Workplace Stress & Non-communicable Diseases

I do not think I need epidemiological evidence to convince you that chronic diseases incidence is on the ascendancy in our dear country, Ghana. Neither do I need any GDP growth rate nor foreign direct investments inflow data to make the assertion that there a continuous increase in workplace restructuring and industrialization. In this article, I will be attempting to uncover the association between industrialization, chronic workplace stress and non-communicable diseases.

The way work is organized, i.e. the control it allows, the hierarchy, the pace, the social support, the psychological demand, the job insecurity and the rewards workers are given for their efforts, is strongly associated with disease endpoints such as cardiovascular, diabetes, mental health, musculoskeletal diseases and social and learning behaviors. The workers physical, psychological and emotional response (job stress) to these psychosocial stressors of the work organization is what makes him them at risk for to all these disease and behavioral endpoints. Recapping, some form of work organization leads to psychosocial stressors and these stressors lead to job stress and subsequent diseases. I should however, stress on the point that it is mainly chronic exposure to work related psychosocial stress that leads to these unhealthy outcomes.

Surprised that mere job stress is a risk factor of high cholesterol, high blood pressure, diabetes? Here’s how it works…

Chronic stress, such as what we experience at a stressful workplace, puts us in a long-term ‘fight or flight’ mode. This fight or flight mode is absolutely necessary for a short-term reaction to a stressor, such as being pursued by a wild dog. During fight or flight, the body responds by putting breaks on all activities than can wait, such as digestion and growth, and channels all resources to aid the body to be vigilant, concentrated, energetic and faster. Many hormones pour into the bloodstream. The vessels that send blood into the heart tightens, pushing blood forcefully into the heart. The heart responds by forcefully driving blood out to supply the legs and hands with oxygen and nutrients and also the lungs to enrich the blood with more oxygen. This increases the pressure at which the blood is pumped. The obvious result of a continuous fight or flight is a continuous high pressure in the blood vessels which is what physicians call High Blood Pressure (HBP). Also, the overworking heart muscles become unevenly muscular, leading to Left Ventricular Hypertrophy (LVH), another risk factor of heart diseases. Now the obvious and eventual wear and tear and the hardening of the veins lead to injuries in the blood vessels and also, leakages of the smaller vessels (capillaries) that supply the cells of the body and heart. Does angina, arteriosclerosis, thrombus ring a bell?

What makes ‘bad’ cholesterol bad is its affinity to clog up and hold on to the inner linings of our vessels and heart. Injuries and scars caused by the chronic HBP enhances the clogging up of our vessels making us more likely to suffer heart attack and brain attack (stroke). Also, the continuous release of adrenalin, cortisol, glucose and other stress related hormones makes the blood more viscous, making the vessels even more prone to clogging.

During fight or flight, the body converts stored energy to glucose and also stops converting excess glucose to stored energy to make energy readily available for concentration, vigilance, fight or flight. Chronic stress ie fight or flight condition, therefore makes the body insulin resistant for as long as the body is stressed – a condition also known as adult onset diabetes. Diseases such as depression, fertility diseases (barrenness), Alzheimer’s, stunted growth or dwarfism and even some cancers have all been fingered to be related to chronic workplace stress. I will not bore you with the ‘hows’ now.

Here is a scenario: Emefa, a young graduate of from one of Legon, has been employed at one of the prestigious banks in Accra as a Credit Analyst and subsequently given a loan to purchase a cool Nissan Corolla. As much as she is happy about her new job, she is also careful about maintaining her job security to keep up with her newly acquired lifestyle. She sets off to go to work on Monday in her car. 5 minutes into her 30 minutes ride, she gets into a heavy traffic. For 20 minutes in the still Accra traffic she is dreading that she’s going to be late. She then calls her colleague and to her utmost relieve she is told their firebrand supervisor, whose specialty is micromanagement, was not at the office after all. She is relieved and drives to work. Upon her arrival she spots the supervisors Mercedes at the parking lot. She tiptoes carefully through the cleanest architecturally endowed office which is devoid of all traditional chemical, biological and ergonomical occupational hazards to her desk without being caught by the supervisor. She sits in her ergonomic chair and starts her daily routine of a monotonous, repetitive job which she has no control whatsoever on what skill to use but a fixed and rigid laid down method autocratically decided by the upper echelons of the organizational hierarchy. If Emefa goes through this chronically or on a daily basis, she would be exposing herself to chronic stress and mostly all of the non-communicable diseases mentioned above.

Although I haven’t’ really had a real job in Ghana, this, I think is a common occurrence to most employees. Research has proven that employees who are exposed to psychosocial stressors at work, whether they are aware or not, are at a greater risk of non-communicable diseases and cancers.

The solution sounds simple; get these stressors from the workplace and employees won’t be exposed. Implementing the solution is the arduous part. There are several legislative, organizational and personal level intervention strategies drawn from a plethora of scientific knowledge than can help in diminishing these psychosocial and organizational threats to workers’ health. Matured economies have an uphill battle in implementing recommended solutions since their work organization was designed way before they realized psychosocial stressors were detrimental to health. This has made incorporating healthy work organizational design measures extremely difficult into the already structural organizational and psychosocial set-up at their workplaces. They are also introducing these noxious workplace and organizational structures into developing nations through mainly foreign direct investments. Ghana and now developing countries have a rare advantage. Developing nations are lucky to be building their industries and organizational structures at the period where there is ample evidence to support the positive relationship between healthy workplace design and not only reduction in non-communicable diseases but also increase in long term productivity. Not repeating the mistakes of already grown economies is one of the rare advantages developing nations have over developed countries. Refusal to tap such an advantage would undoubtedly be reckless and absurd. It will be incredibly antisocial if we do not factor in healthy work organizational design and practices in Ghana’s occupational health policies and production practices and follow the mistakes of the west blindly.

A work quality-based production model prioritizing healthy work organizational design should be what our policymakers consider as Ghana develops…

Capital must serve labor!

The author of this article is the founder of Workplace Stress Café, a new portal that is being constructed for employers, employees, academics and researcher to discuss and share expert indigenous intervention stratagems for Sub-Saharan Africans unique occupational stress hazards.

Wil Agbenyikey, ScD, MPH

wilfred.agbenyikey@aya.yale.edu