Principles of Healthy Work

The Principles of Healthy Work are one of several tools created by the Healthy Work Campaign (HWC) to learn about, discuss and promote “healthy work.” The Principles are intended to educate working people and all stakeholders (employers, labor leaders, regulators, journalists, educators, and others) with a common understanding of what healthy work is and how it is related to health, well-being and the chronic disease burden.

The Principles are a very brief summary of some of the most essential and recognized elements of (un)healthy work, based on a large, international body of scientific research. The following five categories describe the main factors that need to be considered in promoting “healthy work.” This is just one way to organize what we know about healthy work, so it’s easier to understand, relevant and accurate.

The following five categories describe the main factors that need to be considered in promoting “healthy work.”

Principles of Healthy Work

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Physical
Environment

A healthy work environment should be free of physical hazards. These include safety and mechanical hazards, toxic chemicals, noise, radiation, infectious diseases, extremes of heat and cold, ergonomic design hazards (e.g., heavy lifting, prolonged standing and computer work without adjustable equipment).

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Psychosocial
Environment

Healthy work should limit “psychosocial” work stressors caused by how work is organized (work organization). Job-related work stressors can affect your mental and physical health and well-being,^1,2 and contribute to chronic illnesses such as depression³—a leading cause of disability, cardiovascular disease (CVD),^4,5 loss of productivity, healthcare costs⁶, and even death and decreased life expectancy.^7,8

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Culture/
Climate

All organizations have a “culture” that reflects the values and practices of its leaders and supervisors. A workplace’s “climate” reflects how managers and workers relate to each other, the organization’s policies and practices, and how respectfully and fairly workers are treated. A positive work climate can reduce work stressors and improve your health and well-being.³¹

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Work
Organization

How management organizes tasks and work in general (work organization) includes many things. It can cover: employment arrangements (e.g., full/part-time, employee, contractor/temp worker); staffing decisions or practices (e.g., lean production); downsizing and restructuring practices; work hours, shifts, and schedules (e.g. on-call, irregular schedule, forced overtime). Psychosocial work stressors are a consequence of how work is organized⁵ and are linked to poor mental and physical health, and chronic disease, higher healthcare costs and loss of productivity.⁶

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Rewards/
Benefits

Rewards are the economic and other benefits (e.g., promotions, seniority status, job security, support, and respect) that are the expected outcome of work. When rewards do not match the required effort or responsibility of a job, this is a major stressor (i.e., “effort-reward imbalance”). Fair pay and living wages, access to paid time off to use preventive care, or when you’re sick or to take care of family, and adequate health insurance and retirement benefits—all are necessary, along with reducing work stressors, for the overall health of working people and to lower the risk of illness, disease and early death.⁷

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PHYSICAL ENVIRONMENT SUBCATEGORIES

Freedom from Physical Harm

Fundamental to healthy work is your right to safety and freedom from physical harm at work (including injuries, work-related illness and disease, and death). The Occupational Safety and Health Act (OSHA), signed into law in 1970, sets out standards, as a minimum requirement, to limit exposure to some work hazards. While Federal OSHA no longer regulates ergonomic design hazards, some states have implemented regulations or programs to prevent musculoskeletal injury (e.g. in California for hotel housekeepers). You have a right to know what hazards you are exposed to in your workplace and there are many organizations in your county or state that can help you identify and report hazards. (See WorkSafe.)

PSYCHOSOCIAL ENVIRONMENT SUBCATEGORIES

Healthy work requires job control; lack of it leads to job strain. This requires being given some autonomy over your work tasks (decision-authority), having a “say” or a voice about making improvements in your working conditions and participating with management in decision-making about the organization. Job control can be improved by designing jobs that encourage creativity, provide opportunities to learn new things, and develop or use your special skills or abilities (skill discretion). Job control is a powerful predictor of better health, particularly because it can protect workers from the negative effects of high job demands. (See job strain.)⁵

Manageable “demands” or workload requires having enough time to complete your work tasks in a regular workday, and a reasonable pace at which you produce a widget, write a report, or serve a customer. Manageable demands can be accomplished with adequate staffing, protected break times, and time off. It is essential that management has clear expectations, decided with input from workers directly or through collective bargaining about staffing, realistic timelines and workload.

Job strain is a work stressor that describes high demands that are difficult to manage or cope with because you have a lack of control or “say” over your tasks, schedule, and other activities having to do with your job. This work stressor is linked to burnout,⁹ depression,³ high blood pressure,^10,11 CVD,⁵ and death.^12,13 To eliminate job strain, organizations must address job demands to make them more reasonable and enhance control by allowing working people more say in decision-making about how they do their work.

Job insecurity – the concern that you might lose your job at any time – can cause anxiety and lead to depression¹⁴ and CVD.¹⁵ The common organizational practices of downsizing and restructuring, resulting in layoffs of workers, have significant economic¹⁶ and health effects for those who are laid off and for those remaining,^17,18 and also increase sickness absence and mortality.¹⁹ While competing in a global economy might make these practices seem inevitable, implementing and supporting social/government policies can make a difference and reduce job insecurity. Policies can provide access to adequate unemployment benefits, job retraining and health insurance, as is the case in many western European democracies.²⁰

Effective forms of job redesign, such as rotation between different tasks in a day or in a week, or new tasks, can make work more interesting. It is one way to help workers learn and use new skills, and to reduce repetitive, monotonous work. Whether it is job rotation or other changes to jobs, when done well, changes can reduce burnout, and lead to greater “engagement” (the opposite of boredom) and productivity. ²¹

Teamwork and good leadership are the hallmarks of an effective and productive workplace. Hostile or negative relationships with a supervisor are a significant source of stress and negatively affect health and well-being.²² Good and effective supervisors listen, accept input from employees, provide help or feedback in a timely and constructive manner, and are successful in getting people to work together. They help create a supportive work environment where workers are less likely to get burnout,⁹ get sick, or leave their jobs.

Co-workers are important sources of support. Helping each other complete tasks, answering questions, and showing a personal interest in each other, are important for worker well-being and can help people cope with stressors. Employers can promote a culture of teamwork (not just calling employees “team members”) and co-worker support by providing opportunities for positive interactions and stopping practices that create negative, overly competitive work environments. Supervisor and coworker support help to reduce the negative effects of high demands and low control (job strain).²²

“Effort” in the effort-reward imbalance (ERI) model of job-related stress is similar to “demands.” A reasonable effort level includes having enough time to complete a heavy workload, being free of frequent interruptions, and not having ever-increasing levels of demands in your job. Balanced with an appropriate level of “reward” (e.g., fair pay, job security, promotion opportunities and recognition), working people experience a sense of fairness and reciprocity which decreases stress and leads to improved health and less illness, particularly depression and CVD.^23,24 Organizations can reduce ERI by making workloads more manageable, applying “rewards” fairly for all workers, including a living wage, adequate seniority rewards, recognition, as well as using policies that ensure advancement opportunities.

Many Americans experience “work-family/life conflict,” a lack of time and energy to adequately meet both the demands of work and non-work life. For example, you come home too tired after work to do the things you enjoy or you have so much work that it prevents you from spending time with family or friends or pursuing personal interests. Or you work long or irregular hours, which can make it difficult to manage family demands like childcare. This stressor can lead to burnout, sleep problems and impacts many productivity outcomes.²⁵ Organizations can help address this problem by reducing work stressors and providing flexible work policies (e.g. working from home, part-time hours, shared jobs). Training supervisors to be “family-supportive”²⁶ and establishing policies that respect and recognize workers right to have lives off the job will increase employees’ sense of control and autonomy, decrease turnover, and can address gender inequity.^27,28

Jobs that involve caring for others, managing customers or clients often require a mostly invisible and often undervalued kind of work. Emotional labor is the work of managing human feelings (yours and others) and is most often performed by women and human service workers (nurses, teachers, social workers), but also retail workers and those that provide customer service. It is a requirement of the job to smile, and to be kind and compliant—even when you don’t feel that way or even when you are treated poorly by clients or customers. While this kind of work is essential, and can be rewarding, the requirement to display positive feelings and suppress negative emotions can lead to burnout.²⁹ Organizations can help to avoid the high costs of burnout by recognizing the long-term health effects of emotional labor, and by reducing the formal requirements to display positive feelings,³⁰ or implementing training programs and mentoring those new to this kind of work.

CULTURE/CLIMATE SUBCATEGORIES

Justice is about fairness and doing the right thing. “High organizational justice” is present when employees feel that workplace policies, practices and decision-making procedures and outcomes are fair, and that they are treated fairly. When workers experience their workplace as fair and just, they are less likely to develop depression or heart disease,^32-34 be absent or leave their job.^35,36 Organizations that support democratic values and worker participation in decision-making processes enhance organizational justice, reduce stress and improve health. These democratic rights include the right to organize, act collectively, bargain, and choose a union to represent themselves.³⁷

A healthy workplace has policies and practices that ensure everyone is treated with dignity and respect. This includes freedom from bullying, sexual and other harassment, discrimination, and retaliation for whistleblowing. All these kinds of experiences are significant stressors that can negatively affect health.^38,39 They can also affect job security (often resulting in job loss), promotion prospects, and financial rewards.⁴⁰ Many organizations now require that managers, supervisors and other workers participate in training about preventing workplace bullying, harassment, retaliation and discrimination, and have established policies and practices to deal with these stressors.

WORK ORGANIZATION SUBCATEGORIES

Are you hired “on-call”? On a day-to-day basis? As a “gig worker” or by a “temp agency”? What about as a seasonal worker, on a short-term contract, or as a freelancer, or part-time because you can’t get full-time work? It’s all considered precarious work. Full-time, lifelong employment in one job or for one employer is being replaced by “gig work” or non-standard employment (e.g., independent contractors). It is estimated that 40% of the workforce is part of the “gig economy.” These workers are usually younger, earn less, and are non-white.⁴¹ For some working people, this provides flexibility. But for many others – particularly lower wage workers – it increases job insecurity and subjects you to other work stressors.⁴² The precariousness of some jobs can be reduced by stopping the misclassification of employees as independent contractors, limiting short-term contracts, or by organizing a cooperative or union.⁴³

Working night or rotating shifts, or long shifts (more than 10 hours), is common in many 24-hour industries, and affects 15 million Americans. Those who work these shifts know how this can disrupt sleep, family life, motivation to exercise, and make healthy eating choices more difficult. Shift work can increase the risk of heart disease and stroke (CVD).^44,45 Organizations should minimize or provide adequate accommodations, including additional recovery time, for those doing night or rotating shifts. Check out these resources for working people and managers to manage such demanding shift schedules.

U.S. workers work more hours annually than other high-income industrialized countries. Over 50% of full-time salaried employees report working more than 50 hours per week. If you work mandatory overtime, long work days/weeks or don’t take vacations, you are more likely to have injuries,⁴⁶ disrupted sleep, work-family conflict,⁴⁷ depression^48,49 and heart disease.^50,51 In fact, long hours of work increase your risk of mortality by 20%.⁵² Organizations also need to know and recognize that productivity declines substantially when people work more than 40 hours a week.⁵³ They should limit long work weeks (especially 50+ hours a week), eliminate mandatory overtime (e.g., with adequate staffing), and promote a work culture that encourages working a regular schedule, limiting weekend work and requiring adequate recovery time (including vacations).

REWARDS/BENEFITS SUBCATEGORIES

Healthy work means receiving a fair “living wage” (i.e., income to meet minimum standards given the local cost of living) to all workers, especially those with low wages. These measures will greatly improve the economic security, health, well-being and costs on all levels for working people and society.^54-56 Organizations that pay a “living wage” (such as Costco) have less turnover, greater job satisfaction amongst workers and continue to be highly profitable. Even with higher pay, however, you can still have effort-reward imbalance when you believe that the required effort and responsibilities of your job are not “balanced” by fair rewards (i.e., adequate pay, recognition, and promotions).

More than 43 million Americans – especially those paid low wages, working part-time, or who are non-standard employees (e.g., a gig worker) – do not have paid sick leave or family leave benefits. Workers with no paid sick leave are less likely to use preventive care or get needed medical care for themselves and their families.^57,58 One in four Americans in the private sector have no paid vacation time; many more don’t take all of their paid vacation time. This limits the individual’s ability to recover from work stress and other hazards, and contributes to mental and physical health problems.⁵⁹ Some organizations are starting to offer Paid Time Off (PTO) that provide a bank of days to use for any reason you choose (e.g., sick/family leave, vacation), which contribute to engagement and retention.

Most Americans rely on employer-based healthcare benefits. The Affordable Care Act requires that employers with 50 or more employees – including large staffing agencies – provide affordable access to health insurance to all employees. If you are one of the growing number of workers without employer-based benefits, don’t qualify for benefits, or can’t afford to pay for private health insurance, you are at greater risk of illness and mortality.⁷ Organizations that want to ensure “healthy work(places)” need to provide adequate health insurance for all their workers.