European Commission Guidance on work-related stress Spice of life or kiss of death? Employment Sc social affairs Health and safety at work European Commission Directorate-General for Employment and Social Affairs Unit D.6 Manuscript completed in 1999 The contents of this publication do not necessarily reflect the opinion or position of the European Commission, Directorate-General for Employment and Social Affairs. If you are interested in receiving the electronic newsletter 'ESmail' from the European Commission's Directorate-General for Employment and Social Affairs, please send an e-mail to [email protected]. The newsletter is published on a regular basis in English, French and German. A great deal of additional information on the European Union is available on the Internet. It can be accessed through the Europa server (http://europa.eu.int). Cataloguing data can be found at the end of this publication. Luxembourg: Office for Official Publications of the European Communities, 2000 ISBN 92-828-9806-7 © European Communities, 2000 Reproduction isauthorised provided the source is acknowledged. Printed in Belgium CONTENTS Page PREFACE i EXECUTIVE SUMMARY iii PARTI- THE BACKGROUND 1 Stone-age reactions in modern organisational settings 3 What is stress? 3 Some work-related examples 4 Mainstreaming of stress prevention into organisational development 5 A better organisation of work 5 Ensuring proper training 6 Developing working time packages 6 Facilitating the diversification of working relations as well as new forms of work 7 Ensuring optimum conditions for the introduction and uptake of new technologies 7 Promoting workers ' motivation and adaptability through increased involvement 7 Promoting equal opportunities 7 Education and training 7 Resolution of the European Parliament 8 The London Ministerial Declaration 8 Promotion of occupational mental health 9 Four recent initiatives 10 Is there a problem? 11 Costs of work-related stress 12 Work-related stressors 13 Temporal aspects of the work day and work itself 13 Work content (other than temporal aspects) 14 Interpersonal - work group 14 Interpersonal - supervision 14 Organisational conditions 14 Causes of work-related stress and ill health 15 Aspects of occupational stressors 15 Occupational demands 16 Decision latitude, control over one's working life 17 Social support 17 The demand-control-support model 17 Person-environment misfit 18 Shiftwork 18 VDT-related work 19 Effort-reward discrepancy 19 Unclear or conflicting roles 19 Potential stressors of future work organisation 20 What are the manifestations of stress? 20 Emotional manifestations 21 Cognitive manifestations 21 Behavioural manifestations 21 Physiological manifestations 22 Is stress harmful? 22 Stress and health 23 Heart disease and stroke 23 Cancer 23 Musculoskeletal diseases 23 Gastrointestinal diseases 23 Anxiety disorders 23 Depressive disorders 24 Accidents, suicides 24 Other diseases 24 Scope of the problem in the EU 25 High-risk groups 26 The young 26 Single parents 26 Elderly workers 27 The disabled 27 Increased vulnerability and exposure 27 Legal framework of work-related stress within the EU 27 Organisational consequences of stress 29 Preventive action - obstacles and options 30 Sense of coherence, and skills for life 31 Investment for health and productivity 32 PART II - THE CHALLENGE 35 Stress prevention programmes 37 A multifaceted approach 37 Organisational and individual prevention 39 Strategy options for health promotion in the workplace 39 The Luxembourg Declaration on Workplace Health Promotion 41 Key elements for stress prevention at the workplace 42 A checklist of work-related stressors 45 Work over- and underload 45 Insufficient time for good job performance 46 Discrepancy between responsibility and rights 46 Unclear instructions and role 46 Unclear organisational and personal goals and meaning 46 Lack of support 47 Lack or appreciation or reward 47 Lack of influence/decision latitude 47 Exposure to violence or threat of violence 47 Discrimination and bullying 47 Noxious physical work exposures 48 Inadequate capacity and skills 48 Mistakes causing high costs or risking other people's life or health 48 Risk of losing one 'sjob 48 Health promotion, and prevention of stress-related disease 49 Organisational prevention 49 Job redesign 50 Participative management 50 Flexible work schedules 51 Career development 51 Design of physical settings 52 Noise and vibration 52 Machinery and tools 53 Odours, illumination, climatic factors 53 Buildings and premises 54 Combined environmental stressors; reciprocal impact of occupational and other influences 54 Improving relationships 55 Improving shift work schedules 56 Examples of successful intervention programmes 56 The Swedish T50 Programme 56 The Belgian PRA Programme 57 The A2000+ Programme 5 7 Look after your employee 58 A tripartite approach 58 Employees and their representatives 59 Employers ' associations and individual companies 59 Occupational health services, health insurance agencies 59 Are health promotion strategies effective? 60 European programmes 61 Three reviews 62 A comprehensive proposal at national level 62 PART III -THE ACTIONS 65 Internal control - a feasible way to create a healthier workplace 67 Norway 68 Sweden 68 Belgium 69 Stress risk assessment tools 70 Diagnostic measures 70 From assessment to intervention 71 Primary prevention for individuals 72 Stressor-directed primary prevention 72 Response-directed secondary prevention 73 Symptom-directed tertiary preven tion 73 Three targets, four questions 73 Enlightened self-interest 74 Safeguards for individual workers 75 Information, instruction and training 75 Roles and tools for workers, managers and their representatives 76 Spice of life or kiss of death? 77 Glossary of selected terms 79 List of references 85 Index 95 PREFACE This is a Guidance on work-related stress prepared by the European Commission. Member States and their social partners can use or adapt it as they choose, in line with national, legislative and administrative arrangements in their territories. The aim of any resulting national guidelines would be to raise awareness within the Member States that work-related stress is a major occupational health issue and to encourage action to alleviate the cause of stress in order to improve health and safety at the workplace and elsewhere in a cost- effective and pertinent manner. This Guidance provides general information on the causes, manifestations and consequences of work-related stress, both for workers and work organisations. It also offers general advice on how work-related stress problems and their causes can be identified and proposes a practical and flexible framework for action that social partners situation, both at national level and in individual compames, can adapt to suit their own situation. The focus is on primary prevention of work-related stress and ill-health, rather than on treatment. These recommendations should be considered in the light of Framework Directive 89/391/EEC, which states that "employers have a duty to ensure the safety and health of workers in every aspect related to the work". The implications of this Directive in the present context are discussed on page 27. Given the wide variety of working conditions across Member States, across professions and across individual workplaces, the guidance given is of a non-binding nature. It provides a menu from which the various actors can choose a specific mix of measures to meet their own specific needs, going beyond mandatory requirements, if they so wish. One of the challenges in the present context is to target not only larger companies but also the medium-sized and small enterprises (SMEs) and other work organisations. This Guidance takes into account the views and recommendations contained in the Report on Work-Related Stress by the European Commission's tripartite Advisory Committee for Safety, Hygiene and Health Protection at Work, and by its Ad Hoc Group on Work-Related Stress (European Commission, 1997a). The latter was set up by the Advisory Committee with a remit to investigate national and Community work and measures on work-related stress and report on its findings to the Commission with a view to further action. Part I provides relevant background information, including European and other Treaties, Resolutions, Directives, Communications and other initiatives. It describes the incidence, causes and consequences of work-related stress, defines the phenomena and provides a number of examples. It also reviews present knowledge of who is at risk and the risks they run. Part II describes the challenge the interested parties are facing in terms of a variety of multifaceted organisational and individual approaches - their key elements, targets and effectiveness. Part III is devoted to the full scope of options for action at various levels, including Belgian, Norwegian and Swedish examples from the workplace, diagnostic measures and primary, secondary and tertiary prevention, targeting both individuals and organisations. To facilitate the use of this Guidance by all interested parties, the main concepts and terms have been defined and an index and glossary have been added to help the reader to find what he or she is looking for. The text is referenced to enable interested readers to review the evidence and access more in-depth information. The task of preparing this Guidance was entrusted to Lennart Levi, M.D., Ph.D., Emeritus Professor of Psychosocial Medicine, of the Karolinska Institutet,