How work has changed over the last 20 - 30 years
During the 1980’s the tertiary sector, consisting of services such as retailing, banking and leisure industries, greatly increased in size and importance. The growth of the service industry had many implications on the economy; one implied a growth of white collar jobs which in turn resulted in a decline of manual work and another implied that physical skills are now less important than interpersonal skills which shifted the focus of dexterity within jobs such as shop and office work. This growth and decrease in physical work resulted in an increase in job opportunities for women and is somewhat responsible for their increased participation in the labour market. (Cooke 2008)
The boundaries between paid and unpaid work
Nicholls (2005) states that, ‘work does not automatically suggest regular, full time or even paid employment. Part of the reason for this is that work has become a contested concept’. He implies that work has now become a challenged idea because work can include both non-paid work such as house work or being an un-paid carer and having an occupation for which one gets paid. However due to the type of society we live in today, parents are now encouraged to pay for childcare instead of caring for their children themselves under schemes such as ‘welfare to work’. (Mooney 2004).
Much unpaid work nowadays is carried out by women (Cooke 2008). The 2003 Census findings showed that over 5 million people within England alone cared for a relative or friend. The majority of these people were elderly women caring for their ill husbands. The census findings also established that approximately 15,000 children under the age of 18 were also caring for an ill family member.
How does employment affect health?
Lack of control over work conditions and hazardous and repetitive tasks can all result in a negative employment experience which in turn can have a negative effect on health, (Marmot et al 1991, Pantry 1995) lead to low self esteem and employment insecurity (Heaney et al 1994). Positive work experiences include skill development (Hackman and Lawler 1971); autonomy (Kohn and Schooler 1973); and a sense of belonging to a significant group of colleagues (House et al 1998). Differences between the positive and negative work experiences are known to have different physical and psychological effects on an individual employer. The negative effects that can have an impact on an individual’s health are discussed below.
Evidence of the impact work can have on an individual’s health
Substantial evidence demonstrates how work can have a negative effect on an individual’s physical and mental health. For example, Karasek’s job strain model (1979) and Miers (2003) study of emotional and physiological factors and CHD. Evidence of the impact work can have on health includes the connection between stress and different diseases, particularly coronary heart disease, type 2 diabetes and some mental health illnesses that stress is known to have a link to. All these links are discussed below.
Karasek’s job strain model (1979) and the effect reward imbalance model, Marmot et al (1999) demonstrate how negative health effects within the workplace can impact on health. Karasek’s job strain model also known as the demand control model states that the stressors of work can be caused by a high level of psychological demands, such as working fast and not having enough time to get everything done combined with a low level of decision making and low control in meeting the demands that had been made. Karasek and Theorell (1990) noted that learning may contribute to a worker’s possibility of applying control over the work situation.
Marmot et al (1999) states that the effort reward imbalance model is associated with recurrent options of contributing and performing within a workplace setting and in turn being rewarded and feeling a sense belonging to a significant group, for example work colleagues. Marmot et al found six studies which reported findings relevant to his model. The Whitehall II studies (Bosma et al 1998) and a German blue collar manual work study (Siegrist et al 1990) found a risk of CHD among those who reported effort –reward imbalance compared to those who did not report chronic work stress. Overall the Whitehall II study reported that both the Karesak’s demand control model and the effort- reward balance model were separately related to the outcomes of CHD.
Repetitive Strain Injury
Cannan (1999) explains the reported incidence of repetitive strain injury (RSI) in Britain has risen dramatically. Evidence from a Department of Employment workplace found survey found that musculoskeletal problems accounted for 550,000 lost working days in 1990. Kihilji and Smithson (1994) found that this figure had doubled since 1983. RSI incidences can be linked to the increase in mechanical tasks within the workplace which are known to have a link to upper limb disorders.
Coronary Heart Disease
There are many physical risk factors related to Coronary Heart Disease (CHD) such as high cholesterol, smoking and high blood pressure, but more recently research has found evidence linking workplace stress and CHD. Recent workplace changes in developed society show a greater demand on physiological and emotional factors, for example more jobs now demand interpersonal skills (Miers 2003). This can cause a great deal of psychological stress to an individual. Recently there has also been an increase in part time jobs, unemployment and job instability (Marmot et al). This can also have an effect on a person’s physiological health, which in turn increases stress within the workplace.
Sokejima and Kagamimori (1998) examined the extent to which working hours affect the risk of Myocardial infarction (MI) through a case control study of men aged between 30 and 69 in Japan. Japan is a country known for very long working hours but low levels of morbidity and mortality caused by CHD (Uehata 1991). The study demonstrated that the risk of a MI was increased not only by long working hours but shorter than average working hours as well. Sokejima and Kagamimori noted that the risk of an MI may be increased by shortened hours and unemployment but for long working hours a biological explanation of changing activities within the autonomic nervous system was given to explain how this can increase stress thus eliciting an acute MI.
Type II Diabetes
A study published by the British Medical Journal (2003) has shown a link between type II diabetes (non insulin dependent diabetes) and stress in the workplace. Researchers observed the association between work place stress and metabolic syndrome in 10,308 British civil servants aged between 35 and 55. The study took place over a period of 14 years. Work stress was measured on four different occasions throughout the 14 years. Researchers found a dose-response relation between exposure to job stress and the metabolic syndrome, even after accounting for other risk factors such as social position and health damaging behaviour. Men with chronic work stress were nearly twice as likely to develop the syndrome as those with no exposure to work stress. A possible explanation for the findings is that long-standing exposure to stress at work may affect the nervous system, also stated by Marmot et al. Chronic stress may also reduce biological resilience which can disturb homeostasis of the body, thus causing an imbalance of the body’s systems.
Unemployment and Health
Stress within the workplace has been shown to have an ill effect on an individual’s health but unemployment can also affect a person’s mental and physical health. Many different research studies have established a link between unemployment and physical ill health (Morris et al 1994, Bartley et al 1996, Nylen et al. 2001) and psychological ill health (Warr and Jackson 1987, Montgomery et al 1999) amongst both men and women who are out of work. Poor physical effects in men aged 33 who had experienced unemployment were more likely to have a lower body weight, smoke and have a drinking problem (Bartley et al 1999.) Psychological effects of unemployment identified include anxiety, low self esteem, and depression and more likely to self harm and/or commit suicide (Moser et al 1984 and Bartley 1994)
Conclusion
Summary
This assignment has defined social determinants of health and how their recognition have helped healthcare workers extend their understanding of how they can all influence a individual’s health in different ways and how negative effects of one or more social determinant can greatly influence the onset of an illness.
The main body of the assignment discussed how the Babbage Principle, Taylorism and Fordism have all influenced the development of work from industrialisation to the tertiary sector. The boundaries of unpaid work and employment were also outlined and statistics from the 2003 census were given to show the increase of unpaid carers, particularly women in England.
Secondly the assignment discussed important evidence relating to physical and psychological of effects of stress in the work place. This included models by Karasek and Marmot et al, which both showed a link between stress, ill health and a connection to CHD. A study by the British Medical Journal also showed a link between type II diabetes and chronic stress in the workplace. Research has also concluded that unemployment appears to play a large part in the onset of stress, illness and disease. Some research has found a link between unemployment particularly among males and high risks of suicide. All the evidence found illustrates that both stress within the workplace and stress caused due to unemployment can have a serious number of negative effects on an individual’s health, which in turn can result n the onset of illness or disease and/or psychological factors which can result in a number of issues for an individual, such as low self esteem, anxiety, depression and even suicide.
Implications for Nursing Practice
The consequential problems due to chronic stress in the workplace have been recognised and some solutions have been made to endeavour the problem. The majority of social determinants have various implications for nursing, according to Gordon et al (1999) the NHS have two interlinked responsibilities in relation to health inequalities. Firstly to provide equitable access to effective healthcare in relation to the individual’s needs and secondly to work in partnership with other agencies to tackle the broader determinants of health. They also pointed out that in terms of equity the observations of the NHS should be to contribute towards reducing inequalities in health status, achieve equality of access to health services in relation to need and finally to achieve equality of treatment and intervention outcomes.
A document published by the Canadian Nursing Association (CNA) also pointed out that individual nursing practices have a lot of input when addressing problems associated with social determinants of health. Within an individual practice nurses could ask questions when doing an assessment to see if there is a link between their patient’s illness and stress at work and understand the impacts that different social determinants can have on a patient’s health. It has also been suggested that nurses are u to date with what services are available to their patient’s within their area of residence and to help them make a link with social determinants and help them understand the common health issues that are associated with them.
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