The role of the workplace in the production and containment of health costs: the case of stress-related disorders.

Workplaces vary enormously in the amount of harmful stress they produce, even within specific economic sectors. Stress of certain kinds and at certain levels tend to produce health harms and costs that are borne not only by individual employees and employers but also by families and society at large. Variations in stress levels within economic sectors can be traced to variations in management practices that govern key conditions of work involving demand, effort, control and reward. The costs of stress-related disorders produced by adverse governance practices are transferred outside the workplace in varying degrees. The actual extent of this cost transfer depends on policies and programs within the workplace. We can characterize workplaces according to a typology in which the key dimensions are commitment to abate harm through participatory management practices and the effectiveness and efficiency of harm containment through programs such as employee assistance and health promotion. The most health-promoting and cost-avoiding workplaces foster high control, high reward conditions and support employees with employee assistance and health promotion programs. The policy implications of this observation are drawn out.

Communicating alcohol and drug prevention strategies and models across cultural boundaries: preliminary report on an ILO/WHO/UNDCP [International Labour Office/World Health Organization/United Nations International Drug Control Program] Interagency Program.

The joint ILO/WHO/UNDCP collaborative program "Prevention of Drug and Alcohol Problems among Workers and their Families" represents transfer of an innovative model to a culturally diverse group of nations: Egypt, Mexico, Namibia, Poland, and Sri Lanka. The concept is to move from reactive programs-led by alcohol and drug experts, reactive to problem employees-to proactive prevention led by management. Nontechnical language and metaphors have been developed to secure the commitment of managers in the private and public sectors. Participating countries and enterprises adapt the program to local conditions, fostering "local ownership" with the objective of creating self-sustaining activities. The objective is to describe elements of the program which may be readily transferable worldwide across the cultural borders that characterize nations, enterprises, and public sector workplaces.

Future research needs in policy, prevention, and treatment for drug abuse problems.

This paper outlines major research issues for the areas of illicit drug use. Research questions are posed for the following areas: (1) epidemiology and etiology; (2) social policy development; (3) prevention; and (4) treatment.

The synergism of health promotion and restoration in the prevention of substance abuse in the workplace.

Representatives from both health promotion and restoration fields can concert energies in preventing and reducing excessive and inappropriate substance use by employees. This liaison requires that workplace health promoters such as employee fitness/wellness directors, and workplace health restorers such as employee assistance providers, become more familiar with one another's work and better understand the nature of excessive or inappropriate drug consumption. Existing at the interface of these employee health services are opportunities for preventing workplace substance abuse through both enhancing workers' healthy lifestyles and establishing referral pathways to care.

Convergent results of two methods of estimating the prevalence of problem drinking.

Two studies were conducted using different methods of estimating the prevalence of problem drinking among the Canadian Armed Forces. In one case, data on alcohol sales from base outlets were used to calculate mean per capita consumption, which in turn was applied to a theoretical and, to some extent, empirically-validated plot of the distribution of consumption often referred to as the Ledermann curve. Criteria for different levels of problem drinking were then applied to this distribution. In the other case, estimates of problem drinking and presumptive problem drinking were derived from self-reported data on the correlates and sequelae of excessive drinking. The results derived from the two methods were highly convergent. As in the case of studies from the United States, the estimates were disturbingly high, both placing approximately 18% of the respective populations in he hazardous drinking category. The preventive and treatment-related implications of these findings are discussed.