Stress consists of a pattern of “stone-age” reactions preparing the human organism for fight or flight, i.e., for physical activity. Stress was adequate when stone-age man was facing a wolf pack, but not so when today’s worker is struggling to adjust to rotating shifts, highly monotonous and fragmented tasks or threatening or overly demanding customers. It is often maladaptive and disease provoking.

Health and wellbeing can be influenced by work, both positively (“spice of life”) and negatively (“kiss of death”). Work can provide a goal and meaning in life. It can give structure and content to our day, our week, our year, and our life. It can offer us identity, self-respect, social support, and material rewards. This is more likely to happen when work demands are optimal, when workers are allowed to exercise a reasonable degree of autonomy, and when the “climate” of the work organization is friendly and supportive. If this is so, work can be one of the most important health-promoting factors in life.

If, however, work conditions are characterized by the opposite attributes, they are – at least in the long run–likely to cause ill health, accelerate its course or trigger its symptoms.

Pathogenic mechanisms include:

  • Emotional reactions (anxiety, depression, hypochondria, and alienation);
  • Cognitive reactions (difficulty concentrating, remembering, learning new things, being creative, making decisions);
  • Behavioural reactions (abuse of drugs, alcohol, and tobacco; destructive and self-destructive behaviour, and inhibitions about seeking and accepting the offer of therapy and rehabilitation); and
  • Physiological reactions (neuroendocrine and immunological dysfunction).

Work-related stress and its causes and consequences are all very common in the 28 European Union Member States. Such work-related ‘stressors’ are likely to have contributed to the present spectrum of ill health.

Sustained work-related stress is an important determinant of depressive disorders. Such disorders are the fourth leading cause of the global disease burden. They are expected to rank second by 2020, behind ischaemic heart disease, but ahead of all other diseases (1, World Health Organization, 2001).

In the EU Member States, the cost of these and related mental health problems is estimated to be on average 3-4% of the GBP (2, ILO, 2000), thus amounting to a loss of approximately €365 billion annually. It is further likely that sustained work-related stress is an important determinant of metabolic syndrome (3, Folkow, 2001; Björntorp, 2001). This syndrome contributes to ischemic heart disease and type 2 diabetes morbidity.


Thus, virtually every aspect of work-related health and disease can be influenced. This can also be mediated through emotional, and/or cognitive misinterpretation of conditions of work as threatening, even when they are not, and/or the occurrence of trivial bodily signs and symptoms as manifestations of serious disease.

All this can lead to a wide variety of disorders, diseases, loss of wellbeing, and loss of productivity. Examples discussed in some detail in the EU Guidance include ischemic heart disease, stroke, cancer, musculoskeletal and gastrointestinal diseases, anxiety and depressive disorders, accidents, and suicides (European Agency for Safety and Health at Work).