The Monitoring and Surveillance of the Psychosocial Work Environment in Canada: A Forgotten Determinant of Health

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ABSTRACT

The psychosocial working environment is an important determinant of health status and health inequalities in Canada. Particular dimensions of the psychosocial work environment such as low job control, job strain and imbalances between perceived efforts and rewards have been related to cardiovascular disease (the leading cause of mortality in Canada) and poorer mental health status. Despite its importance to the health of Canadians and health inequalities in Canada, the national surveillance of the psychosocial work environment is decreasing. Currently, the surveillance of the psychosocial work environment in Statistic Canada's population health surveys is limited to convenience-based samples within particular health regions. Not including important dimensions of the health, such as the psychosocial work environment, in our population-based surveys limits the ability of these surveys to help us better understand the challenges and opportunities to reducing health inequalities in Canada.

Key words: Psychological factors; surveillance; public health; Canada

RÉSUMÉ

L'environnement psychosocial de travail est un important déterminant de l'état de santé et des inégalités en santé au Canada. Certains aspects, comme le manque de liberté de décision, le stress au travail et les déséquilibres entre les efforts et les récompenses perçus, ont été liés aux maladies cardiovasculaires (lesquelles sont la principale cause de mortalité au Canada) et à la dégradation de l'état de santé mentale. Malgré son importance pour la santé des Canadiens et le redressement des inégalités en santé au Canada, la surveillance nationale de l'environnement psychosocial de travail diminue. Aujourd'hui, ce type de surveillance dans les enquêtes sur la santé de la population de Statistique Canada se limite à des échantillons de commodité prélevés dans certaines régions sanitaires. L'absence d'aspects de la santé aussi importants que l'environnement psychosocial de travail dans les enquêtes représentatives canadiennes réduit l'utilité de ces enquêtes lorsqu'il s'agit de comprendre les difficultés et les possibilités de réduire les inégalités en santé au Canada.

Mots clés : facteurs psychologiques; surveillance; santé publique; Canada

The psychosocial environment is an important determinant of health status. It has been defined as "the sociostructural range of opportunities given to an individual to meet his or her need of well being, productivity and positive self-experience".1 A large part of an individual's psychosocial experiences occur at work. The most commonly used measures of the psychosocial work environment are job control (a measure that includes an individual's ability to make decisions and use their skills at work), psychological demands, job strain (the combination of low job control and high psychological demands),2 and imbalances between perceived efforts and rewards.3 In addition, research has also focused on perceptions of organizational justice,4 social support and employment and employability security.5 A recent systematic review reported that there is consistent evidence from both longitudinal observational and case-control studies, among primarily male respondents, that job strain is associated with increased risk of cardiovascular mortality.6 In addition, among observational studies it is likely this risk is underestimated given that imprecise measurement of exposure to job strain is likely to produce results biased to the null. Others have estimated the population attributable risk (PAR) associated with negative psychosocial work conditions and myocardial infarction to be between 7% and 12%,7,8 making them similar to previously reported PARs for fruit and vegetable consumption and exercise and just below those reported for hypertension and obesity.9 Additional evidence has also linked job control (one aspect of job strain) independently with cardiovascular mortality.6 Other dimensions of the psychosocial work environment have also been associated with greater risk of cardiovascular disease in prospective observational studies. …