Ferrie J E, Shipley M J, Marmot M G, Stansfeld S, Davey Smith G
Department of Epidemiology and Public Health, University College London Medical School, London, U.K.
Soc Sci Med. 1998 Jan;46(2):243-54. doi: 10.1016/s0277-9536(97)00158-5.
Since August 1988 an increasing proportion of the executive functions of government in the United Kingdom have been devolved to executive agencies. Transfer to an executive agency involves a period of uncertainty during which the options of elimination or transfer to the private sector are considered, followed by a marked change in management style and further periods of uncertainty when the agency's function is reconsidered for transfer to the private sector. This paper examines the effects of this major organisational change and consequent job insecurity on the health status of a cohort of 7419 white-collar civil servants by comparing groups either exposed to or anticipating exposure to this stressor, with controls experiencing no change. Compared with controls, men both already working in and anticipating transfer to an executive agency experienced significant increases in health self-rated as "average or worse", longstanding illness, adverse sleep patterns, mean number of symptoms in the fortnight before questionnaire completion, and minor psychiatric morbidity. Significant relative increases in body mass index were seen in both exposure groups while exposure to agency status was also associated with significant relative increases in blood pressure. Health-related behaviours, where they differed between exposure and control groups, tended to favour those in the exposure groups. Compared with controls, women in both exposure groups reported small increases in most self-reported morbidity measures and most clinical measurements, accompanied by slight beneficial changes in some health-related behaviours and small adverse changes in others. Significant relative increases were seen in mean number of symptoms, and ischaemia among women anticipating exposure and in body mass index among those exposed to agency status. Policy makers should be aware of the wider consequences of job insecurity when considering the efficiency of changes in employment policy.
自1988年8月以来，英国政府的行政职能越来越多地被下放给执行机构。向执行机构的转移会经历一段不确定时期，在此期间会考虑裁员或转移到私营部门的选择，随后管理风格会发生显著变化，当重新考虑将该机构的职能转移到私营部门时，还会有更多的不确定时期。本文通过比较暴露于或预期暴露于这种压力源的群体与未经历变化的对照组，研究了这一重大组织变革及其带来的工作不安全感对7419名白领公务员健康状况的影响。与对照组相比，已经在执行机构工作以及预期会转移到执行机构的男性在健康自评“一般或较差”、长期疾病、不良睡眠模式、完成问卷前两周内的症状平均数以及轻度精神疾病发病率方面都有显著增加。两个暴露组的体重指数均有显著相对增加，而处于机构状态也与血压的显著相对增加有关。在暴露组和对照组之间存在差异的与健康相关的行为，往往对暴露组有利。与对照组相比，两个暴露组的女性在大多数自我报告的发病率指标和大多数临床测量指标上都有小幅增加，同时一些与健康相关的行为有轻微的有益变化，另一些则有轻微的不利变化。预期暴露的女性在症状平均数和局部缺血方面以及处于机构状态的女性在体重指数方面有显著相对增加。政策制定者在考虑就业政策变化的效率时，应意识到工作不安全感带来的更广泛后果。
