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Rapid Workplace Expansion Linked to Long-Term Sickness Absense

(pp 1173, 1193). Lancet 2004; 363: 1173, 1193-97

A Swedish study in this week's issue of THE LANCET examining the health effects of exposure to personnel change has shown that rapid workplace expansion is strongly associated with an increased risk of long-term sickness absence and hospital admissions-especially among women working in the public sector.

Previous studies have focused on the negative health effects of downsizing, but there have been no extensive studies on the long-term effects of rapid workplace expansion. Hugo Westerlund from Sweden's National Institute for Psychosocial Medicine and colleagues assessed personnel change from 1991-96 in relation to long-term (90+ days) absence in around 24000 Swedish employees.

The sample consisted mostly of healthy workers with a good employment record who were under 65 years of age in 1999. Whilst repeated exposure to large workplace expansion (increase in the number of employees by 18% or more yearly) was related to an increased risk of long-term sickness absence and hospital admission, exposure to moderate expansion (8-18% increase) resulted in a decreased risk of hospital admission.

Centralisation of workplace functions is suggested by the investigators as a possible background to large and rapid workplace expansion, especially in the public sector. Hugo Westerlund comments: "That the effects of rapid expansion on health are negative is somewhat surprising, since expansion is usually thought to imply high job security and a positive, successful context, which should promote good health. A positive effect of exposure to moderate expansion can indeed be seen in relation to hospital admissions. However, large and rapid expansion could lead to problems such as difficulty in recruiting enough qualified personnel and a generally unstable and less than ideal organisational structure, as indicated in an earlier study. High workload, plus insufficient practical and social support could be pathways between these organisational factors and health."

The strongest association between large expansion and sickness absence was in women in the public sector. Such women who were exposed to large expansion every year for the 6-year period of the study had a 2-3 times increased risk of long-term sickness absence than those who were never exposed to large expansion.

Dr Westerlund adds: "Women have for 20 years had higher and gradually increasing absenteeism by comparison to men in Sweden. The study suggests this could be linked to a female domination in less qualified, often part time, health-care work in the public sector. Ergonomic and other hazards have been successfully dealt with in raditionally male jobs in the private sector, whereas demands and hazards have increased for health care personnel, teachers, and other jobs employing many women in the public sector."

Moderate downsizing caused an increased risk of sickness absence, which confirms earlier findings that downsizing is associated with health risks.

This week's Lancet Editorial (p 1173) comments on the unexpected finding from Westerlund and colleagues' research, commenting: 'Perhaps the terminology that characterises 21st-century work can provide some clues. According to Richard Sennett, author of a tellingly titled book, The corrosion of character: the personal consequences of work in the new capitalism (New York: Norton, 1998), today's employees are expected to be flexible, open to change, take risks, do more with less, tolerate ambiguity, view instability as normal, and accept that a long-term relationship with an employer can no longer be expected, nor that they will benefit from long-term social networks established through shared experience in the same workplace. A young American worker with 2 years of college education, for example, can expect to change jobs at least 11 times during his or her working life, a period of time that is also being compressed because of prejudice against older workers. And job security? A concept that belongs to a former era.'

The editorial concludes: 'What's the solution? Value people over profits? Recognise human capital as paramount? These answers are obvious. But given the high-handed, soulless treatment doled out today by many employers, it's a start. If appeals to integrity and character fail, there's always the bottom line: depressed and anxious personnel are unlikely to be productive, and absence from work costs employers and society money. The re-engineering of work ought to perpetuate fulfilment and productivity in employees, not illness and disability.

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