MarnieDobson,Ph.D.Center for Occupat ional andEnvironmental Health,

Univers ity of Cal i fornia, I rv ine

OHPSummer Inst i tute , OregonHea l th Workforce Center Ju ly 10 , 2018

AdvancingtheHealthyWorkCampaignDisseminatingworkstresseducationandpreventionstrategies.

BACKGROUND:CenterforSocialEpidemiologyCSEisaprivatenon-profitfoundationestablishedin1988…topromotepublicawarenessoftheroleofoccupational/workstressintheetiologyofpsychologicaldisordersandcardiovasculardisease.

à Collaborationwithotherresearchinstitutions/researchersonmajoroccupationalhealthstudies.

àWebsite(unhealthywork.org):translationanddisseminationof40+yearsofscientificevidence(longitudinalstudies,reviews/meta-analyses,interventionstudies)oftherelationshipbetweenworkorganization/psychosocialworkstressorsandchronicillness,healthandwell-beingofworkingpeople.

à “WorkingonEmpty”(workingonempty.org)isinnovativefilmprojectbegunin2016

à Developingthe “HealthyWorkCampaign”(2017-2018)

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Translation/DisseminationandtheHWC

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Characteristicsofthetranslationalframeworkforpublichealthresearch(Oglivie etal2009)

• Redefinestheendpointfromthatofinstitutionalising effectiveinterventionstothatofimprovingpopulationhealth

• Incorporatestheepidemiologicaltraditionsofpopulationhealthsurveillanceandtheidentificationofmodifiableriskfactors

• Reflectsaspectrumofdeterminantsofhealthfromtheindividualtothecollectivelevelandacorrespondingspectrumoflevelsofintervention

Oglivie,D.etal.Atranslationalframeworkforpublichealthresearch.BMCPublicHealth2009;9:116

HealthyWorkCampaign:MISSIONTheHealthyWorkCampaign(HWC)isapublichealthcampaignthataimstopromote

healthywork andreduceunhealthyworkingconditions intheU.S.àand,thereby, preventandreduceinjuries,chronicillnesses,healthinequalities,

andthecoststoworkers,businessesandsociety.

Reduceharmfulworkstressors.Improvejobqualityandhealth.WWW.HEALTHYWORKCAMPAIGN.ORG

4Healthy Work Campaign in partnership with The Center for Social Epidemiology

HWCGOALS1.EDUCATE Americanworkersandorganizationsaboutunhealthywork,howitmakesworkersill,thecoststoallofus,andwhatsolutionsexisttoachievehealthywork.

2.ASSESSwhetherworkishealthyornotbyidentifyingworkstressorsforindividualworkersandfororganizationsutilizingtheonline “HealthyWorkSurvey.”

3.EQUIPAmericanworkersandorganizationswithtools,sothatindividuallyandcollectively,peoplecanhelptobringaboutpositivechangestotheorganizationandcultureofworkinAmerica.

4.ADVOCATE- provide allstakeholderswithopportunitiestosupportortakeactiontopromotehealthyworkforall.

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WHATIS“HEALTHYWORK”?

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NIOSH:TOTALWORKERHEALTH™(2011)Integrating:HealthPromotionwithHealthProtection(OccupationalHealth)

http://www.cdc.gov/niosh/twh/

WHEREISWORKORGANIZATION(2013)?

http://www.cdc.gov/niosh/twh/totalhealth.html

Mechanisms

What is work organization?(adapted from NIOSH model (2002))

LandsbergisP,etal.OccupationalHealthPsychology(pp.1086-1130).InAnnaD(ed.)TheOccupationalEnvironment(3rded.).AmericanIndustrialHygieneAssociation,2011.

EmploymentConditions

Formal/informaleconomy

Forced/childlabor

Precarious/full-timepermanentemployment

Unemploymentrate

Laborregulations

Unionizationofworkforce

OrganizationalFactors

Downsizing,outsourcing,privatizationofpublicservices

Subcontracting/temporarywork

Productionsystems

Safetyculture/climate

Staffinglevels

HRpolicies

Labor-mgmtrelations

Job/Task-SpecificFactors

Physical/chem,biomechanicalhazards

Longhours,shiftwork

Psychosocialstressors:Highdemands+lowcontrolHighefforts+lowrewardsLowsupportJobinsecurityHarassment/discrimination

PhysiologicalSleepInflammatory factorsWork ABP

PsychologicalBurnoutAnxietyDepression

BehavioralSmokingLack of exerciseAlcoholEating behaviors

HealthandCosts

ChronicIllness/Injury

HypertensionCardiovasculardisease

Obesity/DiabetesMusculoskeletaldisorders

Injuries

Productivity/CostsAbsenteeism/SickLeave

PresenteeismDisability

WorkersCompensationHealthCareCosts

Workstressorsplayaroleinchronicillness

• JOBSTRAIN• EFFORT-REWARDIMBALANCE• LONGWORKHOURS• ORGANIZATIONALINJUSTICE• DOWNSIZING• SHIFTWORK

CVD

• JOBSTRAIN• EFFORT-REWARDIMBALANCE• WORK-FAMILYCONFLICT• THREAT-AVOIDANCEVIGILANCE

HYPERTENSION

• JOBSTRAIN• EFFORT-REWARDIMBALANCE• WORK-FAMILYCONFLICT• LONGWORKHOURS• LOWSOCIALSUPPORT• ORGANIZATIONALINJUSTICE• DOWNSIZING

BURNOUT/DEPRESSION

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Schnalletal.IJHS,2016Theorelletal.EurJPubHlth,2016Kivimaki etalLancet2012Kivimaki etalLancet2015Ha&Park.JOH2005

LandsbergisetalAJPH2013Trudel etalOEM2013Gilbert-OuimetJPsychosom Res2011

TheorelletalBMCPubHealth2015SiegristJ.EurArchPsychClinNeurosci 2008

UnhealthyWorkCostsAllofUs

CardiovascularDisease(CVD)remainsthe#1causeofdeathintheUSatnearly801,000deaths/year.

TheAHAstatesthecurrentcostofCVDis$600billionayear.

Andweknowthat10-20%ofannualCVDdeathsarecaused bythewaywework.

(AmericanHeartAssociation,CardiovascularDisease:ACostlyBurdenforAmerica2017;TokyoDeclaration,March2013viathe InternationalJournalofOccupationalMedicineandEnvironmentalHealth,

January 2015, vol. 28)

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CostsofWorkStressors“JobstresscostsUSemployersmorethan$300

billionannually.”

“Morethan120,000deathsperyearareassociatedwithhowU.S.companiesmanageworkers.”- GohandPfefferetal,ManagementScience,

February2016

Infact,differentworkstressorsincludingjobinsecurityandjobcontrol,collectivelyshortenthelivesofAmericans,onaverage,byasmuchasthreeyears.- GohandPfeffer,HealthAffairs,October

2015vol.10

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TheHEALTHYWORKCAMPAIGNandTotalWorkerHealthTM

• NIOSHTotalWorkerHealthnowrecognizesworkasasocialdeterminantofhealth and“acknowledgesriskfactorsrelatedtoworkthatcontributetohealthproblemspreviouslyconsideredunrelatedtowork.”

•TheHWCcouldbeacollaborativepartnertoNIOSH’sTWHprogram– asabroad“publichealth”campaigntoeducateandoutreachtothepublic,industryandlaborunionsabouttheimpactofworkstresscausedbyunhealthyworkorganization,onworkerhealthandwell-being.

•HWCproposesto helpdisseminateTWHCOE’sworkorginterventionresearch,programsandbestpracticestothepublicandotherstakeholders.

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Goal1:HealthyWorkEducationEDUCATE Americanworkersandorganizationsaboutunhealthywork,howitmakesworkersill,thecoststoallofus,andwhatsolutionsexisttoachievehealthywork.HWCuser-friendlyeducationalresourcesinclude:oThePrinciplesofHealthyWorkoHealthyWorkStatistics/InfographicsoWorkingonEmpty filmprojectandMedia

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HealthyWorkCampaignwebsite– UnderConstruction

www.healthyworkcampaign.org

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PrinciplesofHealthyWork

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ØIntendedtoeducatethepublic:ØDefines“HealthyWork”– similartopreviousdefinitions(Karasek’s“GoodJobs,BadJobs,”WHOHealthyWorkplaceFrameworketc.)asthe“opposite”ofcommonworkstressors(demands,control,support,jobsecurityetc.)includingabriefoverviewofpossiblechangestothecultureororganizationofworkthatcouldreduceworkstressors.

Ø TobedesignedasaninteractivegraphiclocatedontheHWCwebsite.

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PrinciplesofHealthyWork– InteractiveGraphic(underconstruction)

Goal1:HealthyWorkEducation,continued

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HealthyWorkStatistics/Infographics

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Goal1:HealthyWorkEducationcontinued…WorkingonEmptyFilmProject&otherMedia

◦ workingonempty.org◦ Cross-platformmedia(videos,Mediumarticles,podcasts)

◦ 11minutevideoteaser◦ Featurelengthdocumentary(inprogress)

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SocialPlatforms

- Facebook- Twitter- Medium.com:“WorkingonEmpty: StoriesfromtheHealthy WorkCampaign"

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HWCGoal2:ASSESSwhetherworkishealthyornotbyidentifyingworkstressorsforindividualworkersandfororganizationsutilizingthe“HealthyWorkSurvey.”

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TheHealthyWorkSurveyØ PURPOSE:toeducateworkersandorganizationsbyidentifyingworkstressorsusingastandardized,validatedonlinesurveyà intendedtosupportworkplacechange.

Ø CurrentlyindevelopmentbytheCenterforSocialEpidemiologyandpartners,Dr.BongKyooChoi(COEH,UniversityofCalifornia,Irvine),Dr.PaulLandsbergis(SchoolofPublicHealth,SUNYDownstate)

Ø Collectinginternationalexamplesofnationalworkplacesurveysà oftenpartofnationalsurveillancesystems/regulationsin:Columbia,Mexico,Taiwan,Korea,Japan(StressCheck),Europeancountries(COPSOQ),Canada(stressassess.ca)àfuturepublication:

vInternationalcomparisonofnationalworkorganizationalriskassessmenttoolsinsevencountries(UnitedKingdom,Canada,SouthKorea,Spain,Mexico,Colombia,andChile)ChoiB,Garcia-RivasJ,LandsbergisP,DobsonM,SchnallP,BakerD,ChangSJ,KoSB,Juarez-GarciaA,Gomez-OrtizV(CollaborationwiththeICOH-WOPSscientificcommittee)PresentedatAdvancesinTWHSymposium,May2018

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StressAssessØCanadianOccupationalHealthClinicsforOntarioWorkers(OHCOW)developedanonlinesurveytoolforindividualsandorganizationsbasedontheCOPSOQØMeasures:demands,control,support,jobinsecurity,work-lifeetc.ØCurrentlyscoresarebeingcomparedtoaDanishpopulation,butcolleaguesaredevelopingaCanadiannationallyrepresentativedataset.ØWewillusethisonourHWCwebsiteuntilaU.S.basedonlinesurveyisdeveloped.

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www.Stressassess.ca

Creatingashort,validquestionnaireforworkorganizationriskassessmentforUSworkers…

� BasedontheNIOSHQWLquestionnairehttps://www.cdc.gov/niosh/topics/stress/qwlquest.htmloEnablingcomparisontonationalstatisticso63itemsfor34scalesaboutjob-levelandorganizationallevelworkingconditions,includingmajorworkstressors(demands,control,support,work-lifeetc.)

� Basedoncommon,coreandvalidQWLquestionso IdentifyingcommoncoreQWLitemsthathavebeenusedacrossallormostGSS-QWL

surveys(2002,2006,2010,2014,and2018)o TestingthevalidityofthecommoncoreQWLitems/scales(constructvalidity,

predictivevalidity,andDIF/DEFanalyses)

� Addingmorekeyitemsformissingdomains� Ashorterquestionnaire:≤35itemsoAcceptabletomanyTWH-basedprojects/businessesoAcceptabletoseveralnationalsurveys,includingNHIS

HWCGoal3:EQUIPAmericanworkersandorganizationswithtools,sothatindividuallyandcollectively,peoplecanbringaboutpositivechangestotheorganizationandcultureofworkinAmerica.

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TheHealthyWorktoolkitPurpose:Todisseminateevidenced-basedinterventionresearchandcaseexamplestoorganizations/individualswhocompletetheHWSorwhoareinterestedinworkorganizationchange.

o ORGANIZATIONS- Onlinetoolkitforbusinesses,unions/workerorganizationsandothersincludingevidenced-basedstrategiesandprograms thatpromotehealthywork,reduceworkstressorstoimprovehealthandproductivity.

oINDIVIDUALS- Onlinetoolkitforworkingpeoplewhichincludes:someresourcesrelatedtomanagingworkstress,butALSOex.ofcollectiveways workergroups(collectives,unions,employeeownedbusinesses)havechallengedstressfulandtoxicworkenvironmentsExamples:

o NationalDomesticWorkersAllianceo WorkersLab– RestaurantWorkersOpportunitiesCentersUnitedo Fightfor$15o UnitedStatesFederationofWorkerCooperativeso WorkplaceBullyingInstituteo AFL-CIO

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HealthyWorktoolkitcont.oHWCToolspageswillincludelinks/summariestovaryingexamplesofsuccessful“interventions”byworkstressorscategories:Improving:

ØWorkload/demandsØEmployeeparticipation/jobcontrolØWork-lifebalanceØSupport/leadershipØJustice/respectanddignity/workclimateØLongworkhours/scheduleØShiftworkØPrecariouswork

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HealthyWorktoolkitcont…CURRENTLY- Usingadatabase tocollect:1. Bestpracticesinprocess-orientedtools(e.g.NIOSHTWH/CPHNEW“Healthy

WorkplaceParticipatoryProgram– providingorganizationslinks,ILOsStressPreventionChecklist)

2. Evidenced-basedinterventionstudies -effectivelyreducedworkstressors,improvedworkorgandhealth.

3. Caseex.ofworkers/NGOs organizingtoimprovework(e.g.reducingon-call-scheduling,collectivebargainingworkloadreductions)

4. Stateandnationallegislativeex - promotehealthywork(e.g.nurse-patientstaffratios,anti-bullyingbills)

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HWCGoal4:AdvocateProvideallstakeholderswithopportunitiestosupportortakeactiontopromotehealthyworkforall.

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AdvocateforHealthyWork Agenda for Healthy Work in America

Ø Spreadthemessagethatifwewanthealthypeople,weneedhealthywork.

Ø Changethecultureofwork inAmerica.

Ø Changetheorganizationofwork inAmerica.

Ø StrengthenAmericanworkers’voice&laborpowertocreatehealthywork.

Ø Supporttheenforcementofexistinghealthandsafetyregulationsandanexpansiontoinclude“healthywork”guidelines.

1. “HealthyWorkAgenda”– outlinesactionstepsforindividualsororganizationstopromote“healthywork”à

2. “ShareYourStory”form– allowsworkingpeopletowriteabouttheir(un)healthyworkexperiences.

3. “JointheMovement”– andreceiveournewsletter.

4. “BecomeaPartner”– allowsorganizationsandotherinterestedgroupstojointhe#healthyworkmovementinvariouscapacities.

5. Buildsupportfordeveloping“HealthyWork/WorkStressPrevention”guidelinesfortheU.S.

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TheHWCTeamPeterSchnallMD,MPH – HWCExecutiveDirector

MarnieDobsonZimmerman,PhD - HWCCo-ExecutiveDirector (Research)

PaulLandsbergis,PhD,MPH- HWCResearchAssociate,PIHealthyWorkSolutionsToolkit

BongKyooChoi,Sc.D.,MPH– HWCResearchAssociate,PIHealthyWorkSurveydevelopment

EllenRosskam,PhD,MPH - HWCResearchAssociate

CassBen-Levi,MA – HWCDevelopment/GrantWriter&ContinuingEducationConsultant

DonaldGoldmacher, MD - HWCSupervisingMediaProducer

MariaDoctor,BA - HWCManager&MediaAssociateProducer

IndigoImpact - HWCImpactManager– campaignstrategy,engagement,audiencebuilding,andoutreach

AmyTurner – HWCWebsiteandOnlineToolsDesigneranddeveloper

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WorkingonEmptyINTRODUCTIONTOTHEWOEVIDEOTEASER

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Discussion1. WhatwerethemostcompellingpartsoftheWorkingonEmpty

teaser?2. Whatareascouldbeemphasizedfurtherinafeature-length

documentaryfilm?3. HowcouldyouusetheHWCincludingtheWOEfilmasaresource

foryou,yourworkplaceororganization?

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WHATYOUCANDOTOHELP?1.SUBSCRIBE toournewsletter.https://goo.gl/forms/uwuJM81P0aRMcYSO2

2.FOLLOWUS onsocialmedia.Facebook:workingonemptyTwitter:@workingonempty #healthyworkMedium.com: @workingonempty

3.SHAREYOURSTORY:Useour"ShareYourStory"formorshareitwithfriends&colleaguesforwork-relatedstories.https://goo.gl/forms/ggV77cMhj5peivy12

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Thankyouforyourtime.

Nowit'stimefor#healthywork!

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