Healthy Work Tools

For Unions & Worker Advocates

What is the next step?

If you have collected surveys from enough people using the StressAssess survey, you’re probably wondering what to do about these results (beyond what the survey recommends).

We have some recommendations, tools and resources to help you make proposals to the employer about the best action to deal with the work stressors that threaten the health and well-being of workers you represent. (And if those you represent are affected, so too are their employers.)

While workers need their own personal resources to help them cope, we also provide information about the importance of working together to get organizational change. (See Healthy Work Tools for Individuals to learn more.)

Healthy Work & “Health and Safety”

History tells us that working conditions start to improve only after workers stand together through protests, demonstrations, or strikes, and by joining unions. With the support of public health advocates and others, workers and their unions demanded health and safety standards and regulations to protect them from unhealthy conditions like toxic chemicals at work (e.g., coal dust, benzene, asbestos) and unsafe facilities and equipment. A long campaign for healthier workplaces led eventually to the passing of the U.S. Occupational Health and Safety Act (OSHA) in 1970.

Health and safety issues remain a major concern for labor and workers in general, due to insufficient enforcement by OSHA, as employers frequently ignore the minimum requirements of the law. Too many workers still face preventable incidents, injuries and diseases. Additional, often invisible, root causes of these outcomes; work stressors (the “psychosocial work environment”) can increase the risk of injuries and chronic diseases. (See Stats to Know to learn more.)

Unions can be more effective in protecting their members’ health and well-being by working to reduce and prevent work stressors that can harm their members’ mental and physical health. Many unions are already tackling issues affecting #healthy work including, work intensification (often the result of understaffing, layoffs, or “lean work” practices), “job strain” (high demands, low control, little support), long work hours, shift work, and “precarious” work (non-standard employment, temp work), as well as workplace incivility (bullying, discrimination and sexual harassment) and the respect and dignity all people deserve whatever job they have.

Collective Strategies to Address Work Stressors

Strategies that unions, other worker advocates, or researchers have used to address or reduce specific “psychosocial work stressors.” Click below to see examples.

Address demands, control and support.

Safe nurse-patient staffing ratios: A coalition of nurses’ unions (National Nurses United) have been working to pass federal legislation based on the California safe-staffing ratios law, enacted in 2004 after a 13-year struggle. Studies show that higher staffing ratios save lives; yet understaffing is a major issue RNs and other healthcare workers struggle with every day. Understaffing affects their “workload/demands” and can lead to burnout and high turnover. Whether or not you’re a nurse, join efforts to support this legislation that protects us all, as well as promotes healthy work for nurses.

A labor-management program to reduce work stressors and burnout: This was a study by researchers with healthcare staff and unions in a hospital in Quebec, Canada, beginning in 2001. It is one of several studies involving a team of workers (in this case, healthcare professionals and others in the hospital). They met regularly to develop specific ways to improve the health of all care staff at the hospital by reducing work stressors including: improving teamwork (support), staffing (demands), work organization (hours, schedules), training (skill discretion, job control), communication (support) and ergonomic design. It was highly successful; after three years, stressors and worker burnout were significantly reduced. Taking part in a study is not always possible, but you can set up and/or join a workplace committee or team that is interested in assessing healthy work and coming up with innovative ways to reduce or prevent stressors. Find examples in other studies for more ideas about how you can work with others to improve work situations.

Housekeeper Study and Workload Reductions. Hotel housekeepers face a higher risk of injury than other hotel workers, in part due to high workload and pressure to clean hotel rooms quickly. In 1999, the hotel workers union in San Francisco, after documenting hazards faced by the housekeepers, was able to bargain a contract, reducing the hours quota that each worker was required to clean in a day from 15 to 14. Since then, hotel workers and their union (UNITE-HERE) have bargained contracts on workload, conducted researcheducated workers and the public, helped pass a California regulation on preventing hotel housekeeper musculoskeletal injuries, and also campaigned against sexual harassment of hotel housekeepers. Find out more and how you can help.

Tell USDA to reconsider increasing the speed at pork-processing plants. You can sign a petition that tells the U.S. Department of Agriculture (USDA) to reconsider increasing the production line speed at pork-processing plants. Many advocates are worried that it will result in more injuries and serious disabilities among workers in meat packing and processing. We also know that increasing demands/pace of assembly line work can lead to more job strain, which is also linked to mental health problems, high blood pressure and heart disease.

Address shift work, long work hours, and inadequate/irregular work hours.

Change “on-call scheduling” and irregular schedules: Food service workers, retail workers, cleaners and many other occupations have irregular or “on-call” schedules which play havoc with people’s lives, like scheduling child care at a moment’s notice, or finishing college courses. Some success stories addressing these issues include: 1) San Francisco, which was the first city in the U.S. to pass a Retail Worker Bill of Rights (in 2014), and 2) retail workers and others who came together in New York City and successfully passed a law in 2017 that ends “on-call” scheduling in the City. Support the Schedules That Work Act, a bill in Congress that seeks to remedy this problem nationally.

NIOSH resources on sleep, fatigue, shift-work and long hours: A significant number of U.S. workers are exposed to health and safety risks associated with shift work, long work hours, and related workplace sleep and fatigue issues. If you are working in the aviation, transportation, and healthcare industries, are an emergency responder, or otherwise find yourself working long hours and night shifts, this can be particularly dangerous to your health and well-being. NIOSH has made available a webinar series and other resources about how shift work and long hours affect fatigue and sleep, as well as providing training and resources for coping with them.

Reduce work-life conflict and improve flexibility and control over schedule.

Family Values at Work grew out of the recognition that valuing caregiving and enabling people to be good providers and good family members is key to achieving racial, gender and economic equity. Labor Project for Working Families (LPWF), a long-standing initiative now working in partnership with FV@W, raises the visibility and engagement of labor unions in state FV@W coalitions. See their resources and toolkit.

A Better Balance is an organization that “seeks to reduce the stress of conflicting work-family demands and responsibilities, as well as end discrimination against workers (most of whom are women) who care for their children or other family members.” They pursue campaigns to strengthen legal protections and to advance policies that provide paid leave, paid sick time, fair and flexible work, workplace equality (including gender equity), pregnant worker fairness and breastfeeding support at work. They offer you resources and information on these issues and your rights at work.

The Work Family Health Network is an interdisciplinary team of researchers who have conducted research on workplace psychosocial interventions to improve the health and well-being of working people and benefit employers. These researchers found that workers supervised by family-supportive managers were significantly more likely to experience lower levels of work-family conflict, higher job satisfaction, lower intention to change jobs, and higher reports of physical and mental health. If you are experiencing work-life balance issues, check out these important toolkits. These tools can be used in your workplace to help teams find ways to reduce work-family conflict, by decreasing unnecessary work, increasing everyone’s control over their time and providing more flexible work schedules.

Prevent workplace bullying, sexual harassment, and discrimination.

Workplace Bullying Institute (WBI) is an organization in the U.S. that has been offering comprehensive resources about workplace bullying—for individuals who have been bullied and to organizations that want to address bullying in the workplace. WBI includes self-help advice for individuals, personal coaching, research, books, public education, union assistance, training for professionals, employer consulting, and legislative advocacy. In 2001, WBI launched the Healthy Workplace Bill, which has now been introduced in 31 states/territories. If you feel you want to get involved in supporting this bill in your state, see how you can help.

The Minnesota Association of Public Employees (MAPE) created an anti-bullying toolkit for their union members to use. This union has led the charge in understanding and combating this serious problem and offers tools to guide workers in navigating a bullying work environment and helping those who may be victims of bullying. MAPE is working together with members to ensure a “happy, healthy and safe work environment for all.”

Coalition for Restaurant Safety and Health (CRSH) is a Philadelphia-based coalition that helps restaurant workers and owners identify and prevent sexual harassment. Although sexual harassment pervades the restaurant industry, restaurant workers often do not report it. They may think that their treatment comes with the job. They may fear retaliation for reporting, or they may believe that their employer won’t do anything to address it. CRSH offers free trainings to restaurants to prevent sexual harassment and to promote respectful and safe workplaces in the restaurant industry.

Restaurant Opportunities Center United (ROC United) is the leading restaurant workers’ rights advocacy organization in the country, representing thousands of people who work in restaurants, over 750 high-road employers, and thousands of engaged consumers united for raising restaurant industry standards. With the mission to improve wages and working conditions for the nation’s restaurant workforce, they have also been a leader in addressing sexual harassment and discrimination in the restaurant industry.

Improve working conditions/rights and benefits for 'gig workers' or 'independent/precarious workers.'

The Portable Benefits for Independent Workers Pilot Program Act would allow the U.S. Department of Labor to authorize grants to states, local governments, and nonprofits to design new models to provide and implement “portable benefits” (retirement savings, workers compensation, life or disability insurance, sick leave, training or educational benefits, healthcare and more) for independent workers such as contractors, temporary workers and self-employed workers, and would especially benefit low-wage precarious workers. This bill could help to alleviate some of the stressors related to being a precarious/gig worker.

The National Domestic Workers Alliance: Domestic workers are housekeepers, nannies, and elder care providers. The work caring for our children, seniors, people with disabilities and other home care work that makes all other work possible, is often invisible and can be physically and emotionally demanding. However, many domestic workers (who are mostly women) are “gig/temp workers” or “independent contractors” excluded from the basic protections guaranteed by the Fair Labor Standards Act—things like minimum wage, overtime, sick and vacation pay or health insurance. The NDWA, formed in 2007, passed the “Domestic Worker Bill of Rights” and continues to advocate for improved working conditions, leadership and skill-building.

NIOSH Science Blog – Non Standard Work Arrangements include workers considered temporary help, contingent, part-time, on-call, direct hire, agency, contract, app-based, on-demand, freelance, and gig workers. Independent contractors do not have a legal right to a safe workplace and are not legally eligible for workers’ compensation benefits if they are injured on the job. Many non-standard, low-wage workers do not earn minimum wage. Studies have shown that non-standard workers are more likely to get injured on the job and are more likely to become ill compared to permanent workers which may be related to a lack of paid sick leave. OSHA and NIOSH have developed a joint guideline for employers of temporary workers (e.g. staffing agencies): Recommended Practices for Protecting Temporary Workers and Cal OSHA has also produced a Safety and Health Fact Sheet on this issue.

Fair pay/living wage and adequate benefits (e.g. health insurance, paid sick leave/family leave/vacation time).

Fight for $15 began in 2012 when 200 fast-food workers walked off the job to demand $15/hr and union rights in New York City. Today, it is a global movement in hundreds of cities on six continents. It includes fast-food workers, home health aides, child care teachers, airport workers, adjunct professors, retail employees—and underpaid workers everywhere. If you are struggling with low wages and making ends meet, find information, support or join the Fight for $15 movement. Even if you are not a low-wage worker, you can still help support the struggle for fair, living wages for all workers.

Healthy Families Act: The American Public Health Association (APHA) urges support for this bill (currently in Congress) which would allow workers to earn up to seven paid sick days a year. Creating a national paid sick leave standard would allow millions of Americans to earn the time necessary to recover from illnesses like the flu, access health care and take care of a sick family member.

Oxfam America – Best and Worst State to Work in America index ranks states according to their wage policies (changes to federal minimum wage), worker protection policies (paid sick leave, pregnancy protections and equal pay), and right-to-organize policies. They also show that there is a relationship between a state’s ranking in the Best State to Work Index and positive economic and health indicators. The higher the index, the less infant mortality and poverty rates, and the higher the life expectancy, median income, GDP per capita, and labor force participation rates in that state.

Address physical or environmental stressors at work (e.g. unsafe equipment/facilities, heat stress, noise or exposure to chemicals).

National Council for Occupational Safety and Health is a federation of local and statewide “COSH” groups—committees/coalitions dedicated to advancing the rights of workers related to health and safety issues. COSH groups are typically non-profit organizations. You can find a local COSH group near you or find information about starting one.

WorkSafe is a California-based organization (part of the National Council for Occupational Safety and Health) and is dedicated to promoting and protecting the basic right of all people to a safe and healthy workplace. You can get free worker trainings about health and safety rights, hazard awareness, immigrant rights and workers compensation. You can also get resources to find out how to file an OSH complaint, address retaliation, or protect yourself as a whistleblower.

Collective Bargaining Contract Language On Work Stress

Need some sample contract language?

See examples of contract language on job stress and on staffing in a variety of occupations from an excellent Labor and Occupational Health Program (LOHP) book on collective bargaining on occupational health and safety.

Examples of successful collective bargaining that helped create “healthy work”:

The hotel workers union (UNITE-HERE) bargained a contract in 1999 in San Francisco reducing the quota for rooms cleaned in one day from 15 to 14.

The Chicago Teachers Union 2012 contract included:

  • Hiring over 600 additional teachers in Art, Music, Phys Ed & other subjects
  • Maintaining limits on class size, increased funding for smaller classes
  • Increased funding for Special Ed teachers, psychologists, social workers, classroom assistants & counselors in high caseload schools.

The Pennsylvania Association of Staff Nurses and Allied Professionals, following a 28 day strike in 2010 at Temple Univ. Hospital, Philadelphia, won voluntary 12-hour shifts and overtime, accrual of a sleep day after 16 hours. They rejected shorter minimum call times, and lower weekend and night shift differentials.

Legislation Related to Work Stress

Laws that have been passed or are pending which would reduce some workplace ‘job stressors’ include:

Organizations* that Promote #HealthyWork in General

For more guidance, information or inspiration, check out:

Democracy at Work Institute works to expand the model of worker cooperatives in the U.S. A worker cooperative is a values-driven business model that puts worker and community benefit at the core of its purpose. Workers own the business and contribute their labor to participate in its financial success. But workers in cooperatives also have representation on and vote for the board of directors. Cooperatives are democratic and are inherently likely to provide “job control”—having a say in decision-making and about work processes. To find information about the principles behind worker cooperatives in the US, how worker cooperatives are started, check out the U.S. Federation of Worker Cooperatives. In addition, a number of unionized worker cooperatives have been created, for example:

International Labor Organization (ILO) Stress Prevention at Work Checkpoints is a manual and an app which is designed for use by anyone interested in workplace stress prevention: national authorities, company and organizational managers, trade unions, human resource personnel, and occupational safety and health practitioners. The ILO SOLVE program is also available to download. It is an interactive educational program designed to assist in the development of policy and action to address health promotion issues at the workplace. It deals with the prevention of work-related stressors (both workplace stress and economic stressors), alcohol and drug abuse, violence (both physical and psychological), the prevention of HIV/AIDS, as well as the promotion of tobacco-free workplaces and health lifestyles, including good eating, sleeping and exercise habits. It includes guides for trainers and participants.

Jobs with Justice is more than an organization; it is a national network made up of thousands of organizations (labor unions, faith and community organizations, and student activists) and individuals committed to transforming the lives of working people. From fighting for economic justice, to shaping the future of work and improving labor law, you can also find support for advancing #healthywork and protecting labor rights.

NIOSH Total Worker Health® is a government program that offers ways to improve policies and practices around workplace health and safety and health promotion. The Total Worker Health (TWH) approach has been criticized in the past for relying too heavily on health promotion (individual-focused) strategies. NIOSH now more explicitly recognizes that working conditions (including job stressors) are important factors that can lead to illness and injury. NIOSH’s TWH program acknowledges that job-related factors such as wages, hours of work, workload, coworker and supervisor support, access to paid leave, and health-promoting workplaces all can have an impact on the well-being of workers, their families, and their communities. Learning about TWH policies, programs, and practices and how unions can help ensure that they can benefit workers can be a good starting point in promoting #healthywork. Some useful resources include:

  • The TWH “Business Case”, a checklist which can be used as a guideline for conducting a comprehensive workplace health assessment, and a recent critique of TWH, which discusses ways to make TWH programs more responsive to workers’ needs.
  • The Healthy Workplace Participatory Program at the TWH Center for the Promotion of Health in New England (CPH NEW) provides a useful scientifically-developed toolkit for engaging workers, labor representatives, and employers to address a wide range of work environment, work organization, job health and safety, and other health issues. It provides guidelines for starting new programs or improving existing ones. The tools provide information to help convince management about the need for this kind of program. Pair these tools with the Healthy Work Survey (for unions & worker advocates), conduct focus groups with workers, learn how to create labor-management teams to design “interventions” (programs to address work stressors, (e,g., demands, support, work-family conflict), and find ways to carry out and evaluate those programs.
  • The TWH Center for Healthy Work at the University of Illinois-Chicago is working with community partners, such as worker centers, labor unions, and public health and healthcare organizations in the Chicago area to tackle the problem of “precarious” jobs (job insecurity) — jobs which tend to have low wages, high safety and health hazards, and few opportunities for advancement.

*These are just a few examples of organizations that could provide resources to learn how to more effectively work together to address #healthywork. There are many more such organizations.

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