1. Introduction
1. Work stress

has been recognised as a serious
public health issue for many years. Already in 2003, the World Health
Organization (WHO) published a detailed report providing guidance
to occupational health professionals across Europe with regard to
assessing and preventing stress at the workplace.

According to the European Agency
for Safety and Health at Work (EU-OSHA), psychosocial risks and
work-related stress are among the most challenging issues in occupational
safety and health as they impact significantly on the health of
individuals, on organisations and on national economies: around
half of European workers consider stress to be common in their workplace,
and stress seems to be at the origin of around half of all working
days lost.
2. Whilst the phenomenon of stress is often misunderstood or
stigmatised, professionals nowadays consider that psychosocial risks
and stress can be just as manageable as any other workplace safety
and health risk, especially if they are fully recognised as an organisational
issue rather than an individual fault. Where this is the case, responses
and preventive action will need the engagement of governments, companies and
employees.
3. In line with the motion for a resolution (
Doc. 14090) tabled by the Committee on Social Affairs, Health and
Sustainable Development, this report aims to increase awareness
among European parliaments and governments of work-related stress
as a major public health issue, to explore the causes, challenges
and possible responses, and to identify the areas where legislative
or political action is needed with a view to improving psychosocial
working conditions and well-being at work across Europe, both in
the public and the private sector. To gather expert insights and
recommendations, an exchange of views was organised with the representatives
of EU-OSHA and the Centre for Sustainable Working Life of the Birkbeck
University of London (United Kingdom) on 18 September 2018.
2. Stress at work: definitions, causes,
consequences and approaches
4. The International Labour Organization
(ILO), already in the 1980s, defined the term “stress’ as “the harmful
physical and emotional response caused by an imbalance between the
perceived demands and the perceived resources and abilities of individuals
to cope with those demands”.

More recently, in 2016, its annual “World
Day for Safety and Health at Work” focused on “Workplace Stress:
a collective challenge”. We can therefore see that the issue has
been perceived as a challenge for governments, employers and trade unions
for many years.
2.1. Causes of stress at work
5. The causes and factors inflicting
stress upon workers certainly vary according to specific professional environments,
tasks, organisations and cultural practices. The overall economic
context certainly also plays a certain role, such as the economic
crisis which started in 2008, and the spread of new information
and communication technologies across all economic sectors.

6. For the EU-OSHA, the most common factors of stress at the
workplace include: 1) job content (for example boring tasks, non-stimulating
activities); 2) the amount of work and pace of execution; 3) the
work schedule (e.g. long shifts, limited breaks, inflexible hours,
unpredictable working periods, etc.); 4) participation (absence
of participation in decision-making, no control over the mode of
execution of tasks); 5) physical conditions of the work environment
(e.g. low illumination, noise); 6) the organisational culture (e.g.
poor support, unclear division of work) and poor management of organisational
change (leading to job insecurity); 7) conflicts, lack of support
and poor communication between colleagues and managers or even more
severe phenomena, such as psychological or sexual harassment; 8)
lack of career development (e.g. no career plan, stability or functional
mobility); and 9) difficulties to conciliate work and private life
(“work–life balance”).

The agency’s
most recent evidence for Europe has shown that workers are regularly
exposed to excessive demands: 34% of them work at high speed three-quarters
of the time or more, and 37% work to tight deadlines. Moreover,
31% of workers referred to undergoing an emotionally disturbing
situation (more than one quarter of the time at work).

7. This list of determinants and data shows that the notion of
work stress goes beyond the idea of workers acting beyond their
physical limits, being unable to complete services for lack of skills
or resources or manifesting an overburdening in what they are instructed
to do. Over the past years, there has been an increasing recognition
of interpersonal and relationship-motivated conflicts giving rise
to stress at workplaces, putting more emphasis on subjective and
moral aspects of stress.
8. Originally, two approaches were used to explain the development
of stress at the workplace. First, studies of labour-induced stress
centred on essential physical consequences of the imbalance between excessive
workload and autonomy in workers’ decisions. The second school of
research revolved around the idea that stress stems from the frustration
of not being sufficiently rewarded for individual efforts when gaining much
less than expected in terms of payment, esteem and job security.

The most recent approaches seem to
be more concerned with values of justice and fairness, embracing
the understanding of the causes of stress on the grounds of illegitimate
tasks, unjust work allocation or other discriminatory or unreasonable
treatment, based on the premise that roles exercised professionally
by individuals are essential to their identity.

9. Looking into contextual economic trends, addressing work-related
stress could not be more relevant at a time when communication and
information technologies are omnipresent in all economic sectors
and significantly influence individual workplaces and work processes,
both in a positive and a negative way. Their positive effects range
from providing more autonomy and flexibility directly at work to
allowing for new forms of work organisation, including remote work
to promote a better work–life balance and spend less time at the office
(thus saving energy otherwise spent on commuting).

10. However, information and communication technologies often
intensify the pace of processes and tasks by optimising workflows
and making jobs more demanding and time-consuming. They may also
lead to isolation and represent a physiological stressor for lack
of relationships when workers do not interact daily with a face-to-face
or on-site team, or cause burnout through permanent connection to
work (making employees constantly reachable via e-mails, cell phones
or virtual desks, even outside of working hours, and transmitting orders
during off-duty periods or at unpredictable moments).

Workers
have the right to disconnect from work outside working hours.
11. The growing use of monitoring technology via video, audio
or even tracking movements, locations and body signs such as heartbeat
or blood pressure, may result in stress to workers exposed to ongoing surveillance,
behaviour control or performance evaluation. However, monitoring
tools could also be used to identify health complications at work
and alert to excessive burdens for employees (e.g. companies could
track physical symptoms through wearable devices or smartphones).

12. Furthermore, among the contextual elements influencing workers’
mental health many also see the major economic crisis that hit Europe
over the past decade. The recession severely affected job prospects
and escalated job insecurity, dampened wages and restructured labour
distribution, imposing more responsibilities on many of those still
in employment and, for all these reasons, trouble for many employees
to an extent that made them ill.

In
addition, the very nature of work is expected to change significantly
as robots and artificial intelligence applications threaten to replace
humans for many jobs and create new man-machine teamwork patterns.

13. Finally, the gender dimension should not be neglected either:
evidence shows that women and men tend to respond to and manage
stress at work in different ways. Most studies point out that women
at work are the worst affected, especially when they carry a double
burden of work and household responsibilities. Moreover, they face
a higher risk of sexual harassment at work and gender-based discrimination
with lower wages, higher job requirements

as well as involuntary
part-time work,

and
need special protection during pregnancy.
2.2. Consequences of stress at work
14. It is widely recognised today
that some of the above-mentioned working conditions and contextual elements
can lead to negative psychological, physical and social outcomes
such as work-related stress, burnout or depression and even suicide.
I should recall that scientific research over the past 20 years
has clearly evidenced the association of stress with the development
of specific physical and psychological symptoms resulting in serious
health complications such as cardiovascular diseases, diabetes, musculoskeletal
problems, depression or bipolar disorders.

15. The ILO notes that high levels of stress can also lead to
developing unhealthy coping behaviours such as alcohol and drug
abuse, increased smoking, poor diets, insufficient physical activity
and sleep disorders. These in turn would aggravate the general condition,
commitment and performance of individuals, affecting their roles
and well-being in both their professional and private lives.

16. Taking into account only the effects of depression caused
by physiological hazards from working conditions, work stress may
cost €617 billion annually in the European Union through absenteeism (€272 billion),
productivity reduction (€242 billion), health-care services (€63
billion) and disability benefit payments (€39 billion).

However, the burdens of
work stress in Europe and globally go beyond medical risks. Not
only is there significant harm to individual well-being and psychological
integrity, but work-related stress also pushes up the costs involved
in doing business, hindering competitiveness and cutting into profits.
All society is thus impacted: workplace stress is a major collective
challenge.
3. Stress at work: legal and policy responses
17. International organisations,
European institutions, corporate actors and countries have produced
a collection of norms and guidelines relevant to work-related stress;
these instruments vary in content and legal value (mandatory or
soft law) and in how manifestly they refer to work stress (more
or less explicitly).
3.1. Global and European tools
18. At the ILO, the main instrument
is the Convention on Occupational Safety and Health of 1981 (No. 155), followed
by its Recommendation (No. 164), which constitute binding regulation-setting
standards referring to mental health and, by this term, encompassing
work stress prevention. The ILO Occupational Health Services Convention
of 1985 (No. 161) and its complementary Recommendation (No. 171)
deal with occupational health services as multidisciplinary services
that should address physical and mental health issues, thus again implying
work stress.
19. Likewise, EU directives on workers’ health and safety are
not entirely delineated in an explicit manner with regard to work
stress, usually alluding to mental health. The pattern followed
in EU rules are, for example, to be found in the Framework Directive
on Safety and Health at Work (89/391/EEC), which does not contain any
direct reference to work stress although it recognises mental health
needs, a set-up replicated in most EU countries. Thus, not all European
countries recognise mental health disorders linked to stress as
an occupational disease, reflecting the categories mentioned in
the ILO’s occupational disorders list (revised in 2010). Italy,
Lithuania, Latvia, Romania and Hungary are examples of countries
which do have mental health diseases in the official directory of
work-related illnesses.

20. Within the Council of Europe treaty system, the European Social
Charter (revised) (ETS No. 163) enshrines, in its Article 3, the
right to safe and healthy working conditions. The first item of
this clause requires States to implement policies to prevent accidents
and increase standards of health at work. The next items establish
the obligation of safety and health regulations, which should be
enforced by governments in association with occupational health
services for all workers with preventive and advisory goals. As
it was drafted, the European Social Charter (revised) does not contain
straightforward references to any measure relating to work stress.
21. However, already in an early Statement of Interpretation of
Article 3 in 2003, the European Committee of Social Rights (ECSR)
took into account “work-related stress, aggression and violence
when examining the risks covered by occupational health and safety
regulations” and considered “measures taken by public authorities
to protect workers against work-related stress, aggression and violence
specific to work performed under atypical working relationships,
in examining the personal scope of occupational health and safety regulations”.
The monitoring mechanism related to the Charter treaty system has
subsequently delivered opinions against certain countries (e.g.
Bulgaria or Italy) for non-compliance with European standards in
the light of inexistent or poor policies for tackling stress at
the workplace.
22. In addition, agreements concluded at the EU level have introduced
subsidiary forms of promoting policies against work-related stress
based on the voluntary adhesion of unions and business representatives. The
Framework Agreement on Work-related Stress, for example, undertaken
by European cross-industry social partners,

was
concluded in 2004 and the parties committed themselves to implementing
it through procedures and practices in individual countries. The
instrument establishes a normative reference whereby the adherents
agree to follow policies to prevent, monitor and address work stress,
with each country remaining free to incorporate such measures in
the form of national, sectorial or collective agreements or other
tripartite activities or programmes, as well as legislation. Nevertheless,
the latest report of 2011 noted that much progress had yet to be
made until the overall aims were achieved.

23. At European level, the EU-OSHA led a major “Healthy workplaces
manage stress” campaign in 2014-2015, aimed at raising awareness
about the growing problem of stress and psychosocial risks at work.
As part of the campaign, enterprises were specifically targeted
in order to increase their practical knowledge in recognising and
preventing psychosocial risks. Although workplace stress stems from
a combination of external pressures and a working person’s capacity
to manage stress, a very clear emphasis by the EU-OSHA was and is
on the comprehensive responsibility of organisations and managers
to prevent stress at the source (workplace), manage risks and provide
remedial support. The campaign also revealed that small enterprises face
special challenges in managing workplace stress due to reactive
approaches, excessive reliance on individual responsibility and
underestimated health risks.
24. WHO’s Healthy Workplace Model lays special emphasis on work-related
physical and psychosocial risks whilst advocating healthy behaviours
through enabling environments, good corporate practices and workplace wellness
programmes. Leadership engagement and worker involvement around
ethical values are seen as a crucial part of this dynamic and continuous
process. WHO studies have shown that there is still much confusion between
the perceived pressure or challenge and stress at work; this confusion
is sometimes used to excuse poor management practice.
25. Another source of confusion at various levels is the notion
of occupational burnout (a state of extreme emotional and physical
exhaustion) and its recognition as an occupational disease. The
ILO list of occupational diseases, last revised in 2010

and which serves as a model for all
countries, cites “post-traumatic stress disorder” and “additional
mental or behavioural disorders not mentioned”. The European Commission’s Recommendation
on the European Schedule of Occupational Disorders (2003/670/EC)
does not list any stress-induced disorder. However, the burnout
syndrome is increasingly recognised at national level in Europe as
a major occupational health issue.
3.2. National action and good practice
26. National authorities in most
European countries have put in place their own policies, involving
legislation, guidelines or government programmes, for tackling work
stress and in particular psychological hazards related to work.
According to EU-OSHA surveys, about a third of all establishments
in the EU-28 have procedures for dealing with stress-induced psychosocial
risks; in “virtuous” countries, such as the United Kingdom, Romania, Denmark,
Sweden and Italy, this rate can attain 50% or more, whereas the
worst performing countries (the Czech Republic, Estonia, Croatia,
Poland, Luxembourg, Greece and the Slovak Republic) only reach below 15%.
Given a lack of “hard” prescriptions to member States via the EU
directives as regards work-related stress (as explained in the above
section), national authorities have much latitude for action, or
passive attitudes, in the face of the compelling new evidence on
the growing levels of stress at work.
27. The more recent national strategies and initiatives on stress
management at work better cover psychosocial risks and foresee further
studies of such risks. In some countries, labour inspectorates have issued
specific guidance to inspectors to adequately assess psychosocial
risk management measures put in place by employers during workplace
visits. Various national authorities, social partners and professional associations
have also published protocols for the prevention and management
of work-related stress, as well as recommending intervention tools.
However, as ILO notes, insufficient national data on the real scope
of the problem may be failing to influence public policies in the
right direction and to avoid their fragmentation.
28. The Nordic countries have paved the way towards the recognition
of psychosocial risks at work through relevant legislation, such
as the Danish and Norwegian Working Environment Acts of 1977 and
their later revisions, as well as the Icelandic Working Environment
Act of 1980, revised in 2003 and 2004. The latter obliged employers
to carry out systematic preventive measures and assessment of psychosocial
risks and to implement provisions against bullying and other inappropriate
behaviour. Other countries, such as Austria, Germany, Hungary, Italy,
Lithuania and the Slovak Republic, have laws on occupational safety
and health that ask employers to assess psychosocial hazards in
the context of workplace stress assessment.

29. To raise awareness about the psychosocial aspects of stress
at work, some countries carried out nationwide information campaigns
(for instance Denmark in the late 1990s and early 2000s) and specific training
programmes for labour inspectors (such as Sweden as early as 2001-2003).
Others have developed specific screening tools for detecting stressors
in the workplace (for example SIGMA in Germany), management standards
for work-related stress and an “approved code of practice” (such
as in the United Kingdom by the Health and Safety Executive

) or sectoral stress
management policies (for instance in the Belgian federal police).
To address bullying and harassment, Denmark has established a hotline
to give advice to employees in need of support in overcoming situations
of abuse; recent reviews of the programme results seem to indicate
its success.
30. In line with the requirements of the European Social Charter,
all European countries have effective legal provisions for protecting
employed women during maternity and after giving birth and for ensuring
equal opportunities in employment. Some countries (notably Austria,
the Czech Republic, Estonia, Georgia, Italy, Luxembourg, Norway
and Romania) also have legislation to protect pregnant workers from
mental fatigue and job strain. However, national legal provisions
for maternity/paternity leave, related remuneration and flexible adaptations
of working time are still very disparate and can hardly be seen
as promoting a healthy balance between private and professional
life. Recent corporate trials bring fresh evidence that employees
are less stressed, more efficient, more productive and better manage
their work–life balance with a shorter, four-day week (with 28 to
32 work hours per week), flexible hours options and teleworking
possibilities.

31. As regards the burnout syndrome, a 2017 study across 23 European
countries has shown that nine countries (Denmark, Estonia, France,
Hungary, Latvia, the Netherlands, Portugal, the Slovak Republic
and Sweden) recognise it as an occupational disease and some of
them (Denmark, France, Latvia, Portugal and Sweden) have offered
compensation in burnout cases. The same study points out that certain
professionals – health-care workers, social workers, police officers,
teachers and customer service providers – are particularly exposed.

However,
a more comprehensive acknowledgement of the burnout phenomenon is
still lacking; the WHO could in future provide more guidance to
policy makers on burnout as an occupational disease, which would
enable more preventive action.
4. Healthy workplaces – our collective
responsibility
32. As we have seen above, workplace
stress is a very complex and pervasive phenomenon, impacting not only
health and well-being of people at work but also institutions, economies
and society at large. None of us would like to take the risk of
flying on a plane with an exhausted pilot in the cockpit, or be
treated by an overstressed doctor, or collapse one day ourselves
after chronic stress. Yet this can and does happen to nearly every
second European and we encounter stressed people around us all the
time.
33. Although stress is still too often misunderstood and stigmatised,
research evidence shows that it is manageable – like any other workplace
safety and health risk – when it is acknowledged and addressed as
an organisational issue rather than an individual fault. Valuable
guidance from international organisations and the research community
needs to be translated into national benchmarks, notably for psychosocial
hazards, and be cascaded down to each and every institution, with
an emphasis on risk-screening and prevention. This collective effort
needs the engagement of governments, companies and employees.
34. As rapporteur I wish to plead for the more explicit recognition
of stress-induced health disorders (including burnouts) as occupational
diseases in all European countries because that would help shift
the responsibility for action to our institutions. I also believe
that policy makers should mainstream gender-related concerns more
adequately through policies and regulatory tools, ensure enhanced
protection for vulnerable population groups and, turning eyes to
the future, start preparing for the new era in the world of work
where humans will be challenged but hopefully not marginalised by
robots and artificial intelligence applications.