Weds 11 Rosskam

8/14/2019 Weds 11 Rosskam

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Work-Related Stress:A 21st Century Global

Disease

Ellen Rosskam, Ph.D., MPH

Senior Work Security Specialist

International Labour Office, Geneva

Fourth Conference on Work Environment and CardioVascular Disease,

Newport Beach, CA., March 10, 2005


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Washington driven policies aremaking life more stressful

1. International financial market liberalization

2. Trade liberalization (esp. developing countries)

3. Labour market flexibility4. Reduction of public sector

5. Social safety net approach to social protection(more selectivity of who gets benefits)

6. Liberalization and privatization of social

protection and social policy7. Shrinking state


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Work-related Stress: A 21st

CenturyDisease

Causes of stress includeCauses of stress include: labour intensification competitive pressures

time-squeeze

rapid technological change

lack of worker control in jobs

flexible labour relations (downsizing, contracting out)

higher injury rates, hazard exposure, disease, work-related stress

SelfSelf--regulationregulation weak collective Voice eroded workers health& safety


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Labour Market Insecurity Leads to Stress

ILO Enterprise and Household surveys show:

Hidden unemployment pervasive world wide

Barriers to mobility threatening womens labour

market security Employment growth rate cannot accommodate

population growth rate

Labour Market Insecurity:a feature of globalization Agricultural share of employment share declining De-industrialization People forced to migrate for jobs


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Employment Insecurity Leads to StressILO Enterprise and Household surveys show:

Global economy being informalized

Non-wage work spreading

Widening income differences between men &women, and younger & older workers

Large informal economy & informal support

networks act as buffer during economic shocks Formal, individualistic labour markets cause

devastating consequences


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Income Insecurity Leads to StressILO Enterprise and Household surveys show:

Disability of saving: global problem, prohibiting

families to solve emergencies on own. Result:

financial crisis and indebtedness

Inadequate income for healthcare

Prospects of old age well-being are catastrophicfor many


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Income Insecurity

0

10

20

30

40

50

60

70

80

90

100

%r

espondents

Argentin

a

Brazil

Chile

Bang

ladesh

China

India

Indones

ia

Ethiop

ia

Ghana

Tanzan

ia

South

Africa

Hunga

ry

Russia

Ukrain

e

Income insufficient Income irregular Could not save


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Income Dissatisfaction

0

10

20

30

40

50

60

70

%r

espondents

Argentin

a

Brazil

Chile

Bang

ladesh

Chin

a

India

Indones

ia

Ethiop

ia

Ghan

a

Tanzan

ia

South

Africa

Hunga

ry

Russia

Ukrain

e

Income level Non-wage benefits


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Future Income Insecurity

0

10

20

30

40

50

60

70

80

90

100

%r

esponde

nts

Argentin

a

Brazil

Chile

Bang

ladesh

Chin

a

India

Indones

ia

Ethiop

ia

Ghan

a

Tanzan

ia

South

Afric

a

Hunga

ry

Russia

Ukrain

e

Unsure if can keep job

Household income reducing

Expect poverty in old age


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Past Financial Crises & Indebtedness

0

10

20

30

40

50

60

70

80

90

100

%r

esponde

nts

Argentin

a

Brazil

Chile

Bang

ladesh

Chin

a

India

Indones

ia

Ethiop

ia

Ghan

a

Tanzan

ia

South

Africa

Hunga

ry

Russia

Ukrain

e

Financial crisis in past

Outstanding debt


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Main Causes of Financial CrisisCountry Urban Rural

Crisis % Crisis %

Bangladesh 1. Medical cost 26.4 1. Medical cost 29.6

2. Business failure 25.5 2. Crop failure 17.83. Loss of job 17.9 3. Marriage cost 12.6

Ethiopia 1. Commodity prices 24.0 1. Crop failure 28.8

2. Cost of medicine 9.1 2. Commodity prices 16.3

3. Loss of work illness 8.6 3. Cost of medicine 10.0

Indonesia 1. Cost of medicine 32.7 1. Cost of medicine 33.2

2. Loss of job 13.3 2. Crop failure 18.3

3. Crop failure 11.1 3. Commodity prices 6.5Ghana 1. Medical cost 38.3 1. Medical cost 41.5

2. Funeral cost 16.9 2. Funeral cost 23.7

3. Childrens education 7.9 3. Childrens education 4.8

Tanzania 1. Medical cost 22.1 1. Crop failure 32.3

2. Business failure 15.1 2. Natural disaster 17.2

3. Natural disaster 11.6 3. Medical cost 14.0

India 1. Loss of job/employment

opportunities

31.8 1. Expenditure on social

functions/Illness

45.9

2. Expenditure on social

functions/Illness

30.2 2. Rise in price of essential

commodities or inputs

29.5

3. Loss of work due to illness 16.5 3. Loss of job 14.9

South Africa 1. Death of a household

member

9.3 n.a. n.a.

2. Loss of job/employment 6.5 n.a. n.a.

3. Death of wage-earning

household member

3.6 n.a. n.a.


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Socio-Economic Insecurity, Stress

& Disease

Systematic understatement of the inequality of workershealth insecurity (workers health information limited,unreliable)

Economic liberalization

shift away from statutory regulation worse working conditions, increased stress, declininghealth

Flexible labour relations worse working conditionshazard exposures, work-related stress, disease, injury rates

Time insecurity is global, magnified by work intensification

management practices, increased commuting time, growinginsecurities


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Socio-Economic Insecurity, Stress& Disease

Aptly captured by Karasek (2005):

Beyond material deprivation, there seems to be a

new possibilty of creating a low social class whichhas few possibilities of social control and yet faces

heavy demands, which faces a broad range of new

debilitations particularly as a consequence of our

economic system: a third explanation of the adverse

social gradient in health.


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Causes of Absence from WorkNote: These findings refer to time off due to stressat work or stressoutside work

0

5

10

15

20

25

%r

esponden

ts

Argenti

na

Brazil

Chile

Bang

ladesh

China

India

Indones

ia

Ethiop

ia

Ghana

Tanzan

ia

South

Africa

Hunga

ry

Russia

Ukraine

InjuryIllness

Stress


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& Disease Globally heart attacks, suicide, strokes expected to be top

occupational diseases of 21st

century (stress) Globally depression impt. cause premature death/disability

(WHO, 2001) incl. death from overwork (karoshi) (Hazards, 2003)

much of which is stress-relatedILO Enterprise and Household surveys show:

Transition countries industrial enterprises lack safety

depts./committees workers more vulnerable to occupationalaccidents & diseases

Over half of workers in Indonesia have no workplace OSH

department/committee The poor report extremely poor working conditions

Women more disadvanta ed with less rotection than men


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Workplace Safety

0

10

20

30

40

50

60

%r

espon

dents

Arge

ntina

Braz

ilCh

ile

B

angla

desh

China

India

Indo

nesia

Ethio

pia

Ghan

a

Tanz

ania

So

uthAfri

ca

Hung

ary

Russi

a

Ukrai

ne

Unsafe workplace No safety committee/department/specialist


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ILO Household surveys show:

Majority in developing & transitional countries bear costswork-related accidents/illnesses, no benefits for incidents (leastable to afford it)

Sick/injured workers work without taking leave (fear incomeor job loss) (Increased Presenteeism)

Majority families surveyed in Africa & Eastern Europe have

difficulty paying for basic health care

88% of families in Ukraine

60% in Ghana and Ethiopia

Workers in African countries, rural women workers, & casualworkers least likely to have insurance against work accidents

or injury


& Disease


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Lack of Healthcare

0

10

20

30

40

50

60

70

80

90

%r

esponde

nts

Argenti

na

Brazil

Chile

Bang

ladesh

China

Ind

ia

Indone

sia

Ethiop

ia

Ghana

Tanzan

ia

South

Africa

Hungary

Russia

Ukraine

Ill health

No access to adequate healthcare

Income insufficient for healthcare


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& DiseaseILO Enterprise and Household surveys show:

Social support based on informal networks arebuffers during economic shocks

Informal networks: the glue holding people togetherduring increasing insecurity

But: Informal systems declining in developing countries

Many workers have no access to such networks

Informal networks are culture-bound Who can give when more have less?


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Rely on Whom During CrisisCountry Urban Rural

Whom % Whom %

Bangladesh 1. Relatives 66.9 1. Family/siblings/relatives 53.4

2. Friends/neighbours 18.6 2. Moneylender 20.83. Moneylender 4.6 3. Bank 13.1

Ethiopia 1. Friends/neighbours 25.7 1. Family/siblings/relatives 21.7

2. Relatives 19.2 2. Friends /neighbours 20.8

3. Officials/government 5.2 3. Officials/government 11.3

Russia 1. Support from relatives 34.0 1. Support from relatives 33.2

2. Other household members 18.8 2. Social payment from State 20.8

3. Social payment from state 14.8 3. Other household members 15.6Indonesia 1. Relatives 61.9 1. Relatives 61.2

2. Friends/neighbours 21.0 2. Friends/neighbours 27.0

3. Employer 4.3 3. Bank 2.1

Ghana 1. Friends/neighbours 35.3 1. Friends/neighbours 41.8

2. Land or asset sales 25.9 2. Land or asset sales 25.7

3. Money lenders 2.9 3. Money lenders 2.5

Tanzania 1. Relatives 50.3 1. Relatives 44.12. Friends/neighbours 30.9 2. Friends/neighbours 33.5

3. Employer 3.4 3. n.a. n.a.

India 1. Relatives 66.1 1. Relatives 72.5

2. Friends/neighbours/mayor 12.8 2. Bank 16.0

3. Bank 6.2 3. Friends/neighbours/mayor 4.8

South Africa 1. Friends/neighbours 21.2 n.a. n.a.

2. Bank 20.9 n.a. n.a.

3. Employer 3.8 n.a. n.a.


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(Lack of) Social Support

0

10

20

30

40

50

60

70

80

90

100

%r

esponde

nts

Argent

ina

Brazil

Chile

Banglade

sh

China

India

Indone

sia

Ethiopia

Ghana

Tanza

nia

South

Africa

Hungary

Russia

Ukraine

Not union member at work

Negative attitude to trade union

Trust management to look afterworkers' welfare


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Gendered Disadvantages

0

10

20

30

40

50

60

70

80

90

100

%r

espondents

Argent

ina

Brazil

Chile

Banglade

sh

China

India

Indone

sia

Ethiopia

Ghana

Tanza

nia

South

Africa

Hungary

Russia

Ukraine

Discrimination against women at work

Loosing job due to pregnancyNot entitled to maternity leave


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Harassment:Important Cause of Stress

ILO Enterprise and Household surveys show: Harassment (physical, sexual, psychological) causes

stress & ill health esp. among women workers

(19% women wage workers in Tanzania, 11% womenworkers in Bangladesh, 1 in 5 female workers in China

suffering effects of harassment)

Women experience more than men Harassment from managers & authorities

stress

Most countries lack policies to deal withharassment at work


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Lack of social protection combinedwith globalized economic trends

causes life to become very stressful,

rife with increasinginsecurities. Work-related stress and

ill health became global sicknesses.

A Rights-Based Approach to Workers Health is

needed a move toward the recognition of workers

knowledge and need for their full participation in theworkplace


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Coping with the Challenges Economic security is crucial to counter current trends

Basic income security plus Voice representationsecurity needed to provide economic security

Strengthen collective voice to stop work intensificationand self-destruction from overwork

Understand the differential aspects of stress

Universalistic policies for redistribution and access tosocial protections without means testing and targeted

benefits Strengthen social support

Strong voice representation associated with strong

protection of workers health Proof: Zebras dont get ulcers! (Sapolsky, 1994)


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THANK YOU

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