Transcript Mansel Aylwood: What Works? Research Issues for the future

WORK & HEALTH IN EUROPE
What Works?
Research Issues for the Future
Professor Mansel Aylward CB
Cardiff University Conference Centre; 31st May,
2007
The Other Side of the Hill:
“…all the business of life, is to
endeavour to find out what you don’t
know by what you do; that’s what I
called “guessing” what was at the
other side of the hill.”
Arthur Wellesley, Duke of
Wellington, 1816
What do we know:
• Beneficial effects of work depend on the nature and
quality of work and its social context.1
• Occupational health and safety services: quality and
extent of central importance to achieving good health
outcomes at work 2
• Pressing need to address, at least, the:
– Conditions of the work environment
– The health needs of workers, and
– The social contexts of economic activity
1.
Waddell & Burton, 2006
2.
Walters D, 2007
The other side of the hill: some
features of the landscape:
• Ageing
• Women and the workforce
• New types of jobs / ways of • Economy and employment
working
• Migration
• Healthcare & Service
provision
• Rights and responsibilities
• Psychosocial influences
• New Technology / new
hazards
• Obesity
• Old Hazards manifesting
Distress and the Workplace: what
we think we know?
• Demand, Control & Support1 – high strain and harmful outcomes
– perceptions of “stress” / emotions
ignored
• Effort-Reward Imbalance2 (ERI) – importance of subjective perceptions
– fails to predict health outcomes
• Cognitive Appraisal Theory3 (CAT) – appraisal and coping
– individual responses pivotal
1.
2.
3.
Karasek, 1979
Peter and Siegrist, 1999
Lazarus & Folkman, 1984; Cox, Griffiths et al, 2000
Inadequacy of prevailing models of
work/workplace “distress”:
– Ongoing structural changes in labour market
(mergers, downsizing, outsourcing, etc)
– Employer reluctance
– Very short period of interventions
– Randomization not meaningful (large samples
required)
– DCS & ERI: “conceptually sterile” stimulusresponse models1
– Scientific foundation and practicality of
interventions: inadequate
– Inflexibility and “groupthink”.
1. Spector, 2003
Research: work-related “distress”:
•
•
•
•
Basic concepts and definitions
Methods of measurement
Cause and effect relationships
Psychosocial characteristics: adverse-vs-beneficial
effects
• Personal responses and perceptions
• Cultural attitudes, beliefs, and socio-economic contexts
The need for further rigorous
research:1
• Effect sizes and quantitative research:
– How much work is good for health?
– How much does unemployment harm health?
– Worklessness vs economic inactivity vs unemployment
– Relative contribution of differences between individuals
and jobs
• Longitudinal studies
1. Waddell & Burton, 2006
– lifetime perspective
– retirement vs continued working
Research Issues for the Future:
• The cardinal characteristics of: a “good job”
a health-promoting workplace
• Intervention:
practicality and flexibility
target groups
scientific foundation
rigorous outcome-based evaluation
• Horizon Scanning (“over the hill”): anticipating the unexpected
political will
social change
employer engagement