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
 Washington driven policies are
making life more stressful
1. International financial market liberalization
2. Trade liberalization (esp. developing countries)
3. Labour market “flexibility”
4. 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 policy
7. Shrinking state
2
Work-related Stress: A 21st Century
Disease
„ Causes of stress include:
ƒ labour intensification
ƒ competitive pressures
ƒ time-squeeze
ƒ rapid technological change
ƒ lack of worker control in jobs
ƒ flexible labour relations (downsizing, contracting out)
> higher injury rates, hazard exposure, disease, work-
related stress

„ Self-regulation weak collective Voice eroded workers’ health

& safety
3
Labour Market Insecurity Leads to Stress
ILO Enterprise and Household surveys show:

„ Hidden unemployment pervasive world wide

„ Barriers to mobility threatening women’s 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

4
Employment Insecurity Leads to Stress
ILO 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

5
 Income Insecurity Leads to Stress
ILO 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 catastrophic
for many

6
 % respondents
A
rg

0
10
20
30
40
50
60
70
80
90
en 100
tin
a
Br
az
il
Ch
ile

Ba
ng
la
de
sh
Ch
in
a
In
di
Income insufficient

In a
do
ne
sia

Et
hi
op
ia
G
ha
Ta na
n
So zan
ut ia
h
Income irregular

A
fri
ca

H
un
ga
ry
Income Insecurity

Ru
ss
ia
U
kr
ai
ne
Could not save

7
 % respondents
A
rg

0
10
20
30
40
50
60
en 70
tin
a
Br
az
il
Ch
ile

Ba
ng
la
de
sh
Income level

Ch
in
a
In
In dia
do
ne
sia

Et
hi
op
ia
G
ha
Ta na
n
Non-wage benefits

So zan
ut ia
h
A
fri
ca

H
un
ga
ry
Ru
ss
i
U a
kr
ai
ne
Income Dissatisfaction

8
 Future Income Insecurity
100
Unsure if can keep job
90
Household income reducing
80 Expect poverty in old age
70
% respondents

60

50

40

30

20

10

ry

U a
a

sh

Ta na

ia
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sia

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ne
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ca

i
tin

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So zan
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Ch

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In
Br

Ru
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kr
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la

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G
do

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Et
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H
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In
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Ba

9
 % respondents
A
rg

0
10
20
30
40
50
60
70
80
90
en 100
tin
a
Br
az
il
Ch
ile

Ba
ng
la
de
sh
Ch
in
a
In
In dia
do
ne
sia

Et
hi
op
ia
G
ha
Ta na
n
So zan
ut ia
h
A
fri
ca

H
un
ga
ry
Ru
ss
i
Outstanding debt

U a
kr
ai
ne
Financial crisis in past
Past Financial Crises & Indebtedness

10
Main Causes of Financial Crisis
Country Urban Rural
Crisis % Crisis %
Bangladesh 1. Medical cost 26.4 1. Medical cost 29.6
2. Business failure 25.5 2. Crop failure 17.8
3. 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 6.5
Ghana 1. Medical cost 38.3 1. Medical cost 41.5
2. Funeral cost 16.9 2. Funeral cost 23.7
3. Children’s education 7.9 3. Children’s 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 31.8 1. Expenditure on social 45.9
opportunities functions/Illness
2. Expenditure on social 30.2 2. Rise in price of essential 29.5
functions/Illness commodities or inputs
3. Loss of work due to illness 16.5 3. Loss of job 14.9
South Africa 1. Death of a household 9.3 n.a. n.a.
member
2. Loss of job/employment 6.5 n.a. n.a.
3. Death of wage-earning 3.6 n.a. n.a.
household member
11
 Socio-Economic Insecurity, Stress
& Disease
„ Systematic understatement of the inequality of workers’
health insecurity (workers’ health information limited,
unreliable)
„ Economic liberalization Ö shift away from statutory regulation
Ö worse working conditions, increased stress, declining
health
„ Flexible labour relations Ö worse working conditions Ö
hazard exposures, work-related stress, disease, injury rates
„ “Time insecurity” is global, magnified by work intensification
management practices, increased commuting time, growing
insecurities
12
 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 which
has 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. »

13
 Causes of Absence from Work
Note: These findings refer to time off due to stress at work or stress outside work
25
Injury
Illness
20 Stress
% respondents

15

10

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14
 Socio-Economic Insecurity, Stress
& 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-related
ILO Enterprise and Household surveys show:
„ Transition countries’ industrial enterprises lack safety
depts./committees Ö workers more vulnerable to occupational
accidents & diseases
„ Over half of workers in Indonesia have no workplace OSH
department/committee
„ The poor report extremely poor working conditions
„ Women more disadvantaged, with less protection than men 15
 % respondents
A
rg

0
10
20
30
40
50
en
60
tin
a
Br
az
il
Ch
ile

Ba
ng
la
de
sh
Ch

Unsafe workplace
in
a
In
In dia
do
ne
sia

Et
hi
op
ia
G
ha
Ta na
n
So zan
ut ia
h
A
fri
ca

H
un
ga
ry
Workplace Safety

Ru
ss
i
U a
kr
ai
ne
No safety committee/department/specialist
16
Socio-Economic Insecurity, Stress
& Disease
ILO Household surveys show:
„ Majority in developing & transitional countries bear costs
work-related accidents/illnesses, no benefits for incidents (least
able to afford it)
„ Sick/injured workers work without taking leave (fear income
or 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, & casual
workers least likely to have insurance against work accidents
or injury 17
 % respondents
A
rg

0
10
20
30
40
50
60
70
80
en 90
tin
a
Br
az
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Ch
ile

Ba
ng
la
de
sh
Ch
in
a
In
di
In a
do
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sia

Et
hi
op
ia
G
Ill health

ha
Ta na
n
So zan
ut ia
h
A
fri
ca

H
un
ga
ry
Lack of Healthcare

Ru
ss
i
U a
No access to adequate healthcare
Income insufficient for healthcare

kr
ai
ne
18
 Socio-Economic Insecurity, Stress
& Disease
ILO Enterprise and Household surveys show:
„ Social support based on informal networks are
buffers during economic shocks
„ Informal networks: the glue holding people together
during 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?
19
Rely on Whom During Crisis
Country Urban Rural
Whom % Whom %
Bangladesh 1. Relatives 66.9 1. Family/siblings/relatives 53.4
2. Friends/neighbours 18.6 2. Moneylender 20.8
3. 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 15.6
Indonesia 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 44.1
2. 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.

20
 (Lack of) Social Support
100
Not union member at work
90
Negative attitude to trade union
80
Trust management to look after
70 workers' welfare
% respondents

60

50

40

30

20

10

ry

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Ta na
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21
 Gendered Disadvantages
100
Discrimination against women at work
90 Loosing job due to pregnancy
80 Not entitled to maternity leave

70
% respondents

60

50

40

30

20

10

ry

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a

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Ta na
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22
 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% women
workers in Bangladesh, 1 in 5 female workers in China
suffering effects of harassment)
„ Women experience more than men
„ Harassment from managers & authorities Ö
stress
„ Most countries lack policies to deal with
harassment at work 23
 Lack of social protection combined
with globalized economic trends
causes life to become very stressful,
rife with increasing
insecurities. 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 the
workplace
24
 Coping with the Challenges
„ Economic security is crucial to counter current trends
„ Basic income security plus «Voice » representation
security needed to provide economic security
„ Strengthen collective voice to stop work intensification
and self-destruction from overwork
„ Understand the differential aspects of stress
„ Universalistic policies for redistribution and access to
social protections without means testing and targeted
benefits
„ Strengthen social support
„ Strong voice representation associated with strong
protection of workers’ health
„ Proof: Zebras don’t get ulcers! (Sapolsky, 1994)
25
THANK YOU

26