Effort-reward imbalance at work and cardiovascular diseases.

Working conditions and employment arrangements make a significant contribution to the burden of cardiovascular disease, in particular in modern societies where mental and emotional demands and threats are becoming widespread. Occupational research has identified health-adverse features of modern work with the help of theoretical models. One such model, effort-reward imbalance, has been developed by this author and his group and has been widely tested in epidemiological and experimental studies. The model claims that stressful experience at work is elicited by a lack of reciprocity between efforts spent at work and rewards received in return, where rewards include money, promotion prospects, job security, and esteem. Results demonstrate elevated risks of coronary heart disease among employees exposed to effort-reward imbalance. Moreover, in ambulatory and experimental investigations, elevated heart rate and blood pressure and altered secretion of stress hormones were observed under these conditions. Although additional scientific evidence is needed, available findings call for practical measures towards improving quality of work, most importantly at the level of single companies and organisations. This conclusion is supported by first results from intervention studies that are guided by this theoretical approach. In view of the burden of cardiovascular disease attributable to unfavourable working conditions, such efforts are well justified and need to be extended in order to promote healthy work.