Weds 11 Rosskam

Work-Related Stress: A 21st Century Global Disease

Ellen Rosskam, Ph.D., MPH Senior Work Security Specialist International Labour Office, Geneva Fourth Conference on Work Environment and CardioVascular Disease, Newport Beach, CA., March 10, 2005

Washington driven policies are making life more stressful 1. 2. 3. 4. 5.

International financial market liberalization Trade liberalization (esp. developing countries) Labour market “flexibility” Reduction of public sector “Social safety net” approach to social protection (more selectivity of who gets benefits)

6. Liberalization and privatization of social protection and social policy 7. Shrinking state

2

Work-related Stress: A 21st Century Disease „

Causes of stress include: ƒ labour intensification ƒ competitive pressures ƒ time-squeeze ƒ rapid technological change ƒ lack of worker control in jobs ƒ flexible labour relations (downsizing, contracting out)

> higher injury rates, hazard exposure, disease, workrelated stress

„

Self-regulation weak collective Voice eroded workers’ health & safety 3

Labour Market Insecurity Leads to Stress ILO Enterprise and Household surveys show: „ „ „ „ „ „ „

Hidden unemployment pervasive world wide Barriers to mobility threatening women’s labour market security Employment growth rate cannot accommodate population growth rate Labour Market Insecurity:a feature of globalization Agricultural share of employment share declining De-industrialization People forced to migrate for jobs 4

Employment Insecurity Leads to Stress ILO Enterprise and Household surveys show: „ „ „ „ „

Global economy being “informalized” Non-wage work spreading Widening income differences between men & women, and younger & older workers Large informal economy & informal support networks act as buffer during economic shocks Formal, individualistic labour markets cause devastating consequences 5

Income Insecurity Leads to Stress ILO Enterprise and Household surveys show: „

„ „

Disability of saving: global problem, prohibiting families to solve emergencies on own. Result: financial crisis and indebtedness Inadequate income for healthcare Prospects of old age well-being are catastrophic for many

6

ss

ry U

ia kr ai ne

Ru

Income irregular

H un ga

Income insufficient

Et hi op ia G ha Ta na n So zan ia ut h A fri ca

Ba ng la de sh Ch in a In di In a do ne sia

A rg en tin a Br az il Ch ile

% respondents

Income Insecurity

100

Could not save

90

80

70

60

50

40

30

20

10

0

7

rg en tin a Br az il Ch ile

ry Ru ss i U a kr ai ne

H un ga

Income level

Et hi op ia G ha Ta na n So zan ut ia h A fri ca

Ba ng la de sh Ch in a In In dia do ne sia

A

% respondents

Income Dissatisfaction

70

Non-wage benefits

60

50

40

30

20

10

0

8

Future Income Insecurity 100 90 80

Unsure if can keep job Household income reducing Expect poverty in old age

60 50 40 30 20 10

un ga ry Ru ss i U a kr ai ne

H

Et hi op ia G ha Ta na n So zan ia ut h A fri ca

Ba ng la de sh Ch in a In di In a do ne sia

rg en tin a Br az il Ch ile

0

A

% respondents

70

9

rg en tin a Br az il Ch ile

ry Ru ss i U a kr ai ne

H un ga

Et hi op ia G ha Ta na n So zan ut ia h A fri ca

Ba ng la de sh Ch in a In In dia do ne sia

A

% respondents

Past Financial Crises & Indebtedness 100

90

Financial crisis in past

80

Outstanding debt

70

60

50

40

30

20

10

0

10

Main Causes of Financial Crisis Country

Urban Crisis Bangladesh 1. Medical cost 2. Business failure 3. Loss of job Ethiopia 1. Commodity prices 2. Cost of medicine 3. Loss of work – illness Indonesia 1. Cost of medicine 2. Loss of job 3. Crop failure Ghana 1. Medical cost 2. Funeral cost 3. Children’s education Tanzania 1. Medical cost 2. Business failure 3. Natural disaster India 1. Loss of job/employment opportunities 2. Expenditure on social functions/Illness 3. Loss of work due to illness South Africa 1. Death of a household member 2. Loss of job/employment 3. Death of wage-earning household member

% 26.4 25.5 17.9 24.0 9.1 8.6 32.7 13.3 11.1 38.3 16.9 7.9 22.1 15.1 11.6 31.8 30.2 16.5 9.3 6.5 3.6

Rural Crisis 1. Medical cost 2. Crop failure 3. Marriage cost 1. Crop failure 2. Commodity prices 3. Cost of medicine 1. Cost of medicine 2. Crop failure 3. Commodity prices 1. Medical cost 2. Funeral cost 3. Children’s education 1. Crop failure 2. Natural disaster 3. Medical cost 1. Expenditure on social functions/Illness 2. Rise in price of essential commodities or inputs 3. Loss of job n.a. n.a. n.a.

% 29.6 17.8 12.6 28.8 16.3 10.0 33.2 18.3 6.5 41.5 23.7 4.8 32.3 17.2 14.0 45.9 29.5 14.9 n.a. n.a. n.a.

11

Socio-Economic Insecurity, Stress & Disease „

Systematic understatement of the inequality of workers’ health insecurity (workers’ health information limited, unreliable)

„

Economic liberalization Ö shift away from statutory regulation Ö worse working conditions, increased stress, declining health Flexible labour relations Ö worse working conditions Ö hazard exposures, work-related stress, disease, injury rates

„

„

“Time insecurity” is global, magnified by work intensification management practices, increased commuting time, growing insecurities 12

Socio-Economic Insecurity, Stress & Disease Aptly captured by Karasek (2005): « Beyond material deprivation, there seems to be a new possibilty of creating a low social class which has few possibilities of social control and yet faces heavy demands, which faces a broad range of new debilitations – particularly as a consequence of our economic system: a third explanation of the adverse social gradient in health. » 13

Causes of Absence from Work Note: These findings refer to time off due to stress at work or stress outside work 25

Injury Illness Stress

15

10

5

i U a kr ai ne

ss

y Ru

ar un g H

Et hi op ia G ha na Ta nz So a ut nia h A fri ca

de sh Ch in a In di In a do ne sia

Ba ng la

rg en tin a Br az il Ch ile

0

A

% respondents

20

14

Socio-Economic Insecurity, Stress & Disease „

Globally heart attacks, suicide, strokes expected to be top occupational diseases of 21st century (stress)

„

Globally depression impt. cause premature death/disability (WHO, 2001) incl. death from overwork (karoshi) (Hazards, 2003) much of which is stress-related

ILO Enterprise and Household surveys show: „

„ „ „

Transition countries’ industrial enterprises lack safety depts./committees Ö workers more vulnerable to occupational accidents & diseases Over half of workers in Indonesia have no workplace OSH department/committee The poor report extremely poor working conditions Women more disadvantaged, with less protection than men 15

az il

a

Unsafe workplace H un ga ry Ru ss i U a kr ai ne

Et hi op ia G ha Ta na n So zan ut ia h A fri ca

Ba ng la de sh Ch in a In In dia do ne sia

Ch ile

Br

A rg en tin

% respondents

Workplace Safety

60

50

40

30

20

10

0

No safety committee/department/specialist

16

Socio-Economic Insecurity, Stress & Disease ILO Household surveys show: „

Majority in developing & transitional countries bear costs work-related accidents/illnesses, no benefits for incidents (least able to afford it)

„ „

„

Sick/injured workers work without taking leave (fear income or job loss) (Increased “Presenteeism”) Majority families surveyed in Africa & Eastern Europe have difficulty paying for basic health care „ 88% of families in Ukraine „ 60% in Ghana and Ethiopia Workers in African countries, rural women workers, & casual workers least likely to have insurance against work accidents 17 or injury

un ga ry Ru ss i U a kr ai ne

70

H

80

Et hi op ia G ha Ta na n So zan ut ia h A fri ca

Ba ng la de sh Ch in a In di In a do ne sia

A rg en tin a Br az il Ch ile

% respondents

Lack of Healthcare

90

Ill health No access to adequate healthcare Income insufficient for healthcare

60

50

40

30

20

10

0

18

Socio-Economic Insecurity, Stress & Disease ILO Enterprise and Household surveys show: „ „

Social support based on informal networks are buffers during economic shocks Informal networks: the glue holding people together during increasing insecurity

But: „ „ „ „

Informal systems declining in developing countries Many workers have no access to such networks Informal networks are culture-bound Who can give when more have less? 19

Rely on Whom During Crisis Country

Urban Whom Bangladesh 1. Relatives 2. Friends/neighbours 3. Moneylender Ethiopia 1. Friends/neighbours 2. Relatives 3. Officials/government Russia 1. Support from relatives 2. Other household members 3. Social payment from state Indonesia 1. Relatives 2. Friends/neighbours 3. Employer Ghana 1. Friends/neighbours 2. Land or asset sales 3. Money lenders Tanzania 1. Relatives 2. Friends/neighbours 3. Employer India 1. Relatives 2. Friends/neighbours/mayor 3. Bank South Africa 1. Friends/neighbours 2. Bank 3. Employer

% 66.9 18.6 4.6 25.7 19.2 5.2 34.0 18.8 14.8 61.9 21.0 4.3 35.3 25.9 2.9 50.3 30.9 3.4 66.1 12.8 6.2 21.2 20.9 3.8

Rural Whom 1. Family/siblings/relatives 2. Moneylender 3. Bank 1. Family/siblings/relatives 2. Friends /neighbours 3. Officials/government 1. Support from relatives 2. Social payment from State 3. Other household members 1. Relatives 2. Friends/neighbours 3. Bank 1. Friends/neighbours 2. Land or asset sales 3. Money lenders 1. Relatives 2. Friends/neighbours 3. n.a. 1. Relatives 2. Bank 3. Friends/neighbours/mayor n.a. n.a. n.a.

% 53.4 20.8 13.1 21.7 20.8 11.3 33.2 20.8 15.6 61.2 27.0 2.1 41.8 25.7 2.5 44.1 33.5 n.a. 72.5 16.0 4.8 n.a. n.a. n.a.

20

(Lack of) Social Support 100

Not union member at work

90

Negative attitude to trade union 80

Trust management to look after workers' welfare

60 50 40 30 20 10

ia kr ai ne

ss

U

ry

Ru

H un ga

Et hi op ia G ha Ta na n So zan ia ut h A fri ca

Ba ng la de sh Ch in a In di In a do ne sia

0 A rg en tin a Br az il Ch ile

% respondents

70

21

Gendered Disadvantages 100 90 80

Discrimination against women at work Loosing job due to pregnancy Not entitled to maternity leave

60 50 40 30 20 10

ia kr ai ne

ss

U

ry

Ru

H un ga

Et hi op ia G ha Ta na n So zan ia ut h A fri ca

Ba ng la de sh Ch in a In di In a do ne sia

0 A rg en tin a Br az il Ch ile

% respondents

70

22

Harassment: Important Cause of Stress „

ILO Enterprise and Household surveys show: Harassment (physical, sexual, psychological) causes stress & ill health esp. among women workers (19% women wage workers in Tanzania, 11% women workers in Bangladesh, 1 in 5 female workers in China suffering effects of harassment)

„ „ „

Women experience more than men Harassment from managers & authorities Ö stress Most countries lack policies to deal with harassment at work

23

Lack of social protection combined with globalized economic trends causes life to become very stressful, rife with increasing insecurities. Work-related stress and ill health became global sicknesses.

A Rights-Based Approach to Workers’ Health is needed – a move toward the recognition of workers’ knowledge and need for their full participation in the workplace 24

Coping with the Challenges „ „ „ „ „

„ „ „

Economic security is crucial to counter current trends Basic income security plus «Voice » representation security needed to provide economic security Strengthen collective voice to stop work intensification and self-destruction from overwork Understand the differential aspects of stress Universalistic policies for redistribution and access to social protections without means testing and targeted benefits Strengthen social support Strong voice representation associated with strong protection of workers’ health Proof: Zebras don’t get ulcers! (Sapolsky, 1994) 25

THANK YOU

26