So, What is “Healthy Work” Anyway?— Marnie Dobson Zimmerman, PhD

Working on Empty” (WOE) is a multimedia project on how the U.S. workplace is making Americans sick and what must change to protect the health of our workforce.

Work is fundamental to our well-being. Most of us depend on work for our economic survival and that of our family. Work can contribute to our sense of purpose, belonging, self-esteem and good health. Having a sense of belonging and purpose is related to better physical and mental health and can promote longevity. And, we know that those without work are more likely to experience depression and other illnesses. [1]

At its most promising, work is a place we can develop and apply our skills, engage in a collective enterprise to produce something of value or provide valuable services to others, and be supported in that enterprise by the people around us. Having a say or a “voice” at work in how that enterprise might best be accomplished, or how processes could be improved based on our experience and skill, is essential. Work ought to be a place where we are safe, treated with respect and dignity, and are rewarded fairly for our skills and time, both financially and in terms of advancement and growth. This is what we call “healthy work.” [2]

But, for many of us in the U.S. (and globally), work has a darker, more costly side — costly to our economic well-being and to our health. We know that toxic chemicals and dangerous workplaces take a toll and many workers lose their lives (4,836 were killed on the job in 2015). Fewer people know that the “conditions” of work, our employment arrangements and the quality of our jobs can also negatively impact the health and longevity of working people — what we call “unhealthy work.” [3]

For many decades now, research evidence has accumulated demonstrating how certain kinds of “toxic” working conditions contribute to chronic illnesses, including burnout, anxiety and depression [4] as well as obesity [5], diabetes [6], higher blood pressure [7] and cardiovascular diseases [8].

Contrary to popular belief, and contrary to the typical medical approach that chronic illnesses are the result of individual genetic or behavioral “weakness,” strong evidence exists that they have social causes. A large body of research shows a “social gradient in health,” that is: the lower you are on the socioeconomic ladder (e.g., the poorer you are in relationship to others), the more likely you are to experience illness and earlier death. [9] Partly this can be explained by the communities you live in (and even the type of country), as well as by lack of access to quality education, health care and nutrition, and exposure to racial/gender discrimination. However, a large part of your risk for chronic illness also has to do with the conditions under which you work — the quality of your job.

While we all know that a heavy workload can make you feel stressed and tired, if we are “engaged,” have enough control, skills, and support (from coworkers and supervisors) to accomplish our tasks, and enough recovery time (rest breaks, moderate work hours, vacation time, paid sick leave), demanding work alone is not necessarily “unhealthy.” The combination of highly demanding work (such as fast pace, tight deadlines, conflicting demands, and interruptions) and not having enough control, skills, or support results in heightened stress responses in your body and, in the long term, chronic stress contributes to chronic illness. Work with high demands and little control is called job strain — one of several work-related psychosocial stressors that make work unhealthy. [10]

Have you ever felt like you are accepting more and more responsibility at work and that the effort you put into your job is not reflected by the rewards? Rewards include things like, respect, support, higher status, promotions, job security, and, of course, fair pay. This “psychosocial stressor” is called effort-reward imbalance (ERI). [11]

ERI is based on the idea that it is stress-provoking to be putting in more effort than you are receiving in rewards. ERI is known to lead to depression, unhealthy behaviors, and cardiovascular disease. [12] Those in low-wage work are particularly likely to be exposed to these kinds of psychosocial stressors, but they can occur at all occupational levels.

Unfortunately, there are many “psychosocial work stressors” — the sources of stress that objectively exist in the conditions of a job, not just in someone’s head. For example, job insecurity [13] caused by layoffs from restructuring or mergers or “lean production.” Another is lack of supportive supervisors and coworkers [14], lack of organizational support or organizational justice [15] — that is, lack of policies and procedures that result in employees being treated fairly and with respect, including grievance procedures, policies and training on sexual harassment, discrimination and anti-bullying. The level of conflict between one’s work role and one’s family role (work-family conflict) is also a major stressor, particularly linked to poor mental health, including burnout and depression. [16]

Unhealthy work (work stressors as described above) is not just detrimental to the health and longevity of workers [17], it costs our society and businesses billions of dollars in lost productivity due to “presenteeism”, absenteeism, and turnover, as well as health care and disability costs. [18]

Fortunately, unhealthy work can be identified in any workplace. Employees can also assess their own work stressors and discover whether they have “unhealthy work.” Tools exist to identify the psychosocial work stressors that cause unhealthy work. Workers and their unions can and are taking action collectively to improve work, health and well-being, but they need support. Companies with a commitment to healthy workers, sustainable work, efficiency and profitability can and must identify unhealthy work and take action to improve the health of the workplace (not just the worker).

Join our Healthy Work Campaign and find tools to measure unhealthy work and resources to implement healthy work solutions.

To support the #healthywork movement:

With your help, we will have created more than hope — we’ll have cemented lasting, positive change in the name of healthy working conditions.

Marnie Dobson Zimmerman, Ph.D., WOE Associate Producer of Research and Associate Director of the Center for Social Epidemiology, is a medical sociologist and a work stress researcher for more than 15 years, studying the effects of work organization on worker stress and health. She has worked to give voice to many worker populations, interviewing and conducting focus groups with firefighters, bus drivers, hotel room cleaners, communication workers, publishing academic research articles and co-editing the book Unhealthy Work: Causes, Consequences, Cures. (Baywood, 2009) (LinkedIn, Twitter)



4. Theorell, T. and G. Aronsson (2015). “A systematic review including meta-analysis of work environment and depressive symptoms.” BMC Public Health 15: 738.

5. Schulte, P. A., et al. (2007). “Work, obesity, and occupational safety and health.” Am J Public Health 97(3): 428–436.

Brunner, E. J., et al. (2007). “Prospective effect of job strain on general and central obesity in the Whitehall II Study.” Am J Epidemiol 165(7): 828–837

6. Brunner, E. and M. Kivimäki (2013). “Work-related stress and the risk of type 2 diabetes mellitus.” Nat. Rev. Endocrinol. 9: 449–450.

Schmidt, B. et al. Effort–reward imbalance is associated with the metabolic syndrome — Findings from the Mannheim Industrial Cohort Study (MICS). International Journal of Cardiology 178 (2015) 24–28

7. Landsbergis, P., et al. (2013). “Job strain and ambulatory blood pressure: A meta-analysis and systematic review.” American Journal of Public Health 103(3): e61-e71.

8. Theorell, T., et al. (2016). “A systematic review of studies in the contributions of the work environment to ischaemic heart disease development.” The European Journal of Public Health 26(3): 470–477. Schnall, P. L., et al. (2016). “Globalization, Work, and Cardiovascular Disease.” International Journal of Health Services 46(4): 656–692.

9. Marmot & Wilkinson (eds.) Social Determinants of Health (2nd ed). Oxford University Press 2005



12. Siegrist J. Social Reciprocity and Health: New Scientific evidence and policy implications Psychoneuroendocrinology. 2005;30(10):1033–1038.

13. Quinlan M, Bohle P. Overstretched and unreciprocated commitment: reviewing research on the occupational health and safety effects of downsizing and job insecurity. Int J Health Serv. 2009;39(1):1–44.

14. Hammig, Oliver. Health and well-being at work: The key role of supervisor support. Social Science and Medicine — Population Health Volume 3, December 2017, Pages 393–402

15. Elovainio, M., et al. (2010). “Organizational justice and health; review of evidence.” G Ital Med Lav Erg 32.

16. Hammer, L. B. & Demsky, C. A. (2014). Work-life balance. In A. Day, K. Kelloway, & J. J. Hurrell, Jr. (Eds.), Workplace well-being: Building positive and psychologically healthy workplaces. Wiley Publications.

17. Goh, J., et al. (2015). “The Relationship Between Workplace Stressors and Mortality and Health Costs in the United States.” Management Science March(0): null.

18. Jauregui, M. and P. Schnall (2009). Work, Psychosocial Stressors and the Bottom Line. Unhealthy Work: Causes, Consequences and Cures. P. Schnall, E. Rosskam, M. Dobson et al. Amityville, NY, Baywood Publishing: 153–167.