Download work, stress and health * a global challenge

WORK, STRESS AND HEALTH –
A GLOBAL CHALLENGE
Lennart Levi, MD, PhD
Emeritus Professor of Psychosocial Occupational Medicine,
Karolinska institutet, Stockholm, Sweden; Member of the
Swedish Parliament 2006-2010.
ILO International Safety and Health Conference, Duesseldorf,
November 6-7, 2013: ”Make it visible: Occupational Diseases
– Recognition, Compensation, and Prevention.”
ILO APPROACH TO MENTAL HEALTH
AND WELLBEING AT WORK
• Broaden enterprise policy on OSH to include
psychosocial hazards in risk assessment
measures;
• Evaluate workplace psychosocial risks through
risk assessment;
• Identify specific needs, and measures to be taken;
• Implement workplace action through
preventive/promotive measures.
(Forastieri, SafeWork, 2011)
UN DEVELOPMENT GROUP´S REPORT
(2013):
• ”The international community must give a strong and visible
response to the pressing demand for more and better jobs”, said
the ILO Director-General Guy Ryder.
• 202 million are unemployed; 470 new jobs will be needed globally
2016-30; 900 million are working poor.
• Key recommendations: (1) adapting a stand-alone goal on
employment; (2) shifting from quantity to quality of growth; (3)
combining economic growh with creation of decent jobs for the
poor and most vulnerable; (4) addressing the structural causes of
unemployment; Governments to be more pro-active; (6) Expanding
social protection systems; (7) Social protection systems combined
with employment generation; (8) strengthening social dialogue; (9)
reform in international trade, finance and technology transfer.
(ILO, 2013)
VULNERABLE EMPLOYMENT AS A
SHARE OF TOTAL EMPLOYMENT, 2011
OUTPUT PER WORKER
• Table 1: Labour productivity (output per worker) by region, as a
proportion of productivity levels in developed economies, 1991
and 2011 (per cent) Regions
1991
2011
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•
Middle East
CSEE (non-EU) & CIS
Latin America & the Caribbean
North Africa
East Asia
South-East Asia & Pacific
South Asia
Sub-Saharan Africa
64
38
37
27
6
10
6
9
(ILO, 2011; World Bank 2011)
53
35
32
25
20
14
11
8
PERSON-ENVIRONMENT FIT?
FRAGMENTED OR HOLISTIC
APPROACH?
WORKPLACE HEALTH PROMOTION
AND WELLBEING
• Promotion of health among all workers and their
families through preventive and assistence
programmes in the area of drug and alcohol
abuse, HIV/AIDS, workplace stress and the
promotion of tobacco-free workplaces.
• With the aim of integrating workplace health
promotion into OSH policies. SOLVE focuses on
the prevention of psychosocial risks and the
promotion of health and well-being at work
through policy design and action. (ILO, 2013)
60th SESSION, INTERNATIONAL
LABOUR CONFERENCE:
”The
improvement of working
conditions and the protection of
the physical and mental health of
workers constitute an essential and
permanent mission of the
International Labour Organization.”
THEORETICAL MODELS FOR
OCCUPATIONAL MENTAL HEALTH ACTION:
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Person-Environment Fit
Life changes
Demand-control-support (iso-strain)
Effort-reward imbalance
Person-Environment Fit
Recovery
Justice
GLOBALIZATION + CRISIS + MIGRATION +
AGING + INNOVATION = CHALLENGE!
• Adequate knowledge on traditional OSH
• Great need for close and sustainable
collaboration between the social partners and
Academia
• Uncertainty how to cope with informal sector,
SME, allocation of responsibilty regarding
mobile workplaces, sub-contractors, foreign
cultures, rapidly expanding service sector.
Investments into Mental Health –
challenges and benefits:
• In any one year, the proportion of the EU´s population
suffering from a mental disorder is 38.2 % (Wittchen et al.,
2011). Most common are anxiety disorders (14%), insomnia
(7%), depression (6.9%), somatoform disorders (6.3%) and
alcohol and drug dependence (>4%). Remains significantly
and persistently high. Accounts for 26.6% of total ill-health.
• All EU countries provide prevention of mental illness and
promotion of mental health, mostly school-based but also
work-based.
• Cost savings have been demonstrated (McDaid & Park,
2011; Knapp et al., 2011).
(EU-OSHA, 2011; European Commission, 2013)
CSR AND DEVELOPING COUNTRIES:
• The overall contribution of business to
sustainable development.
• CSR offers real opportunities for governments
of middle and low-income countries to change
the terms on which they interact with
business.
(United Nations, 2007)
MOTIVES FOR INTERVENTION?
• A humanistic quest for ”The Good Working
Life”;
• A wish to improve the health and wellbeing of
the working population;
• Promotion of autonomy and democratic
values;
• Concern for company profit and
competitiveness.
(Gardell, 1980)
PSYCHOSOCIAL FACTORS AT WORK –
RECOGNITION AND CONTROL (1984):
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Report of the Joint ILO/WHO Committee on Occupational Health, Ninth Session. Endorsed by
ILO´s Governing Body and WHO´s Executive Board. Occupational Safety and Health Series No.
56.
ILO: The importance of the psychosocial environment of workplaces was increasing. Economic
growth, economic progress, increased productivity and social stability depend … also on
working and living conditions and the health and wellbeing of workers and their families.
(Psychosocial factors) have a considerable influence on the physical and mental wellbeing of
workers.
WHO: Concern for psychosocial factors at work was reflected in ”Making work more human”,
and in the proposed conclusions with a view to a Convention and to a Recommendation on
Occupational Health Services adopted in 1984.
A vast quantity of litterature has demonstrated that psychosocial factors at work contribute to
a wide range of workers´health disorders.
Positive psychosocial factors can act as health-maintaining and health-enhancing agents.
In developing countries, the determinants of special vulnerability in newly urbanized job
recruits may include psychological aspects like unfamiliarity with the work-leisure dichotomy
(ex-nomads) and separation of the end-product from labour (ex-peasants and rural
craftsmen).
Somatic ill health resulting from infectious diseases, poverty, malnutrition, overcrowding, lack
of education, sanitation and health care probably render individuals more susceptible to
environmental psychosocial hazards at the workplace.
OPTIONS FOR INTERVENTIONS:
1. Job redesign;
2. Organisational measures, e.g., greater
autonomy;
3. Ergonomic measures;
4. Working space, working time;
5. Work process;
6. Workers´participation;
7. Helping workers to cope.
(ILO & WHO, 1986)
OPTIONS FOR INTERVENTIONS:
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Strengthen information and training;
Implement existing knowledge
Monitor and survey
Raise knowledge and competence.
Support by regulations and laws, inspections;
Empower the workers.
SHIFT OF INDUSTRY AND SERVICES
TO DEVELOPING COUNTRIES:
• Absence of (or presence of weak) regulatory
systems;
• Many of these jobs are hazardous to
workers´health;
• 80% of the world´s GDP is produced in
industrialized countries; only 20% in developing
countries (where 80% of the world´s workforce
resides);
• It follows that wealth and prosperity are
extremely unequally shared.
(Kortum et al., 2010)
WHY IS THERE LITTLE IMPROVEMENT?
• Inadequate funding;
• Other health issues compete;
• Psychosocial hazards are not included in the definition
of easily preventable issues;
• Come on top of poverty, economic insecurity, gigh
exposure and vulnerability;
• Poor data collection;
• Lack of data on exposure or causality;
• Struggle with other well-known and traditional
occupational risks.
(Kortum et al., 2010)
INTERVIEWS OF EXPERTS AND DELPHI SURVEY
ON WORK-RELATED STRESS IN DEVELOPING
COUNTRIES
It can be concluded that the health impact from
psychosocial risks and work-related stress is
considerable in developing countries and should
be regarded as a theat to public health.
(Kortum et al., 2010)
It could be expected that the incidence of such
workplace stress is higher in developing
countries.
(Chopra, 2009)
MANY WORK-RELATED DISEASES
HAVE MULTIFACTORIAL ETIOLOGY:
• Occupational diseases, have a specific or
strong relation to occupation;
• Work-related diseases, with multiple causal
agents, where factors in the work
environment may play a role;
• Diseases affecting working populations,
without causal relationship with work but
which may be aggravated by occupational
hazards to health.
(Lesage, 2011)
QUESTIONS TO BE CONSIDERED:
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Strength of association;
Consistency;
Specificity;
Appropriate time relationship;
Biological gradient;
Coherence.
(Lesage, 2011)
GLOBAL WELLNESS SURVEY 2009:
• 1,103 organizations from more than 45 countries
representing more than 10 million employees
have responded to a survey from Buck
Consultants (2012). But not a random sample…
• Stress is cited as the top health risk driving
wellness programs in most areas of the world.
• Strong growth is predicted for programs designed
to improve the psychosocial work environment.
HEALTHY WORKPLACES CONSIDER:
• Health and safety concerns in the physical work
environment;
• Health, safety and wellbeing in the psychosocial
work environment;
• Health promotion opprtunities in the workplace;
• Ways of participating i the community to improve
the health of workers, their families and other
members of the community.
(WHO, 2010)
WORKERS HAVE TO DEAL WITH…
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Increased demands of learning new skills;
The need to adopt new ways of working;
Demands for higher productivity;
Demands for increased quality of work;
Increased time pressure and hectic jobs;
Higher job competition;
Increased job insecurity and less benefits;
Less time for co-workers and socializing.
(TNO and WHO, 2007)
RISKS FOR WORK-RELATED STRESS
AND ILL HEALTH
• Mental health problems(depression,
anxiety);
• Musculo-skelettal problems (neck,
shoulder, back pain);
• Cardio-vascular problems (IHD,
hypertension, metabolic syndrome).
(TNO and WHO, 2007)
WORKERS´HEALTH: GLOBAL PLAN OF
ACTION (WHO, 2008-17):
• Workers represent half the world´s population and are the
major contributors to economic and social development;
• The growing informal economy is often associated with
hazardous working conditions
• And involves vulnerable group as children, pregnant
women, older, disabled and migrant workers;
• All workers shoulde be able to enjoy the highest attainable
standard of physical and mental health and favourable
working conditions. The workplace should not be
detrimental to health and well-being. Primary prevention of
occupational hazards should be given priority.
• The workplace can also serve as a setting for health
promotion.
WORKERS´HEALTH: GLOBAL PLAN OF
ACTION (WHO, 2008-17):
1. Devise and implement policy instruments on
workers´health;
2. Protect and promote health at the workplace;
3. Improve the performance of and access to
occupational healtyh services;
4. Provid and communicate evidence for action
and practice;
5. Incorporate workers´health into other policies.
WORK CAN BE BOTH PATHOGENIC
AND SALUTOGENIC:
• Work provides (1) goal and meaning in life; (2)
structure and content of the working day, week, year
and life; (3) identity and self-respect; (4) social
networks and support; and (5) material rewards.
• On the other hand, dangerous exposures and loads are
often several times greater in the workplace than in
any other environment, with adverse consequences on
health.
• A healthy, productive and well-motivated workforce is
the key agent for overall socioeconomic development.
”WORK-RELATED STRESS…
…is a pattern of physiological, emotional cognitive and
behavioural reactions to extremely taxing aspects of work
content, organization and environment”.
The offer of labour in urban and suburban areas has increased
enormously. Deregulation has also bee the requirement
during the globalization process, which has led to less
protection of workers´m rights, particularly health and
retirement benefits, as well asjob security. As a result, there is
unemployment and under-employment, and people accept
substandard jobs.”WHO estimates that worldwide only 5-10 %
of the workers in developing countries and 20-50% in
industrialized countries have access to adequate occupational
health services. Psychosocial issues are rarely dealt by these.
(WHO and TNO, 2007)
WORK-RELATED IN DEVELOPING
COUNTRIES…
…is often made wore by gender inequalities, poor paths of
participation and poor environmental management of
industrial pollution and illiteracy, parasitic and infectious
diseases, poor hygiene andsanitation, poor nutrition, poor
living conditions, inadequate transportation systems and
general poverty.
Also dealing with increasing fragmentation of the labour
market, the deand for flexible contracts, incrwased job
insecurity, a high work pace, long and irregular working hours,
low control over job content and process, and low pay,
together with new occupational hazards accompanying the
old and new industries and technologies.
GLOBALIZATION AND THE WORLD OF
WORK
• Globalization has not benefitted all;
• The economic and jobs crisis
presents an enormous global
challenge;
• ILO is responding through a Decent
Work Agenda for all.
(Pascual-Teesa, 2011)
IS THERE A PROBLEM?
• More than 2 million people die every year from work-related
diseases;
• 160 million annual non-fatal cases cause immense human suffering;
• This also causes major economic losses – 4% of the world´s gross
domestic product;
• 205 million people are unemployed;
• Young people are nearly three times as likely to be unemployed;
• An estimated 1.5 billion are in vulnerable employment;
• 630 million live in extreme poverty;
• Much of this is preventable.
(ILO, 2013)
HOW IS DECENT WORK REALIZED? DECENT
WORK COUNTRY PROGRAMMES (DWCP):
• Mean ehicle for delivering ILO support to
countries;
• Distinct ILO contributio to UN country
programmes;
• More than 70 DWCPs world wide.
(Pascual-Teresa, 2011)
DECENT WORK FOR ALL IN ACTION:
• Better Factories (Cambodia);
• Employment-Intensive Rebuilding (Liberia);
• Eradicating Child Labour from Mining Industry
(Peru).
(Pascual-Teresa, 2011)
EMPLOYMENT-INTENSIVE
REBUILDING. THE CHALLENGE:
• After many years of devastating conflict,
Liberia has 80 percent under-employment;
• The country lacks basic infrastructure, such as
roads, electricity, running water;
• Young adults are largely unskilled;
• The challenge: To rebuild the country and help
create a skilled employment bvaswe to carry
the nation forward.
(Pascual-Teresa, 2011)
PSYCHOSOCIAL OCCUPATIONAL
FACTORS AND HEALTH:
• Emotional reactions (anxiety, depression,
hopelessness, helplessness, interpretation of extrinsic
and intrinsic perceptions);
• Cognitive reactions (recollection, concentration,
creativity, learning, decision making);
• Behavioral reactions (smoking, alcohol, overeating,
drugs, agressiveness, suicide);
• Physiological reactions (cardio-vascular, genito-urinary,
skeletto-muscular, gastro-intestinal: dysfunction
possibly leading to structural damage;
• Can to some degree influence virtually every disease,
its course, treatment and rehabilitation.
SWEDISH WORK ENVIRONMENT ACT
1990/91:140 (Summary):
• Adapt jobs to employees´abilities and needs;
• Allow employee participation n job design and
change;
• Humanize piece work and shift work;
• Avoid strictly controlled and tied work;
• Promote task variety and continuity; and
collaboration;
• Promote personal development, selfdeterminantion and occupational responsibility.
WORDS DO NOT
COOK RICE!
MONITORING AND ASSESSING
PROGRESS ON DECENT WORK (MAP)
Ongoing processes in, among others:
Bangla Desh, Brazil, Cambodia,
Indonesia, Niger, Peru, Philippines,
Ukraine, Zambia
(ILO, 2013)
DECENT WORK COUNTRY PROFILE
INDONESIA (2011)
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Employment opportunities: mixed; difficulties related to gender, youth, informal
employment.
Adequate earnings and productive work: modest progress.
Decent working time: no progress.
Combining work, family and personal life: improvements, but lessso in informal
work.
Work that should be abolished: Notable progress regarding child work, but many
problems remain.
Stability and security of work: increasing part in precarious or casual work.
Equal opportunity and treatment in employment: increased women´s
participation in management, falling gender wage gap.
Safe work environments: some progress. Fall in fatal and non-fatal occupational
injury rates.
Social security: Universal coverage aimed at but not yet achieved.
Social dialogue: Mixed progress.
(ILO, 2011)
DECENT WORK (ILO)…
• …has been defined as productive work for women and men in
conditions of freedom, equity, security and human dignity;
• It involves opportunities for work that is productive and
delivers a fair income;
• It provides security in the workplace and social protection for
workers and their families;
• It offers better prospects for personal development and
encourages ocial integration;
• It gives people the freedom to express their concerns, to
organize and to participate in decisions that affect their lives;
and
• It guarantees equal opportunities and equal treatment for all.
COMMON OBSTACLES:
• Lack of commitment;
• Ambitious legislation, not
implemented;
• Lack of monitoring;
• Lack of awareness and competence;
• Lack of empowerment.
PREVENTION/PROMOTION
STRATEGIES:
• Exposure and/or disease specific
prevention;
• Generic prevention (multiple
morbidity);
• Promotion of health and wellbeing.
SOCIAL CAPITAL:
”The processes between people
wich establish networks, norms
and social trust, and facilitate
co-ordination and co-operation
for mutual benefit.”
BIGGEST OVERALL CAUSE:
”Mental health problems
and stress-related disorders
are the biggest overall cause
of early death in Europe.”
A RENEWED WORK ENVIRONMENT
POLICY 2010 – 2015 (SWEDEN):
”Work environment policy shall concern, as up
till now, to counteract stamping out from
working life, and improve opportunities for reentry, and to diminish the risk for exposure to
accidents and diseases, but also to a higher
degree than before concern work environment
as developing and contributing to health.”
(Communication from the Swedish Government to the Swedish
Parliament No. 2009/10:248).
EUROPEAN PACT FOR MENTAL
HEALTH AND WELL-BEING:
• Mental health is a human right;
• It enables to enjoy welolbeing, quality of life and
health;
• It promotes learning, working and participation in
society;
• It is a key resource for the success of the EU as a
knowledge-based society and economy;
• There is a need for decisive political steps to make
mental health and well-being a key priority.
(WHO and EU, 2008)
OPTIONS FOR INTERVENTIONS:
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Legislation, ordinances;
Supervisory control;
Regulations of working hours;
Education and training;
Inspections, surveys;
Occupational health services;
Horisontal and vertical cooperatiom/integration;
Development of health promotion skills;
Promotion of collective agreements;
Research and development.
EUROPEAN PACT FOR MENTAL
HEALTH AND WELLBEING:
”We call for action in five priority areas:
• Prevention of depression and suicide;
• Mental health in Youth and Education;
• Mental Health in Workplace Settings;
• Mental Health of Older People;
• Combating Stigma and Social Exclusion.”
(WHO and EU, 2008)
UNITED NATIONS GENERAL ASSEMBLY
RESOLUTION ON HAPPINESS (July 19, 2011)
• ”The pursuit of happiness is a fundamental human goal;
• Happiness as a universal goal and aspiration embodies the
spirit of the Millenium Development Goals;
• Recognizes the need for a more inclusive equitable, and
balanced approach (than measures of GNP) to economic
growth that promotes sutainable development, poverty
eradication, happiness and well-being of all people;
• Invites MS to pursue the elaboration of additional
measures that better capture the importance of happiness
and well-being in development with a view to guiding their
public policies.”
DEFINITION OF ”MENTAL HEALTH”:
”A state of well-being in which every individual
realizes his or her own potential, can cope with
the normal stresses of life, can work
productively and fruitfully, and is able to make a
contribution to her or his community.”
(WHO, 2011)
WHO GLOBAL COMMISSION ON
”SOCIAL DETERMINANTS OF HEALTH”:
Social determinants are the conditions in which people live and work.
They are ”the causes behind the causes” of ill health. Thet include
poverty, social exclusion, inappropriate housing, shortcomings in
safeguarding early childhood development. Unsafe employment
conditions, and lack of quality health systems.
The core of the Commission´s work will be to identify, evaluate. Adapt
and distribute effective strategies to address social determinants, with
the aim of supporting governments to scale up interventions. The six
main recommendations are: Giving every child the best start in life;
Enabling all children, young people and adults to maximize their
capabilities and have control over their lives; Creating fair employment
and good work for all; Ensuring a healthy standard of living for all;
Creating and developing sustainable places and communities;
Strengthening the role and impact of ill-health prevention.
TOTAL RETURNS ON INVESTMENTS:
PAYOFFS PER GB£ 1 EXPENDITURE:
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Early intervention for conduct disorder
Early treatment of depression at work
Screening of alcohol misuse
Suicide prevention training to all GPs
Workplace health promotion
7.9
5.0
11.8
44.0
9.7
(Knapp, McDaid and Parsonage, 2011)
TREATY OF LISBON, ARTICLE 168:
• ”A high level of human protection shall be
ensured in the definition and implementation
of all Union policies and activities.”
”Science can only ascertain what
is, not what should be, and
outside of its domain, value
judgements of all kind remain
necessary”.
(Albert Einstein)
THE ECONOMIC CRISIS IS LIKELY TO:
• Increase inequality, poverty, homelessness, and
social exclusion;
• Increase work intensity, and job insecurity;
• Increase morbidity and mortality;
• Inspire austerity policies that may - but need not further increase such risks, e.g., by decreasing
access to social and health services;
• Have strongly negative effects on productivity,
economic performance - and recovery.
”PANTA RHEI – EVERYTING FLOWS”
• Globalization, technical development, recession, and
recession-related adaptive work restructuring – all
involve change.
• Closure, downsizing, outsourcing, sub-contracting,
layoff, merging, acquisitions – all may, but need not,
lead to unemployment and over employment.
• Their causes, mechanisms and outcomes may all be
powerful stressors - increasing the risk for work- or
unemployment related morbidity and mortality.
GLOBAL EMPLOYMENT TRENDS (ILO, 2013)
• More jobs are destroyed - and fewer created;
• Labour force participation - has fallen drastically;
• Unemployment is increasing: 202 million in 2013, + 39 million who have
dropped out;
• 73.8 million young people are unemployed globally;
• 12.7 young Europeans are Neither Employed nor in Education or Training
(NEETs). - A ”lost generation”?
• Many of the employed experience - vulnerable employment and working
poverty. 397 million workers are ”extremely poor”, and an additional 472
million cannot address their basic needs on a regular basis.
• There is, often, an incoherence between monetary and fiscal policies,
piece-meal approaches, uncertainty about future conditions;
• Skill and occupational mismatches;
• Austerity measures and uncoordinated attempts to promote
competitiveness increase the risk of a deflationary spiral of lower wages,
weaker consumption and faltering global demands.
PSYCHOSOCIAL HAZARDS AT WORK:
• ”The interactions among job content, work
organization and management, and other
environmental and organizational conditions, on
the one hand, and the employee´s competence
and needs on the other” (ILO, 1986).
• ”Aspects of the design and management of work
and its social and organizational contexts that
have the potential for causing psychological or
physical harm” (Cox & Griffiths, 2005).
WORLD HAPPINESS REPORT 2013
Three types of measures: (1) positive emotions, (2)
negative emotions, and (3) evaluations of life as a
whole. ”Happiness” appears twice, once as an
emotional report, and once as part of a life
evaluation.
• 10% of the world´s population suffers from
clinical depression or crippling anxiety disorders.
• There was an obvious detrimental happiness
impact of the 2007-2008 financial crisis.
(Helliwell, Layard & Sachs, eds., 2013)
OCCUPATIONAL HEALTH IN
DEVELOPING COUNTRIES:
• Much emphasis on industrialization.
• Industrial workers now face not only endemic
diseases but also occupational ailments.
• Data from Nigersteel Clinic show that 75% of
all care is spent on endemic rather than
occupational diseases.
• This needs to be considered in training
occupational physicians to practice in Third
World Countries.
(Asogwa, 1981)
UNITED NATIONS DEVELOPMENT
GROUP MESSAGE (2013):
1. respect for rights, justice and reducing
inequalities;
2. One-size-fits-all policies should not be
promoted;
3. Recognize the need for structural transformation
toward more energy-efficient and less carbonemitting sectors;
4. Greater role for the State;
5. The international community should play a key
role.
A GLOBAL CHALLENGE?
• Psychosocial factors include: design and
management of work, and its social and
organisational contexts - with a potential for
causing psychological or physical harm;
• Work-related stress and workplace violence are
associated with cardiovascular, depressive and
musculoskeletal disease;
• Weak epidemiological, but solid circumstantial
evidence at the global level.
(Leka et al., 2010)
ECONOMY, STRESS AND HEALTH
• Numbers do not have any
emotions. Data do not cry.
Economic statistics do not bleed.
• But human beings feel pain. They
get sick. They suffer. They die.
FIFTH EUROPEAN WORKING CONDITIONS SURVEY (EU27)
• Psychosocial dimensions are a decisive factor, and not only in
cases of anxiety or depression.
• High ‘psychological demand’ increases musculoskeletal
diseases among white-collar workers; high ‘skill discretion’
decreases them among all workers, while ‘decision authority’
increases them for both blue-collar and white-collar workers.
• The positive role of rewards emerges as a protective factor
for all health outcomes considered, and also decreases work
accidents among all groups of workers.
• Work accidents – together with musculoskeletal disease –
also show clear associations with many physical hazards, such
as environmental hazards, and awkward working postures.
”Demand-control-support”-model
low DEMAND high
high
CONTROL
low
relaxed
passive
active
high strain
high
SUPPORT
low
(Karasek, Theorell & Johnson)
Lennart Levi
”Effort-Reward-Imbalance”-model
(ERI)
Intrinsic
Overinvolvement
Extrinsic
High
effort
Demands
Low
reward
Salary
Appreciation
Security
Career opportunities
(Johannes Siegrist)
Lennart Levi
FAIRNESS AT WORK
• Social determinants exercise a strong
influence on health and wellbeing;
• Poverty kills;
• So does socio-economic inequality;
• These may be ”the causes of the causes”.
(Marmot, 2013)
ILO CHECKPOINTS FOR DECENT JOBS:
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Leadership and justice at work;
Job demands and workload;
Job control;
Social support;
Physical environment;
Work-life balance and working time;
Recognition at work;
Protection from offensive behavior;
Job security;
Information and communication.
SANTIAGO DECLARATION (2013):
• Consider health, in addition to other impacts, of all policies;
• Coordinate their efforts across sectors, by pro-active,
synergistic strategies;
• Maintain, or even invest in, social welfare, and active labour
market policies;
• Recognise the economic benefits of investment in ”more
and better jobs”;
• Prioritise these investment according to need;
• Ensure access to high quality health services;
• Support relevant research on the human dimensions of the
economic and financial crisis.