Who's to Blame for Job Strain?

Your boss? Genetics? Maybe it's your work culture.

The American Heart Association estimates hypertension, or high blood pressure, affects about 73 million people ages 20 and older. In 2004, according to AHA, high blood pressure was the cause of death for 54,707 people in the United States.

Recent ongoing research suggests that hypertension is a relatively new problem that has only recently emerged in industrialized societies. Dr.Peter Schnall, MPH, director of the Center for Social Epidemiology, says when societies were largely agricultural, hypertension was virtually nonexistent. The emergence of hypertension and other coronary disease risk factors coincides with industrialization in countries around the world, Schnall adds. This posed a question to researchers: “What is it about an industrialized society that may be contributing to high blood pressure?”

To find the answer, Schnall, who is also a clinical professor of medicine at the University of California at Irvine, says researchers have considered many factors of an industrialized culture. “In the last 30 years, the focus has been on trying to figure out why people have hypertension, or high blood pressure,” he says. “The research has focused on aspects of the individual’s genetics, weight, sodium in the diet, obesity, cigarette smoking, and alcohol. None of them have very strong relationship to blood pressure except people’s weight. Weight is important, but it’s obviously not the only factor because there are many people who get hypertension that aren’t overweight, so it’s not an absolutely critical part of the development of hypertension.”

In 1979, Robert Karasek, a sociologist at the University of Massachusetts at Lowell, came up with the concept of the Job Demand Control Model (Figure 1), which showed that job strain occurs in work environments that have lots of demands coupled with little control. Control, Schnall says, is conceptualized by two different components: the ability of workers to learn and use their skills, called skill direction, and the ability to have some say or authority in the work process. When workers don’t have this perceived level of control, job strain is present and hypertension develops. Jobs with high demands and low control can include those in basic manufacturing, the transportation industry, short-order cooks, and salespeople, to name just a few. As an example, Schnall explains that, “In general, people on production lines with low-control jobs are far more likely to have hypertension than managers or executives. Managers and executives have the luxury of being able to take breaks when they want to, of changing their job around, of hiring people to do their work, et cetera. They have much greater skill use and skill utilization. They have much more say over their jobs, and this say buffers the effects of the demands.”

At the other end of the spectrum, but just as dangerous to the health of workers, are passive jobs, shown in the model as having low demand and low control. “That turns out to be a bad combination for other reasons,” Schnall says. “It tends to have a lot of association with mental disorders, with passivity, with burnout. With passive jobs you tend to get demoralized, you tend to get apathetic.”

Surveying the Scene
The first step in tackling job strain and its ensuing hypertension, thereby ensuring the healthiest environment for your workers, is to survey the workforce to find out where there are instances of imbalance, Schnall says. In addition to surveys, employers should screen employees’ blood pressure at work to see where high blood pressure levels cluster and compare the two sets of data.

Previously, researchers studying workers’ blood pressure levels used readings that were taken in a doctor’s office. But non-work blood pressures are weak predictors of heart disease, Schnall says. His research has shown that blood pressure readings taken at the workplace—or work-determined blood pressure readings—are better related to psychosocial stressors such as job strain and give strong indications of future problems, such as the chance of hypertension or stroke. “When you go to a doctor’s office and you shed the stress of work, the blood pressure that is measured there is weakly related to the work organizational factors that we are investigating,” he says. “Unfortunately, the fact that it was believed that blood pressures in the office were reflective of peoples’ blood pressures in the [work] day is one of the reasons why there was so little progress in this field over the last 25 years.”

Once the processes or job functions that cause hypertension have been identified, the employer must start what Schnall calls participatory action research. “That’s where management and working people sit down together, sometimes with a researcher present, and look at the survey data and ask the working people what are the problems in this workplace,” he says. People who experience the stressors “will usually have suggestions on how you can improve things,” he adds.

Some employers might question the accuracy of using an employer survey and then asking those employees to identify problems in the workforce, arguing this will only give employees reason to complain rather than be constructive. But Schnall says the whole reason why jobs can cause job strain is because workers care about the fact that when they have high demands, they are doing a good job. “If they didn’t care, it’s not likely the demands would do anything to their body,” he says. “Demands are only stressful when they’re a perceived threat to the ability to do a decent job, or perhaps a threat to one’s job security.Nonetheless, people are motivated to do well in these various occupations and jobs. Most people are.”

Proactive Solutions
Once the problem areas have been identified, the employer can make some changes. These can involve enhanced skill training, giving workers more say over their work, and collectivizing work as opposed to making it linear. “Have groups work on tasks instead of in a production line. Skill rotation and job rotation are frequently helpful,” says Schnall, although he cautions against establishing a routine, which, despite their best efforts, is the case in many automobile plants. “They rotate people through multiple jobs over the course of a work day, but even though people will spend two hours doing one thing and two hours doing the other, it becomes boring and routine anyhow. Much of the benefit is lost over time in doing that.”

Once employers have done all they can to balance the demands and controls of each work role, their job is not yet done. Steps must be taken to ensure an overall healthy work environment. Judd Allen, Ph.D., president of the Burlington, Vt.-based Human Resources Institute, has devoted his life to helping his clients create supportive cultural environments that not only benefit the individual, but also the organization. To revitalize the work environment, Allen says there are three factors (Figure 2) that play an important role in a person’s well-being and ability to change, as well as the group’s ability to adapt and change. These three factors were first discussed in a 1987 article co-written by Allen and his father, Robert F. Allen, Ph.D. Entitled “A Sense of Community, A Shared Vision and a Positive Culture: Core Enabling Factors in Successful Culture Based Health Promotion,” the article was published in the American Journal of Health Promotion (Vol. 1, No. 3).

Enabling the Workforce
The first factor an organization must ensure is A Shared Vision. In order to determine this, Allen says it is necessary to meet with a cross-section of the employees. “It’s important for the employer to identify some core values or purposes for their culture,” he says. “For example, Dell really has a core value around speed of innovation. Workers really get behind that idea that you have to keep products around the cutting edge of what’s available from a technology standpoint. So, they’ve basically got a culture that is driven by that vision. It’s exciting for people to be able to innovate like that.”

The second factor, Allen says, is A Positive Outlook, which is one in which people are not focused on what’s wrong with one another or with the organization, but rather focused on their strengths. With such an outlook, employees look for opportunities rather than obstacles and for strengths rather than weaknesses in one another. “Instead of having evaluations focus on what’s wrong with people, have evaluations focus on what’s right with people and how they can build on that,” he adds.

However, this doesn’t mean engaging in unrealistic thinking. Instead, employees must recognize that only through the use of their assets and strengths will they overcome their challenges. “The classic business strategy is to focus on our weakness,” he says. “For example, with total quality management, the whole focus has been on the things that we do wrong. This is a different perspective. This is saying what do we do right and how do we build on that to take on what’s left.”

The last factor, A Sense of Community, has to be structured in the way work is organized. “You’re basically trying to create an environment where it’s very welcoming and people know each other, so when somebody makes a mistake, they don’t feel like it’s a big deal— they can work it out,” says Judd, explaining that such an environment allows organizations and individuals to be more adaptable, thus healthier. “Of course, when you are an organization that can’t adjust to anything and is kind of hunkering down, you’re much more susceptible to stress because there are changes that are required all the time. There’s a resilience and a growth factor—resilience in that if you have these qualities, we have found that individuals, in particular an organization as a group of individuals, are less susceptible to breaking down when they’re facing something that is an obstacle.”

Looking Inward
Whatever the approach taken, the key to making your workplace healthier is to involve the employees and seek their input, Schnall stresses. “This whole notion that working people don’t care, as far as I’m concerned, is propaganda; it’s not supported by evidence,” he says. “Most workforces are pretty highly motivated.They become less motivated when they are worn down by bad working conditions over time.Nonetheless, there are whole piles of things that can be done to improve the work environment.”

This article originally appeared in the June 2008 issue of Occupational Health & Safety.

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