CASE STUDY

1. Health Psychology
1999, Vol. 18, No. 1,82-8
Copyright 1999 by the American Psychological Association,Inc.
0278-6133/99/S3.00
REVIEW ARTICLE
Occupational Health Psychology: Historical Roots and Future Directions
James CampbelLQuick
The University of Texas atArlington
Occupational healthpsychology (OHP) is a term first coined by Jonathan Raymond in1990,
yet OHP has historical, international roots dating at least to the early decades of the twentieth
century. It involves research and practice to create healthy workplaces. This article has 4
sections. The 1st section discusses psychology's long history of concern for occupational
health in industrial organizations, beginning with Hugo Miinsterberg's study of industrial
accidents and human safety in the late 1800s. The 2nd section focuses on OHP's movement
from the convergence of public health and preventive medicine with health and clinical
psychology in an industrial/organizational context. The 3rd section addresses the central issues
of organizational and individualhealth through the frameworkof preventive management. The
article concludes with OHPcase examples drawn from the Chaparral Steel Company, the U.S.
Air Force, and Johnson & Johnson.
Key words: occupational stress, occupational health, prevention, preventive medicine
Occupational health psychology (OHP) is an emerging
special area of focus in the science and practice of psychol-
ogy and is related to health psychology.The focus of OHP is
healthy workplaces, defined as ones in which people may
produce, serve, grow, and be valued. Specifically, healthy
workplaces are ones in which people use their talents and
gifts to achieve high performance, high satisfaction, and
well-being. OHPpresents aleadership challenge inorganiza-
tions to take the best theory, scientific research, and public
health policy to design, develop, implement, evaluate, and
continuously improve business and organizational policies
and structures for healthy workplaces. Further, OHPpresents
a challenge for leaders who have a responsibility for
organizational and individual health (Adkins, 1995; Quick,
Quick, Nelson, & Hurrell, 1997, Principle 2, p.151).
After a brief historical perspective, the article consists of
three sections. The first of these examines the emergence of
I thank past president Cynthia Belar for the invitation to present
an earlier version of this article to Division 38, Health Psychology,
at the 104th Annual Convention of the American Psychological
Association, Toronto, Ontario, Canada, 1996. I also thank Sheri
Schember Quick and Joyce A. Adkins for helpful comments on
drafts of this article; my brother Jonathan, for educating me about
the public health notions of prevention, surveillance, and epidemi-
ology (errors of fact or interpretation are mine, not my brother's);
Cynthia Cycyota, for research support and comments on revised
materials; Maggie Schaefer, for her helpful comments on the
Johnson & Johnson Health Care Systems references; and Jeff
Roesler, for help on the Chaparral Steel data.
Correspondence concerning this article should be addressed to
James Campbell Quick, Department of Management, College of
BusinessAdministration, The University of Texas, P.O. Box 19467,
Arlington, Texas 76019-0467. Electronic mail may be sent to
jquick@uta.edu.
OHP from the convergence of public health and preventive
medicine withhealth andclinical psychology in anindustrial/
organizational context.The next section addresses the issues
of organizational and individual health through a preventive
management framework,elaborating on organizational envi-
ronment, individual behavior, and work-family elements.
The final section presents three OHP case examples: one
from ChaparralSteel Company,one from the U.S.Air Force,
and one from Johnson &Johnson.
Historical Perspective
The term occupational healthpsychology was first coined
by JonathanRaymond,apsychologist workingin a school of
public health (Raymond, Wood, & Patrick, 1990). The need
for OHP is discussed in the 13th edition of Maxcy-Rosenau-
Last Public Health and Preventive Medicine, where work-
related psychological injuries and distress are noted among
the top occupational health risks in the United States (Ordin,
1992). Sauter, Murphy, and Hurrell (1990), in collaboration
with an international network of scientists and researchers,
framed a national strategy to deal with this occupational
health risk and the psychological distress that all too often
results. However, OHP's historical roots predate the 1990s
in both NorthAmerica and Europe, especially Scandinavia.
Psychologists have a long history of concern for occupa-
tional health in industrial organizations, beginning with
Miinsterberg's attention to injuries and accidents in the late
1800s (Offerman & Gowing, 1990), followed by Kornhaus-
er's lifelong attention to industrial attitudes, conflict, and
labor-management relations (see,e.g., Komhauser, 1965)
and Kahn's focus on role conflict and ambiguity in organiza-
tions during the 1960s (see Kahn, Wolfe, Quinn, Snoek, &
Rosenthal, 1964). James at Harvard and Meyer at Johns
82
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2. REVIEW ARTICLE 83
Hopkins raised awareness of mental hygiene early in the
century (see Winters, 1952), and Elkind (1931), the first to
use the term preventive management, extended their con-
cerns into industry and applied psychology, psychiatry, and
mental hygiene to industrial relations, human nature in
organizations, management, and leadership. Chesney and
Feuerstein (1979) applied behavioral medicine in occupa-
tional settings, with emphasis on prevention, remedial
intervention, and behavioral assessment and evaluation.
During the 1980s, the American Psychological Association
collaborated with the National Institute for Occupational
Safety and Health to extend this tradition (see, e.g., Quick,
Camara, et al., 1997).
In addition to this North American tradition, important
Scandinavian research beginning in the 1970s investigated
work life from the workers' health perspective. Gardell's
(1971) early work focused on the problem of alienation and
the threat to human dignity posed by mechanization and
bureaucracy. Later Gardell (1981) examined the psychoso-
cial aspects of various production technologies, suggesting
that some of the psychosocial problems were preventable.
Frankenhaeuser, Levi, and Gardell (1982) considered both
the physiological and psychological stresses of working life,
with particular attention to strategies for social change and
the stressful aspects of mass production technology, highly
automated work processes, and shift work. Frese pulled
together this Scandinavian and European tradition with the
North American tradition advanced by Kahn and others, to
address the psychopathology associated with industrial
organization (see Frese, Greif, & Semmer, 1978). These
traditions set the stage for emerging OHP.
Occupational Health Psychology:
Emerging From a Convergence
OHP is an emerging specialty in the science, practice, and
profession of psychology. The blend of public health and
preventive medicine with health and clinical psychology
reflects two primary, converging disciplines essential to
OHP. Public health and preventive medicine have a unique
body of knowledge and practice to blend with health and
clinical psychology to the emerging OHP. Further, the
converging blend of these unique bodies of knowledge and
practice need to be extended in industrial/organizational
contexts if OHP is to emerge with its own unique, special
focus. The organizational context is a distinguishing feature
of the science, practice, and profession of OHP. Contribu-
•tions from industrial/organizational psychology and organi-
zational behavior are essential to OHP. The organizational
context brings focus to OHP and distinguishes it from other
specialties, such as community health psychology, that focus
on broader population concerns.
Public health and preventive medicine are concerned with
the health of human populations. Acentral element of public
health and preventive medicine relevant to occupational
health psychology is epidemiology and the study of disease
epidemics. If an epidemic is denned by the speed and
pervasiveness with which a disease or disorder penetrates a
human population, along with the severity and intensity of
its impact, work-related psychological distress may not yet
qualify as an epidemic in American organizations. However,
work-related psychological distress is of vital importance to
well-being at work because it continues to be among the top
10 occupational health risks in the United States. Therefore,
it is time to embrace the epidemiologist's practice of
building surveillance systems, both passive and active, to
monitor health risks and their adverse impacts on people.
The public health battlefield and associated burden of
suffering have shifted from acute and infectious diseases
early in the century to the chronic and noninfectious diseases
at the close of the century (Cohen, 1985). Because behav-
ioral factors are much more important in the chronic
diseases, this public health trend suggests an increasingly
important role for health psychology in caring for human
populations.
Health psychology is concerned with the behavior-
physical health connection, with consideration given to
attitudinal and cognitive moderators of these relationships,
whereas clinical psychology is ultimately concerned with
helping people to become as whole and functional as
possible. The growing interface between health psychology
and public health is reflected in Health Psychology's special
section; "Health Psychology and Public Policy" (Kaplan,
1995), with its consideration of the health psychology
workforce and other public policy issues. Further, the
consideration given to epidemiology when considering
behavioral and sociocultural issues in ethnicity and health
reflects a public health influence within health psychology
(Flack etal., 1995).
Organizational behavior andindustrial/organizational psy-
chology provide an essential context for OHP, which is the
organization in which goods are produced or services are
delivered. Leaders, executives, and scholars of all forms of
organization desire healthy, vital, vibrant people working
within an effective and productive organizational environ-
ment to fulfill their missions, hence, the importance of
healthy people in healthy work environments.
Preventive Health Management
Organizational and individual health are essential to high
individual performance and organizational effectiveness.
Organizational and individual health are necessary, although
not sufficient, enabling forces to fuel high levels of achieve-
ment. Ilgen (1990) has examined five approaches to health at
work: (a) safety, (b) early ergonomics, (c) wellness, (d)
medical, and (e) systems. The systems view, whichIlgen has
advocated, is highly compatible with the public health
notions of prevention, which, when translated into an
organizational context, form a framework for the preventive
management of occupational health. This shift to a systems
and prevention view was noted by Cohen (1985) on the basis
of a shift in the focus in health from the acute and infectious
diseases to the chronic ones, where simple cause (e.g.,
infectious agent)-and-effect (e.g., acute disease) models
breakdown.
Figure 1 presents a framework for preventive health
management and identifies three levels of preventive inter-
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3. 84 REVIEW ARTICLE
Organizational health context Preventive medicine context
Organizational demands
andoccupational health risks
Primary prevention Health risk
factors
Low intensity, low cost
individual and organizational
health problems
Secondary prevention
Asymptomatic disorders,
behavioral problems
and disease
High intensity, high cost
individual and organizational
health problems
Tertiary prevention Symptomatic disorders
and disease
Figure 1. A framework for preventive health management.
vention: primary, secondary, and tertiary. Primary preven-
tion is the preferred point of intervention in preventive
medicine and aims to identify, then eliminate or mitigate,
health risks. Secondary prevention is the next best alterna-
tive and aims to arrest diseases or disorders at theasymptom-
atic stage. Tertiary prevention is available where primary or
secondary prevention have failed, affording individuals
therapeutic relief. These three prevention strategies form a
basis for intervention in the organizational health context.
Preventive management is well suited to chronic occupa-
tional health problems, just as preventive medicine is well
suited to chronic as opposed to acute health problems, and
primary prevention aims to manage organizational demands
and occupational health risks. Secondary prevention aims to
arrest and manage low-intensity, low-cost health problems,
whereas tertiary prevention addresses high-intensity, high-
cost health problems. OHP seeks to develop healthy people
in healthy organizations, recognizing their interdependency
(see Quick, Quick, et al., 1997, Principle 1,pp. 150-151).
Prevention is one important theme in OHP, as it is in
health psychology and as noted in the mission statement of
the Journal of Occupational Health Psychology (JOHP).
JOHP is one vehicle through which OHP is defining itself.
JOHP has three key foci: The first is on the organization and
work environment, with particular attention to organiza-
tional demands, occupational health risks, and direct as well
as indirect costs of health problems. The second focus is on
the individual, behavior, and psychology, with particular
attention on health-risk vulnerability as well as on behav-
ioral, medical, and psychological health problems. The third
focus is on the work-family interface. Work and family life
are more integrated in agrarian societies, and it is only with
the advent of the Industrial Revolution that a bifurcation
between work and home life has developed (Scott, 1967).
Each of the three foci is developed separately.
The Organization and the Work Environment
One school of thought suggests that a large portion of the
variance in individual and organizational distress is ex-
plained by variables in the organization and the work
environment. A central variable in this school of thought is
control, alternatively called self-determination and job deci-
sion latitude (Gardell, 1987; Sauter, Hurrell, & Cooper,
1989; Theorell & Karasek, 1996). The emphasis in this line
of research is on an attribute of the psychosocial work
environment, as opposed to an attribute of the physical work
environment, and the evidence suggests that long-term
exposure to low workcontrol is a risk factor for cardiovascu-
lar disease mortality (Johnson, Stewart, Hall, Fredlund, &
Theorell, 1996). Siegrist (1996) has drawn attention to
another organization and work environment set of condi-
tions that may be equally distressing. In two independent
studies, high-effort-low-reward conditions were particularly
stressful, explaining some of the prevalence of cardiovascu-
lar risk factors, such as hypertension and atherogenic lipids.
If one accepts this school of thought and the evidence on
which it is based, then one is led to the use of primary
prevention strategies to alter the natureof the organization or
the work environment to prevent or alleviate the resultant
distress. The host of primary prevention strategies include
performance-planning systems, participatory leadership and
management systems, and flexible work-scheduling pro-
grams (Quick, Quick, et al., 1997). Although primary
prevention strategies can go only so far in accommodating
the design of the organization and the work environment to
the individual, primary prevention at the societal level, such
as through health-related labor legislation, has played a
significant role in improving worker health in parts of the
world. However, primary prevention for enhancing health at
work does not provide a comprehensive solution to address-
ing organizational and individual distress.
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4. REVIEW ARTICLE 85
The Individual Variable
Although primary prevention throughenvironmental modi-
fication, reengineering, and risk reduction is the preferred
point of interventionfrom a public health standpoint, OHPis
not public health. A second school of thought in OHP
suggests that the individual and his or her behavior consti-
tute a primary source of variance in explaining individual
and organizational distress and ill health. In this arena,
health psychology has much to offer individuals in organiza-
tions and work environments. For example, Porter (1996)
has taken an addiction view of workaholism, or excessive
work behavior. Individuals vary in the degree to which they
(a) spend long hours on the job, (b) set high performance
standards, (c) experience high job involvement, (d) control
work activities, and (e) personally identify with their job.
Working to integrate theory across domains, Porter has
suggested the research potential and importance of worka-
holism to further the discipline of occupational health
psychology.
There are two primary emphases in this school of thought.
One emphasis attempts to identify variables, such as worka-
holism (Porter, 1996), defensive hostility (Helmers et al.,
1995), or cognitive-affective stress propensity (Wofford &
Daly, 1997), which account for individual vulnerability to
demands, stressors, and health risks. Another emphasis
attempts to identify the secondary prevention strategies
effective in strengthening the person against the inevitable
demands, stressors, and health risks to which he or she is
exposed at work. For example, in a study of the buffering
effect of social support, Peirce, Frone, Russell, and Cooper
(1996) found tangible support to moderate the financial
stress-alcohol involvement relationship, whereas, in con-
trast, neither appraisal nor belonging support revealed a
buffering pattern. For an exercise example, Wilcox and
Storandt (1996) found exercisers to be significantly more
self-motivated, with greater exercise self-efficacy, than non-
exercisers, and Ilgen (1990) noted exercise as a key health-
related behavior targeted by wellness programs at work.
Although not discounting the role of organizational
demands and health risks, this school of thought works to
change the individual and is predisposed to accept the
organization and work environment as a given. OHP recog-
nizes the legitimacy of both schools of thought and works to
serve as an overarching rubric under which both may carry
on a constructive dialogue. The effort to achieve integration
in these two schools of thought is reflected in person-
, environment (P-E) fit models, such as to stress (Edwards,
1996). P-E fit models help explain distress on the basis of
poor P-E fit.
The Work-Family Interface
Whereas the first two foci in OHP offer alternative
explanations for distress at work, the third recognizes that
life is composed of more than work. Some believe that work
is the central concern of life and that salvation is achieved
through works, not grace (Weber, 1930). Actually, the
tension between work and family life has increased since the
advent of the Industrial Revolution (Scott, 1967), and OHP
recognizes the importance of the interface between these
two domains. For example, Frone, Russell, and Barnes
(1996) found that work interfering with family life and
family life interfering with work were uniquely related to
depression, poor physical health, and heavy alcohol use in a
study of over 1,000 employed parents in two community
samples. Success in the work domain is possible, evenwhen
one's iamily life has a high priority, if one achieves balance
between these two domains. The life and work of leaders,
corporate executives, and entrepreneurs (both women and
men) who manage stress well through supportive, secure
interpersonal relationships at work and at home exemplify
this balance (Quick, Nelson, & Quick, 1990). As women
have achieved increased occupational success (see, e.g.,
Powell & Butterfield, 1994), the gender perspectives on the
work-family interface may well be converging.
Applying Occupational Health Psychology in Practice
Avenues for effective application of OHP in practice
abound. Applying OHPrequires a collaborative undertaking
of psychologists and nonpsychologists, including industrial/
organizational, health, and clinical psychologists as well as
leaders, executives, employees, unions, and human resource
and health care professionals. In this section, I discuss three
practical applications of OHP, which exemplify how a chief
executive, a psychologist, and a team of medical and public
health professionals have used the concepts in three very
different organizations: Chaparral Steel Company, the U.S.
Air Force, and Johnson & Johnson. OHP should concern
itself with both the health and the human side of the
enterprise, as well as with individual and organizational
performance, and should be data based, in the epidemiologi-
cal tradition of Tyler and Last (1992), drawing on indicators
and metrics of health and performance at work.
Chaparral Steel Company
OHP is a leadership challenge, and Gordon Forward
displayed uncommon leadership in the design, development,
and implementation of an occupationally healthy work
environment at Chaparral Steel Company (Midlothian, TX;
Forward, Beach, Gray, & Quick, 1991). For example, after 3
months of observation and over three dozen interviews,
eight graduate students concluded that there was a consis-
tency between the occupationally healthy theories espoused
by Chaparral's officers and their daily patterns of action and
behavior (Quick & Gray, 1989/1990). Chaparral has set a
standard for American industrial excellence by designing an
organizational culture that is people friendly and productive.
Advancing the idea of mentofacturing (vs. manufacturing),
Forward set out a quarter of a century ago to develop an
organization that emphasized learning, human development,
risk taking, and technology transfer.
Chaparral values people as human resources, not labor
costs,' and links its people with its strategy through the
founder's values of trust, challenge, learning, risking for
achievements, and work as fun. Leonard-Barton (1992) has
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5. 86 REVIEW ARTICLE
explored the dynamics of Chaparral as a learning laboratory
and complex organizational ecosystem. The central notions
of the Chaparral Steelculture, andits underpinningphilosophy of
mentofacturing, engage the mind and spirit of each person,
without making work overshadow other life domains.
Chaparral monitors both the performanceand human side
of the enterprise. For example, from 1996 to 1997, sales
increased from $605 million to $611.5 million while net
income increased from $44.3 million to $46.3 million and
labor productivity stayed at the top of the industry at 1.3
man-hours per ton of steel. In 1998, 50% of Chaparral's
employees were in formalized educational programs. Al-
though overall turnover ran 13% in 1997 with a strong
economy, turnover continued at around 4%-5% for employ-
ees who passed the 3.5-year Apprenticeship Program, and
50% of Chaparral's employees had over 10 years of service.
Chaparral's accident-injury rates are very low (a frequency
of 9/million man-hours for the history of the company,with
rates of 5/million and 6/million for 1996 and 1997).
U.S. Air Force
Another organizational example of applying OHP is
illustrated in the context of the U.S. Air Force. Joyce Adkins
of the U.S. Air Force Biomedical Sciences Corps pioneered
an organizational health center, first implemented in 1993 at
the Sacramento Air Logistics Center, McClellan Air Force
Base, Sacramento, CA (Adkins & Schwartz, 1996). The
mission of an organizational health center is to maximize
human potential and productivity through optimal health:
physical, behavioral, and organizational. The goals of the
organizational health center correspond to the national goals
for the prevention of work-related psychological disorders
(Sauter et al., 1990): to improve working conditions through
organizational intervention; to monitor psychological disor-
ders and risk factors at work; to provideinformation, education,
and training;and to enrichthe psychological health services for
all employees. These goals are achieved through six pro-
gram elements: community services coordination, organiza-
tional consultation, information brokering, specialized pro-
gram development and management, worksite support and
conflict resolution, and research and evaluation.
Some of the tangible results realized in the 1st year of
operation showedthe following (Adkins, 1995): First, a total
cost reduction in workers' compensation of 3.91%, com-
pared with a near doubling of baseline data between 1985
and 1993. Although this is a substantive savings equal to
$289,099, note that there was a systemic decline in workers'
compensation throughout the state of California during this
period. Second, medical visits and health care utilization for
job-related illness and injury decreased by 12%, with a
savings for lost productivity alone of $150,918. Third, there
was a decrease in premature mortality rate and associated
productive years lost savings of $5.4 million (120 produc-
tive years multiplied by $45,000 per year average cost of
labor per year), to include a decrease of 10 behaviorally
related deaths. These results are positive and caution is
appropriate, so as to not overinterpret early results from
OHPstrategies and interventions.
Johnson &Johnson
In 1978 Johnson & Johnson developed a comprehensive
health-promotion program called Live for Life, which
includes health-risk assessments, education and behavioral
change materials, and fitness center programming and
management. The health-risk assessments look in-depth at
lifestyle behaviors and practices that impact health status for
the individual, including health, stress, fitness, time manage-
ment, blood pressure, safe home, and ergonomics. The
Action Program Guide units are organized into topical areas,
including stress management, weight management,nutrition
and cholesterol management, medical, smoking cessation,
exercise education, safety, ergonomics, blood pressure man-
agement, and anger management. Physical fitness and
exercise is another major component of the Johnson &
Johnson comprehensive program.
Research on the program across Johnson & Johnson
companies found improvements in exercise, physical fitness,
and employee attitudes. Blair, Piserchia, Wilbur, and Crow-
der (1986) found that daily energy expenditure in vigorous
activity increased 104% among employees in companies
offering the health promotion program, compared with a
33% increase among employees at comparison companies.
Holzbach et al. (1990) found positive change in attitudes
toward commitment, supervision, working conditions, job
competence, pay and benefits, and job security in a 2-year
study. Comparing two health promotion groups in the Live
For Life Program and one control group, Bly, Jones, and
Richardson (1986) found (a) lower mean in-patient health
care cost increases ($43 and $42 vs. $76), (b) lower rates of
increase in hospital days, and (c) no difference in outpatient
and other health care costs between groups.
Workplace health promotion programs, such as Johnson
& Johnson's, which have developed during the latter part of
the twentieth century, are distinguished by, first, individual
behavior change with, second, physical fitness and exercise
as the centerpiece. The payoff periods for these programs are
often long and uncertain, and evaluation research is neces-
sary (Ilgen, 1990; Landy, Quick, & Kasl, 1994).
Conclusion
OHP is emerging from the convergence of public health
and preventive medicine withhealth and clinical psychology
in an industrial/organizational context. As this process
continues, OHP refines its focus as a specialty within the
science, practice, and profession of psychology. OHP re-
quires interdisciplinary and multidisciplinary research and
practice among the specialties from which it is emerging.
These efforts aim to build and extend theories, to design and
conduct basic, applied, and evaluative scientific research,
and to translate the results for public policy and business
practice. OHP is in need of organizational and human
systems that enable it to fulfill its mission: to create healthy
workplaces in which people may produce, serve, grow, and
be valued.
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6. REVIEW ARTICLE 87
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