According to Burke and Fiksenbaum (2008), most people believe that work is healthy, desirable, and protects against many illnesses. Apart from presenting a means of earning a living, work fulfills a range of individual needs in providing temporal structure, challenge, variety, a sense of accomplishment, and the opportunity to use and develop skills. Work also fulfills social needs and provides a sense of identity (Warr, 1987). In contrast, worklessness is widely considered to be bad for the health of the working-age population and has adverse repercussions for the wider community. In a review of unemployment research published in the last year of the twentieth century, Hanisch (1999) found that almost every study conducted reported negative physical and psychological outcomes for affected individuals and their families, ranging from psychiatric illness to academic underperformance of the school-age children of the unemployed. Whilst research has shown that being unemployed carries a significant risk to health, particularly in the long term (Antoniou and Cooper, 2005), the health of many people is also at risk because of the nature of the work they perform and other wider characteristics of the workplace. It has been long recognized that the physical demands of work, shift and night work, exposure to unusual temperatures, noise or certain chemicals and substances, and poor safety practices carry an increased risk of developing serious illness or injury (Beehr, 1995; Cooper, Dewe, and O’Driscoll, 2001; de Camargo, 2009). For example, working in extreme cold has been shown to reduce manual dexterity and sensitivity, and lead to increased risk of accident (Clarke and Cooper, 2004). Although the physical demands of jobs and the number of workplace injuries have significantly declined over the last 50 years due to health and safety legislation, concern regarding the myriad psychosocial hazards to which workers are increasingly exposed has steadily grown. Consequently, in recent years, work-related mental and behavioural disorders have become increasingly prevalent in industrialized economies.
According to the American Institute of Stress, over 75 percent of visits to doctors and over 60 percent of accidents are related to stress. The most common stress-related conditions are depression and anxiety which affect one in five of the UK population and one in six US employees each year (Quick, Macik-Frey, and Cooper, and Nelson, 2007). Furthermore, the International Social Survey (2004) conducted in 15 OECD countries found that 80 percent of employees reported that they felt stressed by their work. Workers who perceive their jobs as stressful are twice as likely to work long hours, think about leaving their job, or experience burn-out (Burke and Fiksenbaum, 2008). A growing body of research has also shown a significant link between stress and workplace accidents and serious errors (Clarke and Cooper, 2004; Reason, 1997). In a survey of 9,000 safety representatives polled by the UK Trade Unions Association, stress was named as the top health and safety priority by two-thirds of respondents (Pearson, 2001). Consequently, various trade union bodies in the major world economies have campaigned to highlight the impact of excessive workloads, unreasonable job demands, and precarious employment on employee health (Kelly and Colquhoun, 2005) and remind employers of their obligations to ensure that individuals are not made ill by their work.
Unscheduled absence is estimated to cost employers around 4 percent of annual payroll (Marsh and Mercer, 2008) in direct costs, which has triggered many very large organizations to invest in healthcare and absence management programs. Yet, as many as 55 percent of UK organizations still do not monitor their absence costs at all. There is limited but impressive evidence that healthcare and absence management programs can achieve a significant return on investment in reducing absence and increasing return-to-work rates (Sainsbury Centre for Mental Health. 2007). However, the focus of these programs tends to be directed at improving worker health by changing individual behavior and lifestyle habits and providing improved rehabilitation services following illness rather than by providing healthier work by changing the nature of the job and the work environment.
Whilst acknowledging that health screening and other health promotion activities have a major role in improving and maintaining worker health, evidence suggests that levels of job dissatisfaction amongst workers are rising (Westwood, 2002). Given that job satisfaction is often an antecedent to ill-health, this chapter is concerned with addressing the factors that contribute to making some jobs potentially more detrimental and risky to health than others.
The Costs of Work-related Ill-health and injuries
The costs of workplace ill-health internationally are huge (Rossi, Quick, and Perrewe, 2009). In the US, the annual cost of occupational injuries and ill-health is estimated to be US$171 billion (NIOSH/CDC, 2003). In the European Union, the estimated cost is suggested to be around over £20 billion (Geurts and Grundemann, 1991). The annual cost of absence in the UK was over £13 billion in 2007, and represented 172 million days lost (CBI, 2008). Around 2 million people in the UK, representing around 5 percent of the working population, suffer from ill-health caused by work each year. Approximately 40 percent of all sickness absence in the UK is attributed to mental health problems, and the cost of replacing those who leave their jobs as a result is estimated to be £2.4 billion each year (Sainsbury Centre for Mental Health, 2007). There is also considerable evidence that mental health problems lead to a range of physical ill-health conditions, including coronary heart disease, cancer, stroke, diabetes, and respiratory diseases (Osborn et al., 2007; Prince et al., 2007).
A closer examination of the UK figures consistently shows that absence is significantly higher in the public than the private sector. Ironically, sickness absence rates are amongst the highest in the health sector where one in three UK workers are experiencing work-related stress, and nursing staff currently take an average of 16.8 sick days each year, at a cost of £470 million (Healthcare Commission, 2005). Furthermore, absence levels and ill-health conditions vary within and between work groups, departments, and occupations (Johns, 2001). For example, whereas musculoskeletal conditions are the main reason for work-related illness in the construction industry, most absences in education are attributed to mental ill-health problems (HSE, 2008).
According to Nicholson and Johns (1985), in certain sectors and organizations “absence cultures” exist in which workplace norms are created in regard to tolerable levels of worker absence. In such cultures, employees observe their colleagues’ absence behaviors and their managers’ reaction and go on to act in a similar way. The notion of an absence culture has been supported by studies such as Gellatly (1995) who identified that perceptions of co-worker absence over a 12-month period were positively related to individual absenteeism, up to one year later. However, in contrast, Johns (2008) argues that, in certain occupational categories, distressed employees are highly likely to continue to attend work when they are ill because they do not want to let other people down or feel guilty about increasing the workload of their co-workers. Research by Aronsson, Gustafsson, and Daliner (2000) supports this view in finding that employees with jobs involving the care of vulnerable clients, such as nurses and healthcare workers, were most inclined to attend work despite ill-health. Caverley, Barton Cunningham, and McGregor (2007) found that presenteeism was more prevalent in work settings that are understaffed or have downsized.
The loss of productivity that occurs when employees come to work but function at less than full capacity because of ill-health has been defined as presenteeism (Sainsbury Centre for Mental Health, 2007) and has raised extensive concerns amongst employers and public health bodies. Research evidence, mainly based on North American studies (e.g., Goetzel et al., 2004; Stewart, Matousek, and Verdon 2003) suggests that the costs of presenteeism in terms of lost productivity are significantly higher than the costs of absenteeism. Importantly, Dewa and Lin (2000) found that presenteeism behavior is associated with workers experiencing mental health problems, such as depression, rather than physical ill-health conditions. Furthermore, presenteeism is more prevalent in managerial and professional occupations than in trades (Hilton, 2007).
A large-scale study of male employees conducted by Kristensen (1991) highlights the long-term detrimental consequences of continuing to work when ill. After controlling for a range of coronary risk factors, the study found that the incidence of serious coronary heart problems was twice as high in those employees who took no sick leave compared with those who took a moderate amount of sick leave.
Type of Job
In the same way that individuals differ in terms of their response to work-related pressures, certain occupations, job roles, and work environments are generally considered to be more demanding and potentially more stressful than others. For example, research has highlighted that teachers (Travers and Cooper, 1993) nurses and healthcare providers (Kahn, 1993; Bradley and Cartwright, 2002), and ambulance service workers (Young and Cooper, 1999) experience particularly high levels of stress and psychological strain. Nurses represent 5 percent of all female suicides in the UK (Eaton, 1998). Furthermore, as nursing involves high physical, as well as emotional, demands, it carries a higher risk of musculoskeletal disorders and records significantly higher absence rates than most other jobs (Hodgson et al., 1993). In a large-scale study of 25,000 UK managers and employees Johnson et al. (2005) compared the experience of work-related stress across 26 different occupational groups: their results showed that ambulance workers reported the poorest levels of physical health whereas social workers reported the poorest levels of psychological health. Teachers, police officers, fire service workers, and call-center service agents were also ranked amongst the most stressful jobs, and prison service workers emerged as the most dissatisfied occupational group. Evidence from the same study suggested that those in higher job grades were more healthy and job-satisfied than lower-grade colleagues. Jobs which involve shift working have been shown to be associated with a greater use of alcohol, decreased life satisfaction, increased work errors, and a range of general health problems (Sparks, Faragher, and Cooper, 2001; Clarke, 2008). A European study (Tuchsen et al., 1998) also found an increased risk of ischemic heart disease amongst occupational groups that engaged in shift/night working. Evening, weekend and shift workers also carry a greater risk of suffering workplace violence.
Working in extremely bright lighting or very noisy environments have also been identified as being particularly stressful to occupational groups such as air traffic controllers (Cobb and Ruse, 1973) and health workers (Arnold, 2005; Hay and Oken, 1972). Teaching and telephone call handling is associated with an increased risk of voice problems (Holman, 2003). Engagement in jobs which are held in low regard, such as garbage collection, or risky, such as mining, or experienced as boring have been shown to be linked to chronic work-related alcoholism (Rossi, Quick, and Perrewe, 2009). Other researchers have found that physical health is adversely affected by repetitive, unpleasant, and dehumanized work settings such as fast-paced assembly lines (Cooper, Dewe, and O’Driscoll, 2001).
Burn-out, a special from of strain characterized by chronic fatigue, depression, and frustration, is more prevalent in the teaching and health professions as well as amongst police and prison officers (Cooper, Dewe, and O’Driscoll, 2001). The military, police, and the emergency services are also more likely to suffer from post-traumatic stress disorders. One of the emergent psychosocial hazards in recent years has been the risk of workplace bullying. Again, this workplace hazard has been found to be more prevalent amongst certain occupational groups, such as teachers, the police, and the prison service (Cartwright and Cooper, 2008).
Clearly, every job has its own potential intrinsic and environmental sources of stress, and increasingly sophisticated models of occupational stress have been developed over that last three decades. In broad terms these models still continue to address, to some extent, four types of stressors: the physical demands of the job; the job role demands; the job task demands; and the social/interpersonal issues (Cooper, Dewe, and O’Driscoll, 2001). However, not all take into account or place the same emphasis on individual characteristics such as personality or coping skills which may serve to moderate the appraisal, response, and management of stress. Having said this, research findings seem to consistently highlight certain situational factors which contribute to make certain jobs more risky to health than others.
The role of the environment and the individual job-holder in the stress process is perhaps best understood within the person-environment (P-E) theory of stress (Caplan, 1983; Harrison, 1978). Central to this theory and other later models (Cox and McKay, 1981; Cummings and Cooper, 1998) is that strain occurs when there is a lack of fit, mismatch or imbalance between the characteristics of the person (e.g., skills, abilities, values and needs) and the environment (e.g., job demands, supplies and resources). However, strain only occurs if the individual perceives and appraises this misfit to be important and a threat to their well-being which they are unable to deal with effectively. Strain can be physiological (e.g., cardiovascular or biochemical symptoms) or psychological (e.g., job dissatisfaction, anxiety, depression, exhaustion, or other ill-health symptoms). Strain can also produce adverse behavioral responses. These can be measured in terms of their significance to the organization, such as absence or lowered productivity, or in terms of their significance to the individual, such as use of alcohol or smoking. Cooper et al. (2001) conclude that the psychological strains are the most commonly studied and are generally assessed by self-report measures.
Clearly, a mismatch is likely to occur if individuals engage in jobs to which they are unsuited because they overstretch their abilities, underutilize their skills or do not meet their expectations. Job and career choices are limited by a variety of factors including education, availability, mobility, life stage, and experience. As those entering the workforce tend to be better educated than those who leave (Kompier, 2005), evidence suggests (Bibby, 2001) that young workers hold higher expectations about what they want from a job. Based on a study of 10,000 young workers, Bibby (2001) concluded that young people today place an increased emphasis on the intrinsic aspects of work—that is, having interesting work, making a difference to people’s lives and achieving a greater sense of meaning and purpose.
In terms of the environmental psychosocial factors that interact with the characteristics which the individual brings to the workplace to determine health outcomes, Cooper and Marshall (1976) identify six potential sources of work stress. These are broadly described as factors intrinsic to the job, role in the organization, work relationships, career development, organizational structure and climate, and home/work interface. Fletcher (1988) differentiates between intrinsic factors (e.g., work conditions, workload responsibility, role factors, and career) and extrinsic factors (e.g., domestic and social factors).
However, one of the most influential models of workplace stress relating to job content is the job demands-control or decision latitude model proposed by Karasek (1979). This model was originally developed and tested in Sweden on various occupational groups, but with a particular interest in the health of blue-collar/manual workers. As observed by Wong, De Sanctis, and Staudenmayer (2007), the vast proportion of research on the job-demand control model has involved nurses and production workers.
The job demands-control model centers on two dimensions of the work environment considered to be of critical importance to employee health—namely, job demands and job control. Job demands are psychological demands or stressors present in the work situation and have been typically operationalized as time pressures, high working pace, and complex work (van de Doef and Maes, 1999). High job demands in terms of excessive workloads and time pressures are likely to lead to long working hours which in turn adversely impact on health and the quality of life. Job control or decision latitude is the amount of control an individual has over his or her work activities in terms of work organization and skill discretion (Karasek, 1979).
Karasek (1979) defines strain as the physical and psychological effects of work stress resulting from a combination of demands and control (see Figure 9.1). The model proposes that the most severe psychological strain is found in individuals who perform jobs that have both high demands and low control. Jobs with high demands but which also afford the individual with a high level of control, described by Karasek (1979) as “active jobs,” are regarded as being beneficial to individual health and as promoting psychological growth and high levels of learning. Jobs with low demands and low control are described as “passive,” and, whilst they offer little opportunity for learning and personal development, are considered to be low-strain. Finally, jobs with low demands and high control are considered to be low-strain, and also offer workers the opportunity to learn and develop.
Source: Taris and Kompier (2005)
There has been considerable empirical research to support the notion that jobs with high demands and low control adversely effect both physical and psychological health. Theorell and Karasek (1996) assert that 80 percent of epidemiological studies have indicated a clear relationship between low decision latitude and elevated risk of coronary heart disease. Landsbergis (1998), in a study of hospital workers and care home staff, found that psychological strain was significantly greater amongst workers reporting high demands and low decision latitude There has also been some limited, but weak, support for the hypothesis that high demand/low control is predictive of absenteeism (Parkes, 1991). Not surprisingly, job satisfaction and commitment have been consistently found to be highest in workers with high demand/high control jobs. However, taken overall, the demands-control model has emerged as being a much stronger predictor of physical ill-health than of psychological ill-health.
Consequently, because high demand/low control jobs tend to be low-skilled and of low economic status (e.g., assembly line workers, bus drivers), the model has been widely criticized in that the studies derived from it have confounded the influence of social class on health status. Social class is well recognized to be an important social determinant of health. A plethora of studies worldwide have consistently shown that, compared to higher socioeconomic groups, the lower social classes suffer a higher incidence of mental ill-health, die younger, and are more likely to be absent from work.
In addition, the majority of studies which have shown support for the job demands-control model have been cross-sectional in design and hence unable to establish causal relationships. Evidence from reviews of longitudinal studies has presented only mixed support for the interactive effect of demands and control (Terry and Jimmieson, 1999), with many showing that high levels of work control do not appear to invariably militate against the negative impact of high demands.
Furthermore, there has been comparatively little research focused on the other quadrants of the model. Whilst active jobs may be stimulating and absorbing, high levels of job involvement have been shown to be predictive of long working hours which, as will be discussed in more detail later, present a major risk to health.
There is also evidence that jobs with low demands—that is, work that is too simple, provides little challenge or is insufficient to fill one’s time—are also potentially stressful (Terry and Jimmieson, 1999). Importantly, the model takes little account of the possibility that individuals do not necessarily seek jobs that provide them with high levels of control and autonomy. For example, Savery (1988) found that whilst managers were attracted to job roles which gave them a high level of autonomy, non- managerial groups valued shorter working hours and job security over autonomy.
However, the job demands-control model is important in highlighting the role of organization-level factors in determining health and well-being and the fact that job characteristics can be modified to make jobs more motivating and less harmful to health. It also reinforces the importance of, and has renewed interest in, the job characteristics model (Hackman and Oldham, 1976) which emphasizes the motivating potential of jobs that provide task variety, task significance, task identity, and feedback as well as greater autonomy. According to Kanter, Stein, and Jick (1993) the characteristics of a situation (e.g., job redesign) can be sufficiently powerful to override personal predispositions. Eroding levels of individual control and autonomy have been increasingly attributed to the increased incidence of stress and ill-health among the teaching professions (Tytherleigh et al., 2007).
Perceptions of control can be increased by greater employee participation in decision–making, as was shown by Jackson (1983) in a well-designed intervention study in a hospital outpatient facility. The intervention involved training employees in participative decision-making and scheduling an increased number of staff meetings. In a six-month follow-up study it was found that increased employee involvement resulted in a significant reduction in emotional strain, increased job satisfaction, reduced absenteeism, and reduced turnover intentions. Other studies (Wahlstedt and Eddling, 1997; Theorell and Karesek, 1996) have shown that changes in job design which increase decision latitude result in reduced absence and improved sleep patterns.
Participative management and employee involvement are the forerunners of the concept of employee empowerment which gathered popularity from the late 1980s onwards as a change management tool. Conger and Kanungo (1988) define empowerment as being more than simply a managerial practice of giving employees more autonomy and individual control; it is, rather, a process of enhancing feelings of self-efficacy and responsibility, and of providing meaning to work by giving front-line workers more decision-making power. The introduction of techniques and practices to increase employee empowerment has been considered to be particularly appropriate and potentially beneficial in the “electronic workplace” (Bray, 2001) where there is an intense level of electronic performance monitoring and control, such as in call centers. Call-center jobs have been described as exemplars of modern-day “Taylorism.” Typically, call centers are associated with highly controlled, low-skill, low-wage jobs based on a mass service model designed to provide standardized customer service. The number and duration of calls is closely monitored, and employees have to meet demanding call-handling targets; the interaction between agent and customer is often rigidly scripted, and there is little opportunity for social interaction and restricted freedom to leave one’s work station. As Johnson et al. (2005) and others (DiTecco et al., 1992) have shown, customer service agents report significantly higher levels of stress, and record higher sickness/absence and attrition rates than most other occupations. To date, the positive benefits of empowerment programs in improving well-being in call centers have proved to be rather elusive because of managerial resistance to surrendering power and control, and there is some evidence to suggest that the relationship between stress and empowerment is curvilinear in that moderate levels of empowerment result in low stress and low or high levels of empowerment increase stress (Holdsworth, 2007).
While originally ignoring the social dimension of work, the job demands-control model has since been expanded to include the dimension of social support (Karasek and Theorell, 1990). In many research studies, social support is defined as a global concept (Veiel and Baumann, 1992). However, according to House (1981), there are different types of social support in that it can be:
instrumental—that is, giving direct help, often of a practical nature,
emotional—that is, showing care,
informational—that is, giving helpful information, and
supportive—that is, giving encouraging feedback.
The job demands-control-social support model suggests that workers who have high job demands, low control and low social support are at the greatest risk of experiencing psychological distress, poor health, burn-out and job dissatisfaction (McClenahan, Giles, and Mallet, 2007). There has been extensive empirical support for the model. De Lange et al. (2003) reviewed 19 longitudinal studies using this model and found that demands, control, and support were predictors over time of overall employee well-being, job satisfaction, and psychological distress. They also found evidence that high strain was predictive of sickness absence, mental ill-health problems, and alcohol consumption in half of the studies reviewed.
It is not surprising that, as many jobs demand a great deal of contact with other people, relationships at work—be it with co-workers or managers—make a significant contribution to job satisfaction and overall health and well-being. Many years ago, Kahn et al. (1964) demonstrated that poor working relations and mistrust of work colleagues can lead to psychological strain. At the same time, many studies (e.g., Cooper, Dewe, and O’Driscoll, 2001) have shown that supportive and considerate managers and co-workers directly enhance health, and help individuals cope with work pressures. In a study of three large Finnish organizations Kinnunnen et al. (2000) found that social support significantly moderated the adverse impact of job security on employee well-being. Moyle (1998) found that managerial support during organizational change influenced job satisfaction and psychological health. Bradley and Cartwright (2002) found that perceived support from the organization was a significant predictor of health levels and job satisfaction in UK nurses. In an Australian study of occupational injuries, Iverson and Erwin (1997) found that high levels of support from supervisors and co-workers were significantly associated with low injury rates. Burke et al. (2002) found that organizations which provided high levels of informational support in terms of safety knowledge and training had better safety records than other organizations.
Debate continues as to whether social support directly influences health outcomes or is an intervening variable or buffer which only influences health in situations where the individual is exposed to stressors (Bradley and Cartwright, 2002). However, research has consistently shown that a lack of social support is associated with high levels of depression and job dissatisfaction (Cooper, Dewe, and O’Driscoll, 2001), although for some individuals seeking help may have negative consequences, such as loss of status and a threat to self-esteem.
A survey of HR professionals and managers conducted by the UK Industrial Society (2001) found that 95 percent of those surveyed rated supportive managers as the workplace factor most likely to help employees cope with stress. Lack of social support and quality connections with others are particular risk factors for those in very senior positions (Macik-Frey et al., 2009), as well as for those in jobs which provide little opportunity for social interaction. Whilst the increase in home working has provided employees with greater flexibility to structure and organize their jobs, research has highlighted the related problems of social isolation and increased feelings of loneliness such workers can experience in comparison to those working in a centralized workplace (Huws, 1993). Therefore, jobs which involve lone, remote working or membership of virtual teams may carry an increased risk of ill-health if job-holders are not able to access an adequate level of social support.
The Vitamin Model
In recognition that aspects of work can be positive and health–enhancing, Warr (1987, 2008) developed the “Vitamin Model” which suggests that the presence of certain features in the work environment can boost vitality. According to Warr (1987), there are nine environmental features or “vitamins” that are present to a greater or lesser extent in any job. These features, which include externally generated goals, opportunities for control, skill use, interpersonal contact, role clarity, and feedback, are conceptualized as being similar to vitamins A and D in that a lack or overdose of them results in poor psychological health. Hence the relationship between these variables and health is curvilinear. In contrast, the remaining three features—availability of money, security, and valued social position—are compared with vitamins C and E whereby only an absence or low dosage is harmful to psychological health, and excessive exposure has no adverse impact. Thus, these features present a more linear relationship between work characteristics and health. The vitamin model also allows greater consideration of individual differences than other models.
In contrast to Karasek (1979), Warr (2008) argues that extremely high levels of control can lead to adverse health outcomes, particularly if the individual feels that the task is too difficult for him or her. Jeurissen and Nyklicek (2001) tested the vitamin model in a sample of Dutch healthcare workers, and found support for the notion that job demands and job autonomy influence anxiety and depression levels. However, job demands were found to exert a stronger influence on health outcomes than autonomy.
The job demands-resources model (Bakker, Demerouti, and Verbecke, 2004) proposes that working conditions may be categorized into two broad dimensions—job demands and job resources. In contrast to job demands, job resources are the physical, organizational or social aspects of the job that motivate workers to achieve work goals, and stimulate psychological growth and personal development (Bakker and Demerouti, 2007). Training, support and adequate equipment to perform the job, as well as autonomy, coaching and team climate, have been identified as potential job resources (Xanthopoulou et al., 2009). Personal resources are regarded as the skills, self-belief, optimism, and resilience that workers bring to the job. A small-scale diary study of Greek workers in a fast-food company conducted by Xanthopoulou et al. (2008) suggests that job and personal resources fluctuate from day to day and determine how engaged employees are in their job tasks. The presence of daily coaching was also found to influence objective measures of performance.
This model highlights the need for organizations to ensure that workers are provided with the necessary information, equipment, and supportive and directive leadership to perform their tasks effectively. It also emphasizes the importance of ongoing training, team–building, and personal development activities, particularly when job requirements change.
The Effort-reward Imbalance Model
The effort-reward imbalance model (Siegrist, 1996) is based on the principles of interpersonal exchange and social reciprocity whereby workers expect that, in exchange for performing their work tasks effectively, they will be adequately rewarded for their efforts. Money is the primary form of expected reward, but esteem, career opportunities, and job security are also forms of reward. According to the model, individuals who perceive that they invest high effort but receive low gains experience high levels of frustration, which lead to adverse health consequences. Research among nurses (Hasselhorn, Tackenberg, and Peter, 2004) has also shown that effort-reward imbalance is associated not only with a perceived lack of general fairness, but also with decisions to leave jobs. Effort-reward imbalance has also been shown to lead to obstructive work behavior and a reduction in pro-social behaviours (Martinson et al., 2006). The implications for organizations are that they need to ensure that promotion procedures are transparent and that reward policies are just and fair.
Long Working Hours
The UK has the longest working hours in Western Europe. The average number of weekly hours worked in the UK is 44.7 hours, compared with 36 hours in Germany and 38 hours in Belgium (Sparks et al., 1997). Working under increased time pressures has become a feature of all types and grades of job, but is particularly prevalent at the managerial and professional level A study of over 19,000 Australian workers found that managers and professionals reported putting in significantly more effort and working at an increased pace than other occupational groups. In a study of over 1,300 UK managers Worrall and Cooper (1998) found that 78 percent of respondents reported that they often or always worked late, and more than half reported that they regularly took work home and worked at weekends. The General Household Survey (1998) based on data gathered from 5,000 households found that employees who consistently worked long hours over a five-year period were more likely to develop health problems, such as high blood pressure and chronic headaches, than employees who worked shorter hours (Bridgwood et al., 2000). A much earlier study of 100 young coronary patients revealed that 25 percent of them had been working at two jobs, and an additional 40 percent worked for more than 60 hours per week (Russek and Zohman, 1958).
Interestingly, workaholism has been defined as regularly working at least 50 hours per week. Workaholism is the so-called addiction to work that individuals display either because of anxiety and insecurity or because of a genuine enjoyment of the job. High levels of work involvement are characteristic of the workaholic profiles proposed by Spence and Robbins (1992). They are often taken to be a measure of job engagement and a proxy for productivity, and hence beneficial to the organization. Engagement is also considered by some researchers to have positive effects on individual health, being at the opposite end of the health continuum to burn-out.
Individuals who work longer hours than they would like because they experience organizational pressure to do so are more likely to experience ill-health and home-work role conflict than those who choose to do so. But work enjoyment is not adequate protection against the potential ill-health consequences of working long hours over time (Burke and Fiksenbaum 2008). Cartwright (2000) has suggested a variety of ways in which individuals and organizations can act to dismantle a long-working-hours culture. These include scheduling meetings only during core hours, monitoring the number of hours worked, and ensuring that staff take their full vacation allocation.
Emotional exhaustion is a central characteristic of burn-out and reflects the incapacity to regulate emotions. Jobs which require a worker to attempt to suppress their feelings or inhibit the expression of positive or negative emotions are considered to present an increased risk of burn-out. In particular, Hochschild (1983) has highlighted the problems encountered by individuals in jobs which require them to display emotions which they do not feel and are inauthentic. Although research into burn-out has traditionally focused on jobs in the “helping” professions, such as social work and healthcare, increasing attention is now being paid to a wider range of jobs in the service industry that involve high levels of customer interaction and rules of emotional display.
Holman, Martinez-Inigo, and Totterdell (2008) differentiates between two types of emotional rule which operate in jobs involving emotional labour. Feeling rules govern the type and degree of emotional feeling, whereas display rules govern the type and extent of emotional expression. For example, in some jobs, such as debt collecting, job-holders are not expected to feel sympathy when dealing with clients. In other jobs, such as sales and service agents, role-holders are expected to express considerable enthusiasm. Fake emotional displays, in creating emotional dissonance, have been shown to lead to emotional exhaustion, depersonalization, psychosomatic complaints, and depression (Holman, Martinez-Inigo, and Totterdell, 2008; Holman, Chissick, and Totterdell, 2002). Even if individuals successfully regulate and act out deviant emotions, their well-being can be adversely affected Furthermore, Holman, Martinez-Inigo, and Totterdell (2008) uphold that research evidence demonstrates that the effects of emotional labour on well-being operate over and above individual and contextual variables.
The pursuit of economic growth and the increased pressures of operating in a rapidly increasing global market have led to greater job demands across a range of occupational groups. The pressure for organizations to achieve more with fewer resources has contributed to making work more stressful, less satisfying, and more insecure. In a recent survey Flade (2003) found that over 80 percent of the UK workforce currently lack any real commitment to their jobs and are looking for a better work-life balance.
There is much that organizations can do to improve the content and context in which work is performed, and to provide more healthy work. Advocates of the positive psychology movement argue that organizations should be addressing not only the aspects of work that could lead to ill–health, but also the factors that positively enhance health, such as providing employees with more meaningful work (Cartwright and Holmes, 2006; Quick, Little, and Nelson, 2008).
Currently, 80 percent of European employers use contingent workers (Probst 2008). In 2003 a survey of US HR professionals found that one-third expected to lay off people in the coming year. The impact of the recent global recession is likely to reinforce the notion of a “disposable workforce,” and lead to further expansion in the utilization of contingent labour and an increase in the jobless population, as well as more presenteeism in the workplace (Probst, 2008).
Health is the most valuable personal, organizational, and societal asset. In these recessionary times it assumes an even greater importance. The centrality of job to health has been well and long recognized by organizational psychologists and occupational health professionals. Therefore, the biggest challenge for future researchers in workplace health is to provide robust evidence to business that serious investment in areas such as job redesign, job enrichment, training, flexible working, and fair employment practices represents a good return on investment if the incidence of work related ill-health and injuries is thereby reduced.
 The preparation of this chapter was supported in part by York University. Several colleagues participated in the design and conduct of the research program: Lisa Fiksenbaum, Mustafa Koyuncu, Zena Burgess, Astrid Richardsen, Stig Matthiesen, and Graeme MacDermid.
 Of course, where “himself”, “his” or “he” and so on is used in the text, “herself”, “her” or “she” can be read as well.
 The other five are routine medicals, transfer testing, post-accident testing, “for cause” testing, and post-treatment or follow-up testing.
 According to the CIPD survey (2007), just over 60 percent of those employees who organizations referred to treatment or supported through rehabilitation remained working for the organization after successfully managing their problem.
 Barab later became a high-ranking safety official of the US Department of Labor in the Obama administration.
 The commission members were Joseph Califano (chairman), Douglas Fraser, B. Hamburg, M.D., D. Hamburg, MD, John E. Robson, and Robert Zoellick. The chairman was a former US Secretary of Health and Human Services.
 Susan Lander of AFSCME, quoted in Denenberg (2005a).
 The views of Keashly and Yamada are summarized in Minneapolis Star Tribune, (2003)
Bridgwood, A. , Lilly, R. , Thomas, M. , Bacon, J. , Sykes, W. , and Morris, S. (2000) Living in Britain: Results from the 1998 General Household Survey, London: The Stationery Office. Available at: http://www.statistics.gov.uk/downloads/theme_compendia/GHS98.pdf
Confederation of British Industries (CBI) (2008) “Sickies and long-term absence give employers a headache,” News release, CBI/AXA survey, May 14. Available from: http://www.cbi.org.uk
Macik-Frey, M., Quick, J. C. , Shinoda, P. , Mack, D. A. , Gray, D. A. , Keller, N. , and Cooper, C. L. (2009) “Leadership from a positive health perspective” in A. M. Rossi , J. C. Quick , and P. L. Perrewe (eds) Stress and the Quality of Life—The Positive and the Negative, Charlotte NC: IAP Information Age Publishing, pp. 95–122.
NIOSH (National Institute for Occupational Safety and Health)/CDC (2003) Fact Sheet at: http://www.cdc.gov/niosh/pdfs/2003-116.pdf