Health educators, health psychologists, behavioral specialists and occupational health specialists have become increasingly aware of the workplace as a critical social environment that influences health behaviors. Therefore, primary prevention interventions, aimed at redesigning jobs, work organization and employer policies, will be the focus. We will also discuss programs that are complementary to these efforts (secondary prevention strategies), such as individual stress management and health promotion. Examples will be provided of programs that integrate workplace health promotion and occupational health.

The first half of this session will review the variety of legal and legislative measures that have been instituted to reduce employee exposure to workplace stressors. These include legislation (and accompanying regulations) and collective bargaining by labor unions and employers, both of which are designed to reduce exposure to workplace chemical, physical, ergonomic and psychosocial hazards. The costs of workers' compensation for work-related disease may also provide an incentive to reduce workplace exposure to these stressors. The state of legislation (and regulations) in Europe, the United States and Japan is briefly reviewed. In addition, the use of workers' compensation and collective bargaining as prevention strategies in the United States will be discussed.

The second half of this session will allow for a discussion that reviews the major themes of the course. The empirical (epidemiologic), theoretical, and biological evidence presented in this course provides convergent validation that the relationship between workplace stressors and a number of adverse health outcomes is causal. In other words, the empirical findings are consistent with and predicted by the theoretical models, while the linkage between the theoretical models and empirical evidence is demonstrated to be plausible by considering biological mechanisms and experimental research. Based upon these conclusions, new strategies are explored for enhanced prevention and clinical management, work place interventions, and social policy to reduce the impact of disease, psychological distress and unhealthy behaviors that result from stressful working conditions. These strategies acquire an urgent public health dimension, given the magnitude of the epidemic of stress?related diseases and widespread psychological/behavioral effects, and the current deterioration in conditions of working life. Creating a healthy work environment is a high priority, and would entail the full participation of working people in the decision?making processes surrounding the organization of work.

Lead Instructor: Peter Schnall

Faculty contributors: Peter Schnall, Karen Belkic, Paul Landsbergis

Readings:

Kristensen, TG. Workplace intervention studies. In: Schnall PL, Belkic K, Landsbergis PA, Baker D. (eds.) The Workplace and Cardiovascular Disease. Occupational Medicine: State of the Art Reviews. 2000; 15: 293-305.

Landsbergis PA, Cahill J, Schnall PL. The impact of lean production and related new systems of work organization on worker health. J Occup Health Psychol 1999; 4: 1-23.

The Tokyo Declaration on Work-Related Stress and Health in Three Post-Industrial Settings - EU, Japan and USA. J Tokyo Med Univ 1998; 56: 760-767.

Belkic K, Schnall P, Landsbergis P, Baker D. The workplace and cardiovascular health: Conclusions and thoughts for a future agenda. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15 (1): 307-321.

Gardell B. Worker participation and autonomy: a multilevel approach to democracy at the workplace. In: Johnson JV, Johansson G. (Eds.) The Psychosocial Work Environment: Work Organization, Democratization and Health. Essays in Memory of Bertil Gardell. Baywood Publishing Co., Inc., Amityville, 1991, pp. 193-223.