Mon Sep 2, 2002

Work, Health and Social Structure

BBC News is running a story headlined Work ‘puts health at risk’. It summarizes two studies on occupational health and safety. The first one, done in Sweden, found that 7% of workers surveyed fell asleep unintentionally on the job several times a month. The second one, done in Britain, found that the number of people who may be suffering hearing problems as a result of their jobs is higher than previously estimated.

So far, so nothing. Both studies are, I’m sure, perfectly good and useful. But the news story itself bugged me. The headline encourages the standard response to research in social medicine and social science. “Researchers discover work bad for you”—- tell me something I don’t know. And the focus is too narrow: most people don’t work in jobs where falling asleep unintentionally can have serious consequences, or where our hearing is at risk. These are not the most important reasons why work may be bad for you.

If you want to estimate how your job may be affecting your health, ask yourself how high up your chosen career ladder you are. The famous Whitehall studies examined the health of British civil servants across all occupational grades, as well as over time. The British civil service has a very well-defined organizational hierarchy. The question was, who was healthier, people in the lower ranks or people at the top? If you believe the rhetoric of, say, American CEOs, one might think that the stress levels of people at the top are much higher. All that responsibility, all those decisions to make, all those management crises to deal with. (That’s what justifies those obscene salaries, remember?) Life would be much easier with fewer responsibilities, right? Wrong. The Whitehall studies found, across a whole range of health measures, that the lower your status the worse your health and general happiness. Controlling for the usual covariates, one’s position in the occupational status hierarchy strongly influenced one’s wellbeing. Inequality is bad for your health.

You can read the evidence in different ways. Some psychologists talk about “status-related stressors” and—- inevitably—- want to classify the phenomenon as a syndrome in order to develop individual-level treatments for it. Treating such problems is a good thing, of course. But thinking in individual-level terms misses the most interesting thing about the findings. A more sociological approach would explore the social-structural determinants of health systematically, and think about social policies (rather than individual therapies) that might affect it. The central idea is so compelling: the next time someone tells you there’s no such thing as society or social structure, you can point to their cholesterol score. All in all, much more interesting than piecemeal reports of this or that occupational hazard.