Friday, March 12, 1999
8:00 am - 9:30 am
Health Outcomes, Discrimination and Workstress in Female Funeral Directors
*Robyn RM Gershon, MHS, DrPH; Linda Goldenhar, PhD; Charles Mueller, MS;*Christine Karkashian, MA; and Naomi Swanson,PhD. *Johns Hopkins University, School of Public Health; CDC/NIOSH.
The association between psychosocial workstress and health outcomes (e.g., headaches, backaches, high blood pressure) has been well documented. Not as much is known however about the health effects related to workplace discrimination (based on gender, race, sexual orientation, etc.), and harassment (i.e., verbal and sexual harassment and physical assaults). In order to improve our understanding of this relationship, we conducted a cross sectional survey of female funeral workers. A 14-page, 322-item questionnaire was constructed to measure the following major constructs: demographics, job characteristics, discrimination, harassment, workstress and health outcomes.
A mailing list was obtained from the Society of Women Morticians, and a random stratified sample of 350 names were sent a confidential, self-administered questionnaire along with a consent form and disclosure letter.
Completed questionnaires were obtained from 265 respondents (response rate= 76%). Respondents had a mean age of 40yrs, 83% were white, 54% were married, and 95% had at least a college education.
Twenty-six percent of the respondents reported that they were currently discriminated against at work, mainly related to their gender (93%), or sexual orientation (18%). Discrimination took several forms, most often 1) unfair pay (72%), 2) lack of advancement (64%), 3) unequal division of labor (56%), 4) poor /scheduling (31%), and 5) menial work (36%). Only 35% said that they immediately reported it to their boss (supervisor). When asked why they did not report it, the reasons given included "because it would not have changed anything" (79%), "the boss was the one doing the discrimination" (76%), "fear of retaliation" (53%), "I did not want to seem weak" (33%), and "I was uncomfortable telling my boss" (43%).
Thirteen percent of the respondents reported frequent/often workplace harassment (verbal, sexual and physical abuse) from co-workers. Fourteen percent reported frequent/often hostile interpersonal relations at work and 2% reported frequent unwanted sexual advances from the families of the deceased.
Harassment was significantly associated with perceived stress (OR=4.49), somatic symptoms (OR= 2.0), anxiety (OR=3.5) and chronic illness (OR= 2.19).
These results indicate that workplace harassment may be significantly associated with both perceived stress as well as health outcomes. It may be possible to determine the loss of productively, lost work-time, compensable time, and other performance/quality indices related to workplace harassment.
CORRESPONDING AUTHOR:R.Gershon,DrPH;The Johns Hopkins University, School of Public Health, 615 N.Wolfe St. Baltimore, MD 21205.
Perceived Injustice and Workplace Aggression: The Role of Cognitions
Constant D. Beugré, Ph.D., Kent State University, Tuscarawas Campus
Research on workplace aggression (Neuman & Baron, 1997; Baron, Neuman, & Geddes, 1997; Beugré, 1996; 1998; Folger & Baron, 1996; Greenberg & Alge, in press) has considered a positive relationship between perceived unfairness (or injustice) and aggressive behaviors in the workplace. When people feel unfairly treated, they are likely to become aggressive in work settings. According to Greenberg (1997), antisocial motives in organizations are triggered by the insensitive treatment employees receive at the hands of their employers. Similarly, Berkowitz (1989) notes that people are likely to become aggressive if they believe that someone has unfairly tried to hurt them. Empirical evidence has also supported this relationship (Baron et al., 1997; Beugré, 1996).
Perceptions of unfairness, however, are not sufficient by themselves to trigger aggressive reactions. Although experiencing injustices, people may decide not to use aggression as a means of restoring justice. Recognition of an inequitable exchange might instigate an awareness that an injustice exists, but this might not always create any distress nor motivate attempts to reduce that injustice (Greenberg, 1984). As mentioned by Greenberg & Alge (in press), reactions to perceived injustice are not spontaneous. "It is one thing for people to recognize that they have been victims of unfair distributions or unfair procedures, and quite another for them to act on these beliefs. That is to say, before people respond to injustices by behaving aggressively, they must decide to do so" (Greenberg & Alge, in press). Using a cognitive perspective, the present article contends that aggression following an injustice is calculative rather than spontaneous and impulsive. When deciding to react to a perceived injustice, a person may ask himself or herself the following question. Was the situation really unfair? If the individual decides to react aggressively, is he or she ready to support the consequences of this aggression? Answers to these questions may moderate the individual’s likelihood to perpetrate an aggressive act.
The relationship between unfairness and workplace aggression may be moderated by the probability of retaliation. Bjorkqvist, Osterman, & Lagerspetz (1994) developed the concept of effect/danger ratio that refers to "an expression of the subjective estimation of the likely consequences of an aggressive act. The aggressor assesses the relation between a) the effect of the intended strategy, and b) the dangers involved, physical, psychological or social for him or herself, and for people important to him or her. The objective is to find a technique that will be effective and, at the same time, incur as little danger as possible. The aggressor tries to maximize the effect, and to minimize the risk involved" (Bjorkqvist et al., 1994: 28-29).
Constant D. Beugré, Ph.D., Kent State University, Tuscarawas Campus, 330 University Drive, NE, New Philadelphia, OH 44663-9403, USA
Organizational Unfairness and Occupational Stress
Catherine A. Heaney, PhD, MPH and Farahnaz Joarder, MS, Ohio State University School of Public Health
OBJECTIVE: Although fairness has been considered an important component of a productive workplace and a satisfied workforce, little research has investigated the link between employee perceptions of organizational unfairness and other psychosocial factors at the workplace that have been shown to influence health (e.g., stress, perceived control, social support). This paper reports the results of an exploratory qualitative study of the nature of employee perceptions of unfairness and the extent to which they are related to occupational stress levels, perceptions of employee control, and the exchange of social support.
METHOD: Semi-structured in-depth interviews were conducted with employees enrolled in stress reduction classes offered by their organizations. The employees worked in predominantly white-collar or clerical jobs. Verbatim transcripts of the taped interviews were submitted to a systematic inductive analysis by two analysts. Data bits were identified and coded according to categories that emerged from the data. Inconsistencies in the codings of the two analysts were resolved via discussion of project staff.
RESULTS: Employees described many issues that contributed to their perceptions of organizational fairness: being treated in a manner consistent with how other employees are treated; being dealt with consistently over time; being treated with dignity and respect; organization having realistic expectations for employee productivity; being given a voice in decision-making; organizational responsiveness to new or special needs of employees; well-explained rational decision-making and policy-making and more. These issues reflect and build on those identified in the organizational justice literature. As can be noted from the list above, some of the issues that contribute to perceptions of fairness are the same as those that contribute to perceptions of control (i.e., having a voice in decision-making) and to perceptions of stress (i.e., workload demands). Further, the analysis suggests that perceptions of organizational unfairness are related to (1) heightened employee distress related to exposure to worksite stressors, (2) increased feelings of powerlessness when worksite stressors are experienced, and (3) increased use of withdrawal or avoidance coping strategies. Implications of these findings for further research and for worksite stress reduction programs will be discussed.
CORRESPONDING AUTHOR: Catherine A. Heaney, PhD, MPH, School of Public Health, The Ohio State University 320 West 10th Avenue, Columbus, OH 43210
Unfair Treatment, Stress and Psychological Outcomes Among Correctional Healthcare Workers
J. Antonio Escamilla-Cejudo, M.D., Johns Hopkins University, School of Public Health, and Instituto de Salud, Ambiente y Trabajo (ISAT), Christine D. Karkashian, M.A., Robyn R.M. Gershon, Dr PH, Johns Hopkins University, School of Public Health, Larry Murphy, Ph.D., NIOSH, CDC
Unfair treatment at the workplace has been recognized as a source of stress among different working groups. It may have a negative impact on a worker’s health and on work related outcomes such as productivity and quality of patient care. As part of a work stress study among correctional health care workers, the possible sources and characteristics of unfair treatment were evaluated.
The study population was comprised of nearly 350 correctional healthcare workers employed in all 28 correctional facilities in the State of Maryland. A confidential self-administered questionnaire was mailed to all these workers. Participants were asked to complete measures on sources and types of unfair treatment at the workplace. The questions also included items on stress and somatic and psychological stress-related health outcomes. Unfair treatment was assessed by the following: 1) feelings of discrimination; 2) unfair treatment; and 3) helplessness. Psychological and somatic complaints were assessed based on the SCL90-R inventory. Psychological outcomes assessed in this study included items on symptoms of depression and anxiety. Somatic complaints included questions on headaches, and pains in the lower back among others. Statistical data analysis included exploratory, bivariate and multivariate modeling.
Preliminary bivariate associations using logistic regression models showed a positive, significant association between unfair treatment at work and presence of depression. Depression among health care workers reporting unfair treatment was almost three times higher than those not reporting unfair treatment (Odds Ratio -OR- 2.5, 95% CI 1.1, 5.9). Although marginally significant, anxiety and somatization were almost two times higher among correctional health care workers reporting unfair treatment (OR’s of 1.9 and 1.5, respectively).
Unfair treatment at the workplace among correctional health care workers seems to be related to increased depression, anxiety and somatization. These findings suggest that unfair treatment at the workplace among this group of workers adversely affects their health and, additionally, the quality of patient care might be impaired. Future studies should provide additional information on determinants of unfair treatment at the workplace, and may suggest possible interventions in this area.
CORRESPONDING AUTHOR: J. Antonio Escamilla, M.D., The Johns Hopkins University, School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205
Organizational Fairness and Employee Attitudes Toward Occupational Health Programs
Catherine A. Heaney, PhD, MPH and Farahnaz Joarder, MS, Ohio State University School of Public Health
OBJECTIVE: Recent national surveys indicate that the proportion of organizations that are providing worksite health programs (including stress management programs) is increasing dramatically. However, employee participation in these programs is often low. Health and safety programs offered at the worksite are not offered by "neutral parties"; employee perceptions of their organizations are likely to influence their attitudes and behaviors toward worksite health programs. Issues of fairness have been considered central to productive workplace and a satisfied workforce. This paper reports the results of an exploratory qualitative study of the nature of employee perceptions of organizational fairness and the extent to which they influence employee attitudes toward occupational health and safety and worksite health promotion programs.
METHODS: Semi-structured in-depth interviews were conducted with employees enrolled in stress reduction classes offered by their organizations. Verbatim transcripts of the taped interviews were submitted to a systematic inductive analysis to generate hypotheses for further testing.
RESULTS: Employees were careful to differentiate between the fairness of their supervisors and the fairness of their organizations more broadly. They described many issues that contributed to their perceptions of organizational fairness: consistent treatment over time and across employees; being treated with dignity and respect; realistic expectations for employee productivity; being given a voice in decision-making and more. These issues reflect and build on those identified in the organizational justice literature. Furthermore, the analysis suggests that employees who believe that they are treated unfairly by their organizations are (1) more likely to believe that the organization does not safeguard employee interests nor care about employee health, and (2) more likely to view worksite health promotion programs (and health protection programs that demand employee behavior change) as efforts of social control rather than as vehicles for personal growth and well-being. Implications for further research and for the development and implementation of occupational health programs will be discussed.
CORRESPONDING AUTHOR: Catherine A. Heaney, PhD, MPH, School of Public Health, The Ohio State University, 320 West 10th Avenue, Columbus, OH 43210
Future Directions and Initiative for the Journal of Occupational Health Psychology
Chair: Julian Barling, PhD, Queen's University, Ontario, Canada
The Journal of Occupational Health Psychology was launched in 1996, and there is a change pending in the editorial team. Thus, this is a very appropriate time to meet with the incoming editorial team and consider future directions for the journal. The discussion will be broad ranging with a specific focus on the future of the journal.
Introduction: Social Policy and Absenteeism
Robert Anderson, European Foundation for the Improvement of Living and Working Conditions
This workshop deals with the changes in the workforce and workplace in Europe and the implications of these changes for meeting the health needs of workers. It looks at how governments and social partners (employers and trade unions) are responding to the changing situation, particularly through the rethinking of health policies, professional practices and legal responsibilities.
In practice many of the policy initiatives have sought to address workplace absenteeism of both shorter and longer duration. However, the issue of absenteeism is seen differently across European Union countries and among the social partners. It may be regarded as in isolated phenomenon, or placed in the broader context of policies for the labour market, social security and occupational health and safety. Examples of recent initiatives in different Member States illustrate the diversity of strategies and professional foci, but also the common challenges and objectives faced by EU Member States.
The agenda for social policies to reduce workplace absenteeism, to promote workers’ health and to prevent premature exit from the labour market are changing rapidly and markedly. These changes are driven by financial and economic considerations but also be social and ethical arguments about health as a factor in social and economic exclusion. The workshop will identify the rationale for action on absenteeism and will illustrate the interests or perspectives of the different parties involved - but it will also be able to point to joint (national) programmes to combat workplace absenteeism and to reduce ill-health at work.
The debate will consider what further possibilities there are for more joint action and for more integrated approaches that, in the next decade, can contribute to better health for workers and reduced absence from work for health reasons.
CORRESPONDING AUTHOR: Robert Anderson, European Foundation for the Improvement of Living and Working Conditions, Wyattville Road, Loughlinstown, Co Dublin, Ireland
Challenges for Workplace Health Promotion in a Changing Workplace
Richard Wynne, Work Research Centre, Dublin, Ireland.
Many features of the workplace are changing in Europe. There are changes in demography, with Europe’s workforce aging rapidly and more and more women entering the workforce; changes in technology, with increased use being made of telemediated work and other forms of advanced technology; changes in working conditions, with increased prevalence of part-time and temporary working and self-employment, more shiftworking and more homeworking; and changes in the nature of the health hazards and health outcomes associated with working life, with increasing prevalence of work-related stress, RSI and other health effects, and reductions in traditional occupational diseases and safety hazards. In addition, there are increasing pressures of globalisation of the economy with associated changes in management style and methods which offer new possibilities to influence workers health.
These changes in working life pose new challenges to how health issues are dealt with in the workplace and by the responsible authorities. There are challenges of identifying new hazards and health issues, and particularly in relation to the delivery of new workplace health policies in new ways; these need to be faced in the new millenium.
This paper presents selected findings from a European study of new trends in assessment and policy in workplace health issues. Specifically, it provides examples of new policies and studies which are under development in many European countries in relation to older workers, stress at work, and delivery of services to SMEs. Some of these policies and initiatives are outlined in more detail in subsequent papers in the seminar.
The paper also contains some preliminary conclusions about what are likely to be the issues on the workplace health agenda in the coming decade. In addition, it sets out implications for the practice of workplace health promotion over the coming years.
CORRESPONDING AUTHOR: Richard Wynne, Work Research Centre, 22 Northumberland Road, Dublin 4, Ireland
Ill Health and Workplace Absenteeism: Initiatives for Prevention
Robert Gründemann, NIA TNO, Amsterdam, The Netherlands
There is a paradox at the heart of the analyses of workplace absenteeism in Europe. On the one hand huge amounts of money are involved in paying for absenteeism due to ill health but on the other hand major players have been relatively inactive for a long period. In each of the Member States the social security schemes pay out billions of euros yearly as benefits for absenteeism and disability. Attention to this problem within European governments is growing at this moment, but this phenomenon is rather recent. Likewise employers organisations and unions have not been very engaged by the issue until recent years.
This situation has changed since governments have become more concerned about public spending and the reduction of the national debt. Other significant factors are the creation of the open European market, increasing international competition, the growing numbers of unemployed persons and the globalisation of the production process, where (international) companies shift out jobs to (cheaper) developing countries. It is evident that in this situation the costs of labour have to be reduced to remain competitive and to keep industrial employment in Europe.
Governments are transferring the financial responsibility for absenteeism and disability to employers and employees. This policy has a double-sided effect: it relieves pressure on the national budget and it is an incentive to employers and employees to reduce absenteeism. In most European countries employers try to reduce absenteeism by tightening up procedures and checks on absent workers (regulatory and disciplinary measures). In spite of the implementation of the EU Framework Directive on Health and Safety at Work, preventive activities are still not very common within companies in the European Union. Most preventive activities are limited to person-oriented measures in the field of occupational accidents and diseases - such as training and information, use of protective equipment and stress management - and are not directed at work-related causes of ill-health and accidents. It also appears that reintegrative activities too, directed at the redeployment of long-term absentees, are not used much at this moment by European employers.
CORRESPONDING AUTHOR: Robert Gründemann, TNO Arbeid, P.O. Box 718, NL - 2130 AS Hoofddorp, The Netherlands
The Legal Situation and the Reactions of Social Partners in Portugal
Luis Graça, National School of Public Health, New University of Lisbon, Portugal
Dramatic changes have been taking place in Portuguese demography, economy and society, since the 25th April 1974 Revolution. More than a decade after having joined the European Union in 1986, Portugal is now facing the same problems, common to the other EU Member States, concerning the work, health and social policy agenda and trends. These include: competitiveness and globalisation; age and gender-related health issues at workplace; downsizing and out-sourcing; prevalence of median, small and micro-enterprises (SMEs); changes in the nature of work and of risks at work.
There are continuing concerns about the high level of work-related disability and about safety issues in traditional industries. Against the increasing costs of social protection, including Social Security and National Health Service, there has been growing attention to the needs for internalization of work-related health insurance costs and for accurate cost-benefit analysis of health initiatives. Government and social partners increasingly emphasise the reintegration of disabled workers; together with stress and coping as issues in the services sector. There has been a call for integration of public, environmental and occupation health policies, alongside the reorientation of traditional OHS services and the strengthening of workplace health promotion.
The main weakness of Portuguese experience in the field of workplace health policy and action is the existing gap between public and private initiatives in order to address health issues at the workplace, and the lack of multi-disciplinary and multi-policy debate in this field. Workplace health promotion as part of the national health strategy for the next millenium is very recent, public agencies and social partners being more concerned until now with the traditional issues of OHS, like in other Southern European countries (e.g., implementation of EU Framework Directive, reinforcement of legislation and regulations, prevention of accidents and occupational diseases, role of labor inspectorate, shortage and training of OHS professionals).
However, one can notice some years ago a change in the attitude of Government and social partners, being now more sensitive to the need of putting the workplace health issues on the social agenda and of adopting a more flexible, proactive, integrated, comprehensive, participatory and cost-effective approach to work and health. Some illustrative examples of initiatives will be presented in this paper.
CORRESPONDING AUTHOR: Luis Graça, Human and Social Sciences Department, National School of Public Health, New University of Lisbon, Av. Padre Cruz, P - 1699 Lisbon Cedex, Portugal
The Legal Situation and the Reactions of Social Partners in the Netherlands
Sabine Geurts, University of Nijmegen
There has been significant recent initiative in the Netherlands to change social security legislation in the area of sickness absence and work disability. Originally Dutch employers and employees did not really bear any financial consequences for sickness absence and work disability and the levels of absenteeism and disability in the Netherlands were extremely high. As a result, social security legislation in this country has been radically changed since the beginning of the nineties. The main characteristics of this new policy are full responsibility of employers with respect to both the financial costs and the medical supervision of sickness absences. Questions which can be raised considering the changed legislation are: What are the effects of the legislative changes on the levels of sickness absence and work disability? Is it fair to let the employer pay for absences that are not work-related? Are the ‘weaker’ ones (on both the employer side and the employee-side) not too vulnerable in this system? Should there not be a division in responsibility between government and social partners?
CORRESPONDING AUTHOR: Sabine Geurts, University of Nijmegen, Department of Work and Organizational Psychology, P.O. Box 9104, NL - 6500 HE Nijmegen, The Netherlands