7.1 Work and Health Effects

Maleka is a precarious worker. Precarious employment is non-standard work that lacks stability, security, and control. It can be part-time or temporary, and is under-protected by regulation. Precarious workers lack control over how or when the work is performed. Benefits are rare and usually the wages are insufficient to support a family. ^[4]Women and racialized workers are more likely to be found in precarious employment. ^[5] Precarious work is also linked to increased risk of work-related injury and poorer health outcomes, including increased stress and poorer physical well-being. The precariousness of the employment relationship leads to worse OHS conditions. Further, gender and race have OHS implications because certain groups of workers are more likely to hold precarious jobs.

Precarious work is one example of how the structure of work and the employment relationship itself can be linked to ill health. This chapter will discuss how work itself can be an OHS issue. In addition to explaining the reasons precarious work leads to worse health, it will also examine work structure issues such as shift work, working for a small employer, and the health effects of different forms of work.

OHS practitioners rarely identify work itself as an occupational hazard. Traditional approaches look at aspects of work—such as work location, tools, and processes—to identify hazards that could harm workers. Yet studying the entirety of work, and even broader effects of work that spill over into workers’ home lives, provides a fuller picture of the health effects of work. Indeed, there is a growing body of research that shows that the structure of work, the nature of the employment relationship, and the type of the employer all have measurable physical and psychological effects on workers. For that reason, it is an area demanding greater attention by OHS practitioners.

Karasek’s Job Demands-Control Model, which was introduced in Chapter 6, links high demand and low control over work to high levels of worker stress. Karasek’s model was the first to connect the nature of the employment relationship to health and safety outcomes. Yet the degree of control over one’s work is only one aspect of employment that can affect workers’ health. This section examines three other dimensions to work that have health consequences: shift work, extended work hours, and emotional labour.

Shift work requires workers to work outside of regular weekday hours. It may include regular evening or night work, rotating schedules, split shifts, irregular shifts, or on-call work. Shift work is a growing trend in Canada. In 2005, nearly 30% of employed Canadians did not work 9 to 5, Monday to Friday hours.^[6] The most common form of shift work is rotating schedules, where a worker cycles through a series of day, evening, and night shifts. Not surprisingly, shift work is particularly common in health care and emergency services. It is almost as prevalent, however, in sales and service (e.g., consider the growth in 24-hour stores and restaurants).

The primary concern about shift work is its potential to disrupt a worker’s circadian rhythms. Circadian rhythms(commonly known as the biological clock) are the daily (24-hour) cycles our body follows to ensure (in humans) high activity during the day and low activity at night. Sleeping and waking, eating, adrenalin, body temperature, blood pressure, pulse, and many other bodily functions are regulated by circadian rhythms. When work occurs outside of that daily rhythm, it places strain on the body as it is forced to alter the cycle. A second concern is that shift work is associated with behaviour contributing to poorer health, including smoking, poor diet, and increased alcohol consumption.^[7] Shift work also disrupts family and social activities. This disruption adds stress and reduces the support that workers can draw upon to manage stress.

Some forms of shift work disrupt the rhythms more than others. The worst forms of shifts are those that are constantly changing (irregular shifts, rotating schedules, on-call), as well as those that invert the natural rhythm (for example, permanent night shifts). Workers whose rhythms have been disrupted can experience insomnia and non-restorative sleep, as well as changes in hormone levels, which can affect cell growth. Workers rarely become habituated to shift work, even after long periods on disruptive shifts.^[8]

Research into shift work has been extensive and shows a wide range of health effects. In the short term, shift work leads to shortened and less restorative sleep and chronic tiredness and lack of alertness, as well as stomach aches, indigestion, and heartburn. Shift work is associated with increased risk of workplace incidents and injury. The risk increases as the number of days on the disruptive shift grows. It also jumps if the disrupted shift lasts longer than eight hours.^[9]

Longer-term exposure to shift work is associated with a series of illnesses and conditions. Shift workers report significantly higher rates of burnout, emotional exhaustion, stress, anxiety, depression, and other psychological distress. Shift work increases a worker’s risk of developing diabetes, and some studies have also found a greater risk of heart disease. Some studies have also suggested a link between shift work and pregnancy complications. Likely the most significant long-term risk of shift work is increased risk of cancer, in particular breast cancer. The International Agency for Research on Cancer (IARC) has concluded that disruptive shift work is “probably carcinogenic to humans” (Group 2A)—the second most conclusive category in the IARC.^[10]

Much less research has been conducted at mitigating the negative effects of shift work. Some recommendations have included:

• Restricting consecutive evening/night shifts to no more than three
• Avoiding permanent night shifts
• Using forward rotation for rotating shifts (moving from morning to evening to night) rather than the opposite
• Providing more than 11 hours’ rest time between shifts
• Limiting weekend work^[11]

The effectiveness of these measures has been sparsely studied and therefore their mitigating power is uncertain. At this time, the only reliable method for addressing shift work’s health effects is preventive: eliminating or minimizing shift work in the workplace. This may be particularly challenging for essential services such as health care and emergency response, given the 24-hour nature of that work. Nevertheless, considering the health risks, there is room to question the value in 24-hour restaurants, late-night convenience stores, and other all-night service industries.

Extended work hours is defined as working for long hours over a period of time. Most commonly it entails working extra hours in a day or over the course of a week. There is some disagreement whether an extended work day is defined as over 8 hours or over 12 hours. In general, extended work weeks are defined as anything over 40 hours. The most obvious consequence of extended work hours is fatigue and the increased risk of error associated with it.

One of the reasons there is disagreement over how to define extended work days is that the research is contradictory regarding the effect of working between 8 and 12 hours. Some (but not all) studies have shown that working beyond 8 hours in a day leads to increased risk of incidents and sleep disruption. When workers work more than 12 hours, the research becomes clearer that this schedule is linked to increased injury rates, more illnesses, and an overall lower level of perceived general health. Some studies have found a link between long hours and pre-term birth. Over the longer term, extended workdays are associated with weight gain, increased use of alcohol, and smoking.^[12]

Working extended hours over the course of a week is also associated with negative health effects. Workers who work longer than 40 hours in a week are more likely to become injured. One study found that workers who worked 64 or more hours a week were almost twice as likely to be injured than those who worked less than 40.^[13] Prolonged exposure to long workweeks leads to worsening mental health and an increase in unhealthy behaviour, including poor diet and increased alcohol consumption. Women’s mental health appears to be more negatively affected by long hours than men’s mental health.^[14]

When the two types of extended work are combined—working both long shifts and long workweeks—the effects are magnified. Other work factors, such as work pace, temperature, and mental exertion required also intensify the health and safety risks of longer working hours. Particularly concerning is the combination of long hours and shift work (common in health care and other emergency services).^[15] Extended working hours also create stress in family and social spheres as work encroaches upon those aspects of workers’ lives.

At the core of all these findings is the physical strain put on the human body by long hours of work. The worker is unable to achieve sufficient rest between periods of work to recover from the exertion of work. Complicating the picture, however, is that many workers prefer extended hours. Extended shifts often result in a compressed workweek, meaning more days with no work. Others appreciate feeling important, busy, or challenged by long hours. As with many aspects of occupational health, workers vary in their susceptibility to the negative effects of long hours.

This hazard is easily controlled by reducing the number of hours worked. The reason employers don’t control this hazard is that longer shifts simplify scheduling and reduce pressure to hire more staff. These economic benefits for employers (paid for by workers in the form of ill health) ensure that long working hours and weeks remain commonplace practices.

Emotional labour is a term describing any aspect of a job that requires workers to regulate their emotions to meet organizationally defined rules and to display the required emotions to customers. In other words, workers engage in emotional labour when they are asked to display an emotion—empathy, happiness, friendliness— that they may not actually feel. Emotional labour is a key part of work in many occupations involving clients, patients, or customers and is required of a wide variety of workers, including nurses and doctors, store clerks, restaurant/bar servers, airline attendants, and teachers. Box 7.1 provides a more detailed discussion of emotional labour and its significance.

Emotional labour is a well-established concept in the study of work but is rarely discussed in OHS. The studies that have been performed find extensive performance of emotional labour leads to higher levels of anxiety, stress, and emotional exhaustion in workers.^[19] These psychological states lead to a variety of physical and mental ailments over time, including depression.

Emotional labour can also be linked to workplace violence and harassment, in that moments of intense emotional labour are often associated with managing threatening behaviour from customers or clients. Essentially, the worker is forced (by lack of alternatives) to manage a dangerous situation by regulating her own emotions, including fear. One result is that the trauma of the event may then be compounded by the mental costs of regulating emotions under a stressful situation, leading to intensified psychological stress.^[20]

Little work has been done to examine how to mitigate the negative health effects of emotional labour, in large part because it is not widely recognized as a significant health hazard. Reducing the need for emotional labour by allowing for a greater degree of honest expression of feelings is a key aspect of reducing the consequences of emotional labour. Allowing safe spaces for “venting,” establishing zero-tolerance policies for customer misbehaviour, and revoking policies requiring workers to engage in emotional labour (e.g., smile policies) are all ways to control the health hazard of emotional labour.

Shift work, long hours, and emotional labour are linked because they all introduce a health risk into the workplace by altering how, when, or what kind of work is performed. In this way, they are distinct from other hazards discussed in previous chapters because they are associated with the nature of work itself rather than a specific task or location. Also, because they are inextricably linked with the employment relationship, employers have been resistant to recognizing and controlling the hazards they pose.