have responded to these work-life issues with an array of programs, resources, and accommodations. These include, for example, elder and child care initiatives, flexible work schedules, job sharing, work-at-home arrangements, on-site or telephonic concierge services, and time and stress management training. Most U.S. workers, however, do not have access to such programming or work benefits. The 1993 Family Medical Leave Act’s right to job-protected time off from work may be the principal source of temporary accommodation for many workers. However, it is unpaid leave and pertains only to serious medical conditions that affect the employee, a spouse, a dependent, or a parent and to care for a child after birth or placement for adoption or foster care.


The changes occurring in the structure of organizations and the context of work are creating new challenges for workers and worker wellbeing, particularly psychological well-being. Organizations are becoming smaller and flatter and are redefining the content of work and the nature of the employment relationship. They are pressured to compete for talent, innovate, provide exceptional service quality, and bring products and services to market fast at competitive prices. The implications of these business developments for workers include demand for new skills and continuous learning, expanded job scope, accelerated work pace, changing workplaces, uncertainty in employment relationships, heightened interactivity in job performance, and greater interface with information and communications technologies.

Work stress and its effect on health are major consequences of the changing work environment and the organization of work. Occupational health professionals must be competent in recognizing psychological conditions related to stress and in knowing the appropriate interventions and when to use relevant expert resources. They must also be familiar with concepts that relate to the structure and context of work and organizations to recognize and account for the influences that work and organizational context have on workplace injury, illness, or other health issues. These skills are essential to respond to various manifestations of cognitive overload or other work or organizational sources of distress in the workplace. The need for competency in this area is particularly keen when traditional risk factors fail to explain the occurrence or distribution of cases or events. It has been demonstrated, for example, that work organization factors are important in the epidemiology of work-related musculoskeletal disorders (Moon and Sauter, 1996; Bernard, 1997). Core curricula and training for OSH health professionals need to address these important competencies.

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