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Disease Forecasting

Stress Tests

The Japanese have a word for it: karoshi, meaning death from overwork. And in America, more employees than ever report being "stressed out."

But what exactly does being stressed out mean, and how do you measure it? And how do you show conclusively that workplace stress affects immediate or long-term employee health? Researchers around the world have found it extremely difficult to conclusively link pressures on the job with heart attacks, say, or strokes, in the same way that black lung disease can be associated with inhaling coal dust in a mining operation.

Agnew's research has focused on developing and validating specific measures of occupational stress among such different groups as garment workers and Army Reservists. Agnew believes that "stress management" is largely a misnomer. "What we need to be doing is finding ways to remove the stressors," she says. "If it was workplace exposure to a chemical, we wouldn't simply tell folks to hold their breath."

Strain caused by stress can take different forms. "In our study of garment workers, those with high demands, low control and low levels of social support had the highest risk of musculoskeletal disorders," Agnew says. "Assembly work using quotas, pay incentives and piece-rate systems pressures workers to work very quickly and causes stress. The way to counter that is to reduce long working hours, set a reasonable job pace, encourage work breaks and allow workers to have more say in how their job is designed."

Past research has shown that jobs without much worker input or control tend to be more frustrating and stressful for workers. "Mental health issues are a very important concern for employers, in terms of health care costs and indirect costs associated with absenteeism and decreased productivity at work," Schwartz says.

Another potential hazard for workers is "sick" office space. Today's employees complain about experiencing a bewildering array of illnesses and side effects, from respiratory impairment to migraine headaches and musculoskeletal injuries, all of which may—or may not—be caused by the work environment.

Says Mitchell, "Increasingly our focus is on indoor environments. Workers today inhabit a variety of boxes of different kinds: Some are well built, some are not. Some are adequately ventilated, some are not."

In the 1970s, windows that could be opened started to disappear from most commercial buildings. To prevent illness, the heating, ventilation and air- conditioning systems in buildings must be carefully maintained. Often, however, this doesn't happen, and the results can lead to everything from mold allergies to Legionnaire's disease. "Generally with indoor air exposures we're not talking about acute toxic exposures," Mitchell says, "but instead these steady, low-level exposures that, even if they are not life-threatening, can still be disabling."

Workers can experience increased incidence of asthma, allergies, sinusitis and other forms of respiratory illness from poorly designed or maintained air-handling systems. "These are not imagined diseases," says Mitchell, who notes that too often employers and building owners tend to discount worker complaints. "We need to respond to these as genuine health threats."

Working Over Time

"In the past, you retired at age 65 and lived to be about 70, and so at the end of your working career it was sort of 'good luck and good bye,'" says Pat Breysse, EHS professor. "But now if you are going to live to be 90, there are additional needs that must be met. As people live longer, the likelihood that workplace exposures will result in chronic diseases increases. If an exposure takes 30 or more years to develop into disease, oftentimes you won't see the effect of what happened in the workplace until after people have retired."

Breysse, PhD '85, MHS '80, should know. For more than a decade, he has led a health study of former workers from Los Alamos National Laboratory (LANL)—workers who conducted weapons research throughout the Cold War years that exposed them to a wide range of hazardous agents, including radiation, solvents, asbestos and beryllium. With colleagues Brian Schwartz, assistant professor Virginia Weaver and research associate Maureen Cadorette, Breysse is reviewing work histories and conducting medical examinations of these former lab workers. Over 2,300 examinations have been performed to date, screening for health effects such as cancer, chronic lung diseases and hearing loss from exposure to hazardous agents.

Former workers found to have potentially work-related diseases are referred to occupational medicine physicians or specialty clinics. They can also apply for additional follow-up care and compensation.

Breysse is encouraged by what this effort may represent for the future. "This is the first case I'm aware of where an employer has assumed responsibility for exposure-driven, follow-up medical care for workers after they have retired," says Breysse. "There is a real need to supply ongoing medical surveillance for many workers in retirement. I hope this is the wave of the future."

Occupational health specialists also foresee an increasing need to address health issues of older workers, especially those who opt to work past age 65. "Right now, the 55-plus age group as part of the labor force is growing four times faster than any other segment," says Gary Sorock, associate professor in Health Policy and Management. "People need to work longer, or want to keep working part-time after they've retired. We're talking about a lot more older people at work."

Older employees present entirely new kinds of health and safety challenges, especially in terms of injuries, which still account for the vast bulk of costs in terms of medical expenses and employee lost time. "If you look at worker's compensation events, you see that about 95 percent are injuries and the remaining 5 percent are related to disease and illness," says Sorock, PhD.

In one study, Sorock and colleagues looked at 9,000 women in different professions age 55 and older who suffered fractures from falls on the same floor level—the kind that might occur when someone simply trips or slips. (Falls on the same level are the second most costly source of disabling injuries, behind overexertion.) They found that these injuries were more common than generally recognized, and in this age group they have a much greater impact on employee performance. "Fractures at work are often overlooked," Sorock says, "but they can be very common following a fall, particularly among older women. Our research indicates that as people are working longer, these injuries have the potential of becoming serious disability issues for workers and employers both."

Sorock's study found that moderate physical activity and standing on the job (as opposed to sitting all the time) were associated with a reduced risk of fractures. As the workforce ages, employers should be emphasizing the prevention of injuries in older adults by rotating jobs, moving them from sitting to standing and including a moderate amount of physical activity, he says.

Though U.S., Japan and other post-industrial nations report that worker injuries and deaths have declined steadily since the 1970s as tougher safety codes have been introduced and many hazardous occupations have moved overseas, it's still difficult to know exactly how safe the workplace is today.

"It's hard to just look at statistics we now collect and know everything we'd like to about what is going on," says Paul Locke, JD, DrPH '98, MPH, an attorney, scientist and visiting scholar in EHS. "Is it due to the fact we're not collecting the type of data that we should? Should we be moving toward collecting more information on chronic disease and the deaths they cause? Are there different illnesses we're not even considering?

"There has been a change in the workplace from the assembly line to the cubicle, and we need to keep up with those changes."

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