C1-05: Shiftwork and health: a systematic review
Mark Petticrew, LSHTM
Improving workplace health is increasingly recognised as an important and achievable policy goal. However, to date, little attention has been paid to shiftwork as a determinant of health for many workers. Shiftwork is common in the UK, and is increasing; Labour Force Survey data suggest that about 14% of women and 18% of men are employed in shiftwork. Although there has been an increase in the proportion of employees engaged in shiftwork in recent years, this change is quite small (from 13% to 15% from 1993-2003), with one exception: young people. Here, the increase has been around 8% in both young men and women. Shiftwork is also socially patterned, being less common in graduates, and more common among those working in the manufacturing sector.
Reported health problems include sleep disturbance, fatigue, digestive problems, emotional problems and stress-related illnesses, as well as increases in general morbidity, and sickness absence. Shiftwork also involves significant social desynchronisation, involving working at times and on days that may make it difficult to maintain a balanced domestic and social life. Shiftwork has been implicated in the development of breast cancer, and also with the birth of pre-term (premature) babies. Shiftwork may also involve increased risk of injuries and accidents.
A range of interventions has sought to address the negative health effects of shiftwork, including reductions in shiftwork (especially night shift), redesign of the shift system according to ergonomic criteria, educational interventions (e.g. to help workers cope with shiftwork), improvements in working conditions (reducing noise or improving unfavourable working environments) and regular medical surveillance and counselling. However, no existing systematic review has evaluated the effects of changes in the organisation of shiftwork on health and well-being. This is needed (i) to summarise existing evidence about the effects and cost-effectiveness of organisational, and other interventions, (ii) to identify issues of differential effects - what works, in which groups of workers; and (iii) to contribute to the development of new interventions.
Aims, methods and contribution
The review aimed to answer the question: What are the effects on health and well-being of changing the organisation and experience of shiftwork? The review examined organisational changes as well as educational and other interventions aimed at individuals. We included studies from OECD countries which were reported in any language or format, and identified them from clinical and social science databases, hand searches of personal collections, expert consultations, and bibliographies. We also searched internal databases that we have previously assembled for systematic reviews on work and health. We included an assessment of (i)the differential effects of shiftwork and its potential impact on health inequalities, and (ii) all health and psychosocial impacts which are reported in the primary studies, including positive measures (e.g., improvements in self esteem, confidence, quality of life, income) and negative impacts (e.g., reductions in status, control, and increases in work-related demands, and stress). Data on changes in health behaviours (smoking, drinking, physical activity) were also extracted and analysed where available.
The White Paper “Choosing Health” sees the workplace environment as an important setting for addressing health and health inequalities, and this project has the potential to support the delivery of the Public Service Assessment (PSA) targets in Delivering Choosing Health. In particular, it will contribute to the evidence base for the healthy workplace programme. This review will also contribute to more accurate health impact predictions for future employment policies, supporting the White Paper and Delivery Plan's commitment to "proofing" policies with respect to health and health inequalities. In addition, the EU working time directive specifically aims to reduce the adverse effects of disrupted work patterns, excessively long hours, and having inadequate rest. A better understanding of how shiftwork patterns affect health can contribute to guidance on avoiding negative effects, and to the identification of sectors particularly at risk.
The White Paper also describes the major role the NHS itself plays in creating health as an employer (the NHS is responsible for about 1.3 million jobs). In this review, we will be able to analyse separately those studies carried out in healthcare settings to explore how bodies like the NHS can develop healthier employment policies.
Duration: October 2005 - September 2006 (12 months)