Tuesday, April 19, 2011

Interventions in the Workplace to reduce psychosocial stressors

This blog is the first of a series that will address ways to intervene at the workplace to reduce psychosocial stressors and create a healthier workplace. Our colleague Dr. Tores Theorell, who with Dr. Robert Karasek created the Job Strain model (a leading model of workplace psychosocial stress) has been conducting research intended to shed light on improving the workplace. Here is his blog (at the end of the blog is a short list of references for those interested in more information on this topic). Dr. Theorell is Professor Emeritus in Psychosocial Environmental Medicine, Karolinska Institute, Sweden

How do we increase empathic awareness in managers of the importance of
psychosocial environment at work?

I have been involved in research on adverse psychosocial working
conditions and their effects on employee health since the late 1960's. 

There is no doubt that a change in attitude and knowledge among managers
could be of fundamental importance to the improvement of psychosocial
working conditions for workers in the US and in the whole world. Of course
working with the whole organisation may even be better but to start with
the managers could be a good idea. Peter Schnall and others have discussed
this in the book Unhealthy Work. According to their findings many managers
do not know and even more importantly do not seem to see the importance of
psychosocial working conditions to the health of their workers. They are
also unaware of their organisation´s extensive financial costs caused by
unhealthy working conditions. But how to change such attitudes? In our
first experiment which was evaluated using a controlled design (Theorell et
al Psychosomatic Medicine 2001, see above, open access) a good education
program was used lasting for a year. The manager education was mandatory
for all managers in the ”experimental” part of the organisation. They met
every second week at the work place for a short lecture lasting half an
hour and then split up in discussion groups with 7 participants in each.
The two-week period between sessions was used for practical application and
discussions with manager colleagues and other colleagues. Another part of
the organisation with very similar work tasks and organisation served as
control group. Measurements of psychosocial working conditions and morning
plasma cortisol were performed both in the managers themselves and in their
employees in both groups. During the study year, the morning plasma
cortisol decreased in the employees in the experimental group whereas no
change at all was seen in the comparison group. Also the standard measure
of decision authority showed a significantly better development in the
employees in the experimental group. It should be pointed out that a
strength in this study was that the participating managers were all working
in the same organisation and they supported one another during the process.

I would, however, like to bring your attention to a recently published
article from our group which brings up a topic that could be of major
importance to our ways of dealing with psychosocial work environments. This
project will be discussed in the upcoming Work and Stress congress in
Orlando, Florida, in May 2011. It describes an RCT (randomly controlled design)
experiment comparing two manager education programs and their effects on employees.

Participating managers had to accept in advance that they would be
randomized. A three-day course introducing good management principles was
the start for both groups. They were then randomized to two groups.
Managers attending these two different kinds of education lasting for a
year were followed as well as their subordinates (four subordinates for
each manager) with measurements before start, after one year and then after
a follow-up period of 6 months. Sessions of similar length took place
approximately once a month in both groups. A good established manager
education program (very similar to the one used in the previous study) in
this case constituted the “comparison” condition and it was compared with a
program which included exposure to art experiences (poetry “amplified” by
music) designed to evoke discussions regarding choices in ethically
difficult situations. Group discussions and diaries were used very actively
to structure these ethical discussions. Significantly more beneficial
effects on the employees (mental health using standardised questionnaires
and plasma levels of DHEA-s, a hormone with regenerative/anabolic function
as well as plasma cortisol) were observed half a year after the end of the
two programs after the "new" program compared to the "established"
(actually very good) one, indicating (as one would logically think) a
slightly delayed effect of the program on the employee conditions. Season
effects (May compared to follow-up in November) were balanced by the

It is speculated that effects on empathy were more pronounced on the
managers in the new program with artistic components. Our results indicate
that the employees also seem to experience that there is a change in
attitude (more courage and more agreeableness) in their managers compared
to the employees in the other group. The artistic component represents an
educational principle to be tested in other manager education programs.
However such programs have to be carefully adapted to specific
circumstances. They could perhaps be used as a supplement to other
education. In the comparison between the two programs it should be
mentioned that in the second study the participating managers were “loners”
in the sense that they did not come from one and the same organisation and
accordingly they did not have support from colleagues in the process. This
may be less important in the artistic program in which more individual
effects were likely to arise.

Psychother Psychosom 2011;80:78–87 DOI: 10.1159/000321557 (open access):
Health Effects on Leaders and Co-Workers of an Art-Based Leadership Development Program
Julia Romanowska, Gerry Larsson, Maria Eriksson, Britt-Maj Wikström, Hugo
Westerlund and Töres Theorell, Department of Public Health Sciences, Karolinska Institutet, Stress Research Institute, Stockholm University, Department of Leadership and Management, Swedish National Defense College, Stockholm , Sweden, and Akershus University College, Faculty of Health, Nutrition and Management, Oslo , Norway

Some of our more recent publications are the following:

Theorell, T., Emdad, R., Arnetz, B. and Weingarten, A-M. Employee effects
of an educational program for managers at an insurance company.
Psychosomatic Medicine, 63: 724-733, 2001.

Theorell, T., Oxenstierna, G., Westerlund, H., Ferrie. J., Hagberg, J. and Alfredsson, L. Downsizing of staff is associated with lowered medically certified sick leave in female employees. OEM 60: e9, 2003.

Theorell, T. Democracy at work and its relationship to health. In:
Research in Occupational Stress and Well being.  Emotional and
Physiological Processes and positive intervention strategies. Eds. Perrewé, M.L. and Ganster, D.C. Elsevier, vol 3, 323-357, 2004.

Liljeholm Johansson, Y. and Theorell, T. Satisfaction with work task
quality correlates with employee health. A study of 12 professional
orchestras. Medical Problems of Performing Artists. 18; 141-149, 2003.

Kivimäki, M., Theorell, T., Westerlund, H., Vahtera, J. and Alfredsson, L. Job strain and ischaemic disease: does the inclusion of older employees in the cohort dilute the association? The WOLF Stockholm Study. J Epidemiol Health. 62; 372-374, 2008.

Theorell T. Psychosocial factors in research on work conditions and health in Sweden. Scand J Work Environ Health. 2007;33 Suppl 1:20-6. No abstract available. PMID: 18389569

Hanson, L., Theorell, T., Oxenstierna, G., Hyde, M. and Westerlund, H.
Demand, control and social climate as predictors of emotional exhaustion
symptoms in working Swedish men and women. Scand J Public Health. 36(7),
737-43, 2008

Hagerman, I., Rasmanis, G., Blomkvist, V., Ulrich, R. And Theorell, T.
Influence of intensive coronary care acoustics on the quality of care and
physiological state of patients. J Acoust Soc Am. 123(5); 3094, 2008.

Nyberg, A., Westerlund, H., Magnusson Hanson, L., & Theorell, T.
Managerial leadership is associated with self-reported sickness absence and sickness presenteeism among Swedish men and women. Scand J Publ Health. 26; 803-811, 2008.

Nyberg, A., Alfredsson, L., Theorell, T., Westerlund, H., Vahtera, J. and
Kivimäki, M. Managerial leadership and ischaemic heart disease among
employees: the Swedish WOLF study. Occup Environ Med. 66;1, 51-55, 2009.

Magnusson Hansson, LL., Theorell, T., Bech, P., Rugulies, R., Burr, H.,
Hyde, M., Oxenstierna, G. and Westerlund, H. Psychosocial working
conditions and depressive symptoms among Swedish employees. Int. Arch.
Occup Environ Health. 82; 951-960, 2009 2009.

Theorell, T. Anabolism and catabolism. In: Research in occupational stress
and wellbeing, vol 7. Current perspectives on job-stress recovery. Eds.
Sonnentag, S., Perrewé, P.L., and Ganster, D.C. pp 249-276, 2009.

Hasson D, Theorell T, Liljeholm-Johansson Y, Canlon B. Psychosocial and
physiological correlates of self-reported hearing problems in male and
female musicians in symphony orchestras. Int J Psychophysiol. 74; 93-100,

Theorell, T., Andreeva, E., Leineweber, C., Hanson Magnusson, L.,
Oxenstierna, G., and Westerlund, H. Restructuring and employee health. 5th Int. Vilnius Conf., EURO Mini Conference, Sept 30 – Oct 3, 2009, Vilnius, Lithuania.

Leineweber, C., Westerlund, H., Theorell, T., Kivimäki, M., Westerholm, P. and Alfredsson, L. Covert coping with unfair treatment at work and risk of incident myocardial infarction and cardiac death among men: prospective cohort study. 2011 May;65(5):420-5. Epub 2009 Nov 24

Theorell, T., Bernin, P., Nyberg, A., Oxenstierna, G., Romanowska, J. and
Westerlund, H. Leadership and employment health. A challenge in the
contemporary workplace. In: Contemporary Occupational Health Psychology.
Global perspectives on research and practice. Vol 1. Ed. Houdmont, J. And
Leka, S. Wiley-Blackwell. J Wiley & Sons. 46-58, 2010.

Sunday, April 10, 2011

Where Swedish Capitalists go for CHEAP labor

I didn't know whether to laugh or cry as i read a story today from the front page of the Los Angeles Times about Ikea. Hats off to Nathaniel Popper for this story and to the Times for publishing it.

Of course, outsourcing to foreign countries to find the least expensive labor is not news. As my readers undoubtedly know U.S. companies, among others, have been moving capital to places like China for several decades where workers are paid extremely low wages to manufacture goods for both the U.S. public and other populations. A good book on this subject which I highly recommend is Alan Tonelson's "The Race to the Bottom" Westview Press 2002 which documents this process in detail and the negative consequences for labor forces in both the "developed" and "developing" nations of the world.

But i digress. Ikea, a famous Swedish company, which is the subject of this blog, has a long well-standing reputation as a good employer with high standards of employment. Its workforce in Sweden is entirely unionized and there is even a code of conduct know as IWAY which guarantees workers the right to organize and stipulates that all overtime be voluntary. In fact, in 2008 Ikea had the third highest reputation as a good company (right after Toyota and Google (of course, Toyota is no longer #1 but that's a blog for another day)) in the world according to Reputation Institute's Global Pulse 2008 (this reputation is built on 7 pillars from which a company can create a strategic platform for communicating with its stakeholders on the most relevant key performance indicators. These dimensions are: Products/Services, Innovation, Workplace, Citizenship, Governance, Leadership, and Performance).  Ikea pays its workers in Sweden a minimum wage of $19/hr and a government mandated five weeks of paid vacation. No wonder they have a good reputation. 

So what's the problem. It turns out that Ikea opened an enormous assembly plant in the U.S. in Danville, Va in 2008 with incentives from the state of Virginia in the amount of $12 million. And now, surprise-surprise, there are labor problems with complaints of racial discrimination, a union organizing campaign that is being fiercely opposed by management, and high levels of turnover from among the new employees who are complaining of eliminated raises, a frenzied work-pace and mandatory overtime. Danville employees start with an $8/hr wage with 12 vacation days (8 of the 12 days on days determined by the company).

Incidentally $8 is above the minimum for both Virginia and the U.S. where the minimum wage now is $7.25/hr. Oh yes, we should also keep in mind that 17% of the U.S. workforce has no paid vacation time (See Joe Robinson, Work to Live 2003). So thing could be worse.

But this is outsourcing coming home to roost.  Here is this large international firm identifying the U.S. labor market as a place to invest its capital so that it can hire lower wage workers and make bigger profits. And why pick Virginia for their new plant? Perhaps its due, in part, to the fact that it is one of 22 states (mostly Southern) with "right to work" statutes which prohibit agreements between labor unions and employers making membership or payment of union dues or fees a condition of employment, either before or after hiring. Of course, the purpose of "right to work" laws is to weaken unions and lower wages (6.5% less on average in "right-to-work" states). And another consequence is that states with "right to work" laws according to the U.S. Dept of Labor in general have a higher rate of workplace fatalities (19 of the top 25 are right to work states). Metro Council Democrats Say No to Right to Work for Less

So no unions, anti-union laws, low wages, work intensification, few paid holidays, etc. etc. Is the U.S. becoming the new CHINA!

Friday, April 8, 2011

Working Hours and CVD risk - some new findings

Here are some new science findings that should concern working people. An interesting article authored by Mika Kivimaki and colleagues using data from the Whitehall Study* appeared in the Annals of Internal Medicine** this week.

The authors report, that above and beyond the traditional Framingham Heart Risk score, that working long work days  (beyond a normal 8 hour work day) increases the risk of a coronary event. The risk increases stepwise up to 11 hours. This finding is an interesting echo of a study published by Haiou Yang, myself and several colleagues in the fall of 2006 at the University of California at Irvine. Our study found a relationship between long working hours during the week (increasing #'s of hours of work per week > 40 per week) were associated with an increase in self-reported hypertension in the CHIS (Calif Health Interview Survey) conducted by UCLA.

Readers should be aware that the Framingham risk score is derived by adding up the total risk due to exposure to the "traditional" risk factors for heart disease in particular weight, smoking, cholesterol, blood pressure and diabetes. Both of these articles are suggesting that there are other factors such as longer working hours that above and beyond traditional risk factors are contributing to the likelihood of having a heart attack.

Also i want to point out that the design of both of these studies does not rule out the possibility that even an 8 hour work day or a 40 hour work week may contribute to the development of heart disease. Both of these studies compared increased hours to either the typical work day or typical work week. Unfortunately, there were no subjects available working less than 8 hours a day in the Whitehall study or 35 or less hours in the CHIS study for comparison. 

Not only are long work days and work weeks associated with heart disease but there is accumulating evidence that a number of other organizational and psychosocial work related factors are playing an important role in the development of hypertension and heart disease.  For much more on this topic stay tuned for further blogs or pick up a copy of our book "Unhealthy Work: causes, consequences and cures" published in 2009 by Baywood Publishers.

Readers should note that the Whitehall study has access to data on other work related risk factors including psychosocial variables such as job strain which were not included in the analyses done in this paper. It will be interesting to see future studies where all of these variables are included.

*The original Whitehall Study investigated social determinants of health, specifically the cardiorespiratory disease prevalence and mortality rates among British male civil servants between the ages of 20 and 64. The initial study, the Whitehall I Study, examined over 18,000 male civil servants, and was conducted over a period of ten years, beginning in 1967. A second phase, the Whitehall II Study, examined the health of 10,308 civil servants aged 35 to 55, of whom two thirds were men and one third women. A long-term follow-up of study subjects from the first two phases is ongoing.

** Article appeared in the news this week on April 5th 2011 based on the report in the Annals of Internal Medicine.

Tuesday, April 5, 2011


Welcome to the blog of the Center For Social Epidemiology. The purpose of this blog is to present, for discussion, information related to working conditions and their impact on health. This blog will discuss globalization, its influence on the modern organization of work and it's role in the decline of health in working people internationally. We hope that you find this blog helpful in your search for information and understanding, whether it is personal or professional.