Research confirms work structure must adapt to benefit long-term health: Expert
Patients are referred to Daniel Hackam because of their high risk for cardiovascular disease, which can be the result of high blood pressure, obesity, high cholesterol, elevated blood sugars and diabetes.
As a clinical pharmacologist at the Stroke Prevention and Atherosclerosis Research Centre in London, Ont., Hackam began to notice many of these patients had something in common — they worked shifts.
“It's just so disruptive in terms of their sleep and their eating (patterns),” he says.
Hackam witnessed the correlation between patients’ occupation and health for years, and decided to explore whether there was factual evidence to support his anecdotal analysis. Shift work had long been associated with unhealthy lifestyles and sleep deprivation, but he wanted to find a solid connection to cardiovascular disease.
“We did a large systematic review and data analysis to see if we could actually quantify a statistical association between heart attacks and strokes and shift work,” says Hackam, who is also an associate professor at Western University in London, Ont.
The research, which appeared in the British Medical Journal, draws on evidence from 34 studies published between the 1960s and 2012 involving more than two million people, says Hackam.
“There's a lot of high quality data which, when put together, strongly suggests that shift workers have a higher risk of heart attacks and strokes, as well as coronary events, compared to regular daytime workers,” he says.
The study found shift work — defined as evening shifts, irregular or unspecified shifts, mixed schedules, night shifts and rotating shifts — increases the risk of a heart attack by 23 per cent, a stroke by five per cent and unstable angina, coronary artery disease and other “coronary events” by 24 per cent.
Night shifts were associated with the steepest increase in risk for coronary events at 41 per cent.
“That was double what we found for the overall population for shift workers,” Hackam says. “That actually makes some sense in that we're, really, evolutionarily supposed to be sleeping at night.”
This is important for Canadians to know because about one-third of the population works some type of shift work, according to Hackam.
Shift work disrupts the body’s circadian rhythm, which is one’s 24-hour sleep cycle. Heart rate, blood pressure and cholesterol levels all return to low levels during sleep while the body rests, he says.
“People are actually working through the night and sleeping through the day, which is actually a complete reversal of what our evolutionary genome would suggest that we should be doing,” he says. “Our genetics are just not adapted to that.”
Changing the workplace
These issues have long been known, but it’s good to have research supporting evidence, says Andrew Harkness, a healthy workplace specialist with Mississauga, Ont.-based Workplace Safety and Prevention Services.
“I think we have more information today that verifies that there is a link between long-term health of employees and individuals and the impact that designs of work and work organization have,” says Harkness, adding that research makes it hard for employers to deny they have a role to play in the health of their employees.
“If we're talking about making change to how we organize work or work pace or job design… we're learning we need to include the people that do that job as part of the solution,” Harkness says.
Lower level employees will be more inclined to change things if leaders take an active role in asking for employee input, he says.
“The research tends to suggest to us today that your direct supervisor, your direct manager has a significant influence on work satisfaction, work identity and job satisfaction and engagement,” he says.
Determining job satisfaction can be accomplished through a perception survey, Harkness suggests. By asking employees where the company may be lacking in terms of health and safety, employers may hear some of the same themes as if an audit were conducted.
For example, creating open dialogue might lead a shift worker to provide an alternate — and just as effective — means of completing a task, he says.
“We need to continue to build the credibility of the value of perception surveys and use that as a gauge to monitor performance of the organization,” he says. “How well is it managing its business an employee satisfaction?”
How shift workers can cope
Workers should start by setting specific goals, says April Smith, owner of Edmonton-based Vitalize Initiatives, which provides corporate health and wellness consulting services.
“It really does help people celebrate their successes,” she says. “If you just have these broad goals, you can be pretty hard on yourself even if you did some wonderful things.
Shift workers will compromise sleep for other commitments, but the importance of sleep cannot be stressed enough, she says, recommending workers suggest alternate activities if they miss out on important events.
“A lot of stress for shift workers can come from being too tired or missing out on things in their personal life,” she says. “I think having that secondary plan is really vital.”
Sleep needs to be a priority or it leads to other problems, Smith says.
“Everything seems harder if you’re tired,” she says.
Digestive problems are also one of the biggest issues for shift workers.
“It seems to be one of those things that not many people are talking about, but when you mention it in a classroom, you can see people going, ‘oh, yes,’” Smith says. “That light bulb goes off.”
Following Canada’s guide to healthy eating is one of the easiest strategies a shift worker can implement, she says.
“Drinking lots of water is also good,” she says. “It’s also good for your energy. I’ve never fallen asleep when I had to go pee.”
