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Health and Safety Needs of Older Workers 3 The Role of the Changing Labor Market and the Changing Nature of Work in Older Workers’ Work Experiences and Health Outcomes CHANGES IN THE LABOR MARKET In the past century, the median income of Americans has increased substantially, many aspects of their working conditions have improved, and their average life span has increased (Council of Economic Advisors, 2002). Nevertheless, some recent economic and workplace trends raise concerns about the health and safety of older American workers. Income growth has been uneven across the income distribution, and while the health and safety conditions of workers in some occupations and industries have improved, this has not been the case for all workers. For instance, as we discuss in Chapter 6, changes in the nature of work (increases in stressful job characteristics and work organization) are associated with increased risk of cardiovascular disease and other illnesses or disorders commonly experienced at older ages. Unfortunately, there is limited evidence on how these trends are affecting the health and safety of older workers. More generally, there is controversy over the validity of the illness or disorder and injury data that we now collect to measure these trends (see Chapter 6). Important changes in the structure of the American economy over the past several decades have affected older workers’ occupational distribution, income, availability of retirement and disability benefits, job security, union membership, and, potentially, their health and safety. Employment in the United States has gradually shifted from the production of goods to the service-producing industries (U.S. Bureau of Labor Statistics [BLS], 2003). Employment relations have become more flexible, or more precarious,
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Health and Safety Needs of Older Workers depending upon one’s point of view (Kalleberg et al., 1997; Standing, 1999). Deregulation, increasing reliance on voluntary standards, privatization of government services, and an emphasis on market forces to meet societal needs are all key aspects of a new American economy, which has grown substantially and increased employment, especially over the last decade of the 20th century, but has resulted in workplaces that still contain substantial health risks for some workers (Levenstein and Wooding, 1997). Shift to Service Industry Employment In the mid-20th century, about a third of the American workforce was employed in manufacturing. Today, not much more than a tenth are so employed. About 80 percent of the workforce is in the service sector. In the economic downturn after 2000, about 10 percent of manufacturing workers lost their jobs—about 1.9 million workers. On the other hand, service industry employment has continued to increase by almost 2 percent (BLS, 2003). Table 3-1 shows the occupations with the largest expected job growth between 2000 and 2010 (Hecker, 2001). The large, high-growth occupations include a disproportionate share of low-wage service sector jobs, and 60 percent of these high-growth occupations are in the lowest quartile of median hourly earnings. However, many smaller occupations that require advanced training and pay high wages will also expand. Hence, the skill distribution of the future workforce is likely to increase somewhat faster at the high and low ends than in the middle. These trends have important implications not only for income but for benefits received by older workers, including health and retirement benefits. For instance, after substantial increases in employer pension coverage from the end of World War II to the 1980s, primarily obtained through collective bargaining, pension coverage has remained constant at about 50 percent for all workers. Also, a significant percentage of workers are still not covered by employer health insurance. The end of this trend toward growing pension and health coverage was due in part to the shift of jobs from more heavily unionized manufacturing industries to service industries. Nonstandard, Alternative, and Precarious Employment One aspect of increased employment flexibility is the rise in nonstandard, alternative, or precarious work arrangements. Such arrangements include employment for a temporary help agency or contract company, independent contracting, on-call work, day labor, and several forms of self-employment (National Research Council, 1999). Nonstandard workers typically receive lower wages (or salaries) and fewer health and retirement benefits than
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Health and Safety Needs of Older Workers TABLE 3-1 Occupations with the Largest Expected Job Growth Between 2000 and 2010 Employment Occupation 2000 2010 1. Combined food preparation and serving workers, including fast food 2,206 2,879 2. Customer service representatives 1,946 2,577 3. Registered nurses 2,194 2,755 4. Retail salespersons 4,109 4,619 5. Computer support specialists 506 996 6. Cashiers, except gaming 3,325 3,799 7. Office clerks, general 2,705 3,135 8. Security guards 1,106 1,497 9. Computer software engineers, applications 380 760 10. Waiters and waitresses 1,983 2,347 aThe quartile rankings of Occupational Employment Statistics annual earnings data are presented in the following categories: 1 = very high ($39,700 and over); 2 = high ($25,760 to $39,660); 3 = low ($18,500 to $25,760); 4 = very low (up to $18,490). The rankings were based on quartiles using one-fourth of total employment to define each quartile. Earnings are for wage and salary workers. SOURCE: Constructed by Labor Research Associates from Bureau of Labor Statistics data. workers with similar skills who work as full-time, regular employees (Houseman, 2001; Mishel, Bernstein, and Boushey, 2003). Older workers are more likely than younger workers to be employed as independent contractors and other kinds of self-employment (Houseman, 2001). On the other hand, workers between ages 45 and 64 are less likely than younger workers to be employed in a precarious forms of nonstandard employment, including employment as agency temporaries, day laborers, contract company workers, and temporary employees. Workers who are 65 and older are more likely to work in nearly all forms of nonstandard employment. While available data suggest that nonstandard employment has been increasing in a number of advanced industrialized countries (Quinlan and Mayhew, 2000), the long-term trends are difficult to assess in the United States because comprehensive surveys such as the Contingent Work Supplements to the Current Population Survey are not available before 1995. During the economic expansion between 1995 and 2001 the proportion of
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Health and Safety Needs of Older Workers Change Quartile Rank by 2000 Median Hourly Earningsa Education and Training Category Number Percent 673 30 4 Short-term on-the-job training 631 32 3 Moderate-term on-the-job training 561 26 1 Associate degree 510 12 4 Short-term on-the-job training 490 97 2 Associate degree 474 14 4 Short-term on-the-job training 430 16 3 Short-term on-the-job training 391 35 4 Short-term on-the-job training 380 100 1 Bachelor’s degree 364 18 4 Short-term on-the-job training U.S. workers in all nonstandard work arrangements (including part-time employment) declined, falling from 25.3 percent to 23.0 percent among men and from 34.3 percent to 31.0 percent among women. However, the proportion rose during the following recession (Mishel, Bernstein, and Boushey, 2003). One possible indication of the longer-term trend in nonstandard work arrangements is the rising fraction of workers who are employed in the personnel supply services industry. The proportion of employees on nonfarm payrolls who work in this industry rose from 0.3 percent in 1973 to 3.2 percent in 2001, although, as noted above, workers between ages 45 and 64 are less likely than younger workers to obtain employment in this industry (Houseman, 2001; Mishel et al., 2003). The increased use of temporary employees and the practice of contracting out pose challenges for the protection of worker health and safety. A study of contractors in the petrochemical industry showed substantial deficits in the health and safety practices applied to contract workers, deficits
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Health and Safety Needs of Older Workers that may have played a part in the promulgation of the OSHA’s Process Safety Standard (Wells, Kochan, and Smith, 1991). Trade Union Density Another feature of the U.S. labor market is the decline in trade union membership among nonagricultural employees from 24.1 percent in 1947 to 13.6 percent in 2000 (Hirsch, Macpherson, and Vroman, 2001). By 2001, only 9 percent of private sector workers were union members (BLS, 2000). This reduced the significance of negotiated work rules, including seniority rules. However, the net effect of the decline in unionization—and the consequently greater control over the workplace environment given to management—on the health and safety of older workers, especially their potential loss of seniority protection, is not clear and should be investigated (Standing, 1999; Weil, 1991). Immigration Because of its high level of immigration, the United States may have a relatively younger age structure compared to other industrialized nations (Gibson and Lennon, 1999). On the other hand, as immigrant workers grow older and settle in the United States, problems of racial and ethnic discrimination may be compounded by age discrimination. The lack of attention to the health and safety needs of minority workers may pose problems for U.S. industry (Azaroff and Levenstein, 2002). To the extent age dimensions of such problems have been studied, the focus has been on young workers. Trends in Income and Income Inequality The consequences of the changing labor market structure on family income are significant. While real median family income grew from 2.8 percent annually between 1947 and 1973, annual growth slowed to 0.2 percent per year between 1973 and 1995. Over the latter period income inequality also increased (Mishel et al., 2003). The United States has greater income inequality than other industrialized countries, and its level of inequality rose sharply over the 1980s business cycle (1979–1989). However, the rise in income inequality was slower over the 1990s business cycle (1989–2000), as the growth of real income for low- and middle-income families outpaced that of upper-income families during the boom years of the late 1990s. Despite this economic boom, hourly wages for men in the bottom half of the income distribution were lower in 2001 than in 1979 (Mishel et al., 2003). In addition, income inequality began to rise again as the U.S. economy moved into an economic downturn after 2000.
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Health and Safety Needs of Older Workers A debate is now ongoing in the health literature with respect to the importance of income and income inequality on health outcomes. As discussed in more detail in Chapter 4, income is associated with health outcomes, and a health gradient has been found in many countries. (Lower income persons have worse health outcomes than higher income persons.) Hence, an increase in income over time should improve health outcomes. But if proportional increases in income occur at higher rates for higher income parts of the income distribution, they are also likely to increase inequality in health outcomes, others things equal. Furthermore, it is argued by some that income inequality itself has an independent negative effect on the health outcomes of lower income people. (See Kaplan et al., 1996, and Deaton, 2003, for divergent views on the relative importance of income, poverty, and income inequality on health outcomes.) It is difficult to disentangle the net effect of increases in income (in many groups) and in income inequality on the health outcomes of Americans in general and older Americans in particular. This is especially the case since serious questions have been raised about the validity of current (nonmortality-based) illness or disorder and injury data in the United States (see Chapter 6). THE CHANGING NATURE OF WORK Trends in Working Life Throughout the developed world, economic growth has been accompanied by some of the same trends in income inequality and in the nature of work that are occurring in the United States. This phenomenon may be affecting the health of workers, particularly those with lower socioeconomic status (SES) (Deaton, 2003; Gabriel and Liimatainen, 2000; Landsbergis, 2003; Singh and Siahpush, 2002; Tuchsen and Endahl, 1999; Subramanian, Blakely, and Kawachi, 2003). A report of the National Research Council (1999) describes features of the changing nature of work such as organizational restructuring, downsizing, declines in unionization, flatter organizational hierarchies, increasing job insecurity and instability, teamwork, and nonstandard work arrangements. The report noted that these changes appear to lead to decreased employee morale, but the report did not examine health and safety effects of the changing nature of work. While initially developed in manufacturing, new forms of work organization are increasingly seen in other sectors of the economy (Landsbergis, 2003; Landsbergis, Cahill, and Schnall, 1999; “The Tokyo Declaration,” 1998). These trends have been described by NIOSH (National Institute for Occupational Safety and Health, 2002) and are summarized in “The Tokyo Declaration,” a 1998 consensus document produced by occupational health experts from
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Health and Safety Needs of Older Workers the European Union, Japan, and the United States. Research is needed to determine to what extent and how these changes in work organization affect the health and safety of older workers. For further information, see the website: http://www.workhealth.org/news/tokyo.html. Trends in Work Hours Average weekly and annual hours worked fell for many decades in the United States through the early 1970s, but they have largely stabilized since then. However, the proportion of women who work for pay and who are employed in year-round jobs has continued to rise (Rones, Ilg, and Gardner, 1997). Between 1976 and 1993, total annual hours for men increased by 5.5 percent and for women by 18.0 percent. After age adjustment, these increases were 3.4 percent and 14.9 percent, respectively (Rones et al., 1997). Between 1979 and 2000, for married couple families with children, with heads of household aged 25–54, total annual hours increased by 11.6 percent (Mishel et al., 2003). It is certainly true that employed Americans are engaged in paid work for more hours each year than is the case in most other industrialized countries. Only workers in Japan are typically employed for approximately as many hours as Americans, and the average work week and work year in Japan have recently been falling. International Labour Office (ILO) statistics suggest that Americans now have a longer work year than workers in other rich countries (ILO, 2001). For example, employed Americans work about 200–400 more hours (or 5–10 more weeks) per year than workers in France, Germany, Sweden, or Denmark (OECD, 2002). The growing gap between typical hours in the United States and in other rich countries is mainly the result of declining average hours in the rest of the world. While greatly excessive working hours have been associated with adverse health outcomes, it is not known how many hours are too many. A better understanding of the age-specific effects of working hours over short (weekly) and long (annual) intervals will require better information on trends in different patterns of working hours by age, gender, race, and socioeconomic status. The trends in employment rates and in weekly hours at work among older Americans are displayed in Table 3-2. The top panel in the table shows hours and employment trends among adults of both sexes. Columns 1 and 4 show average weekly hours among employed persons who reported working at least one hour per week in March 1979 and March 2001, respectively. Columns 2 and 5 show the percentages of all adults in each age category who worked at least one hour per week; columns 3 and 6 show the actual percentages holding a job. (Because of vacations or sickness, some
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Health and Safety Needs of Older Workers employed people did not work during the survey week.) Columns 7 and 8 show the change in weekly hours and the change in the fraction of people who were employed between 1979 and 2001. The top panel in the table shows little consistent trend in the average weekly number of hours worked by older Americans, except among workers past the age of 65, where there is a consistent pattern of increase in weekly hours. However, the proportion of older Americans in employment has increased noticeably, particularly for adults between ages 45 and 59. As shown in the bottom two panels of Table 3-2, the rise in employment was driven by a substantial increase in the fraction of older women who work, which more than offset a smaller decline in employment among 45- to 64-year-old men. Moreover, the average work week of employed women also rose, fueled by a decline in the proportion of working women who are employed on part-time schedules. The most significant trend revealed in Table 3-2 is the marked convergence of men’s and women’s life-cycle pattern of labor supply. American women are now far more likely to hold jobs through the traditional job-leaving age than they were in 1979. In contrast, male employment rates have modestly declined. While average weekly hours have been stable, between 1976 and 1993, an increasing proportion of men (from 14.7 percent to 20.6 percent), age 55 or older, were working long work weeks (49 hours or more). For older working women, the proportion increased from 4.9 percent to 7.9 percent (Rones et al., 1997). Whether this trend is continuing needs to be determined. Trends in Job Characteristics Workers in developed countries have experienced substantial changes in psychosocial job characteristics over the past generation. In Europe, surveys indicate increases in time constraints (i.e., time pressures or workload demands) between 1977 and 2000 (European Foundation, 2000). Similarly, in the United States, increases between 1977 and 1997 were reported for “working very fast” (from 55 percent to 68 percent) and “never enough time to get everything done on my job” (from 40 percent to 60 percent) (Bond, Galinsky, and Swanberg, 1997). U.S. findings are based on the 1977 Quality of Employment Surveys (Quinn and Staines, 1979) and the 1997 National Surveys of the Changing Workforce (Bond, Galinsky, and Swanburg, 1998). Somewhat increased job decision latitude or job control was also reported in these surveys. In Europe, the proportion of workers reporting a measure of autonomy over their pace of work increased from 64 percent in 1991 to 72 percent in 1996 (Walters, 1998). In the United States, “freedom to decide what I do on my job” increased from 56 percent in 1977 to 74 percent in 1997 and “my job lets me use my skills and
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Health and Safety Needs of Older Workers TABLE 3-2 Employment and Average Hours of Work Among Older Americans, March 1979 and March 2001 March 1979 Age Group Average Hours Last Week at All Jobs for Those With at Least One Hour of Work Percentage of Population With Positive Hours Percentage of Population Employed Both sexes 45–49 41.1 71 74 50–54 40.7 67 70 55–59 40.6 59 62 60–64 38.5 44 46 65–69 30.7 19 21 70–74 25.8 11 12 75+ 24.3 5 5 Male 45–49 44.7 86 90 50–54 44.4 83 87 55–59 43.6 75 78 60–64 41.5 57 61 65–69 32.7 26 28 70–74 27.3 17 19 75+ 24.9 8 9 Female 45–49 36.1 56 58 50–54 35.4 52 54 55–59 36.1 46 48 60–64 33.7 32 34 65–69 27.7 14 15 70–74 23.2 7 8 75+ 23.2 3 3 SOURCE: Tabulation of March 1979 and March 2001 Current Population Survey files.
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Health and Safety Needs of Older Workers March 2001 Change 1979–2001 Average Hours Last Week at All Jobs for Those With at Least One Hour of Work Percentage of Population With Positive Hours Percentage of Population Employed Change in Average Hours per Week Among Employed Population Change in Fraction of Population Employed 41.4 79 82 0.3 8 41.5 75 78 0.8 8 40.4 65 67 –0.2 5 37.4 46 48 –1.1 2 31.6 23 24 0.9 4 27.1 14 15 1.3 2 29.0 5 5 4.7 0 44.2 84 87 –0.5 –4 44.4 82 85 0.0 –2 43.2 72 74 –0.4 –4 40.5 52 56 –1.0 –6 34.1 28 30 1.4 2 29.1 17 18 1.8 0 30.2 8 9 5.3 0 38.4 74 77 2.3 19 38.3 70 73 3.0 19 37.3 58 61 1.2 13 33.8 40 42 0.1 8 28.0 18 19 0.3 4 24.7 11 12 1.5 4 26.6 3 3 3.4 0
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Health and Safety Needs of Older Workers abilities” increased from 77 percent in 1977 to 92 percent in 1997 (Bond et al., 1997).1 A combination of high job demands and low job control has been called job strain or high-strain work—an important risk factor for hypertension and cardiovascular disease (Schnall et al., 2000), a common cause of disability among older workers (Ilmarinen, 1997). In theory, since job control appears to buffer or moderate the effects of job demands on risk of stress-related illness or disorder, increases in job control reported in the European and U.S. surveys might compensate for the increases in job demands. On the other hand, there may be a limit to the buffering effects of job control. Job strain was not analyzed in the U.S. surveys. In Europe, increases in autonomy were not sufficient to compensate for increased work intensity. The proportion of high-strain jobs in Europe increased from about 25 percent in 1991 to about 30 percent in 1996 (European Foundation, 1997). European Foundation surveys in 2000 show continuing increases in work intensity and job demands (working at very high speed and to tight deadlines); however, increases in job control or autonomy before 1995 have leveled off or are declining slightly (Paoli and Merllié, 2001). This suggests that the prevalence of job strain has continued to increase in Europe, a trend with the potential effect of increasing risk of hypertension and heart disease. These trends may also vary by social class, although very little data are available to test this hypothesis. Analyses of national Swedish surveys that combine questions on hectic and monotonous work, as a proxy measure for high-demand, low-control work or job strain, show only a slight increase, from about 9 percent to 11 percent, between 1992 and 2000 for all workers. During 1992, the Swedish economy experienced a major recession. Between 1992 and 2000, among low-income and blue-collar workers, prevalence of hectic or monotonous work increased to a much greater degree, from about 12 to 20 percent (Vogel, 2002). Unfortunately, there are few data available on trends in job characteristics by age group in Europe or the United States. 1 A number of limitations of the 1997 Work and Families Institute Survey suggest that it may underestimate the increase in job strain since 1977. First, the survey excluded anyone who did not have a phone, and the response rate was much lower than the 1977 survey. Only three demands and six decision latitude items were available, not the full Job Content Questionnaire (Karasek et al., 1998). More importantly, the 1977–1997 comparison data file excluded self-employed, contract, or contingent workers—it included only wage and salary workers. The self-employed contingent group was larger in 1997 than 1977. That group was also more likely to have job strain, leading to underestimates of increases in job strain. In addition, today, there are many more undocumented immigrant workers in the United States doing hazardous, high-strain work, a group not likely to have participated in the surveys.
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Health and Safety Needs of Older Workers The negative effect of increases in job strain have not been reflected in measures of injuries and illnesses or disorders in the workplace calculated each year by the BLS (see Chapter 6) or by measures of impairment or function in more general datasets that are used to track heath outcomes of older Americans (Manton, Corder, and Stallard, 1993, 1997; Crimmins, Reynolds, and Saito, 1999). Also, they have not been sufficient to offset the factors that are improving age-constant mortality rates, such as improvements in medical care, increasing income for many groups, and exportation of hazardous industries. However, BLS data greatly underestimates the extent of work-related illnesses or disorders (National Research Council, 1987; Landrigan and Baker, 1991; Biddle et al., 1998; Rosenman et al., 2000). In addition, as noted in Chapter 6, the extent of underreporting injuries and illnesses or disorders may be increasing (Conway and Svenson, 1998; Azaroff and Levenstein, 2002). Analysis of data on impairment of function is only currently available through 1994. Therefore, it is unclear to what degree the negative trends in job characteristics and work organization discussed are offset by improvements in other risk factors, both within and outside the workplace, which may even be leading to reductions in overall rates of injuries and illnesses or disorders. Since stress-related chronic diseases such as cardiovascular disease and hypertension take years to develop, it will be necessary to improve existing data systems in order to provide valid data on trends in work-related injuries and illnesses or disorders. Development of New Systems of Work Organization Paralleling these trends in work hours and job characteristics, new systems of work organization have been introduced by employers throughout the industrialized world to improve productivity, product quality, and profitability. Such efforts have taken a variety of forms and names, including lean production, total quality management (TQM), team concept, cellular or modular manufacturing, reengineering, high-performance work organizations, and patient-focused care (Landsbergis, 2003; Landsbergis et al., 1999). These new systems have been presented as reforms of Taylorism and the traditional assembly-line approach to job design (Womack, Jones, and Roos, 1990). About half of U.S. manufacturing facilities use some innovative work practice, such as job rotation, work teams, quality circles (QCs), or TQM (Osterman, 1994). Manufacturing While these new systems increase worker productivity and contribute to economic growth, they are likely to contain features that increase job
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Health and Safety Needs of Older Workers stress and that may affect worker health. Lean production combines diverse elements of Japanese production management (Babson, 1995); it is an attempt to reduce impediments to the smooth flow of production through continuous improvement in productivity and quality, just-in-time (JIT) inventory systems, and elimination of wasted time and motion (Appelbaum and Batt, 1994). Small teams of hourly workers, or quality circles (QCs), meet to solve quality and productivity problems. A 1990 report (Womack et al.) argued that in the best Japanese auto companies, by rotating jobs and sharing responsibilities, multiskilled workers can solve quality problems at their source and boost productivity; that this results in freedom to control one’s work, which replaces the “mind-numbing stress” of mass production; that armed with the skills they need to control their environment, workers in a lean plant have the opportunity to think proactively to solve workplace problems; and that this creative tension makes work humanly fulfilling. If such claims of increased worker skills and decision-making authority are true, then such programs could reduce job strain and stress-related illness or disorder. Lean production provides for more job enlargement, cross training, and problem-solving opportunities than traditional manufacturing job design (Appelbaum and Batt, 1994). However, QCs are not online autonomous work teams, nor are they empowered to make managerial decisions, in contrast to self-directed or semi-autonomous work teams typical of Scandinavian sociotechnical systems design (Appelbaum and Batt, 1994). Lean production also leaves traditional organizational hierarchy and the assembly line essentially unchanged (Appelbaum and Batt, 1994; Babson, 1993, 1995). Cycle time for job tasks typically remains very short (often one minute or less in auto assembly). Mandatory procedures require that workers follow highly standardized steps at narrowly defined tasks (Berggren, Bjorkman, and Hollander, 1991; Bjorkman, 1996). Reliance is placed on industrial engineering, time studies, and predetermined standards to ensure maximum workloads (Adler, Goldoftas, and Levine, 1997). JIT inventory systems remove the stock between operations that acts as buffers in the system and also removes any free time the worker may have previously enjoyed while the machine ran through its cycle (Delbridge, Turnbull, and Wilkinson, 1993:66), leading to more strictures on a worker’s time and action (Klein, 1991). Thereby, workers’ personal time and flexibility become the buffers (Delbridge and Wilkinson, 1995; Johnson, 1997; Lewchuk and Robertson, 1996). In Canadian and U.S. studies of lean production in auto manufacturing, job demands were often reported to be elevated (Lewchuk and Robertson, 1996). For example, at a Michigan assembly plant, in 1991, 73 percent of workers surveyed reported “I will likely be injured or worn out before I retire” (Babson, 1993). British auto parts employees reported slightly less
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Health and Safety Needs of Older Workers workload if they participated in the implementation of a lean system, but a significant increase in workload if they did not participate (Parker, Myers, and Wall, 1995). Lean production practices may lead to reduced availability of lighter duty jobs for older workers (Lewchuk and Robertson, 1996). Low or decreasing decision authority was also reported in many cases, including a decline in participation in decisionmaking and influence over the job over time as new systems were implemented (Babson, 1993; Parker and Sprigg, 1998; Robertson et al., 1993). The promise of producing highly trained, multiskilled workers was also challenged by Canadian and U.S. (Babson, 1993; Robertson et al., 1993) and British (Parker and Sprigg, 1998) survey data. Some alternative new work systems, jointly bargained for by management and labor, have been labeled high-performance work organizations. However, little research has been conducted on the health and safety effects of such systems. One example is a Michigan auto plant where 71 percent of workers report having benefited from the team concept and, on average, report a slight decrease in perceived stress since the program began (Kaminski, 1996). Workers provided input to the design of the new system before it was put in place, team leaders were elected, teams could schedule personal and vacation time, the union monitored overtime and seniority rights, and the new system was written into contract language and ratified overwhelmingly (Kaminski, 1996). In the U.S. garment industry, the traditional (and still widely used) production process is the bundle system (Bailey, 1993; Berg et al., 1996). Inventories are stored in bundles of about 30 cut garment parts each. Operators perform one task, such as sewing a hem, on each piece in the bundle, which often takes only a few seconds (Bailey, 1993; Batt and Appelbaum, 1995). The fragmented, repetitive work combined with piece-rate payment leads to high rates of work-related musculoskeletal disorders (WRMDs) (Brisson et al., 1989; Punnett et al., 1985; Schibye et al., 1995). In a new work system known as modular manufacturing, teams of multiskilled operators assemble an entire garment with reduced supervision and are involved in quality control, machine maintenance, and sometimes in setting and meeting group goals (Bailey, 1993). Piece-rate wages are replaced by an hourly wage with a group bonus (Berg et al., 1996). Modular workers reported greater skill use, but also increased perceived stress and no difference in job satisfaction compared to bundle workers (Berg et al., 1996). Worker teams or job redesign (to create more task identity and significance) were significantly associated with satisfaction; however, increased workload or stress or both were associated with reduced satisfaction. There was no net gain in satisfaction for modular workers (Batt and Appelbaum, 1995). Notably, 38 percent of textile sewing machine operators are 45 years of age or older, greater than the average of 34 percent for all jobs (Dohm, 2000).
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Health and Safety Needs of Older Workers Similar new work systems have also been implemented outside of manufacturing in industries such as telecommunications and health care. Telecommunications Little effect of self-managed teams on unionized customer service work has been found. However, unionized installation and repair workers reported significantly more job satisfaction, autonomy, coworker support, days of training, and advancement opportunities relative to workers in traditionally managed, highly skilled craft jobs. Their job satisfaction was significantly associated with online participation (e.g., greater autonomy) but not with offline participation (e.g., quality of work life, TQM, problem-solving teams) (Batt and Appelbaum, 1995). Forty-nine percent of telephone installers and repairers are 45 years of age or older, greater than the average of 34 percent for all jobs (Dohm, 2000). Health Care Industry In the U.S. health care industry, two forms of work restructuring introduced in the 1990s have been studied. First, patient-focused care, based on TQM, uses cross-trained multiskilled teams, with fewer individual job categories, decentralized ancillary services, and computers to reduce case recording time. Registered nurses (RNs) manage teams, but fewer RNs are needed because lower paid, unlicensed generic health care workers undertake some direct care (Richardson, 1994; Sochalski, Aiken, and Fagin, 1997). Second, operations improvement seeks rapid cost savings by reducing the number of RNs and replacing them with nurses’ aides (Greiner, 1995). These two new approaches are replacing a system developed in 1970s, known as primary nursing (Brannon, 1996), professional nurse practice models, or magnet hospitals. These older models featured RN autonomy and control over clinical practice and decentralized decisionmaking (Aiken, Sloane, and Klocinski, 1997; Kramer and Schmalenberg, 1988; McClure et al., 1983). Cost containment efforts have led to longer hours of work and increased stress among nurses and have contributed to a nursing shortage (Joint Commission on Accreditation of Healthcare Organizations, 2002). Thirty-nine percent of registered nurses are 45 years of age or older, greater than the average of 34 percent for all jobs (Dohm, 2000). As discussed above, it is unclear to what degree the increased health and safety risks associated with some new systems of work organization (further detailed in Chapter 6) will affect more general trends in health and safety in the workplace or in the overall (nonmortality-based) health of Americans. Current data are insufficient for us to know if the specific negative outcomes are of sufficient importance in the general economy to
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Health and Safety Needs of Older Workers significantly affect overall (nonmortality) injury and illness or disorder trends. Monitoring Job Conditions Several decades ago the U.S. Department of Labor sponsored the Quality of Employment Survey (QES), which used a nationally representative sample of the workforce to characterize and track features of work. NIOSH added a module to these surveys in 1977 to assess job stress (Murphy, 2002). The surveys offered a unique resource for policy and for research. For example, Karasek et al. (1998) used the survey instrument and findings to develop the Job Content Questionnaire, an instrument that has gained international acceptance as a primary tool used to measure job demands, job decision-making authority, job skill use, and supervisor and coworker social support (Karasek et al., 1998). The availability of a tool to characterize these risk factors has led to a large body of research studying the association between work and cardiovascular disease as well as other disease endpoints, as discussed above and in Chapter 5. Although there have been a number of dramatic changes in the workplace since 1977, the Department of Labor has not sponsored nationally representative surveys since that time. Consequently changes in organizational practices and production technologies as well as changes in the structure and composition of jobs held by a more gender-balanced and multicultural workforce are not reflected in data available to understand the modern workforce. In contrast, the European Foundation began carrying out a related survey of working conditions in 12 European nations beginning in 1990 using a prototype survey with only 20 questions. After the pilot survey, the survey was expanded to over 80 questions; it has been repeated every five years, with 15,800 workers surveyed in January 1996 and 21,700 in 2000 (Paoli, 1997; Paoli and Merllié, 2001). This is a questionnaire-based survey, involving face-to-face interviews conducted outside the workplace. The survey permits evaluation of time trends and working conditions that are standardized for a wide variety of workplaces and different cultures. As a result, a number of reports on trends for working condition factors have been published. Groups of factors affecting working conditions include physical environment of the workplace; organization of work; social and psychosocial environment; management of human resources; and labor law, collective agreements, and systems of industrial relations. As an example of the survey findings, the European Foundation is able to report (http://www.Eurofound.ie/working/working_knowledge.htm): that problems related to health, the pace of work and working time continue to rise in European workplaces. One main conclusion of the survey is that the phenomenon of work intensification has become an established
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Health and Safety Needs of Older Workers reality for European Union workers over the last decade. Employees may be working somewhat shorter hours but their pace of work has increased, in certain cases markedly. One in three workers complain of backache related to their job. Nearly half complain of working in a painful/tiring position while over half are working at very high speed to tight deadlines for one quarter of their working day. In 2000 NIOSH sponsored a limited effort to fill the long gap in knowledge about the distribution of working conditions in the workforce (Murphy, 2002). Its approach was to add a module on quality of work life to the 2002 General Social Survey, a biannual, personal interview survey of U.S. households conducted by the National Opinion Research Center (NORC). A quality-of-work-life module was developed by NIOSH with advice from a multidisciplinary panel, but space constraints limited the size of the module to one-quarter the size of the 1977 QES. Results are still being tabulated.
Representative terms from entire chapter: