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The Psychosocial Impacts of Work

Marmot, M., Siegrist, J., Theorell, T., & Feeney, A. (1999). 'Health and the psychosocial environment at work.' In M. Marmot & R. G. Wilkinson (Eds.), Social Determinants of Health (pp. 105-131). Oxford: Oxford University Press.

Marmot et al. argue that the impact of work on health goes well beyond 'traditional' occupational hazards (such as the impact of heavy physical activity and exposure to chemicals) and must consider that 'psychosocial factors at work may play an important role in contributing to the social gradient in ill-health' (p. 105). Different diseases have been related to psychosocial conditions, with perhaps the best-known being coronary heart disease and mental illness.

There are two areas of research interest. The first is that what happens in working life may be important for health. The second is that work and the operation of the labour market play a central role in the organisation of social and economic life, which in turn may impact upon health.

Marmot et al. explain that work plays an important role in life. Clearly, paid work provides income. Also, training for a job and occupational status are important goals of socialisation that lead to personal growth and development, an identity outside the family, and the shaping of intentional goal-directed behaviour. Occupation also defines social status and relates to personal attitudes and behavioural patterns in leisure, family life, education and political activity. Finally, (for those who are employed) 'occupational settings produce the most pervasive and continuous demands during one's lifetime, and they absorb the largest amount of active time in adult life' (p. 107).

Dollard and Winefield (2002, p. 5) state that employment (even bad jobs) can provide latent benefits, such as:

a time structure for the waking day
regular contact with people outside the nuclear family
involvement in shared goals
a sense of identity
enforced activity.

Such latent benefits are considered to contribute to mental health. However, being satisfactorily employed 'enhances psychological growth and self-esteem, but being unsatisfactorily employed is detrimental to psychological health' (Dollard and Winefield 2002, p. 6).

Marmot et al. present two models for understanding work-related stress. The first is the 'demand-control' model, which states that high-level psychological demands at work combined with low-level decision latitude (a low level of decision authority and a low level of skill utilisation) will increase the risk of stressful experiences. Such stressful experiences may lead to physical or mental ill health. The second model is 'effort-reward imbalance'. Here, the work role defines a crucial link between self-regulatory needs of the person (such as self-esteem and self-efficacy) and the social opportunity structure. Occupations are associated with reciprocal patterns of contributing, of being rewarded and of belonging to a significant group (work colleagues). Rewards can be money, esteem and career opportunities (including job security). In situations with high cost but low gain, where effort is considered to outweigh reward, emotional distress can occur. Marmot et al. state that effort-reward imbalance is frequent among service and professional occupations that deal with person-based interactions.

Finally, in stress-theoretical terms, the range of control over one's environmental situation at work is the core dimension in the demand-control model, whereas in the second model, threats to, or violation of, legitimate rewards based on the assumption of reciprocity and fairness in social exchange represent the core dimension. (p. 121)

Both models have the potential to assist in understanding the causes of stress and potential stress-related illness in the workplace. The models underpin potential interventions to reduce stress.

The emphasis of the demand-control model is on change of the task structure (such as job enlargement, job enrichment, and increasing the amount of support within the job, etc.) [The effort-reward imbalance model emphasises] the reduction of high cost-low gain conditions [including] action at three levels - the individual level (eg, reduction in excessive need for control), the interpersonal level (eg, improvement of esteem reward), and the structural level (eg, adequate compensation for stressful work conditions by improved pay and related incentives, opportunities for job training, learning new skills, and increased job security). (Marmot et al., 1999, p. 126)

References
Dollard, M. F., & Winefield, A. H. (2002). 'Mental health: Overemployment, underemployment, unemployment and healthy jobs.' In L. Morrow, I. Verins, & E. Willis (Eds.), Mental health and work: Issues and perspectives (pp. 3-41). Adelaide: Auseinet: The Australian Network for Promotion, Prevention and Early Intervention for Mental Health.