THE TOKYO DECLARATION on Work-Related Stress and Health In Three
Postindustrial Settings - The European
Union, Japan and the United States[1] as adopted at a
"triangular" Conference at the Tokyo
Medical University 1st
November 1998. This Declaration will be made available to government and public sector agencies and partners in industry, labour, health and academia. |
The "triangular"
Conference on "Work-Related Stress and Health in Three Postindustrial
Settings - the European Union, Japan and the United States" – was held in
Tokyo on 31 October - 1 November 1998, sponsored by Tokyo Medical University
and co-sponsored by the World Health Organization, International Labor Office,
the European Commission, Japan Ministry of Labor, Japan Ministry of Health and
Welfare, Tokyo Metropolitan Government, the United States National Institute of
Occupational Safety and Health, Karolinska Institute, Japan National Institute
of Industrial Health, Japan Industrial Safety and Health Association, Tokyo
Citizens’ Council for Health Promotion, The Japanese Association of Stress
Science, Japan Society for Occupational Mental Health, and the Section of
Occupational Psychiatry of the World Psychiatric Association. Its 28 international
scientists (Annex 1) from all three settings and relevant disciplines described
and discussed:
o present conditions of work, stress and occupational
health,
o foreseeable trends,
o needs for action, and
o needs
for research, education, and information.
Discussions focused on the similarities and
differences in all these respects between the three postindustrial settings. Agreement was reached concerning a number
of conclusions and recommendations, including options for continued information
exchange and concerted actions.
The conference participants
are fully aware of the enormous environmental and health burden carried by
workers in countries at earlier phases of industrial development. We envisage
that their corresponding problems and solutions need to be given consideration.
This declaration is based on
the philosophy of “Investment for Health.”
According to a common dictionary the verb “invest” is defined as “a
commitment (of money or capital, technology, human resources, etc.) in order to
gain a return, to spend or devote for future advantage or benefit.” Consequently, an investment for health
refers to a commitment of resources in order to gain a health and social
return. Seen in such a way, the
investment does not constitute a burden, rather an opportunity for increasing
returns.
All around the world, countries
are undergoing rapid, fundamental changes in almost every aspect of life. In
some of these countries, this has created great social stress, whereas others
seem to have managed to maintain the relative stability needed for long-term,
beneficial transformation processes to flourish.
One of the key areas for
such transformation, with secondary effects on virtually all other areas of
human existence, is working life.
Major determinants of these
transformations are the globalization, computerization and robotization of the
production and provision of goods and services. In the three major economies of
the world - the European Union, Japan and the United States - these processes
exhibit many similarities. Technological developments are almost identical, but
the cultural settings and social coping strategies
are not.
These processes and their
effects, both positive and negative, on the health and wellbeing of the
populations of these three regions have been the subject of this
"triangular" Conference.
It was believed that it is
vital to identify ways to overcome current difficulties and prevent forseeable
future difficulties, whilst at the same time maximizing the tremendous
potential inherent in this period of dramatic transformation. It was also
agreed that there is a great need to exchange experiences, and compare
problems, approaches and outcomes from these three postindustrial settings.
The growth of neuroscience
and stress science has allowed elucidation of the links between social
structures and processes (at work and outside it), the way in which these are
perceived and appraised and the resulting interaction between the central
nervous system and other organ systems to promote or counteract workers’ health,
based on a bio-psycho-social approach to all relevant aspects of the
man-environment ecosystem and its dynamics. These dynamics include
organizational restructuring, mergers, acquisitions and downsizing, the frantic
pace of work and life, the erosion of leisure time and/or the blending of work
and home time. Most of these developments are driven by economic and
technological changes aiming at short-term productivity and profit gain.
Organizations are becoming
flatter, if not smaller. There is a growing trend toward increased self-direction
in work. Production practices are increasingly "leaner". New
employment practices such as use of contingent workers are increasingly
adopted. Concurrently, job stability and tenure is decreasing. There is also a
trend toward increasing information (cognitively demanding) and service work. Another common trend is the aging of the
working population.
We have a rather limited
understanding of the effects of these trends on job characteristics and on
workers’ health and wellbeing.
According to a recent study
(Paoli, 1996), the European workforce is presently undergoing rapid
transformation from industry to the service sector, with much more computer
work and work in direct contact with customers, clients or patients. New
management models are introduced with more teamwork, just-in-time, and TQM
(Total Quality Management). The
workforce is getting older with an increasing proportion of women workers, and
with employees more likely to work on fixed term or temporary contracts. These developments
are set against a background of a chronically high unemployment rate
(presently over 10 % in the European Union). This rapid change, combined with
both over- and under-employment, is likely to be highly stress provoking.
Occupational stress-related mental and psychosomatic complaints are very
common in all 15 EU Member States.
With the exception that employment so far remains high in the U.S.,
these conditions aptly describe the situation in the U.S. as well.
Japanese workers also
experience similar situations. In
addition, aspects of the Japanese employment system, such as life-long
employment and seniority wages, have been changing rapidly due to the recent
economic recession.
Thus, our discussions during
the "triangular" Conference have identified the similarities as well
as the differences in the conditions and trends present in Europe, Japan and
the USA.
Under the European Community Framework Directive
(89/391/EEC), as well as the U.S. Occupational Safety and Health Act of 1970,
employers have a “duty to ensure the safety and health of workers in every
aspect related to the work.” Furthermore, the European Community Framework
Directive specifies the following general principles of prevention: avoiding
risks, adjusting the risks which cannot be avoided; combating the risks at
source, and adapting the work to the individual, especially as regards the
design of workplaces, the choice of work equipment and the choice of working
and production methods, with a view, in particular, to alleviating monotonous
work and work at a predetermined work rate and to reducing their effects on
health.
The Japanese government enacted the Industrial Safety and Health Law in 1972 to assure the safety and health of workers in the workplace. A 1992 amendment included a commitment to facilitate the promotion of the “comfortable” working environment. In addition, the Japan Ministry of Labor established the 9th Industrial Accident Prevention Plan in 1998, which includes strategies for managing increasing mental stress.
It can be hypothesized,
but yet remains to be demonstrated, that these interrelated goals can be
achieved through:
-
coordinating action across sectors and disciplines,
-
allocating resources to ensure priority goals are
addressed,
-
developing professional as well as life skills in
the population,
-
improving social networks;
-
implementing the essential elements of the EU Fourth
Framework Programme for Research by “giving priority to projects which are
likely to have a direct impact in terms of competitiveness and quality of
life.”
It can further be
hypothesized that the management and prevention of work stress, in addition to
improving the health and wellbeing of the labour force, will contribute to the
productivity and economic wellbeing of organizations and the economic system,
the participation of workers in the democratic process and the enhancement of
social capital at work and outside it.
The participants of the
triangular conference concur with the recommendations of the Luxembourg Declaration
on Workplace Health Promotion in the European Union (Annex 2). Participants further agreed that special
attention must be paid to the prevention of risks and inequities among the
growing numbers of women in the workforce.
Further, consideration must
also be given to addressing the specific issues relating to the promotion of
health and wellbeing of ethnic minority groups within the labour market.
Finally, attention needs to
be given to disadvantaged groups such as the mentally, physically and socially
handicapped in each country to enable them to work, remain healthy and contribute
to society.
They have formulated the
following specific proposals for healthier work in healthier workplaces and
consider that there is a need for increased cooperation between all relevant
"actors" in all three settings with regard to
·
Implementation of the very
considerable body of current information on prevention measures to reduce
stress related illness and injury in the workplace and promote the health and
wellbeing of workers, and research to
address gaps in such knowledge. Such research needs to specifically address the
contribution of psychosocial factors directly related to working conditions in
the etiology of work related injury and illness. It is important to bridge the gap between current knowledge and
implementation of that knowledge at all levels - international, national,
regional, local and individual. The role of agencies such as NGO’s, labour
organizations and health services will be critical in facilitating the closing
of these gaps.
·
Surveillance at individual
workplaces and monitoring at national
and regional levels, in order to identify the extent of work related stress
health problems and to provide baselines against which to evaluate efforts at
amelioration. They recommend that workplaces assess both workplace stressors
and health outcomes known to result from such exposures (e.g. repetitive work
and WRMD’s) on an annual basis. Materials (references) on how to accomplish
these tasks should be developed and provided on the WWW.
·
Education and
training of occupational and other key professional groups to facilitate their
participation in researching and developing programs to reduce the impact of
work related stress and to evaluate the outcome of such approaches.
·
Methodological
developments for the production of valid and reliable methodology kits for
intersectoral and interdisciplinary monitoring, clarification and action by all
concerned.
· Creation of a Clearing House for all
relevant information using state of the art technology, video, curricula, leaflets,
hotline, etc. This would include utilization of the WWW to collect, review,
integrate and disseminate information concerning such activities.
·
Addressing
the stress-related consequences of unemployment on the
individuals concerned and
their families and the communities in which they live. This will mean
minimizing unemployment and underemployment, minimizing overemployment,
promoting “the healthy job” concept, and humanizing organizational restructuring.
Because these issues do not
respect national borders and in order to proceed meaningfully with respect to
the above mentioned objectives, it will be necessary to develop more formal
interactions and partnerships between international and national authorities,
bodies and organizations with an interest in reducing the economic and health
burden of stress related ill-health in the workplace.
This
declaration is commended to policy-makers and decision-makers throughout the
three settings as a framework for healthier work in healthier workplaces and
expects urgent action in response to the proposals made above. |
Annex 1
(EU)
Sven Ingmar Andersson, Ph.D.
Professor, Department of Psychology
Lund University
SWEDEN
Giorgio Aresini, M.D., Ph.D.
Public Health and Safety at Work
European
Commission
LUXEMBORG
John Griffiths, B.Ed. (Hons), M.Sc.
Integrated Health Development Unit
Department of Health Promotion
and Disease Prevention
WHO Regional Office for Europe
Birgitta Hovelius, M.D., Ph.D.
Professor, Department of Community
Medicine
SWEDEN
Raija Kalimo, Ph.D.
Program
Director
Professor
Finnish Institute of Occupational Health
FINLAND
Marcel
Kornitzer, M.D., Ph.D.
Professor
School of Public Health
and Faculty of Medicine
Brussels Free University
BELGIUM
Lennart
Levi, M.D., Ph.D.
Professor
Emeritus
Department of
Public Health Sciences
Division of
Psychosocial Factors and
Health
Karolinska Institute
SWEDEN
Töres
Theorell, M.D., Ph.D.
Professor and Director
National Institute for Psychosocial
Factors and Health
Head of Division, Professor
Division of Psychosocial Factors and Health
Department of Public Health Sciences
Karolinska Institue
SWEDEN
(Japan)
Yuko Fujigaki,Ph.D.
Vice
Director in Research, Second
Research-Oriented
Group
Technology
Policy
Science and
Technology Agency
JAPAN
Takashi Haratani,
Ph.D.
Senior Researcher
National
Institute of Industrial Health
JAPAN
Hisanori Hiro,
M.D.
General
Manager
Center for
Occupational Health, Tsurumi
NKK Corporation,
Tsurumi Works
JAPAN
Masaaki
Kato, M.D., Ph.D.
Professor Emeritus
Department of Psychiatry
Tokyo Medical University Hospital
JAPAN
Toshihito
Katsumura, M.D., Ph.D.
Professor
Department of
Preventive Medicine and
Public
Health
Tokyo Medical University
JAPAN
Norito Kawakami, M.D.,
Ph.D.
Associate
Professor
Department of
Public Health
School of
Medicine
Gifu University
JAPAN
Reiko Kishi, M.D., Ph.D., M.P.H.
Professor
Department of Public Health
Hokkaido University School of Medicine
JAPAN
Fumio Kobayashi, M.D., Ph.D.
Professor
Department of
Health and Psychosocial
Medicine
Aichi Medical
University
JAPAN
Kazutaka
Kogi, M.D., Ph.D.
Director
The Institute for Science of Labour
JAPAN
Shouji Nagata, M.D., Ph.D.
Professor
Department of
Mental Health
Institute of
Industrial Ecological Sciences
University of Occupational and
Environmental Health
JAPAN
Ken
Nakamura, Ph.D.
Professor
School of Allied Health Sciences
Kitasato University
JAPAN
Satoru Shima,
M.D., Ph.D.
Professor
Department of Management
Tokyo Keizai University
JAPAN
Teruichi Shimomitsu, M.D., Ph.D.
Professor
Department of
Preventive Medicine and
Public
Health
Tokyo Medical University
JAPAN
Takeshi
Tanigawa, M.D., Ph.D.
Assistant Professor
Institute of Community Medicine,
University of Tsukuba
JAPAN
Naotaka Watanabe, Ph.D.
Professor
Department of
Organizational Behavior
Administration,
Keio University
JAPAN
Kazuhito
Yokoyama, M.D., Ph.D.
Associate Professor
Department of Public Health and
Occupational Medicine, Postgraduate
School of Medicine ,University of Tokyo
JAPAN
(USA)
Gwendolyn Keita, Ph.D.
Associate
Executive Director
Public Interest
Directorate
American Psychological Association
U.S.A.
Steven L.
Sauter, Ph.D.
Chief,
Applied Psychology and
Ergonomics
Branch
National Institute for Occupational Safety
and Health (NIOSH)
U.S.A.
Peter Schnall, M.D., M.P.H.
Director
Center for Social Epidemiology
U.S.A.
Lois E.
Tetrick, Ph.D.
Professor, Department of Psychology
U.S.A.
Observer
Kyung Yong
Rhee
Industrial Health Research Institute
KOREA
Luxembourg Declaration on Workplace Health Promotion
(WHP) in the European Union, adopted by the European Network for Workplace
Health Promotion on 28 November 1997 to improve employees’ health.
o WHP includes
individual-directed and environment-directed measures from various fields. It
combines the strategy of risk reduction with the strategy of the development of
health protection and promotion factors and health potentials (comprehensiveness).
o management
principles and methods which recognize that employees are a necessary success
factor for the organization instead of a mere cost factor;
o a culture and corresponding
leadership principles which include participation of the employees and
encourage motivation and responsibility of all employees;
o work organization
principles which provide the employees with an appropriate balance between job
demands, control over their own work, level of skills and social support;
o a personnel policy, which actively
incorporates health promotion, issues;
o an integrated occupational health
and safety service.
WHP is based on
multisectoral and multidisciplinary cooperation and can only be successful if
all the key players are committed to it.
WHP can reach the
aim "healthy people in healthy organizations" if it is oriented along
the following guidelines:
o All staff have to be involved
(participation).
o WHP has to be
integrated in all important decisions and in all areas of organizations
(integration).
o All measures and
programmes have to be oriented to a problem-solving cycle: needs analysis, setting
priorities, planning, implementation, continuous control and evaluation
(project management).
The European
Network for WHP regards the following priorities as a basis for future
activities:
o Increase awareness
of WHP and promote responsibility for health with regard to all stakeholders.
o Identification and dissemination of
models of good practice.
o Develop guidelines for effective
WHP.
o Ensure commitment of
the Member States to incorporate respective policies.
o Address the specific
challenges of working together with small and medium-sized enterprises.