The Psychosocial Work Environment

Work Organization, Democratization, and Health : Essays in Memory of Bertil Gardell

Jeffrey Johnson, Bertil Gardell, Gunn Johannson, Jeffrey V. Johnson

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9780895030771
• eBook ISBN: 9781351841054
• Topic: Politics & International Relations
• Subtopic: Politics
• Index: Politics & International Relations

Dedicated to the late Bertil Gardell, a Swedish Social Scientist, this text comprises of 18 essays that shares a common vision - the impact of work on the interconnected processes of stress and disease.

PART 1

Psychosocial Work Environment and Health

CHAPTER 1

Social Epidemiology and the Work Environment

S. Leonard Syme

A central theme in virtually all of Bertil Gardell’s work is that a person’s position in the social and work environment affects health and well-being. This concern with the environment has been a major influence in the development of a new area of research increasingly being referred to as social epidemiology. Epidemiology may be defined as the study of the distribution of disease in the population and of the factors that influence that distribution. Social epidemiology may be defined as the study of social factors as they affect these distributions. Much of Bertil Gardell’s work is a dramatic and compelling demonstration that a person’s position in the work environment “gives rise in most people to certain types of reactions which are harmful to the individual as a biological and social being and thus are of profound importance for him personally as well as for the whole of industrialized society” (1).

Gardell’s focus on the job environment as a factor in biological and social pathology represents an important departure from the view taken in most epidemiologic research. In most of this work, risk factors for disease are sought in the individual. Thus, individuals are studied in terms of their eating, drinking, smoking, and exercise behavior to see whether these characteristics increase disease risk. Similarly, study is made of the individual’s height and weight, medical history, and physiologic status. The goal of this work is to identify risk factors so that changes can be recommended to lower risk.

While Gardell’s focus on the social and work environment does not ignore these individual characteristics and behaviors, it tends to concentrate more on the importance of structural elements and concludes therefore with structural rather than individual interventions for improvement.

The purpose of this chapter is to emphasize the importance of this environmental approach to disease prevention and to argue that study of social factors in the work environment is of strategic and timely importance.

THE CASE FOR AN ENVIRONMENTAL APPROACH

It is clear that the way we behave as individuals affects both the occurrence of disease and the outcome of treatment. However, a disease prevention program focused only on individual behavior is seriously limited, for at least two reasons.

The Difficulty of Changing Behavior

The first reason an individual approach is limited is that people have such a difficult time changing their behavior. It is reasonably simple to inform someone that they are at risk for disease because of their eating, smoking, drinking, or driving behavior; however, this information will not necessarily result in a change in that behavior. Exhaustive efforts to help people make such changes have shown clearly that it is extremely difficult to bring about a behavior change and even more difficult to maintain those changes once achieved.

Even in the Multiple Risk Factor Intervention Trial (MRFIT) where optimal conditions existed for such change, many people were unable to follow recommendations for dietary change and smoking cessation (2). This occurred in spite of the fact that MRFIT included an informed and highly motivated group of participants, an excellent behavioral intervention plan, an excellent staff in sufficient numbers, and enough time to work with each participant. In the general population, we have even greater difficulty in inducing people to change high-risk behavior. Most people who try to quit smoking fail (3). We have had little success in getting people to lower the fat or salt in their diet (4). The vast majority of people who try to lose weight and maintain losses do not succeed.

This is a difficult and challenging problem. One of the reasons for failure in intervention programs such as MRFIT is that we have viewed these behaviors almost exclusively as problems of the individual. In fact, the behavior of individuals occurs in a social and cultural context. These behaviors are neither random nor idiosyncratic but exhibit patterned consistencies by age, race, sex, occupation, education, and marital status. Indeed, by focusing on individual motivations and perceptions, we may be neglecting some of the most important influences on behavior (5).

The Magnitude of the Problem

Even if we were completely successful in getting people to change their risk behavior, this could have only a very limited impact on the prevalence of disease in the community. The reason for this is that most of the diseases of concern today in industrialized society are so prevalent that a one-to-one approach simply is not efficient or effective. While it may be of value to friends and family, an individual approach does little to alter the distribution of disease in the population because new people develop disease even as sick people are cured and because new people enter the “at-risk” population as others leave it. Thus, an individual approach exhausts substantial medical care resources but does little to address those environmental factors that have initiated the problem. In this circumstance, an environmental approach to prevention obviously is needed and is likely to be more efficient than one-to-one approaches.

TOWARD THE DEVELOPMENT OF AN ENVIRONMENTAL AND COMMUNITY FOCUS

Population groups often have a characteristic pattern of disease over time even though individuals come and go from these groups. If groups have different rates of disease over time, there may be something about the groups that either promotes or discourages disease among individuals in those groups. Everyone is aware of the fact that patterned regularities in disease rates exist for socioeconomic status, race, sex, marital status, religious groups, geographic areas, and so on. In spite of this awareness, we have a very imperfect understanding of the reasons for these patterns. Indeed, most epidemiologic research “holds constant” these “background” factors so that other, more interesting, variables can be studied. This is done because it is tacitly recognized that if these factors were not statistically removed from analysis, they are so powerful that they would overwhelm everything else being studied. In consequence, these factors are rarely studied in their own right.

This is a remarkable phenomenon. Historically, we have had in public health a long experience in preventing and controlling many infectious diseases from a community and environmental perspective. We have long known that it is better to assure clean water supplies at the community level than it is to teach people, one at a time, to boil their household water. The same is true for milk supplies, other foodstuffs, and even air. More recently, we have seen that it is more effective in reducing highway fatalities to design safer cars, build safer roads, and lower speed limits than it is to teach people, one at a time, to drive more safely. None of these problems can be seen in an either/or manner: we need people to drive more safely and to look after their food supply in a hygienic manner. It clearly is crucial, however, that we not rely on these individual initiatives to deal with the problem.

What a difference it makes when we turn our attention to such diseases as coronary heart disease, stroke, arthritis, and cancer, and to such behaviors as smoking, drinking, and eating. With regard to these matters, we tend not to look to the environment but rather to see these as problems that affect individuals and that individuals must deal with.

In the control of infectious diseases, public health workers developed a disease classification system that was environment and community specific and not simply based on a one-to-one clinical model. They used such disease classification categories as water-borne, food-borne, air-borne, and vector-borne diseases. This classification scheme grouped together different clinical entities in terms of their modes of transmission and it pointed to aspects of the environment as being relevant to intervention and disease prevention. In the study of the noninfectious diseases of concern today, we have no such categories. Instead, we still use a set of terms that may be useful in clinical practice, but these terms do not suggest anything about etiology and they do not point us toward prevention strategies.

The reason for this is not clear. It may be easier to think of infectious diseases in terms of a contaminated environment and to therefore take action at that level. It may be more difficult to think of diseases such as coronary heart disease and cancer as having environmen...

Table of contents

• Cover
• Title Page
• Copyright Page
• Dedication
• Acknowledgments
• Table of Contents
• Introduction — Work Organization, Occupational Health, and Social Change: The Legacy of Bertil Gardell
• Part 1: Psychosocial Work Environment and Health
• Part 2: Multilevel Perspectives on Work Organization
• Part 3: Workplace Democratization: Action Research
• Part 4: Diffusion of the Psychosocial Work Environment Model
• Appendix — Bibliography of International Publications by Bertil Gardell
• Contributors
• Index