Is your job killing you?
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The leading global killer in 2017 was cardiovascular diseases (CVD), a chronic illness that affects the heart and blood vessels. These include hypertension (high blood pressure), coronary heart disease (heart attack); cerebrovascular disease (stroke); heart failure; and other heart diseases. Of the 56 million people who died in 2017, cardiovascular diseases were responsible for around one-third of all deaths.
Cardiovascular diseases are the leading cause of morbidity and mortality of the working-age group population, and the onset is a decade earlier than the European counterparts. If we look at the data, it is evident that amongst 15-69 years old, CVD is the leading cause of death. As this is the working-age group, NCDs (Non-Communicable Diseases) such as CVDs are not only a health problem but a development challenge as well.
If we look at the current situation of NCDs in Sri Lanka, Ischemic heart disease, diabetes, cerebrovascular disease, asthma, chronic obstructive pulmonary disease, and chronic kidney disease are among the top 10 causes of death in Sri Lanka and significant public health challenges. Risk factors of CVD are multifactorial of which many are life-style related. There is an abundance of evidence on psychological stress and cardiovascular disease. This article is on how job stress increases the risk of cardiovascular diseases and what can be done to minimize the ill-effects.
Good stress and bad stress
Everyone feels stress in different ways, and stress is a normal part of life; not all stress is bad stress. Stress becomes harmful when these feelings become overwhelming. How much pressure you experience, for how long and how you react to it can lead to a wide variety of health problems, and that’s why it’s important to know what you can do about it.
Stress and your heart
Stress is your body’s reaction to adverse or very demanding circumstances that require you to respond, react, or adjust. A stressful situation initiates a chain of events that prepares you to deal with the situation — the “fight or flight” response. The body releases adrenaline, a hormone that temporarily causes your breathing and heart rate to speed up, and your blood pressure to rise. However, when stress is constant, the body remains in high gear for days or weeks at a time. Although the link between stress and heart disease isn’t clear, several mechanisms have been postulated. High work stress is related to the over-secretion of corticosteroids. Persistent elevation of corticosteroids in turn disturbs/ interferes with coagulation, inflammation, autonomic nervous system, and Endocrinology which ultimately increases the risk of CVD and hypertension.
Additionally, individuals with high job stress may resort to maladaptive behaviours such as smoking, alcohol consumption, binge-eating, physical inactivity, which can increase the blood pressure and may damage the artery walls. The body’s response to work-related stress includes headaches, back strain, exhaustion, sleep difficulties, constant anxiety, and irritation and makes you forgetful and out of control, with racing thoughts, feelings of helplessness, depression, diminished libido, appetite disturbances, and frequent infections.
Work conditions have changed. It has become more challenging in many ways. However, have the workforce attitudes and capacity altered to face the change? Or are we falling ill due to the lack of change? Are we dying a bit too early due to the mismatch? Our work has an influence on our health.
White-collar sweatshops – or should it be?
In Sri Lanka, many full-time permanent employees, especially in the private sector, are expected to work long hours, frequently without being adequately rewarded. Many jobs demand employees be contactable 24/7. Additionally, the workplace culture, inadequate managerial practices mostly to pursue a few narrow metrics, high efforts despite lack of adequate rewards (money, esteem and career opportunities), imbalance of demands, and control in the job are the driving causes of stress.
What is frequently being disregarded is the fact that the situation does not align with the employee’s skill set, capabilities, abilities, resources, or comfort level. Also, if a worker is not supported and appreciated at work, he/ she will not be inspired to work. Poor management and unpleasant work environments are leading causes of stress at work. Since people need money to live, they would feel stuck in a place or with a person they do not like. All of these factors play a role in workplace stress.
Stress at work quite literally comes with the job. Thus it is not healthy to ignore as it would lead to not only mental distress but even physical injury. Therefore the health of a worker is an essential prerequisite for many reasons: being healthy is a fundamental human right, household income, productivity, and economic development of the country. Therefore, preventing diseases amongst workers is an essential function of the health services as well as is the responsibility of the employer.
Over-commitment – doing way too much
This is also referred to as a type A behaviour personality -a person whose ambition and career goals are enormous and therefore likes to control things, and needs approval too.Type A personalities generally try to achieve much more than is possible, and they use up their energy in the process, which becomes overwhelming to the point that it becomes harmful. Studies have proved that these people are prone to chronic work stress and, therefore, CVDs.
Organizational responsibilities
Health is not determined solely by medical care and personal choices but mostly living and working conditions. An employee is important; employee health is essential. A healthy employee adds money, positivity and productivity to any organization. Prevention and promotion of the health of a worker is an investment with a high return of investment. Amid soaring health spending, there is growing interest in workplace disease prevention to improve health and lower the economic impacts.
What can be done?
- Every setting is a health setting. Worksite health promotion activities should include:
- Regular periodic screening and surveillance even for work stress
- Healthy opportunities i.e., Healthy diet, physical activity, mental health well-being
Policy commitment and road maps are also necessary to change the organizational culture which promotes employer-employee relationships, adequate rewards, and a culture of work-life balance. Establishing connections between occupational health and primary care services to facilitate the care of workers suffering from chronic diseases and screening of workers.
What can individuals do?
- Be realistic – plan and organize your workday
- Take rest breaks
- Ask for help: it’s essential to talk and discuss work-related matters with superiors and peers
- Learn new skills – engage in continuous professional development activities to enhance your skills and capacity
- Practise mindfulness – it’s beneficial in day to day life- When you experience stress, take a few minutes off to focus on yourself. Close your eyes, focus on your breathing, and tune out the surroundings. Focus only on the present moment with breath as your anchor – acknowledge your feelings, your sensations, and your thoughts without any judgment coming back to the breath and keeping it as an anchor
Stress often goes unnoticed, and when it is noticed, stress is associated with stigma. Physical illness is something you can tell your employer. Mental illness?
… but nothing’s going to change if we don’t start talking about it.
(The writer is a Consultant Community Physician, attached to the Management Development and Planning Unit, Ministry of Health)