Psychological and social issues – relevance for health and ... Pfaff.pdfPressman, S.D. et al,...

Universität zu Köln Humanwissenschaftliche Fakultät Medizinische Fakultät

Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft

Psychological and social issues – relevance for health and safety at workplace and for the success of OHS systems

International Forum „Occupational Health and Safety Management in the 21st Century“, Chamber of Commerce Luxembourg 25th April 2013

Univ.-Prof. Dr. Holger Pfaff

Agenda 1. The global situation 2. Psychosocial conditions at the workplace and health 3. Psychosocial conditions and OHS system 4. Conclusion

Occupational stress

Gesunde Arbeit NRW 2009. Belastung – Auswirkung – Gestaltung – Bewältigung. LIGA.Praxis 3

Increase in psycho-mental stress High time pressure

High responsibility

Work overload

Restructuring measures

Working hours

Fear of job loss

Instructions, control

Forced physical posture

Lack of information

Percentage of respondents (quite or strongly stressed)

McKeown, R. (2009): The Epidemiologic Transition: Changing Patterns of Mortality and Population Dynamics. Am J Lifestyle Med, 3(Suppl. 1),19-26.

Epidemiological transition Trends: • Decline in infectious diseases • Increase in degenerative diseases

Since degenerative diseases are partly promoted by • lifestyle, • harmful behavior, and • poor conditions of work and life Consequence: as a result prevention and therapy arise not only as medical, but also as psychosocial, occupational and societal duties

The world health report 2008: primary health car now more than ever.

The shift towards noncommunicable diseases and accidents as causes of death*

eigene Darstellung, in Anlehnung an DRV. http://www.deutsche-rentenversicherung.de

Pensions due to reduced earning capacity attributed to selected diagnoses in Germany – women

10.000

15.000

20.000

25.000

30.000

35.000

Skelett, Muskeln, Bindegewebe

Herz- Kreislauferkrankungen

Stoffwechsel, Verdauung

Neubildungen

Psychische Erkrankungen

Atmung

Nerven, Sinne

Sonstiges

Skeleton, muscles, fascia

Cardiovascular diseases

Metabolisms, digestion Neoplasms

Mental disorders

Respiration

Nervous system Skin Other

The basic model

The higher the imbalance between burden and resources, the more

critical!

Burden Stress

Resources

Coping

Vulnerability to diseases

Demotivation

• Burden increases the vulnerability to diseases

• Resources decrease the vulnerability to diseases

Pfaff, H.: 1999

The „castle of health“: Three defensive walls (social, psychological and biological wall)

Health

Attacks on health: social, psychological and biological risks

1. Wall: social “defensive wall” 2. Wall: psychological ”defensive wall“

3. Wall: biological “defensive wall“

objective situation

subjective situation

„outside the skin“ „inside the skin“

Thomas (1928): The child in America: Behavior problems and programs

The theorem of Thomas “If men define situations as real, they are real in their consequences.”

Real age: 50 Subjective age: 45

Relevance of psychological and social issues: FACTS

Psychological issue: self efficacy

Burnout – findings from research: Clinicians

Self-efficacy

Social capital in

the hospital

Burnout Emotional exhaustion

Adjusted for age, gender, marital status, work experience ***p≤0.001

Own results

Social issue: Not having a job

Frese, M.: Zur Verlaufsstruktur der psychischen Auswirkungen von Arbeitslosigkeit. In: Kieselbach, T./Wacker, A. (Hrsg): Individuelle und gesellschaftliche Kosten der Massenarbeitslosigkeit, Weinheim, Basel, 1985, S. 227

Depression of unemployed and employed with and without accounting for “financial issues“

Helmert, U. 2007: Soziale Ungleichheit in Deutschland. Müssen Arme früher sterben? Jahrestagung der Humanistischen Akademie Bayern, 24. März 2007 in Nürnberg

Life expectancy and unemployment rate

Social issue: Reintegration

Badura, B./Kaufhold, G./Lehmann, H./Pfaff, H./Schott, T./Waltz, M.: Leben mit dem Herzinfarkt, Berlin: Springer, 1978

Social issue: Anxiety after myocardial infarction depends on reintegration

Still on sick leave Early retirement

On the job

Social issue: Climbing up the hierarchy

Siegrist, Johannes: Medizinische Soziologie, 5. Auflage, München et al., Urban und Schwarzenberg, 1995, S. 192

Age-adjusted mortality rates of British civil servants according to grade of employment (40-64 years; n = 17,530; Whitehall Study) Source: Marmot 1994

all cases CHD no CHD

Senior executiveofficerHigher executiveofficerExecutive officer

Clerical/support

10-year mortality (%)

Social issue: Mortality is a function of social status (here: level of hierarchy)

Social issue: Type of profession

Burnout – findings from research professionals working with people with disabilities

Burnout-Classification following Kalimo et al. (2003) Prevalence Distribution

without burnout-symptoms (0 – 1.49) 111 63.4

existing burnout-symptoms (1.50 – 3.49) 51 29.1

severe burnout-symptoms (3.5 – 6) 13 7.5

N 175 100.0

Distribution of the subscale “emotional exhaustion”

Burnout – findings from research clinicians

Burnout-Classification following Kalimo et al. (2003) Prevalence Distribution

without burnout-symptoms (0 – 1.49) 72 26%

existing burnout-symptoms (1.50 – 3.49) 150 54%

severe burnout-symptoms (3.5 – 6) 55 20%

N 277 100.0%

Distribution of the subscale “emotional exhaustion”

Social issue: Positive social relationships: social support

Mortality rate is a function of social integration

Socially isolated

Socially integrated

Mortality

Social support from co-workers

Burnout Depersonalization

Burnout Reduced efficiency

-.612*

-.702**

Adjusted for age, gender, marital status, work experience *p≤0.05; **p≤0.01; ***p=≤0.001

OR=1,8

OR=2,1

Social support from supervisors

-1.297***

-.607*

OR=3,6

OR=1,8

Pressman, S.D. et al, Loneliness, Social Network Size, and Immune Response to Influenza Vaccination in College Freshmen, Health Psychology 2005, Vol. 24, No. 3, 297–306

The larger the network and the lower the loneliness, the more effective the flu vaccination

• Small network= 4-12 friends

• Medium network = 13-18 friends

• Large network: 19-20 friends

Social issue: overload

Workload – Psychological overload

2.357***

1.148*

OR=7,6

OR=1,8

Psychosocial issue: demand-resource-misfit

The effort-reward imbalance model

Effort-reward imbalance and depressive symptoms: Whitehall II-study (N=6110, time: 5.3 years)

S.A. Stansfeld et al. (1999)

kein Stress hoheVerausg.

ODER niedr.Bel.

hoheVerausg. UND

niedr. Bel.

kein Stress hoheVerausg.

ODER niedr.Bel.

hoheVerausg. UND

niedr. Bel.

men women OR# OR#

0,5 0,5

Demand-control model

Karasek, Robert A.: Job Demands, Job Decision Latitude, and Mental Strain: Implications for job Redesign, In: Administrative Science Quarterly, 1979

Demand-control model

Social issue: Negative social relationships

Pescosolido, Bernice, Georgianna, Sharon: Durkheim, Suicide, and Religion: Toward a Network Theory of Suicide. American Sociological Review, Vol. 54 (1), 33-48.

In Anlehnung an Pfaff et al: (2009). Methoden für die organisationsbezogene Versorgungs-forschung. Das Gesundheitswesen. DOI 10.1055/s-0029-1239515

OHS intervention

Implementation

Organization

Implemented OHS

Health Well-being Behavior

Types of systems (Luhmann)

Organism Technical system

Social system

Psychol. system

OHS innovation =

Technical innovation

Medical innovation

Psychol. innovation

Social innovation + + +

Learning cycle strategy

development of corporate health

strategies and goals

diagnosis &

outcome evaluation planning the intervention (structure & processes)

process & structure evaluation

intervention

The framework for worksite health promotion

21.2% Presence of a central coordinating committee

Measuring success (employee satisfaction and health, productivity)

Planning (needs assessment, definition of

the objectives and success criteria)

Allocation of financial resources

insurance companies

Prevention maturity matrix Distribution of IT-companies by level of WHPC (n=511)

health promotion management

present not present

health promotion willingness

present A

29.8% B

not present

C 8.3%

D 42.7%

http://www.praekonet.de/

Rogers, E.M. (1983): Diffusion of Innovations. Third Edition. New York, London. S. 5

Implementing change: Diffusion of innovations according to Rogers (1983)

Rate of adoption

„innovators“

„early adopters“

„early majority“

„late majority“

„laggards“

Bild: http://officeimg.vo.msecnd.net/en-us/images/MB900320158.jpg

The change model of Kurt Lewin

unfreezing moving freezing

Example: “The blind spot” Current situation in Europe § a lack of attention to working in health care, § Preventive care provided within the occupational setting is largely

unlinked to the preventive and curative care provided by general practitioners and hospitals § Lack of cooperation in both directions: OPs rarely seek to cooperate with

an employee’s GP, and GPs rarely seek contact with OPs. § Cooperation would be helpful in many situations: § Example 1: GP takes exposures at the workplace into consideration § Example 2: OP identifies risk factors during an occupational health

check-up § Attempts to improve OP-GP cooperation since the 1970s have yielded

no results.

Solution: Prevention pathways Problem: 1. Prevention coordination in a primarily non-hierarchical setting without

traditions 2. Instable structure

Solution: 1. Negotiated order (of prevention process) 2. Stabilization through polycoordination

Prevention pathways for: § Musculoskeletal disorders § Coronary heart diseases § Mental disorders

Worksite health promotion Inclusion of company management, occupational physicians and

general practitioners

Periodic meetings for those involved: Further training for mental health, cardiovascular disease, low back pain, salutogenesis, etc.

Periodic general health monitoring, including MBI, WHO 6, etc.

(organized by the health management)

Check-up performed by the company medical officer:

coronary risk assessment (PROCAM / ARRIBA score)

Consultation hours / appointment with the general practitioner:

coronary risk assessment (PROCAM /ARRIBA score)

Consultation: company medical officer

/ general practitioner

Treatment provided by general practitioner / specialist according

to prescribed guidelins (e.g. hypertension gudeline, diabetes mellitus guideline)

/ general practitioner Specific prevention measures

(initiated by the company medical officer or by an external provider):

e.g., smoking cessation, sports, diets

No risk Medium risk with

no treatment needed

Increased risk and/or need for

treatment

Increased risk and/or need for

treatment

Medium risk with no treatment

needed No risk

¢ medical check-ups executed by OPs ¢ medical check-ups executed by GPs ¢ cooperation/information exchange between GP & OP

Example 1: Pathway for cardiovascular disease

Prevention pathways: combining four principles of coordination

Type of coordination

Personalized coordination

Depersonalized coordination

Standardization of coordination

high Clan (culture) Hierarchy (power)

Network (negotiation)

Market (money)

Prevention

pathways

Prevention

pathways

Conclusion Psychological and social issues are relevant for OHS

§ They are relevant determinants of health and health behavior

§ They are relevant determinants of OHS behavior and

implementation

Psychological and social issues – relevance for health and ... Pfaff.pdfPressman, S.D. et al,...

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