VOLUME 30 , NUMBER 5 May 1999

Worker stress, health reaching critical point

A joint conference of APA and NIOSH finds the landscape of occupational health changing for the worse.

By Patrick A. McGuire
Monitor staff

American workers are working harder and longer than they have in the past two decades just to maintain their standard of living. The predictable result, according to experts who took part in the recent "Work, stress and health '99" conference in Baltimore is a workforce more at risk than ever for psychological, physical and behavioral health problems.

"It certainly has made for social and family disruptions," said Linda Rosenstock, MD, the director of the National Institute for Occupational Safety and Health (NIOSH) which, with APA, sponsored the March 1113 event.

Conference speakers addressed those disruptions, in presentations ranging from the stress of bus drivers in San Francisco who find it hard to have dinner with their families even once a week, to the big picture overview of a former labor secretary who suggested that economic policies that encourage downsizing and wage inequality are the source of the trouble.

"Every day we see reports about the increasing workload shouldered by men and women in this country," said Steven Sauter, PhD, chief of the applied psychological and ergonomics branch of NIOSH. "Not so long ago we talked calmly about work overload. And then we started to hear the expression 'time poverty.' Now, at this meeting we're hearing expressions like 'time famine.'"

Sauter, a co-chair of the event, said more jobs have been lost in the last year than at any time in the preceding decade. And for those still at work, absences due to stress-related illness are of growing concern.

What it all means, said Gwendolyn P. Keita, PhD, associate executive director in APA's Public Interest Directorate, co-chair of the conference "is that the occupational and safety health field is changing faster and more dramatically than we ever believed."

Greater response

APA and NIOSH, she noted, have staged three previous work and wellness conferences beginning in 1990 and with high international representation among participants. Each conference has attempted to bring together industry, labor, government and academia to discuss the issue and the future of research.

"Companies are currently putting more than ever into programs to respond to this," she says of the job stress issue. And APA, she said, had worked with NIOSH to put in place graduate-level training programs in occupational health psychology at the University of Minnesota, Bowling Green State and Kansas State.

The two organizations became close, says Raymond D. Fowler, PhD, APA's chief executive officer, after a NIOSH report in 1988 seemed to take everyone by surprise by including psychological disorders as one of the 10 leading occupational diseases and injuries.

"Until that report," said Fowler, "no one had really taken into account how little of the resources of both communities were devoted to dealing with issues that were psychological and personal in nature as opposed to more environmental or injury related."

The growth in job stress, said Rosenstock, NIOSH's director, may be connected in part to the widespread downsizing of corporate America in recent years.

"It turns out that a quarter to a third of workers have high job stress and are drained and used up at the end of the day," she said. "The most dramatic change we have seen in the United States is the rapid and remarkable increase, in a relatively short period of time, in the number of workers working longer hours."

In the space of a generation, the number of hours Americans work each week has increased by 8 percent to an average of 47, she said. "And 20 percent of the American workforce is now working 49 hours a week."

But as they work harder, she added, "more people are worried about being laid off."

In the last 10 years, the number that fear job loss has doubled. "And most of them have concerns even if they feel they are performing well or very well on their jobs."

In fact, companies that have eliminated jobs are more likely to have an increase in disability claims, more problems with morale and to see decreased productivity of their workforce, said Rosenstock. It all translates into increased health-care costs with "billions of dollars of economic loss in terms of the whole arena of work stress," she said.

Economic stressors

The impact of those costs, and the bigger picture view of the economics of stress were covered by keynote speaker Ray Marshall, PhD, former Secretary of Labor in the Jimmy Carter Administration.

Marshall, a faculty member at the University of Texas, said growing problems of job stress and a decline in worker health were a direct result of an unequal distribution of wealth and income in America since the 1970s. That was when globalization of markets began changing the nature of work. Specifically, increased competition worldwide ultimately led to a wage-cutting, downsizing strategy in American industry, he said.

"The growth of competitive global markets tends to cause countries to lose control of their own affairs," said Marshall. "So that we no longer have monetary fiscal policies that will generate relatively full employment."

Many would disagree with him, he admitted, arguing that unemployment is at a record low. But he made a distinction between unemployment and what he called "The trend toward increasing joblessness."

"If things get so bad you quit looking for work, then unemployment rates go down," he said. "And therefore the measure of unemployment is not necessarily a good indicator that long term unemployment has gone up. That is where we have a lot of our most serious health problems."

For less educated and lower salaried workers, he said the cost-cutting strategy that has evolved promotes unequal incomes and limits the ability of individuals to improve their standard of living.

"The ways of improving your standard of living, under a cost- and wage-cutting strategy," he said, "is to work harder. That's exactly the reason more people are working longer hours. The average now is about 8 weeks longer per year than in 1969, for about the same income."

The economy works well for college-educated people in the top income levels, representing 25 percent to 30 percent of the work force, said Marshall.

"But for the 40 percent of our work force at the bottom, they are worse off than they were in 1970," he said. "And the middle group--the 35 percent between the two--are not sustaining their income. They are the people who are working hard for longer hours and that is where a lot of the stress occurs."

Marshall argued that the nation's economic planners should focus on growth by eliminating the low-wage strategy, guaranteeing a quality education and empowering workers to have a larger stake in their jobs.

"And I think a real war on poverty should be one of the highest priorities," he said, noting that researchers have found that increases in poverty, inequality and unemployment are linked with rising rates of mortality, suicide, homicide, assault and rape.

That was a theme repeated with urgency by another former cabinet officer during a seminar on the "Disparities in occupational safety and health of minorities." Louis W. Sullivan, MD, former secretary of Health and Human Services under President George Bush and currently president of Morehouse School of Medicine noted that "study after study demonstrates the striking disparities in the rates of death between the poor and the wealthy."

Specifically, he said, "poor and minority citizens have been bypassed by our nation's health-care system. We should be alarmed about these disparities, but I don't believe there is enough alarm about them in our society."

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