Implementation of health promotion programmes in the workplace will only progress when employers and trade unions begin to recognize the long-term economic and social benefits associated with a "healthy workforce", i.e. reduced absenteeism and job turnover and improved productivity.

Settings were identified as a vehicle for health promotion by the World Health Organisation (WHO) in 1986. This formed part of the movement away from individual based health promotion towards the need to acknowledge the influence of the wider environmental ‘setting’ in which the individual was placed. The workplace along with cities, neighbourhoods and schools were identified as one of these settings.

Why the workplace? The workplace is the best setting for improving the health of the adult population because of, ease of access to a large umber of people many of whom are at risk of adverse health effects; a potentially low level of attraction as the population is relatively stable; cohesion of the working community which can offer benefits such as positive peer pressure and peer support; and established channels of communication which can be used to publicise programmes, encourage participation and provide feedback.

The workplace is therefore seen as a medium by which health promotion can be advanced, and through which the working population’s health status can be improved both directly, through supporting and allowing the individual to take action on their health and indirectly through the development of an overall health culture.

General principles that run through effective health promotion programmes to effect individual behaviour change:

Trends in effectiveness – according to Centre for the Evaluation of Health Promotion and Social Interventions:

Development and intervention:

The review highlighted the following recommendations of developing and implementing health interventions:

Recommendations for action and further research:

In a recent study by Slán (Survey of Lifestyle, Attitudes and Nutrition the top five ranked requirements for better health were more or less the same for males and females. But high percentage of females indicated personal control as important. Very interestingly, less stress was felt by both males and females to have the most effect on bettering their health.

What Workers Say About Stress on the Job

Job stress has become a common and costly problem in the workplace, leaving few workers untouched. For example, studies report the following:

Fortunately, research on job stress has greatly expanded in recent years. But in spite of this attention, confusion remains about the causes, effects, and prevention of job stress.

What are the Causes of Job Stress?

Nearly everyone agrees that job stress results from the interaction of the worker and the conditions of work. Views differ, however, on the importance of worker characteristics versus working conditions as the primary cause of job stress. These differing viewpoints are important because they suggest different ways to prevent stress at work.

According to one school of thought, differences in individual characteristics such as personality and coping style are most important in predicting whether certain job conditions will result in stress-in other words, what is stressful for one person may not be a problem for someone else. This viewpoint leads to prevention strategies that focus on workers and ways to help them cope with demanding job conditions.

Although the importance of individual differences cannot be ignored, scientific evidence suggests that certain working conditions are stressful to most people. Excessive workload demands and conflicting expectations are usually the prime causes of work-related stress. Other evidence argues for a greater emphasis on working conditions as the key source of job stress, and for job redesign as a primary prevention strategy.

NIOSH Approach to Job Stress

On the basis of experience and research, NIOSH (National Institute for Occupational Safety and Health) favours the view that working conditions play a primary role in causing job stress. However, the role of individual factors is not ignored. According to the NIOSH view, exposure to stressful working conditions (called job stressors) can have a direct influence on worker safety and health. But as shown below, individual and other situational factors can intervene to strengthen or weaken this influence.

Examples of individual and situational factors that can help to reduce the effects of stressful working conditions include the following:

Job Stress and Health

Stress sets off an alarm in the brain, which responds by preparing the body for defensive action. The nervous system is aroused and hormones are released to sharpen the senses, quicken the pulse, deepen respiration, and tense the muscles. This response (sometimes called the fight or flight response) is important because it helps us defend against threatening situations. The response is pre-programmed biologically. Everyone responds in much the same way, regardless of whether the stressful situation is at work or home.

Short-lived or infrequent episodes of stress pose little risk. But when stressful situations go unresolved, the body is kept in a constant state of activation, which increases the rate of wear and tear to biological systems. Ultimately, fatigue or damage results, and the ability of the body to repair and defend itself can become seriously compromised. As a result, the risk of injury or disease escalates.

In the past 20 years, many studies have looked at the relationship between job stress and a variety of ailments. Mood and sleep disturbances, upset stomach and headache, and disturbed relationships with family and friends are examples of stress-related problems that are quick to develop and are commonly seen in these studies. These early signs of job stress are usually easy to recognize. But the effects of job stress on chronic diseases are more difficult to see because chronic diseases take a long time to develop and can be influenced by many factors other than stress. Nonetheless, evidence is rapidly accumulating to suggest that stress plays an important role in several types of chronic health problems-especially cardiovascular disease, musculoskeletal disorders, and psychological disorders.

Job Stress and Health: What the Research Tells Us

Many studies suggest that psychologically demanding jobs that allow employees little control over the work process increase the risk of cardiovascular disease.

On the basis of research by NIOSH and many other organizations, it is widely believed that job stress increases the risk for development of back and upper- extremity musculoskeletal disorders.

Several studies suggest that differences in rates of mental health problems (such as depression and burnout) for various occupations are due partly to differences in job stress levels. (Economic and lifestyle differences between occupations may also contribute to some of these problems.)

Although more study is needed, there is a growing concern that stressful working conditions interfere with safe work practices and set the stage for injuries at work.

Some studies suggest a relationship between stressful working conditions and these health problems. However, more research is needed before firm conclusions can be drawn.

Stress, Health, and Productivity

Some employers assume that stressful working conditions are a necessary evil-that companies must turn up the pressure on workers and set aside health concerns to remain productive and profitable in today's economy. But research findings challenge this belief. Studies show that stressful working conditions are actually associated with increased absenteeism, tardiness, and intentions by workers to quit their jobs-all of which have negative effects on the bottom line.

Recent studies of so-called healthy organizations suggest that policies benefiting worker health also benefit the bottom line. A healthy organization is defined as one that has low rates of illness, injury, and disability in its workforce and is also competitive in the marketplace.

NIOSH research has identified organizational characteristics associated with both healthy, low-stress work and high levels of productivity. Examples of these characteristics include the following:

How to Change the Organization to Prevent Job Stress

Stress Prevention Programs: What Some Organizations Have Done

A Small Service Organization. A department head in a small public service organization sensed an escalating level of tension and deteriorating morale among her staff. Job dissatisfaction and health symptoms such as headaches also seemed to be on the rise. Suspecting that stress was a developing problem in the department, she decided to hold a series of all-hands meetings with employees in the different work units of the department to explore this concern further. These meetings could be best described as brainstorming sessions where individual employees freely expressed their views about the scope and sources of stress in their units and the measures that might be implemented to bring the problem under control.

Using the information collected in these meetings and in meetings with middle managers, she concluded that a serious problem probably existed and that quick action was needed. Because she was relatively unfamiliar with the job stress field, she decided to seek help from a faculty member at a local university who taught courses on job stress and organizational behaviour.

After reviewing the information collected at the brainstorming sessions, they decided it would be useful for the faculty member to conduct informal classes to raise awareness about job stress-its causes, effects, and prevention-for all workers and managers in the department. It was also decided that a survey would be useful to obtain a more reliable picture of problematic job conditions and stress-related health complaints in the department. The faculty member used information from the meetings with workers and managers to design the survey. The faculty member was also involved in the distribution and collection of the anonymous survey to ensure that workers felt free to respond honestly and openly about what was bothering them. He then helped the department head analyze and interpret the data.

Analysis of the survey data suggested that three types of job conditions were linked to stress complaints among workers:

Having pinpointed these problems, the department head developed and prioritised a list of corrective measures for implementation. Examples of these actions included (1) greater participation of employees in work scheduling to reduce unrealistic deadlines and (2) more frequent meetings between workers and managers to keep supervisors and workers updated on developing problems.

A Large Manufacturing Company. Although no widespread signs of stress were evident at work, the corporate medical director of a large manufacturing company thought it would be useful to establish a stress prevention program as a proactive measure. As a first step he discussed this concept with senior management and with union leaders. Together, they decided to organize a labour-management team to develop the program. The team comprised representatives from labour, the medical/employee assistance department, the Human Resources department, and an outside human resources consulting firm. The consulting firm provided technical advice about program design, implementation, and evaluation. Financial resources for the team and program came from senior management, who made it clear that they supported this activity. The team designed a two-part program. One-part focused on management practices and working conditions, which could lead to stress. The second part focused on individual health and well-being.

To begin the part of the program dealing with management practices and job conditions, the team worked with the consulting firm to add new questions about job stress to the company's existing employee opinion survey. The team, to identify stressful working conditions and to suggest changes at the work group and/or organizational level used the survey data. The employee health and well-being part of the program consisted of 12 weekly training sessions. During these sessions, workers and managers learned about common sources and effects of stress at work, and about self-protection strategies such as relaxation methods and improved health behaviours. The training sessions were offered during both work and nonworking hours.

The team followed up with quarterly surveys of working conditions and stress symptoms to closely monitor the effectiveness of this two-part program.