Work-Related Stress and Psychosocial Hazards), and Question 3 (If These Are of Concern in Participants’ Respective Countries) Are Presented

PSYCHOSOCIAL RISKS AND WORK-RELATED STRESS IN DEVELOPING COUNTRIES: A CALL FOR RESEARCH AND ACTION IN POLICY DEVELOPMENT Evelyn Kortum, BSc, MSc Thesis submitted to the University of Nottingham for the degree of Doctor of Philosophy July 2011 'We recognize the impact that working conditions can have on health status, health equity and general well-being. Improving employment and working conditions at global, national, and local levels, in particular to reduce exposure to work-related physical and psychosocial hazards, would help to reduce negative health effects of the environment in which people work. We emphasize the need to devise and implement policies to ensure the health and safety of workers ….' United Nations Economic and Social Council. Ministerial Declaration - 2009 high-level segment. Implementing the internationally agreed goals and commitments in regard to global public health. ACKNOWLEDGEMENTS I have many people to thank for support during the last few years. Academically I am indebted to Juliet Hassard, Elizabeth Phinn and Kasia Rezulski who have provided support in the initial stages of the study. I would also like to warmly thank my PhD supervisor and friend Stavroula Leka who has patiently been guiding me through the last years of work on this dissertation. I have learned a lot from her and thank her for still being my friend despite many stressful moments. My ingenious co-sufferer and friend Aditya Jain has supported me when it was needed and provided me with information and the necessary confidence to continue in this long undertaking. Last but not least I would like to thank my family for being patient with me…. most of the time. My children Lena and Elliot helped me with the challenges of different computer applications and Lena particularly with reading my early long introduction and providing input, as well with making this document look nice. And my husband Maged has been an invaluable help to me. Academically he has acted as one of my independent interrater validity expert and also as my discussant along the way. Emotionally he has been supporting me with good advice at hand at all moments. I have been very lucky to have had all this support from my colleagues, friends and family. What I got out of it? Perseverance, passion, knowledge, a lot of discipline, and I feel I got to know myself and my limits a lot better too. i ABSTRACT This research explores the understanding of psychosocial risks and work- related stress by international multi-disciplinary experts in developing countries. It further explores their views on the perceived health impact of these issues. It identifies preliminary priorities for action while considering similarities and differences in conceptualizing these issues in industrialized and developing countries. Finally, it explores in what ways these issues can enter the policy agenda in developing countries. This research applies atriangular methodological approach where each stage provides the basis for the development of the next. It starts out with 29 semi- structured interviews to explore the views of experts and also to inform two rounds of an online Delphi survey, which then informed four focus group discussions. The total sample amounted to 120 participants (each sampled once). Key findings for developing countries indicate that a) psychosocial hazards need addressing due to an impact on workers' health; b) occupational health and safety priorities have changed during the last decade pointing to the need for monitoring of psychosocial hazards and the need to address work-related stress, violence, harassment and unhealthy behaviours together with other workplace hazards; c) socio-economic conditions and processes of globalization need attention in the study of psychosocial hazards and an extended research paradigm is required; and d) there is an ever present need for capacity building, stakeholder mobilization, infrastructure development and international exchange and collaboration to address all workplace hazards. Developing countries are not spared from the health and economic impact of psychosocial risks and work-related stress, and there will be a need to address these issues through policy development. To pave the way, this dissertation outlines a need for concerted action at different levels. Keywords: developing countries, psychosocial risks, globalization, informal sector ii PREFACE One of the main responsibilities of international occupational health and safety professionals and those with related background is to act upon existing and to generate new data and approaches to prevent possible negative short- and long-term consequences for workers; developments in industrialized countries can also indicate a way for relevant issues to be addressed in developing countries. However, unless research is conducted that addresses the developing country context itself, little can be achieved to promote good practice. As I am working in an international context with a large number of experts from the occupational health arena and beyond, I became more and more intrigued why developing countries would shy back from tackling emerging issues such as psychosocial risks and often refuse to think more towards comprehensive prevention models. This is despite the fact that the public health impact is now quite well known and researched, at least in industrialized countries with more and more research emerging from developing countries. Europe has managed to put into place social partner framework agreements on work-related stress and psychological harassment and is currently implementing these. I felt the frequent response that this is not important or relevant for developing countries was not satisfactory. The questions from developing country experts and trade unions in international meetings, however, indicated that there is an issue that needs further exploration and does deserve attention and the provision of solutions. I decided to explore this issue more in-depth within a PhD thesis, which allowed for exploratory research, which my work context currently does not. This research should add to existing knowledge in the field of occupational health and safety, and at the same time provide a framework for thinking and tackling emerging risks, such as psychosocial risks but also other occupational risks which are not addressed due to lack of missing infrastructures, information and the same. Although the work started out at the micro-level, and addressed a multitude of issues, at the end of the path it opened up to a larger angle. This of course allows for making abstraction from psychosocial risks and work-related stress, as all micro-issues need to be addressed through a much larger scale in order to change the ways governments lead iii their countries, the way globalization is going ahead, the way we address poverty, and the way we treat workers. At the same time, this approach allows to analyse issues at micro level which is a useful approach for developing research evidence and its dissemination, as well as the development of policies. Hence, the focus of this research is on exploring micro issues while discussing these in the context of macro-issues affecting developing countries. This thesis has to date generated two scientific publications in international journals and one book chapter. Since this work has been developed towards its application, it further continues to inform my professional work and I disseminate findings at international conferences, to policy makers and to researchers. Focus of the thesis This study was a first attempt to explore psychosocial risks, work-related stress and more generally well-being of workers in developing countries. The innovative angle refers to the exploration of an issue which has been allotted little or no attention in developing countries. It takes a global approach to the study of the state-of-the-art as concerns psychosocial risks and their management, which is an important occupational risk for experts, their countries and their workers, but invisible to decision-makers (namely psychosocial risks and their impact on workers' health and the wider society). One of the key issues that emerged was that we need to view and to study psychosocial risks, their impact and their relation to other risks, within an extended paradigm in developing countries than has been done so far in industrialized countries, where legislation and its enforcement are largely intact. The focus of the research study was on the question whether the paradigm applied in industrialized countries is also useful for research and action on work-related stress and psychosocial risks in developing countries. Within this perspective, the thesis explored and presents research findings which encompass a comparison of the state-of-the-art of developing countries with industrialized countries in the realm of the understanding of multidisciplinary experts of psychosocial risks and work-related stress in developing countries. These related issues were explored within the wider occupational health and safety context, such as opinions and perception of needs of preliminary iv priorities for action at the workplace and the wider OSH level, gender issues, legislation that addresses these emerging risks, key occupational sectors, and interventions. These key issues were initially explored through an extensive literature review outlining the global view of the world of work and the need to address psychosocial risks and developing countries (Chapter 1), the state-of-the-art

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