Telework - Telenor

48
Flexible work and health
ERIK BERGERSEN
1 Introduction
In the modern, post-industrial world,
most men and women have sufficient
material resources for sustaining a good
life, including good health. After the
demise of infectious diseases earlier in
this century, diseases of affluence have
taken their toll, particularly heart diseases;
but with improved diet, physical
exercise, better diagnostics and medical
care, the prevalence of these diseases is
also reduced. In spite of this, and of the
vast array of services offered by modern
medicine, there are ailments that seem to
increase in the population, such as musculo-skeletal
diseases, hypersensibilities
etc., which are difficult to heal and which
contribute heavily to the human and economic
cost generally, and that of absence
from work through illness.
Within the domain of health and work,
large differences in workers’ health have
been observed, and a significant part of
the difference depends on variations in
the characteristics of the work situation.
Some of these characteristics are associated
with those that teleworkers appreciate
most when they telework, such as
improved job control and less stress. In
this article, the reader will be introduced
to research that substantiates some of the
health effects of the psycho-social work
environment, and postulate that telework
– and non-telework – may be organised
to benefit from this.
However, not all teleworkers are senior
male experts doing high quality work
from their villa or mountain cabin – a
popular image of the archetypal privileged
teleworker. Some are female with
more concern for the domestic agenda
than their male counterparts; some do
‘heads down’ clerical work with strict
and close deadlines; some take purchase
orders or customer complaints by telephone
and are not at all in command of
their own pace of work or at discretion as
to which task to take up next. Also, some
may have a perceived or real feeling that
the work they do, and the way they do it,
is not appreciated by their line managers
or their office-bound colleagues, or that
most interesting new tasks go to those
who are present in the office. Such
effects may be experienced as very detrimental
to the work environment. Thus,
there are considerable challenges in making
telework a panacea for good health.
We do know that some gross parameters
of the work environment, such as position
in a hierarchy and job control, influence
gross parameters of health, such as
morbidity and mortality; we also know
that they influence specific areas of
health such as cardiovascular diseases
and diseases of a number of other organ
systems. There are also strong indications
that psycho-social work environment
influences diseases of the muscles
and the skeleton, which contribute heavily
to sick leave and permanent departure
from working life.
We do not know what effect the specific
factors of the work environment has on
various types of teleworkers. The purpose
of this article is to point to some
of the known facts about psycho-social
work environment and their impact on
health; to outline some of the theories for
the connection between the psycho-social
factors and observed health effects, and
some of the conclusions that may be
drawn for the practice, planning and
organisation of telework, and finally suggest
some perspectives on further development
in this area.
1.1 Why is this important?
Health deficiencies impose heavy burdens
on the employee, on the employer
and on society. Health care may take a
tenth of GDP in an industrialised country,
and compensation for worker sick
leave half that again. Even modest reductions
in work-associated illnesses will
have significant economic benefits.
With the current trend towards higher
levels of morbidity in society, and with
a significant increase in broad, non-specific
ailments – not easily given a diagnosis
and attributed to a single cause –
it is more important than ever to understand
complex causes of illness (Drever,
Whitehead, Roden, 1996; Drever &
Whitehead, 1997). New ways of organising
work, with an emphasis on selfdriven,
self-motivated, always available
employees seem to carry risks of its own,
with burn-out, general fatigue and the
whole gamut of somatic diseases as a
result. With an increasing pace of change
in the workplace – of tasks, organisations,
relationships – the strain will
increase for most people. A better understanding
of how the work environment
influences health, and what means of
intervention are available to improve the
situation, will be indispensable.
It is also important to have in mind that
even if the measured costs in money and
suffering of an increasing morbidity is challenging,
one must ponder the loss of energy,
creativity and productivity that probably
precedes the development of a diagnosed
illness and a registered sick leave.
2 The issues
2.1 Work and health
– a delineation
Health and work is a comprehensive subject,
with numerous aspects which for
decades have held the attention of the
research community as well as public
regulatory bodies and the organisations
of labour and industry. In the industrial
society, physical working conditions and
their effect on workers present at the
workplace: heat, cold, dust, chemicals,
noise, radioactivity etc., have received
much attention and become the subject of
national legislation and international conventions.
So has work ergonomics, which
influences persons in the performance of
their work. In the post-industrial society,
where less than a fifth of the working
population is employed in primary and
physical goods production, these health
risks from the physical environment may
be less pronounced. For the purpose of
this article, the relevant effects of the
psycho-social work environment will be
sufficiently illuminated if we limit the
discussion to ‘office work’; consequently
the physical work environment will not
be discussed here.
The health effects of the psycho-social
work environment manifest themselves
in a number of diseases. It has been
found, however, that there is a great deal
of co-variation in the diseases of various
organs systems and more non-specific
syndromes. For conciseness, this presentation
will mainly be concerned with
cardiovascular diseases, which are widespread,
have received much attention
and are reasonably straightforward with
respect to symptoms and diagnosis. This
should not lead the reader to underestimate
the importance of other diseases,
eg. muscular-skeletal diseases. They
may have a physical cause, but many researchers
are concerned that the aetiology
of these diseases may have an important
psycho-social component.
For the interested reader Kristensen
(1989a,b) gives an extensive survey of
research on both physical work condi-
Telektronikk 4.1999