Source: https://unhealthywork.org/interventions/social-science-based-interventions/
Timestamp: 2019-04-25 02:16:02+00:00

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The “job strain” studies and other research support the idea that social factors play a critical role in the production of common chronic diseases, such as heart disease and hypertension. The intervention studies, and other prevention strategies, indicate that the work environment can be modified to increase employee influence, skills, authority, and support, and to regulate demands. Participatory action research, collective bargaining, and legislation can be effective tools to achieve these goals. Effective PAR requires strong union involvement, while collectively bargained programs can benefit from PAR methods to involve workers and evaluate change. While the growing evidence linking job stress with illness helps to overcome the notion that psychosocial explanations for disease are not legitimate, vigilance needs to continue against our society’s dominant ideology which uses the stress explanation to “blame the victim” indicting those who become ill as well.
We believe that the evidence presented supports the following actions. First, “job strain” assessment instruments should be included in workplace health surveillance and health promotion programs, and in occupational health clinic educational material. Second, unions and their allies need to further increase their emphasis on contract language, education, organizing, and legislation on issues related to their members’ job design, work organization, quality of work life, schedule flexibility, and work and family concerns. Third, multidisciplinary teams (including workers, union and company officials, occupational health specialists, epidemiologists, labor and health educators, social psychologists, physicians and nurses), using PAR methods, can design, implement, and evaluate interventions to reduce or prevent exposure to psychosocial and physical health hazards and risk of illness. Fourth, further research is needed on various health outcomes (other than cardiovascular disease) potentially related to “job strain” or stress in general, including psychological disorders (4), musculoskeletal disorders (78), adverse pregnancy outcomes (79), “sick building syndrome” (80), work injuries (113), and immune system functioning (114), and the possible synergistic effects of psychosocial and physical health hazards. Modern workplaces embrace a complex set of risk factors, including psychosocial and physical/chemical.
For example, rates of heart disease mortality and all cause morbidity have risen (primarily for men) in Eastern Europe since the 1960s in contrast to substantial declines in Western Europe, Canada, Japan, and the U.5. (117) This has been attributed by public health officials to ‘lifestyle” factors such as smoking, alcohol, and a fatty diet, rather than, for example, environmental pollution. (118) However, the post-World War 2 period was also a period of urbanization, social migration, industrialization based on the principles of Taylorism, and introduction of and adjustment to a political system which allowed citizens limited control both in society and in the workplace. We need to consider the possible effects of these social changes not only on lifestyle behaviors, but on the prevalence of “job strain,” or more directly on cardiovascular health.
Just as the elimination of infectious diseases as the major causes of mortality over the last century occurred due to social changes, improvements in sanitation and nutrition, and elimination of slum conditions (and just as the reappearance of diseases such as tuberculosis has resulted from social neglect), chronic diseases are related to the physical and social environments in which people live and work. Our social epidemiological model of illness explicitly recognizes that work reorganization, workplace democracy, and broader societal changes (social and economic democracy) are needed to reduce the risk of cardiovascular disease and improve emotional well-being.
The authors would like to thank Philip Landrigan, David LeGrande, and Dominic Tuminaro for their advice on portions of this article, as well as the suggestions of anonymous reviewers.
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6. The term “stress” is used in this paper to refer to the broad range of psychosocial factors and their insulting mechanisms that affect the worker due to impacts on behavioral, psychological, or physiological outcomes. Within the job stress research community, the term “strain” is typically used to indicate the short term or intermediate effect of job stress (for example, alterations in the hormonal system of the body), which eventually lead to the development of disease. The terminology of “stress” leading to “strain” and then to disease is actually borrowed from the way these terms are used in engineering. In this paper, we use the term job strain” in a more specific way to refer to the objective workplace causes of “stress” described in the Karasek job strain” model.
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103. Cases of similar physical symptoms among a group of workers without an identifiable pathogen (known as “epidemic psychogenic illness,” EPI) have been extensively analyzed by NIOSH and others. (For excample: Colligan, M., Pennebaker, J., Murphy, L. (Eds.) Mass Psychogenic Illncss: A Social Psychological Analysis. Hillsdale, NJ: Lawrence Erlbaum, 1982.) Work organization in workplaces where EPI has occurred has been chracacterizd as repetitive or boring work with rigid pacing and high job pressures, strict rules, and a lack of communication and social interaction. While EPI can therefore be regarded as a desperate reaction to excessive “job strain,” another explanation is that low-level chemical exposure and stress may have synergistic effects.
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