Dr. Töres Theorell of the Swedish Institute of Psycho-social Medicine reviews past and current trends in the world of work

Research indicates a strong connection between human health and the work environment.


The present state of occupational health in Sweden 

THANKS to a strong labour movement and a generally positive attitude on the part of the business community, the Nordic countries have some of the world's most far-reaching laws for the protection of workers' rights. There are also well-developed programmes for the promotion and investigation of occupational health.

The Nordic climate for occupational health may thus be regarded as highly favourable. It follows that any deterioration in general working conditions should become readily apparent in the health of the labour force. The recent economic crisis in Sweden has provided an unfortunate opportunity to test that hypothesis since, not unexpectedly, the reported frequency of job-related stress has increased during the 1990s.

Since there is typically a time-lag between the experience of stress and the onset of medical symptoms, it is too early to detect any widespread health effects of the recent economic crisis. But there are already some indications which, together with a large body of research, tend to confirm a strong connection between human health and the work environment.

Special supplement
on the future of work

The future of work and its relationship to human health is the focus of a special supplement to the Scandinavian Journal of Work, Environment & Health (Supplement 4, 1997). Edited by Töres Theorell and with contributions by colleagues from Norden, Canada, the U.S. and Japan, the supplement reviews research relating to the issues touched upon in this article, and attempts to anticipate their significance for the labour market of the future.
Past experience

Persistent stress is associated with a series of changes in the body, including variations in the production of hormones and other key regulatory substances. Research has demonstrated a clear relationship between job-related stress and the onset of cardiovascular illness-- heart attack, angina, etc.

One of the most well-documented sources of stress is lack of personal control over job duties and conditions ("decision latitude"). Restricted decision latitude has been shown to have a greater effect on the risk of heart attack than either lack of social support or heavy psychological demands.

A recent study found an 80-percent increase in heart attacks among men aged 45-54 whose decision latitude had been reduced. However, the increase occurred over a period of five years, underscoring the time-delay factor.

During the 1970s and '80s, there was a steady decline in the rate of cardiovascular illness in Sweden; the same was true of another key public health indicator, the suicide rate. Although suicide and cardiovascular illness are complex phenomena with a variety of causes, it is probably significant that this improvement in public health took place during a period of general improvement in the work environment, including greater decision latitude on the job and growing indications of psychological well-being from national surveys conducted by Statistics Sweden. But this positive trend appears to have taken a turn for the worse during the 1990s.

Suicide rates

A persistent myth about Sweden is that its citizens are exceptionally prone to suicide. It is true that Sweden's suicide rate is above the world average. But it is not the highest, and has been steadily declining in recent decades. Below, the rates per 100,000 Males/Females in selected countries during 1994-95:

33.0/11.9   Austria
29.3/15.6   Denmark
31.6/11.5   France
55.5/16.8   Hungary
22.2/09.5   Sweden
30.9/12.2   Switz.
19.6/04.6   U.S.A.
Recent trends

The present decade has thus far witnessed a deterioration in the state of both the national economy and occupational health. Heavy budget cuts and organizational changes in the primary care system have contributed to a shift of focus, from long-term preventive measures to short-sighted symptom management.

At the same time, the industrial world at large is undergoing a technological transformation that implies fundamental changes in the world of work. including:

  • steadily sharpening global competition, with increasing demands to produce more with less
  • altered workplace relationships due to new methods of production and communication
  • the differentiation of the labour force into an "A" team with specialised knowledge and greater decision latitude, and a "B" team with decreasing decision latitude in combination with skills and knowledge inappropriate to the "information society"
  • declining influence of workers and their representative organizations due to changes in the structure of global markets
  • a "divide and conquer" strategy by employers and their organizations, including the decentralisation of the bargaining process, leading to growing tensions and conflicts among workers
  • persistently high rates of unemployment, due at least in part to restrictive economic policies, with a resulting spread of insecurity throughout the labour force.

Beginning in the mid-1990s, there was an increase in the segment of the population reporting a decline in psychological well-being-- the first time such a negative result has been recorded since the surveys were initiated.

Warning signals

As noted previously, it is too early to draw any conclusions about the long-term medical consequences of such trends. But in Sweden, there have already been several warning signals which indicate that the situation is deteriorating.

One such signal has emerged from annual surveys of living conditions conducted by Statistics Sweden. Beginning in the mid-1990s, there was an increase in the segment of the population reporting a decline in psychological well-being, i.e. a growing tendency to feel anxious, worried and depressed. It is the first time such a negative result has been recorded since the surveys were initiated in 1975; previously, the trend had been in a steadily more positive direction.

In addition, statistics on death and incapacity from cardiovascular disease indicate a growing disparity between white-collar and blue-collar workers. This is a reversal of the trend toward increasing equality in Sweden during most of this century, and may reflect the division of the labour force into "A" and "B" teams referred to above. Blue-collar occupations are characterised by decreasing decision latitude, and a growing threat of unemployment due to technological change. Among the categories most severely affected by these trends are women in caring and other service occupations, especially within the hard-pressed public sector.

In short, the recent experience of Sweden tends to confirm the well-established relationship between work environment and human health. Emerging trends in the labour market and the political response to Sweden's recent economic crisis can, with a high degree of certainty, be expected to increase the level and intensity of job-related stress and resulting medical problems. However, given that such problems tend to develop over a period of several years, there is still time to reverse the negative trend in many cases-- if appropriate measures are soon taken. The knowledge is available.

-- Töres Theorell   
March 1998   

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