An ESRC Research Centre. ICLS Occasional Paper 5.4 The effect of the recession on work stress Traani Chandola, ICLS & Manchester University

Transcription

1 An ESRC Research Centre ICLS Occasional Paper 5.4 The effect of the recession on work stress Traani Chandola, ICLS & Manchester University About ICLS Occasional Papers Series: The ICLS Occasional Papers Series makes available presentations by or to ICLS members which have not been published elsewhere. Queries resulting from ICLS Occasional Papers, including requests to reproduce the information presented, should be directed to ICLS Administrative Office at University College London ( This is one of four papers prsented at the NatCen/ ICLS/ESRC Policy seminar on Unemployment, Recession and Health hosted at UCL in December Detail of the other papers can be found at the end of this document or on the ICLS website. Page of 13

2 Slides 1 Please help yourself to a copy of this publication if you re interested. It s work that was funded by the British Academy. And we had a launch a few weeks ago so apologies to a few of you that I can remember were at the launch. This presentation is similar. We ve already heard from the previous speakers about the long term scarring effects of unemployment. And we also heard from Ellen Flint (OP5.2) about how unemployment and insecure employment could have relatively similar effects on psychological well-being. And that s in a sense one of the themes of the publication. It s about what s better. Is it better to have any job, no matter how bad the job is, than to have no job at all? So given that most of the people I work with are survey people let me do an informal survey now. Hands up, how many people actually support the notion that any job is better than no job. Hands up. Any job is better than no job. A few takers, only a few takers. How many people believe the other way that actually [counts], got the majority here. Well, okay, so you know, there always is this tension, within a recession or out of a recession there is tension between job quality versus creating more jobs. And in a recession in particular this balance between job quality and creating more jobs gets out of kilter in effect. So the policy from this government and the previous government is we need to get more people into work. That s a very clear message. I wanted to come back to one a point a member of the audience. raised earlier but he seems to be out of the room. I ll wait till he comes back to respond to his questions, What shall we do about getting people with mental health disabilities back into work. And I wanted to refer to some great research that has been done about that. Slide 2 The structure of this presentation is shown here (next page, right). About the first point - measuring work stress - there s been so much material about this. To sum up: there is no gold standard measure for work stress. There absolutely isn t. We have to use very subjective measures of work stress, self reported measures of work stress. The one good thing is now people separate out the stress reaction. Page 2 of 13

3 So when we talk about the stress reaction we re talking about what Ellen Flint (OP5.2) was talking about - psychological well-being or physiological reactions or other kinds of mental health complications or behavioural problems that people get as a result of addictive behaviours, for example. So it s very easy and important to separate out those stress reactions from the stress generating conditions. When we re talking about work stress we re actually talking about those work stressors, those things at work that generate these kind of stress reactions. And there have been a few very well validated and well used measures of work stressors. I ll be talking about a couple in particular. One is the job strain model which is when you have too much psychological demand at work but very little control over how you do your work. It s a combination of too much job demands but too little control over your work. And the other measure, similar to the job strain model which expands on it is the Health and Safety Executive Management Standards which I ll be referring to also later in the theme. I ll also be talking about trends in work stress and trends in the determinants of work stress, some of the implications, the outcomes of the consequences of work stress, especially the economic consequences. And what can we do to manage work stress. Slide 3 Measuring work stress Trends Determinants Costs Managing work stress Professor Francis Green published this report last year about the long term trends in work stress. It s very hard to get trend data on work stress. Therefore it s very hard to get repeated measures of the same work stress questions before But at least from 1992 to 2006 we see a very clear trend of increasing proportions of people reporting job Percentage of employees in British Skills Survey with highstrain jobs, Green 2009: Job Quality in Britain Page 3 of 13

4 strain, reporting that they have high job demands and low job control. We see that this is true for both men and women but we see that especially among women it s exploded. It s gone up threefold from about 8% to 25%. So that s a huge increase over fourteen years. Okay. This is only going up to Slide 4 How about in more recent times - especially in the context of the recession? This doesn t go up until then but the Chartered Institute for Personnel and Development (CIPD)have been charting trends in the determinants of work stressors such as job demands and job insecurity. CIPD have been charting that since spring pretty much at the start of the recession. This is perhaps the best source of current up-todate data on trends in work stress that we have in the UK. And it shows a very clear trend in relation to job insecurity. For the private sector workers had an increase in job insecurity just prior to spring 2009, when the recession was first hitting private sector employment (2008). But they ve come down in job insecurity, they re starting to feel more secure in their jobs. For public sector workers it s just gone up phenomenally. Now we ve got public sector workers feeling more insecure in their supposedly secure public sector jobs than the private sector workers. What I didn t show is, apologies I realised there s some voluntary sector workers, people representing the voluntary sector here. That s also exploded. Job insecurity in the voluntary sector is now higher than in the public sector workers. Slide 5 This is job insecurity which is one of the big determinants of work stress. Another big determinant is job demands.one of the ways of conceptualising job demands is in terms of work intensity. There is the CIPD survey of a sample of how, you Percentage of employees who think they are likely to lose their job as a result of the current economic climate CIPD: Employment Outlook Surveys Percentage of employees feeling they are under pressure at work everyday CIPD: Employment Outlook Surveys Page 4 of 13

5 know, whether they re feeling under pressure at work every day. And when I published a report in I only had data up to 2010, I saw this huge big spike in the public sector workers from winter 2009 to spring And I said wow, work intensity has really gone up among the public sector workers. But the latest round of data shows that that spike is probably a statistical artefact and that actually the work intensity trend is pretty much flat for both public and private sector workers. So that s one aspect of work stress that doesn t seem to have changed much in the post recession period. Slide 6 Another aspect of work stressors is how much support people get at work. How supportive their colleagues are, how supportive their managers are. One of the ways of measuring that is whether they feel that there s greater conflict at work. And conflict at work has gone up for both public and private sector workers but it s gone up even more for public sector workers than for private sector workers. Slide 7 One of the ways we can manage work stress is to have good work-life balance. That s been one of the consistent messages. If you get people to have more flexible working hours, for example, that is one of the ways of managing their work stress. Unfortunately that s not happened. The number of employees reporting that their organisation Percentage of employees who have noticed in conflict at work between colleagues CIPD: Employment Outlook Surveys Percentage of employees disagreeing their organisation provides support to manage their work-life balance CIPD: Employment Outlook Surveys does not support them to manage their work-life balance has just gone up remarkably, especially for the public sector workers in the post recession period. Page 5 of 13

6 Slide 8 Ellen Flint (OP5.2) showed a similar graph to Trends in unemployment rates and job insecurity this earlier. It looks at the long term trends in job insecurity using this measure of temporary employment in the labour force survey. The percentages of temporary employees who cannot find a permanent job. And there is an extremely close correlation with the unemployment rates. So ONS: Labour Force Surveys there is the unemployment rate over here from That s the, this indicator of job insecurity, at least among temporary workers and there s such a strong correlation going on between the two so the periods of recessions are associated with an increase in job insecurity. Slide 9 What s also correlated with is suicide rates. We know from previous literature that unemployment, when unemployment increases suicide increases. But I just wanted to highlight this. Well, it s not just a correlation between rates increasing rates of suicide and increasing unemployment rates, you get the same correlation or even a stronger Trends in male job insecurity and male suicide rate aged ONS: Labour Force Surveys and UK Suicide Rates correlation between increasing suicide rates and increasing male insecure employment rates. And this is summarised in the report. In the report we look at not just the effects of work stress on mental health outcomes like suicide but we also look at the effects of work stress on physical health outcomes like cardiovascular outcomes. We find that there s a moderate evidence that work stress is an important factor influencing your physical health in terms of cardiovascular health. There is strong evidence that work stress affects common mental disorders like depression and anxiety. There s strong evidence that work stress is indicated in workplace Page 6 of 13

7 injuries and accidents. As a consequence of work stress, affecting these different kinds of health outcomes, we also find that it s no surprise that work stress is very strongly associated with sickness absence. The more stressed out somebody is the more likely they are to take sickness absence. And also there is some indication that work stress is also associated with sickness presenteeism. So the concept that if you are ill but you feel compelled to come into work because you feel that if you don t come into work you might lose your job. Although the evidence on, it s very hard to get statistics on presenteeism. Because it s very hard to measure presenteeism. So I haven t said anything in the report about whether presenteeism has increased as a consequence of this current recession. Slide 10 One of the things that I was quite interested in looking at in the BA Stress at Work report was the economic cost of work stress.. And there are, there have been quite a few reports now trying to quantify how much does work stress cost us. The Health and Safety Executive published this Discussion Paper in They showed, they suggested Costs to Britain of workplace accidents and work-related ill health Pathak (2008): HSE Discussion Paper Series that the cost of all work place accidents, so we re not just talking about work stress related accidents but all workplace accidents and work related ill health to the country, to society was around 1% of the GDP. This was calculated for around 2001/2002. So around 1% of GDP is because of Sorry, I got that wrong. This is the cost to Britain of all workplace accidents and work related ill health. And in general we know that around 40% of all work related ill health is due to work stress. So this figure has been a consistent figure for the last ten or twenty years, that around 30-40% of all work related ill health is due to work stress. Using this figure of around billion pounds of cost due to all work related ill health we can estimate that work stress was around 40% of that figure - around 1% of GDP - in 2001/2002. You ll see straightaway that the cost to the employers are much lower than the cost to society and the cost to individuals. And that s one of the things that s remarked about in this report and it shows that as long as most of the cost of work stress are being born by wider society or by individuals employers don t have much incentive to do anything about work stress. Okay, it s costing them something but actually they re being subsidised by individuals and the rest of society. So as long as these costs remain minimal they ll say well, okay, we don t have to do anything about work stress because Page 7 of 13

8 individuals will bear the cost or wider society will bear the cost. That s one of the points. I didn t make it, it comes up from the Health and Safety Executive. Slide 11 Health and Safety Executive: Management Standards Approach The Health and Safety Executive also puts out some advice about what can we do to reduce stress at work and, they have adopted in the past the Management Standards approach which is basically to do a sort of risk assessment of the organisation using this Management Standards approach which I ll talk about in the next slide, and then evaluate the risk, record your findings and try to intervene appropriately. This particular report also goes into what is the evidence on interventions for reducing stress at work. And there are two broad kinds of interventions we re talking about: Either individually focused interventions that talk about stress management reduction. And so the object of those kinds of interventions is the individuals get them to adopt relaxation, meditation, you know, breathing techniques so that they can cope with their stressors, to get them to adopt cognitive behavioural therapies, for example. So not to change anything in the work place but to change the individual. And there s evidence that there is some success in trying to reduce apparent stress levels amongst people who are stressed out using this individually focused approaches. The other kinds of approaches which is focusing on the work organisation trying to change the job demands, for example trying to change the work hours, also trying to change the amount of control people feel they can, you know, they have at work. For example working in semi-autonomous teams. That s another typical way of getting people to have more control over their work or the more, the most typical workplace focus approach is to increase supported work. So we re talking about better communication between managers but also better peer support amongst employees. And the evidence - I myself haven t reviewed it but it s been reviewed very recently, shows very clearly that a combination of approaches, both individually focused approaches as well as workplace focused approaches is generally the best approach for reducing stress in the workplace (see report for evidence review reference) Page 8 of 13

9 Slide 12 Trends in the Management Standards Trends in Management Standards Indicators in relation to people s roles at work, relationships at work, job demands, job control, how change is managed at work, and how much support people get from their managers, this has been tracked by the Health and Safety Executive since And you can see it s pretty much flat. So this Packham and Webster (2009): HSE is the main approach that the Health and Safety Executive has adopted for managing stress in the workplace. To get employers to voluntary sign up to Management Standards approach. But we can see that it s not having much of an effect on work stress levels in the workplace here. There s no change since the adoption of these Management Standards. And this pretty much, this is not my conclusion again, this is the conclusion of the Health and Safety Executive that so far the Management Standards approach to reducing stress levels in the workplace hasn t really worked. We don t have the data for 2010, hasn t come out, but we, it s likely given the earlier figures I showed from the CIPD employer outlook survey it s unlikely that things have improved at all. And what is also very recent - in the last few months - is Lord Young s review of the Health and Safety Executive and that review quite clearly downgrades the Management Standards approach. So it says that, in effect it says that office work is not a high risk situation. It shouldn t be considered high risk at all. And we don t really need to have a Management Standards approach to, you know, this complicated approach to managing work stress. And anyway work stress is probably not really that important and so maybe the Health and Safety Executive shouldn t be investing so much resources in that. So it s, you know, here we ve got evidence that this policy approach isn t working and it s now being sort of disregarded for and even since the policy approach rather than going the other way which is probably more activist intervention in workplaces as a consequence of Lord Young s review of the Health and Safety Executive we probably there s probably colleagues from Health and Safety Executive here, by the way we re probably going to see a less interfering approach of the government into workplaces. So probably stress levels will increase. Page 9 of 13

10 Slide 13 I put in this graph just to show the position of the Job demands and control by country UK in relation to other European countries for work related stress. This is a quadrant of job strains. So these are countries that have higher than average levels of job demands and lower than average levels of job control. And in this quadrant we see quite a few expected people, Greece is very Parent-Thirion et al. (2007): 4th European Working Conditions Survey high up there, Turkey, Cyprus, Slovenia, Romania. This group of countries is not surprising. The UK is pretty much close to the centre so it s got average levels of job demands and average levels of job control. And so it s not doing that great but it s not doing that badly either. Is it because we ve got the Management Standards? Is it because we ve got better legal systems? Probably not. In fact there is no law related specifically on work stress but there is no law specifically related to work stress in any of these countries. So it s not like these countries that have low strain have great policies either. Audience: You have the common law on psychological harm. That s right. So there are common law directives. There are also employers have a duty of care to their employees. One of the complications And there have been a few successful cases related to work stress claims. Again I haven t reviewed that but there s a good reference in the literature on that. The trouble with establishing that in a court of law is that you have to prove that the employer was negligent and it s very hard to prove that because if the employer is Audience: It has to be reasonable foreseeable, doesn t it? That s right. It has to be foreseeable and you know, that And so in general most legal claims related to work stress do not succeed at court because they, the burden of proof for foreseeability that the employer has not taken reasonable steps to reduce work stress, it s very hard to prove in a court of law. Page 10 of 13

11 Slide 14 One thing that may change this is something that s unrelated to the work stress initiatives but something that the DWP has brought in as a result of Carol Black s review the replacment of the sick note with the fit note. And the big difference here is that in the sick notes the GPs or occupational health physicians are meant to be stating what is it that needs to be changed at work that gets the person, gets the employee back into work. And here the DWP has suggested, you know, they ve given case examples of changes, what changes can be done in the workplace. For example, increasing work social support, increasing peer support, workplace adaptations, amended duties. And they suggest changing work hours, for example, whether the employee can be put on a more flexible work So changing the job schedules that might be one way of getting the person back into work on changing their work hours. Of course this is not legally enforceable so an employee can t take this back to the employer and say my GP says that you should change my work hours. But, and this is a big but,, if the courts do get hold of this kind of documentation that here, here s some suggestions for how this person should come back into work. If the employer doesn t take any action related to that, then there s this big question mark will this be used as evidence for changing working conditions, especially stressful working conditions at work. Slide 15 And I just want to come back at the end to this question of is it good, is it better to be out of work, to be unemployed, or better to be working in a poor quality job. And it comes back to what Ellen Flint (OP5.2) was presenting earlier on. This study came out a few months ago now and it looked at the risk of Odds ratios of Depression: follow up of unemployed people in Australia Leach et al (20101) BMC Public Health Page 11 of 13

12 depression. It looked at a cohort of unemployed people and basically they found that the unemployed people who were re-employed into high quality jobs had the lowest risk of depression. The unemployed who remained unemployed after about two years they had a higher risk of depression than those who were employed in high quality jobs. But the ones who were employed into low quality jobs, and by low quality we mean stressful jobs, jobs with job strain and job insecurity, they had a huge increase in their risk of depression. So this is a little bit of evidence that supports the majority view here that actually you can t ignore job quality at the expense of creating more jobs. Thank you. Page 12 of 13

13 In December 2010 ICLS hosted a policy seminar on Unemployment, Recession and Health at UCL. The seminar was chaired by Richard Bartholomew, Chief Research Officer, Children, Young People and Families Directorate, Department for Education. Transcripts from this event, including this paper, have been made available via the ICLS Occassional Paper Series for those who were not able to attend the event or for those who might want to read the material covered in the seminar. See below for full list of papers from this event. Seminar abstract Will the present recession deal any more than a passing blow to some people s living standards? Or will the attention of the Health Service, marriage counsellors, child psychologists and the health and Safety Executive, amongst others, be needed to protect individuals? These questions are sometime overlooked in the tendency to see recession as a purely economic phenomenon. But the idea that unemployment has wider ranging effects on individual and community well-being is not new. In the 1930s there were pioneering studies reporting poorer mental health, and higher levels of TB and rheumatic fever in areas of the UK and Austria worst affected by the economic crisis of that time. In the 1980s in Britain, public health scientists found increased risks of suicide and heart disease among unemployed men and women. In both periods, researchers came up against strong political opposition to their findings. Our workshop will present some results of studies being carried out at the National Centre for Social Research and the ESRC International Centre for Life Course Studies using the most up-to-date survey data and methods. These studies throw light on what are likely to be the wider health and social implications of the presently ongoing recession for individuals and families. Presentation / Speakers: OP5.1 Unemployment, Recession and Health Mel Bartley, ICLS & UCL replacing, OP5.5 Social impacts of recession. Matt Barnes, NatCen OP5.2 The effects of joblessness and insecure employment on psychological wellbeing. Ellen Flint, ICLS OP 5.3 Unemployment, permanent sickness and mortality risk in early old age. Bola Akinwale, Imperial College OP 5.4 The effect of the recession on work stress. Tarani Chandola, ICLS Feedback: Please send comments on the content or format of this document. icls@public-health.ucl.ac.uk Page 13 of 13