Issues of control and responsibility in workers' health

The issues of responsibility for health and control of factors influencing health are discussed with regard to workplace health programs. The role of each of the parties involved - workers, unions, management, and the government - can best be understood in relation to the interests they hold in workers' health. A matrix is presented which divides influences on workers' health according to the degree to which they are controlled by employers and workers. This matrix is used to suggest that workplace health promotion and employee assistance programs may represent employer involvement in areas over which they lack legitimate control. These programs are also criticized for their emphasis on behavior and their neglect of work-related causes of ill health and unhealthy behavior. They should be considered supplemental to a work environment which is conducive to both physical and psychosocial health; they will be most effective and appropriate with a high degree of worker involvement and control. Evidence regarding the effects of occupation and class on health and health-related behavior is presented to support the need for a comprehensive, ecological approach to workers' health. Such an approach should take into account the full range of influences and recognize the limits of legitimate control.