Stressful problems at work are more strongly linked to health complaints than even personal or financial problems, according to one survey. Early signs of those health effects can include symptoms such as headache and difficulty concentrating (www.cdc.gov/niosh). But to better understand why a person experiences job stress, workplace expert Mark Cullen says the elements of the job itself need to be examined. And that greater insight may enable a person to better protect one’s health.
A physician, Cullen has been instrumental in developing occupational and environmental medicine as a medical subspecialty. Over his career, his research interests have included work organization and occupational injury and disease. Cullen is chief of the Division of General Medical Disciplines at Stanford University School of Medicine.
Q: What jobs and/or fields have the highest stress levels?
A: To look at the stress of a job, you have to dissect it into various attributes, and three are pretty critical. One is demand or how much of a load there is. Another axis is how much control an individual has in managing that load, and the third is how well the person is rewarded, relative to their expectations. For example, although an executive has a higher workload as compared to a factory line operator, the executive has an incredible amount of control over that work, and is well rewarded. This leads to a much more healthful environment as compared to people who have less demands but no control and poor reward. The highest stress jobs are not unique to any one segment of the economy, but include lots of retail jobs, and typically floor jobs in which employers tether demand to reward, thereby severely reducing control.
In many fields, people attempting to reduce work stress have approached one axis and left the others alone, and failed. For example, in trying to reduce medical errors associated with (excessive) intern and resident work hours, the medical establishment reduced the number of hours worked but did not touch control or the poor reward. Paradoxically, reducing work hours and forcing them to leave before everything was done to their satisfaction caused more stress. And, of course, no one considered changing the job rewards. Some people think the reward axis is of small consequence, but I’m not one of them.
Q: How does stress manifest itself physically in the short-term and in the long-term?
A: In the short-term, people have difficulties with certain aspects of common life function. (Work stress) creates anxiety, interferes with the way people eat — often encouraging them to eat comfort food — and with sleep patterns often resulting in cycles of terrible fatigue, and may affect GI (gastrointestinal) function. Those are the most common, and although none of them are directly life threatening, all of them are life ruining. And many do, in fact, eventually add up to long-term health issues.
With people in the lose-lose-lose categories (relative to demand, control and pay), you tend to see higher rates of chronic disease in these occupations. These are people who are at risk for obesity, diabetes, cardiovascular disease, hypertension, long-term chronic consequences and higher mortality.
Q: How has the nature of stress in the workplace changed over the past several decades?
A: Far and away the most important is the changing of the work order. When I was growing up in the ’50s and ’60s in the post-war era, it was mostly men who went out and worked during the workday, and mom stayed home and cooked dinner. Many people did one job for many years in someone else’s workplace with a high level of security and mutual understanding. Today less than a quarter of the workforce work at jobs that are the same in all those ways. Now people are self-employed, partially employed, changing jobs frequently, working shifts, or working at home a portion of the time. There is a robust literature looking at the consequences of these workplace changes from a health standpoint.
Q: What do you recommend to decrease workplace-related stress?
A: There are two totally different components — individual and societal. I think the unrest in our society is not just due to unemployment, but also to the vast insecurity about work and its future. As terrible as the Great Recession was, in which 8 to 10 million people lost their jobs, 200,000 million people got nervous, real nervous. So the biggest question is, how do we return to some civil society in which people have security that there will be work, and they can be productive?
But, individually, the biggest step most people can take is to become their own advocates. To do their own job analysis and to think about what parts of their job — the demands, the control over their job and the rewards — are amenable to change. For example, people who have trouble sleeping should give some thought to ways in which they can protect their sleep, even if they can’t change some aspects of their work. Or you can decide that after 8 p.m. at night, your computer is staying off and people in your environment will learn that if they need you in an emergency, there’s always the telephone. Many of us can exercise more control and leverage over our work than we realize. If people dissect these components of their job, many people can actually make the current situation much more compatible with day-to-day good health.