Preventing Work Stressors : a Unicorn or the Elephant in the Room?

by Marnie Dobson Zimmerman, PhD

United States of Stress

Everyday we hear more and more stories in the media about the stressed-out U.S. workforce. One in 3 U.S. workers report typically feeling stressed during a work day, while 3 out of 5 workers cite work stress as the most significant source of stress next to money. We work more hours per year than people in most other high-income countries, because the U.S. is one of the only countries that does not guarantee paid time off, and many Americans have less, or are taking less vacation time, than any other high-income country. One in 4 Americans have no paid holidays or paid vacation time. Full-time workers are reporting longer work weeks than ever. Forty-two percent of all workers report working longer than 40 hours, and 50% of full-time, salaried workers report working 50 hours or more in a typical week.*

Work is more intense and demanding than ever, with many workers reporting that laid-off workers after the financial crisis were never replaced and that they are expected to do more with less. Rates of burnout are skyrocketing, especially among health care workers, and the experience of conflict between work and non-work life is reaching epidemic proportions.

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What do we mean by “stressful work”? Isn’t stress normal? Isn’t it part of performing at your best and meeting the challenge? Stress is a normal response to an abnormal, challenging or threatening environment. With adequate time for recovery, the stress response that changes a person’s physiology can return to normal. But if work demands — physical or psychological — are ever present and exceed a person’s ability to cope or recover, we know that a person’s health can suffer.

How many patients should one nurse or doctor be responsible for before they begin to experience exhaustion, and then burnout? How many “crunch” deadlines that force a video game programmer to give up their personal time and work through weekends can be sustained? How much emotional labor can a sales person perform to calm customers before he doesn’t show up to work anymore? And how many irate customers can one grocery store cashier handle before she begins to feel exhausted on a daily basis? And what if none of these people feel like they have any power to say to management “Hey, you need more cashiers, realistic deadlines, or a manageable patient load”?

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We also know that “work stressors” such as job strain (high work demands combined with low control), measured in numerous epidemiological studies of working people, is related to the development of burnout, depression, greater likelihood of suicide, obesity, diabetes, higher blood pressure, cardiovascular disease, and ultimately death.* And by many accounts, the costs of stressors (like job strain and many others) to high-income societies such as the U.S. can reach into the billions of dollars.**

So, by all accounts, we know we are stressed, and that it costs. But what can we do about it?


Distinct Paths to Prevention

To some, work stress is inevitable and trying to change the sources of stress is a proverbial unicorn — not quite realistic. Work stress prevention is possible, but requires facing the “elephant in the room” — the impact of harmful work stressors over time, and the knowledge that we can do something about it.*

Those interested in preventing work stress-related illnesses from work are faced with two distinct options:

1) help individuals cope better with their stress reactions or symptoms.

2) change/reduce the work stressors in the environment.

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Option 1 has spawned an entire multi-billion-dollar industry dedicated to intervening at the point when individuals are feeling the early stages of chronic stress and include: meditation, biofeedback, mindfulness, yoga, deep breathing exercises, and various other forms of complementary and alternative medicines. Over 50% of medium-large companies have invested in “wellness programs” which may include stress management classes.

While these practices may benefit some workers in the short-term, there are substantial doubts as to their long-term benefits. Also not everyone will or can access these programs due to concerns about confidentiality, lack of time or lack of schedule flexibility. Many low-wage workers, who are arguably the most exposed to chronic stressors, don’t have any access to these kinds of programs. Of growing concern, “wellness programs” and other “stress management” practices focus primarily on changing individual behaviors, such as smoking, drug and alcohol use, and exercise. Illnesses in this context are seen as an individual problem, not one that stems from a stressful work environment.

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Option 2 is directly addressing the work stressors that make a stressful work environment — things like workload/demands, decision-making authority (control), lack of social support, workplace injustice (bullying, sexual harassment or discrimination), work-life balance, and appropriate rewards. The sources of stress that come from organizational policies and practices.


Organizational Policies and Practices

We know from a large and growing body of work organization intervention research that, with the input of workers, labor representatives, and management, many of these work stressors can be addressed through changes to organizational policies or practices.

In Quebec, Canada, hospital workers, union representatives and management came together in a labor-management committee to address issues related to work demands, control and social support. They developed programs and policies to improve communications, training to improve supervisor support, and dealt with workload and staffing issues. Three years after these programs were implemented, the researchers evaluated their impact and found significant improvements in demands, control, support and burnout.

Hotel housekeepers in San Francisco and Las Vegas participated with researchers in collecting data about workload after noticing an increase in musculoskeletal symptoms (sore or painful muscles and joints) and high blood pressure. They recognized that as the amenities in the hotel rooms became greater — for example, larger mattresses, more layers of bedding, or coffee pots, workloads were becoming greater, and they were skipping rest/meal breaks to get their room quotas done. They successfully used the data they collected at their collective bargaining sessions with hotel management to win a reduction in workload — a decrease in the number of rooms to be cleaned per day.

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Worker Advocates Pushing for Change

Of course, research is slow and costly, and many workplaces never get to collaborate with researchers but could benefit from initiatives to reduce work stressors. Many workers aren’t waiting around. Unions and worker advocates over the past 10–20 years have carried out a number of successful social & public health campaigns that have resulted in the passage of legislation, or the enactment of regulations that have improved working conditions and reduced job stressors around the U.S.

Such advocacy efforts include:

  • Fair Workweek Laws that address on-call and irregular scheduling in cities like New York and Philadelphia came about from retail workers organizing to improve their ability to balance their work and non-work life. Work schedules for example need to be posted at least a week or two ahead of time so workers can organize child care, college classes or other jobs, thus increasing their control over their work time.
  • Fight for $15” has been a successful social movement organized by workers and their unions fighting for an increase in the minimum wage. Cities across the nation have implemented laws that require a staggered increase to a $15 minimum wage. Fair pay is part of a healthy workplace. Workers who are paid enough to make ends meet are workers with less financial stress and economic insecurity, and who can also afford health care, which ultimately improves the health and well-being of families and communities.
  • Advocacy by National Nurses United led to improved nurse-patient staffing ratio laws in California, followed by several other states, which protect the health and safety of patients and nurses alike.

Employers Leading by Example

With the rise of conscious consumerism, corporate social responsibility and awareness of the business benefits of treating employees fairly and respectfully, a number of employers have responded positively to pressure. These organizations can serve as an example to other companies of the benefits of working with workers and providing fair, living wages and benefits:

  • In 2002, Harvard University (after protests by the student-led “Harvard Living Wage Campaign”) instituted a “parity policy,” which means that service workers on the payroll of an outside contractor earn the same pay and benefits as direct university employees, thus removing economic incentives to outsource service work to save on labor costs. Harvard’s experiment meant that the 1,000 low-wage dining, security, and janitorial workers previously earning $10/hour now earn the equivalent of a middle-class income. A former Treasury Secretary, Mr. Summers, argues that this is “an important private-sector policy innovation and a good template for a socially-minded organization.”
  • Costco is another good example of a corporation with a large, unionized workforce that pays its workers a living wage, has lower turnover of staff than similar retailers, and has a highly profitable business model. Costco co-founder and CEO Jim Sinegal, who refuses to charge their customers more or shave the benefits and salary of their employees, said “We think when you take care of your customer and your employees, your shareholders are going to be rewarded in the long run.”

Healthy Work, Healthy People

The Healthy Work Campaign, of which I’m co-director, provides tools, resources, and guidance for employers, workers, and unions/worker advocates about how to implement initiatives that address psychosocial stressors, or how to get involved with existing initiatives. These kinds of changes are not impossible. Reduction of work stressors has the potential to improve the quality of jobs, the health and well-being of workers and families, lower costs for businesses, and ultimately create a more just, sustainable, and robust economy.

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We need to educate ourselves and all working people about the causes of ill health at work and encourage individuals and organizations to be active in facing the elephant in the room — that unhealthy work in the U.S. is making us ill. If we want healthy people, we need healthy work.

Visit healthywork.org to learn more about healthy work, the Healthy Work Campaign, and ways you can make a difference.


Dr. Marnie Dobson is the Co-Director of the Healthy Work Campaign, as well as the Associate Director of the Center for Social Epidemiology. She is also an Assistant Adjunct Professor at the University of California, Irvine Center for Occupational and Environmental Health (COEH) where, for the last 12 years, she has been involved in work stress research, including qualitative, participatory methods, enhancing epidemiological studies and intervention development with several blue-collar working populations including firefighters and urban transit operators. She continues to teach in occupational health classes at UCI and UCLA, as well as publish academic articles and book chapters and present at scientific conferences.


*Visit Stats to Know and Stats & Infographs for statistics cited with their references.

**Visit Business Costs of Unhealthy Work for additional statistics cited with their references.