Is stress a health and safety hazard?

What makes for a stressful day?

It's widely thought that employees on lower grades suffer if they have little control over their jobs. Is this true?

A group of middle managers gathers in central London for a half-day workshop on stress. Merren Barber, an occupational health physiotherapist, delivers a stark warning: managers who put too much pressure on their workers can cause serious health problems.

"Stress isn't an illness but there's quite a bit of evidence that it increases the risk of high blood pressure, heart disease and mental health problems. So people potentially can become ill because of chronic stress," Barber tells the group.

Is this really true?

Stress management courses are now a staple of corporate life and the claim often made that there is a link between stress and ill health has become the received wisdom.

The Health and Safety Executive (HSE), the government body in charge of protecting people's health at work, has even made giving workers more control over their workload a legal obligation.

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According to employment lawyer Gordon Turner, the HSE standards on stress are so rigorous that many employers fear details of their working practices becoming public. "It's so easy to slip up. If an employee takes a grievance as far as an employment tribunal, companies often settle rather than risk a public hearing that might attract the attention of the HSE."

Both the HSE and stress management trainers are influenced by a famous survey of the health of British civil servants known as the Whitehall II study. Led by Prof Sir Michael Marmot, an epidemiologist at University College London, Whitehall II has tracked the lives of thousands of civil servants for more than 20 years in an attempt to assess the effect of job status on health.

According to Professor Marmot, it is not stress per se that has an adverse effect on health and life expectancy. Rather it is working in a job where there are high demands accompanied by a lack of control. "People of high status tend to have high demand and that doesn't seem to cause any illness problems at all."

Is it working closely with the boss...

Some academics in this field have their doubts. Dr John MacLeod is one of a team of researchers at Bristol University who are sceptical about Professor Marmot's findings.

"We looked at these issues in a study of 6,000 working men in South West Scotland. Unusually, when these men were recruited in the early 1970s, it was the middle classes and the more advantaged who were experiencing high levels of stress. In those circumstances stress was not associated with poorer health."

Professor Marmot's response is that the Scottish study does not use good measures of stress.

Sick of work

As far as heart disease is concerned, it is not only Dr MacLeod and colleagues at Bristol University who are unconvinced there is a proven link with stress. The American Heart Association website states that "current data don't yet support specific recommendations about stress reduction as a proven therapy for cardiovascular disease".

... or not closely enough?

Dr MacLeod believes that so-called psychosocial explanations of ill health are a distraction from what he believes are more likely causes of a growing health divide between richer and poorer people.

"We don't really know the causes but material disadvantage in childhood is one of the strongest predictors of health in adulthood. So the best bet would be to target and reduce childhood deprivation if we want to see reductions in health inequalities."

So are companies wasting money by sending managers on courses that might make them feel guilty about placing high demands on their workers?

Dr MacLeod doesn't go that far. "It may not reduce the risk of heart disease but creating fairer workplaces is a humane and just thing to do."

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Add your comments on this story, using the form below.

"It's widely thought that employees on lower grades suffer if they have little control over their jobs. Is this true?" Yes, it is. I have no control over my job. I have a timetable worked out weekly by the supervisors that tells me what I have to do every hour on the hour and if something changes I have to go and ask my supervisor for something to do even though I am an adult and I can work out for myself that needs doing. It causes me no end of stress and frustration.
Emma, Egham

Incompetent management is quite easy to find in today's Britain - Terminal 5 being a recent example - but is this caused by too much stress or too little? Of course the Dr Macleods of this world will bleat about "creating fairer workplaces" but will this get the job done or will the job go to India?
Michael Clarke, Kensington, London

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