Hi ho, hi ho, it's off to work we go . . .
As the parent of two young children, I find that cartoon characters are a frequent topic at home. This sometimes bridges over into work, and it was the seven dwarfs that came to mind while writing this article on work and health.
In many ways, Grumpy, Sneezy and the rest of the gang represent all the great things about work. They are employed in occupations that they appear to enjoy and, based on their advanced age, have likely gained many of the benefits of having a positive work life.
The health benefits of work are numerous, and those of us who find an enjoyable and fulfilling career typically live happier, healthier lives. Unfortunately, not all work environments are as ideal as Sneezy's. It's not news that some workplaces can be hazardous, but research is identifying new factors related to workplaces that can have negative impacts on health. And it's likely not the workplace environments you might have thought of.
The Whitehall study is a landmark research project that began in Britain in 1967. The study examined 18,000 men in the British Civil Service over a 10-year period and found that men in lower positions of authority were more likely to die than men in higher positions of authority. This goes against the theory that those in higher positions of authority have greater and more difficult work demands, and negative health outcomes as a result. The Whitehall findings suggest this is not the case, and that the truth may be the opposite - that those in higher positions of authority have better health as a result of a better balance between work demands and degree of control at work.
Following up on Whitehall, a second study (Whitehall II) looked at both men and women, with a focus on the relationship between work and stress. The findings were similar to the original study, but also identified some of the specific factors with respect to the way workplaces are organized that influenced these gaps in mortality. One of the particularly interesting findings was that health outcomes were observed for a wide range of diseases - from heart disease and cancer, to depression and general feelings of ill health - and not limited to any specific outcome.
Were these gaps a result of unhealthy lifestyles? Well, the staff in the lower levels of authority did have higher rates of risk factors such as smoking, obesity and high blood pressure. But this only contributed to a portion of the risk. Once all risk factors were accounted for, it was found that workplace status accounted for a significant proportion of the difference in health.
So why the gap?
Different explanations have been put forward, but the Whitehall findings indicate that a number of factors related to the workplace environment impact on health, including:
- Degree of control over decisions
- Opportunity to develop skills
- Social supports (at work and at home)
- Balance between effort and reward
- Job security
- Organizational stability
- Healthy lifestyle behaviours
The Whitehall studies have helped to dispel two myths:
- that people in higher status jobs have higher risks of heart disease, and
- that the gradient in health in industrialized societies is simply a matter of poor health for the disadvantaged and good health for everyone else.
Conversely, what Whitehall showed is that even among relatively advantaged, middle-class populations in whitecollar occupations, workplace status has a significant impact on health.
Workplaces are now increasingly seen as important contributors to the social gradient of health, where a combination of factors lead to better health for some and poorer health for others, that exists in all societies. The Whitehall studies have helped to better illuminate the role of the workplace in this gradient, and point out the benefits of creating workplaces and other social environments that maximize health across populations. The more employers and employees can look at ways to modify their workplace environments in order to replicate the sense of job satisfaction and productivity that Sneezy and the gang demonstrated, the better our collective health can be.
Dr. Michael Routledge is a Medical Officer of Health with the Winnipeg Health Region.