to relax, said Matheny, director of counseling psychology at Georgia State.

      ``Many people feel like automatons,'' he said. ``The electronic stuff has made things all the worse beepers, e-mail. They can get to you constantly,'' he added.

      But while the US government is just beginning to recognize what researchers call the psychosocial factors of work-related stress, illness and injury, some European countries have already put regulations on the books to protect workers from such hazards, said Robert A. Karasek, professor in the department of work environment at the University of Massachusetts, Lowell.

      For instance, in Norway, government officials can be called in to investigate complaints about employees being forced to do too repetitive a job, or work too fast, according to Karasek, who has advised occupational health officials worldwide.

      And in Japan, officials have recognized work stress as an occupational cause of death for more than two decades. They even have a word that means ``death from overwork'' karoshi.

      In a decision in March that opens the door for workers compensation claims based on suicide, a Japanese court forced the government to award a sum of money to the family of a machine shop worker who hanged himself in 1985, after working 80-hour weeks. And the recent suicide of a Japanese baseball scout, which was considered to be a direct result of unrelenting job stresss, enabled his family to receive an annual government pension.

      Almost any American worker will say they have stress on the job, but researchers have found that the greatest health risks come from a particular type of stressful job one that imposes high demands but gives little control over working conditions.

      Among the kinds of jobs that Karasek has found to put people under excessivly high strain are garment factory workers, phone operators, waitresses, gas station attendants and nurse's aides.

      But work-environment specialists have also found that job strain can be reduced, and productivity improved, by lessening demands or giving workers more control over their working conditions. In other words, they say: change the way that work is organized; don't just tell individual workers to use stress management programs, which often have short-lived effects.

      Researchers recommend that employers and employees, through anonymous surveys or face-to-face meetings, figure out the sources of stress like unrealistic deadlines, lack of support from supervisors and little involvement of workers in decision-making and do something concrete to change the way the work gets done.

      For example, in Germany, some workplaces have ``health circles,'' where employees get together to discuss sources of job stress and come up with solutions, according to Karasek. But, he said, there needs to be a level of trust between employers and employees before such communication can even occur.

      ``The United States is really significantly behind in focusing on the issue,'' said Karasek, a sociologist who devised the job strain model and a job content questionnaire that has been used by officials around the world to understand and prevent the health consequences of high demand low control jobs. He just returned to Massachusetts from a year in Denmark, teaching at the government occupational health institute there.

      Karasek said NIOSH's entire budget would barely pay for one of the comprehensive studies now going on in Europe and Japan, involving tens of thousands of workers, to assess the effects of job strain on such things as heart disease and absenteeism. The US government used to fund large-scale occupational health studies but stopped about 20 years ago, he said.

      NIOSH's Rosenstock acknowledged a ``clear underinvestment in what is needed for the scope of the problem,'' with the agency spending a little under $2 million a year on studies of job stress and other issues such as how best to reorganize duties so that workers have more control over their working conditions.

      But NIOSH has placed job stress and the organization of work on a national research agenda, and issued a report entitled ``Stress...At Work'' the first of its kind to educate employers and workers about the causes and prevention of job stress.

      While Karasek welcomed the new efforts, he still considers the funding ``minuscule.'' Regardless of money, workplace changes are sorely needed, considering the examples of job strain here, said Dr. Peter Schnall, associate professor of medicine at the University of California at Irvine and an author of the hypertension and job strain study.

      For instance, he cites an automobile plant in California, where the assembly line sped up so much that employees were timed spending 58 seconds out of every 60 seconds working. ``Every second of every minute of every working hour is accounted for in plants like this,'' said Schnall, who is also director of the Center for Social Epidemiology.

      While those kinds of working conditions have been linked to repetitive strain injuries, Schnall said, they are ``sort of the canary in the coal mine'' when it comes to the long-term health consequences of speeding up workers.

      In his hypertension and job strain study, published in October in the journal Psychosomatic Medicine, Schnall and colleagues from Cornell University monitored the blood pressure of nearly 200 men for 24-hour periods. Those who had the highest job strain had on average a systolic blood pressure (the upper number) nearly 12 points higher and a diastolic blood pressure nearly 10 points higher than those with the least strain.

      In fact, Schnall said, after looking at all possible causes of high blood pressure, job strain was found to be more important than smoking or salt in the diet. The only other major factor was being overweight, said Schnall, who is an internist.

      Karasek is beginning a similar study at the University of Massachusetts Medical School in Worcester, to assess people's heart rate based on job strain; the volunteers will use a portable monitor for 48 hours. But he and his graduate students have found it difficult to find people in high-strain jobs willing to participate. ``They say, `We have no time to do this,' '' Karasek said.

      While research exists to support the negative health consequences of job strain and the prevention strategies available, Karasek remains disappointed in the US response, compared with that in Europe and Japan.

      ``What I think the problem is in the United States is the lack of social dialogue,'' or the willingness of employers, workers, family members, politicians and the general public to talk about stress at work, he said. ``It's not that the problem is more severe. It's that the solution is less likely to be applied.''



      (The Boston Globe web site is at )