Work and Heart

by Johannes Siegrist, Ph.D.

Work gives people opportunities to receive many rewards. Some rewards include job satisfaction, whereas others are outward societal rewards, i.e., money, esteem, and status. There is, or should be, reciprocity between the effort expended to accomplish work and all the gains realized.

It has long been recognized, however, that a discrepancy exists between work and reward. That discrepancy leads to psychological stress that frequently finds expression in somatic symptoms, including heart risk and cariac health.

In an exhaustive review discussing the links between psychosocial occupational stress and health, Johannes Siegrist, Ph.D., concludes that high-cost/low gain employment must be considered a risk factor for cardiovascular health.

In his review, Siegrist measures high cost by extrinsic forces such as the demands of the job and intrinsic sources such as the motivations of the worker in a demanding situation.

He measures low-gain conditions by salary, the workers perceived esteem of colleagues and supervisors as well as availability of help from those sources and degree of status control the worker perceives as having relative to the work, i.e., control over the type of work done, whether or not relocation was required, prospects for promotion.

The review addresses three relevant questions concerning the links between psychosocial occupational stress and health:

1) How to identify those components within the global psychosocial occupational environment that are of critical importance to health.

2) How chronically stressful experience is maintained in individuals who are exposed to the psychosocial stressors identified in theoretical models.

3) The relationship between adverse health effects of chronically stressful experience in terms of high effort and low reward.

Although Dr. Siegrist concludes that high cost/low gain conditions at work must be considered a risk constellation for cardiovascular health, he defines some of the numerous questions that still remain and should be addressed in future research.

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