“Health Shapes Work and Work Shapes Health”

By | July 16, 2016
Construction workers walking

Photo courtesy jaimebisbal

The Robert Wood Johnson Foundation, as well as the Harvard T.H. Chan School of Public Health and National Public Radio, may have given a boost last week to advocates of employee wellbeing. Here, I refer to what I consider authentic wellbeing — based on workers’ exposure to harmful job conditions and environments — not the store-bought imitation based on wellness websites, apps, incentives, and medicalized interventions.

To promote the findings of their Workplace Health poll of 1,601 workers, these sponsoring organizations waged a publicity blitz that brought the “healthy work” perspective to a broad new audience. A Health in the American Workplace panel, streamed live on the web, served as a centerpiece of the campaign.

Workers’ Views on Jobs and Health

Poll results, according to panelists, revealed that many workers view their jobs as impediments to their wellbeing.

  • 43% said their job has a negative impact on their stress level
  • 28% said their job undermines their eating habits
  • 27% reported that their job interfered with the ability to get a good night’s sleep
  • 22% said their job has a negative impact on their weight.

Author’s note [September 17, 2016]: Shortly after this post was written, closer examination of the Workplace Health poll results revealed what appear to be widespread misrepresentations of the data. Some details are provided in these posts


Panelist Marjorie Paloma, director of RWJF, explained how job stress and health are influenced by workplace policies:

If you think about the stress a person feels whether because of their day to day work routines, or the stress they feel because of caring for a loved one while working a full time job, or workers who feel as if they have to go into work despite being sick…These are all stressors that influence health.

Succinctly describing the relationship between behaviors and the environment, Paloma stated:

The choices we make are as good as the choices we have.

She summarized this position with the catchy phrase:

Health shapes work, and work shapes health.

“Human Resource Failures”

Harvard Business School professor John Quelch described how workforce management and the intensification of work have been shown to influence health. Quelch bemoaned…

…the sheer overload that comes from downsizing and outsourcing and asking someone to do two jobs when previously they had to do one.

He cited an often overlooked source of stress:

It can also come from job ambiguity — the requirements of the job are not being clearly articulated by supervisors.

Quelch characterized these workforce management patterns as “fundamental human resource failures.”

Gloria Sorensen, from Harvard Chan, cited her team’s studies of health care workers, whose job conditions have been linked to health problems:

Risk of injury or musculoskeletal pain or accidents on the job increase…when we look at harassment on the job, inadequate staffing, bullying at work, high job demands, lack of control, and poor supervisor support.

Sorensen went on to say that these job conditions also have been linked to fatigue, sleep problems, and risk of obesity. She concluded…

The point is these conditions of work are critical when we look at a range of health outcomes for workers.

The panelists’ remarks revealed mixed feelings about conventional worksite wellness programs that focus on behavior change. The poll results showed that only half of workers have access to wellness programs, which at times the panelists, such as Harvard’s Robert Blendon, seemed to cite as an indictment of employers:

Almost half of people who work are at a workplace that has no workplace health program.…People go to work every day, and this is something they read about in a magazine, but they don’t see in their own job.

On the other hand, Paloma remarked…

Worksite wellness is insufficient if it’s not going hand in hand with efforts to improve the health of communities.

Blendon, director of the poll, said that the findings changed his mind about stress. He led an uncomfortable laugh at the expense of conventional stress management strategies, and noted…

Employers should have some responsibility for lowering the level of stress.

NPR’s Joe Neel, the panel’s moderator, summarized…

It’s all about conditions of the workplace and stress.

Johnson & Johnson. And Johnson.

Here’s where the mixed messaging gained steam: While the panelists agreed that job conditions trump behavior-change-oriented wellness programs, the panel’s brief video presentation told a different story.

One video featured the employee wellness efforts of Johnson & Johnson, the mega-corporation that, for all intents and purposes, was the parent of the Robert Wood Johnson Foundation.

A second video featured the wellness program of startup Next Jump or, as they call themselves, NxJ.

The two wellness programs — J&J’s and NxJ’s — are admirable, and spokespersons in the videos can be credited for their nods to culture of health, psychological wellness, and the built environment. Both employers, however, ultimately emphasized behavior change — primarily eating and physical activity — with no mention of the policies and the strategies that the panelists advocate as the take-home message of their poll: things like paid family leave, paid sick time, supervisor support, sufficient work breaks, limiting overtime, and job redesign.

It’s like advocating for high-speed rail by showing a video of really cool cars.

Kudos to Harvard Chan’s Sorensen, who introduces the audience to the study of job stress in San Francisco transit operators, in which changing the work — such as modifying schedules, training, staffing changes, and equipment upgrades — succeeded in reducing worker stress, whereas, according to Sorensen, previous efforts to change the workers (for example, with stress management programs) failed. For the curious: The research Sorensen cited has been incorporated into an in-depth analysis of stress prevention for bus drivers, available from the International Labour Organization.

The disconnect between the “healthy work” approach and the behavior change emphasis in the panel’s videos, if anything, highlights the need for an acceleration of credible worker health research, which is exactly what NIOSH’s Total Worker Healthinitiative has set out to do .

Unfortunately, our misplaced preoccupation with changing workers — in the manner implicit in J&J’s and NxJ’s programs — may be the main reason we have yet to identify and promulgate meaningful models and strategies for changing work.

In a future post, we’ll more closely examine the poll data. Preview: It contains some shockers.

In the interim, watch the full one-hour panel here: