What Works? Research Issues for the Future Professor Mansel Aylward CB Cardiff University Conference Centre; 31 st May, 2007 WORK & HEALTH IN EUROPE

The Other Side of the Hill: …all the business of life, is to endeavour to find out what you dont know by what you do; thats what I called guessing what was at the other side of the hill. Arthur Wellesley, Duke of Wellington, 1816

What do we know: Beneficial effects of work depend on the nature and quality of work and its social context. 1 Occupational health and safety services: quality and extent of central importance to achieving good health outcomes at work 2 Pressing need to address, at least, the: –Conditions of the work environment –The health needs of workers, and –The social contexts of economic activity 1.Waddell & Burton, Walters D, 2007

The other side of the hill: some features of the landscape: Ageing Women and the workforce New types of jobs / ways of working Economy and employment Migration Healthcare & Service provision Rights and responsibilities Psychosocial influences New Technology / new hazards Old Hazards manifesting Obesity

Distress and the Workplace: what we think we know? Demand, Control & Support 1 – high strain and harmful outcomes – perceptions of stress / emotions ignored Effort-Reward Imbalance 2 (ERI) – importance of subjective perceptions – fails to predict health outcomes Cognitive Appraisal Theory 3 (CAT) – appraisal and coping – individual responses pivotal 1.Karasek, Peter and Siegrist, Lazarus & Folkman, 1984; Cox, Griffiths et al, 2000

Inadequacy of prevailing models of work/workplace distress: –Ongoing structural changes in labour market (mergers, downsizing, outsourcing, etc) –Employer reluctance –Very short period of interventions –Randomization not meaningful (large samples required) –DCS & ERI: conceptually sterile stimulus- response models 1 –Scientific foundation and practicality of interventions: inadequate –Inflexibility and groupthink. 1. Spector, 2003

Research: work-related distress: Basic concepts and definitions Methods of measurement Cause and effect relationships Psychosocial characteristics: adverse-vs-beneficial effects Personal responses and perceptions Cultural attitudes, beliefs, and socio-economic contexts

The need for further rigorous research: 1 Effect sizes and quantitative research: –How much work is good for health? –How much does unemployment harm health? –Worklessness vs economic inactivity vs unemployment –Relative contribution of differences between individuals and jobs Longitudinal studies– lifetime perspective – retirement vs continued working 1. Waddell & Burton, 2006

Research Issues for the Future: The cardinal characteristics of: a good job a health-promoting workplace Intervention: practicality and flexibility target groups scientific foundation rigorous outcome-based evaluation Horizon Scanning (over the hill): anticipating the unexpected political will social change employer engagement