One nice thing about a blog is that you can post personal stories. I want to share with you an event that occurred Thursday May 19th 2011 at the APA/NIOSH sponsored Work, Stress and Health 2011 Conference which I am attending in Orlando Florida. I was given the honor of introducing Bob Karasek on the occasion of his being awarded the Career Achievement Award by the organizers of the conference. It is the highest honor our profession can bestow on our colleague.
Here is my presentation to Bob on the occasion of his APA/NIOSH Career Achievement Award – May 19 2011
The Job strain hypothesis was formulated 35 years ago and first tested in a paper appearing in the July issue of the AJPH in 1981. Since then Job strain has become the most widely researched psychosocial model in the world, currently being used in 1220 projects in 65 countries.
For four decades now Robert Karasek has championed the JCQ, and the dual hypotheses of job strain as a risk factor for illness, and the active-passive quadrant dimension as a predictor of active learning, human development and social involvement. Each hypothesis has generated important insights into our world of work.
One major reason for the importance of the job strain model resides in the fact that it provides a connection between work organization, and health. It places the individual and his perceptions of his work environment in the forefront of the issues demanding our attention while echoing in a more modern lexicon Marx’s ideas of alienation. It underscores the fact, as well as the degree to which traditional economic analyses of work with their emphasis on productivity, and wealth production ignore the negative human consequences of work in its current form.
Bob, your active role in theory and research has impacted many concerned about work and health. From individuals concerned that their work environment was potentially dangerous, to labor organizations striving for healthy working conditions, to businesses interested in maximizing productivity and to governments setting social policy, all have been impacted by ideas advanced by you Robert often working in collaboration with your lifelong colleague Tores Theorell.
Bob, one of your greatest accomplishments has been the support you have provided to a large number of your colleagues. As you know, much of my own work has been both inspired and shaped by your ideas about the work environment. While I have known you since our participation in the ECHDG in the 1970’s my first involvement in research after leaving the practice of medicine was when I joined your Columbia Job Heart project and with which I worked for 1 year in 1980. My experience working with you Bob, as well as Tores Theorell, Dean Baker, Carl Pieper and Joe Schwartz led me to seek a post-doc to further my training in epidemiology. My thesis proposal ultimately morphed into the 14 year long NYC Worksite BP study in collaboration with Dr. Thomas Pickering (PI) in which you and Jeff Johnson were both active participants.
Over the decades Bob, you and I have collaborated on many projects. From research at Cornell to papers for the AJPH to revisions to the JCQ (now soon to be JCQ 2.0), and conferences from Japan to Amsterdam. I hope that this collaboration will continue for at least another 20 years or longer. Also your work is not yet finished. I found, after an informal poll of your colleagues, that a 2nd edition of your book "Healthy Work" (Basic Books 1990) which builds on your last 20 years of research and experience is wanted from you and Tores.
I want to thank you now Bob for your support and the inspiration you have provided me and many others over the past 4 decades.
Both Tores and I have collaborated on a salute to you, composing a song in your honor, which Tores (the only professional musician among the 3 of us) has volunteered to perform.
For Bob when he received his life time career award in May 2011
Melody by Cole Porter: My heart belongs to daddy
(was sung by Eartha Kitt)
He´s such a man, he knows it all
He started the MODEL, it´s rolling
Demand-control - he made us recall
Why our work is not always strolling
Equilibrium, his newest world
Is offering all of us insight
Once again he is throwing light
He is always on a height
He is father of the DC model
In the seventies he triggered us
Cause he knew the way to coddle
Lots of data and computer-based fuss
Now he harvests all the progress
Let him beam and glory with pride
Dear Bob, we like your success
Let us celebrate now at your side
From Töres Theorell
Saturday, May 21, 2011
Wednesday, May 18, 2011
What is wrong with Long Live 120/80 --- Part 1 of a 2 part answer
I am assuming that the creators of the advertisement are referring to the blood pressure of the healthy appearing young woman holding her young child and not to the child. Long live 120/80 cannot mean the child's blood pressure since 120/80 would be incredible high for such a youngster. Now I cannot know for sure the mind of the advertiser but i think it is fair to assume they are suggesting the a BP of 120/80 is desirable and that it would be great if this woman continued to have such a BP for an extended period of time.
With these assumptions as my starting point - what is the problem?
The problem begins with the fact that a BP of 120/80, which is a national average in some studies, is neither healthy nor ideal. The authors are making a serious error or equating normality/average with health, a rather common error in medicine.
In fact 120 over 80, representing the systolic and diastolic blood pressures and which are the highest and lowest bp's achieved by the heart during each heart beat, are acknowledged by all major medical institutions, including the AHA, as less than ideal. The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure the organization responsible for hypertension treatment guidelines stated that BP's of 120-129 systolic over 80-84 diastolic were "prehypertension". (JAMA 2003:289;2560-2571) Ideal or optimal BP is less than 120/80 and in fact the lower one's blood pressure the better (subject to the limitation that very low blood pressures do not cause symptoms).
What no one wants to say is that there is a linear positive relationship between blood pressure levels in a population and increasing risk of stroke and heart attack (the two main consequences of hypertension) and that this increasing risk is apparent even when comparing groups with average bp of 120/80 to those with 110/70 and they in turn are at higher risk than those with 100/60 mm hg. There is no specific # that discriminates the healthy from the unhealthy. Studies, including the Framingham Heart Study (the most famous American epidemiologic study of heart disease), find that as much of 40% of the risk of stroke and heart disease occurs among people with BP's less that 140/90. Also, as we age as a population the average BP increases yearly with increasing risk.
The problem, however, of what is a healthy blood pressure is complicated by a second even more serious problem in the measurement and diagnosis of blood pressure. All of these BP criteria are derived from studies of casual blood pressures, that is bp's taken of patients in a doctors office after several minutes of waiting and relaxing. It is believed these bp's represent accurately what a person's true average underlying bp is and that it is this bp that is the determiner of risk of heart disease.
Recently studies of individual's ambulatory blood pressure obtained using automated monitors that can measure blood pressure while individuals are at work, home, play, and sleep have demonstrated that it is one's average ambulatory bp, especially ones work time ambulatory bp, that is the best predictor of subsequent disease (and not one's casual office obtained bp). And, unfortunately, there is a big discrepancy between most peoples casual office obtained bp's and what their bp is at work. So much so that millions of American are being misdiagnosed as 1) either having hypertension when they do not; that is their bp is up in the doctors office but normal when they wear an ambulatory bp monitor at work (what is called White Coat Hypertension) or 2) there is a failure to diagnosis hypertension because many people have normal bp's in their doctor's office but when they wear an ambulatory bp monitor it is found that their bp is elevated at work and/or at home. Researchers call this problem "hidden hypertension".
Much of this problem of mis-diagnosis could be avoided if individuals routinely were provided with an opportunity to wear an ambulatory bp monitor but the health industry is reluctant to pay for this expense despite the fact that literally millions of people are being mis-diagnosed. Taken together these problems of equating normal/average with healthy and our inaccurate diagnostic methodology means millions of Americans are either being over treated for hypertension they do not have or not being treated for hypertension which is apparent at work but not in the doctors office. This is a major public health disaster.
In Part 2 of this blog we will address the issue of the role that work plays in the creation of the problem of hypertension and how knowing more
With these assumptions as my starting point - what is the problem?
The problem begins with the fact that a BP of 120/80, which is a national average in some studies, is neither healthy nor ideal. The authors are making a serious error or equating normality/average with health, a rather common error in medicine.
In fact 120 over 80, representing the systolic and diastolic blood pressures and which are the highest and lowest bp's achieved by the heart during each heart beat, are acknowledged by all major medical institutions, including the AHA, as less than ideal. The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure the organization responsible for hypertension treatment guidelines stated that BP's of 120-129 systolic over 80-84 diastolic were "prehypertension". (JAMA 2003:289;2560-2571) Ideal or optimal BP is less than 120/80 and in fact the lower one's blood pressure the better (subject to the limitation that very low blood pressures do not cause symptoms).
What no one wants to say is that there is a linear positive relationship between blood pressure levels in a population and increasing risk of stroke and heart attack (the two main consequences of hypertension) and that this increasing risk is apparent even when comparing groups with average bp of 120/80 to those with 110/70 and they in turn are at higher risk than those with 100/60 mm hg. There is no specific # that discriminates the healthy from the unhealthy. Studies, including the Framingham Heart Study (the most famous American epidemiologic study of heart disease), find that as much of 40% of the risk of stroke and heart disease occurs among people with BP's less that 140/90. Also, as we age as a population the average BP increases yearly with increasing risk.
The problem, however, of what is a healthy blood pressure is complicated by a second even more serious problem in the measurement and diagnosis of blood pressure. All of these BP criteria are derived from studies of casual blood pressures, that is bp's taken of patients in a doctors office after several minutes of waiting and relaxing. It is believed these bp's represent accurately what a person's true average underlying bp is and that it is this bp that is the determiner of risk of heart disease.
Recently studies of individual's ambulatory blood pressure obtained using automated monitors that can measure blood pressure while individuals are at work, home, play, and sleep have demonstrated that it is one's average ambulatory bp, especially ones work time ambulatory bp, that is the best predictor of subsequent disease (and not one's casual office obtained bp). And, unfortunately, there is a big discrepancy between most peoples casual office obtained bp's and what their bp is at work. So much so that millions of American are being misdiagnosed as 1) either having hypertension when they do not; that is their bp is up in the doctors office but normal when they wear an ambulatory bp monitor at work (what is called White Coat Hypertension) or 2) there is a failure to diagnosis hypertension because many people have normal bp's in their doctor's office but when they wear an ambulatory bp monitor it is found that their bp is elevated at work and/or at home. Researchers call this problem "hidden hypertension".
Much of this problem of mis-diagnosis could be avoided if individuals routinely were provided with an opportunity to wear an ambulatory bp monitor but the health industry is reluctant to pay for this expense despite the fact that literally millions of people are being mis-diagnosed. Taken together these problems of equating normal/average with healthy and our inaccurate diagnostic methodology means millions of Americans are either being over treated for hypertension they do not have or not being treated for hypertension which is apparent at work but not in the doctors office. This is a major public health disaster.
In Part 2 of this blog we will address the issue of the role that work plays in the creation of the problem of hypertension and how knowing more
Monday, May 9, 2011
What is wrong with this advertisement appearing in the LA Times on Sunday May 8th 2011?
I will provide an answer to this question tomorrow which will get into the problems that medicine as a profession has with the measurement, diagnosis and labeling of health conditions in our industrial society. Yes, there is something seriously wrong here. Can you leave me a comment and tell me what it is?
Saturday, May 7, 2011
An introduction to Globalization and Unhealthy Work
The following blog is the first in a series looking at globalization. The major part of the blog is a reproduction of my abstract THE ROLE OF GLOBALIZATION IN THE DEVELOPMENT OF UNHEALTHY WORKING CONDITIONS, which I will present at the NIOSH, sponsored conference Work, Stress and Health 2011 to be held May 19-22 at the Doubletree Hotel in Orlando Florida. The focus of the meeting is "Work and Well-Being in an Economic Context. You can visit the APA's website for more information about the meeting.
Cardiovascular Disease (CVD) has become the #1 cause of morbidity and mortality in the world. More than 1.1 billion people have coronary artery disease and another 1 billion have hypertension, exceeding even poverty as the primary cause of ill-health and death. The recent large increase in the prevalence of CVD in China ( a non-existent disease in China 50 years ago) and other developing countries provided further evidence that CVD, as an epidemic and public health crisis, is of rather recent origin - rooted in the structure of modern societies and associated with industrialization and globalization. This conclusion is supported by the observation that the "traditional" risk factors for CVD such as hypertension, hypercholestrolemia due to diets rich in fat, cigarette consumption, obesity and diabetes are all of recent historical development as well.
The processes of globalization - the steadily increasing inter-dependency of world economies, production, trade, technology and culture - is having an enormous impact on work, work organization and the health of working people. There is now increasing competition among nations and between corporations, as resources grow more scarce. The ongoing need for corporate profitability drives restructuring and downsizing, outsourcing, more and more precarious labor and increasing job insecurity, as well as increased time pressure and intensification of work. Companies search for the cheapest labor markets creating a "race to the bottom" for wages.
These changes in work organization, in turn, give rise to psychosocial stressors such as job strain, effort-reward imbalance, emotional labor, threat-avoidant-vigilant work, organizational injustice, long work hours and work weeks, and shift work, which increase stress and can lead to chronic illnesses, including mental and physical health problems. Psychosocial stressors play important roles in promoting CVD risk factors such as obesity and hypertension.
Research findings explicating the inter-relationship between capitalist economic developments, globalization, changes in work organizations, psychosocial stressors and CVD risk factors will be presented. The economic consequences of these changes and the implications for the health of working people will be discussed and a strategy for promoting healthy work will be presented.
It may be helpful to the reader to understand that my training is in Medicine and Epidemiology. I study health outcomes (epidemics) for clues to their causes (my main research interest has been examining the impact of working conditions on hypertension and obesity). Research done by myself and many of my colleagues world-wide strongly supports the conclusion that working conditions influenced by the processes of globalization are having a substantial impact on many health outcomes. In my abstract below I outline the basic argument. In subsequent blogs this perspective will be expanded utilizing topical news events to highlight relevant issues. (see for example Blog's #2 and #3 posted earlier for examples of this approach).
Finally, I plan to create a dictionary of relevant terms to help the reader understand the issues. So we will be defining various concepts as we go along and adding this to a blog that consists only of definitions. Aspects of globalization such as offshoring, outsourcing, and contingent labor, inter alia and of work organization and psychosocial stressors such as long work hours and job strain inter alia will be defined.
Finally, here is my abstract!
THE ROLE OF GLOBALIZATION IN THE DEVELOPMENT OF UNHEALTHY WORKING CONDITIONS - Peter L. Schnall M.D. U. of California at Irvine
Cardiovascular Disease (CVD) has become the #1 cause of morbidity and mortality in the world. More than 1.1 billion people have coronary artery disease and another 1 billion have hypertension, exceeding even poverty as the primary cause of ill-health and death. The recent large increase in the prevalence of CVD in China ( a non-existent disease in China 50 years ago) and other developing countries provided further evidence that CVD, as an epidemic and public health crisis, is of rather recent origin - rooted in the structure of modern societies and associated with industrialization and globalization. This conclusion is supported by the observation that the "traditional" risk factors for CVD such as hypertension, hypercholestrolemia due to diets rich in fat, cigarette consumption, obesity and diabetes are all of recent historical development as well.
The processes of globalization - the steadily increasing inter-dependency of world economies, production, trade, technology and culture - is having an enormous impact on work, work organization and the health of working people. There is now increasing competition among nations and between corporations, as resources grow more scarce. The ongoing need for corporate profitability drives restructuring and downsizing, outsourcing, more and more precarious labor and increasing job insecurity, as well as increased time pressure and intensification of work. Companies search for the cheapest labor markets creating a "race to the bottom" for wages.
These changes in work organization, in turn, give rise to psychosocial stressors such as job strain, effort-reward imbalance, emotional labor, threat-avoidant-vigilant work, organizational injustice, long work hours and work weeks, and shift work, which increase stress and can lead to chronic illnesses, including mental and physical health problems. Psychosocial stressors play important roles in promoting CVD risk factors such as obesity and hypertension.
Research findings explicating the inter-relationship between capitalist economic developments, globalization, changes in work organizations, psychosocial stressors and CVD risk factors will be presented. The economic consequences of these changes and the implications for the health of working people will be discussed and a strategy for promoting healthy work will be presented.
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