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IJOMEH 2010;23(3) 225
O R I G I N A L P A P E R S
International Journal of Occupational Medicine and Environmental Health 2010;23(3):225 – 238
DOI 10.2478/v10001-010-0024-5
PSYCHOSOCIAL RISKS AND WORK-RELATED
STRESS IN DEVELOPING COUNTRIES:
HEALTH IMPACT, PRIORITIES, BARRIERS
AND SOLUTIONS
EVELYN KORTUM, STAVROULA LEKA, and TOM COX
University of Nottingham, Nottingham,UK
Institute of Work, Health and Organisations
Abstract
Objectives: The current research explores experts’ perceptions of psychosocial risks and work-related stress in emerging
economies and developing countries1. This paper focuses on knowledge of potential health impact of psychosocial risks
and preliminary priorities for action, and discusses potential barriers and solutions to addressing psychosocial risks and
work-related stress in developing countries. Materials and Methods: This research applied a mixed methodology includ-
ing semi-structured interviews, two rounds of an online Delphi survey, and four focus groups. Twenty nine experts with
expertise in occupational health were interviewed. Seventy four experts responded to the first round of an online Delphi
survey and 53 responded to the second round. Four groups of experts with a total of 37 active participants with specific or
broader knowledge about developing country contexts participated in focus group discussions. Results: High concern was
expressed for the need to address psychosocial risks and work-related stress and their health impact. Developing country
experts’ knowledge about these issues was comparable to knowledge from industrialized countries, however, application of
expert knowledge was reported to be weak in developing countries. Socio-economic conditions were regarded as important
considerations. Priorities to be addressed were identified, and barriers to implementing possible solutions were proposed.
Conclusion: The future research and action paradigms in relation to psychosocial risk management will need to be broad-
ened to include the larger social, political and economic contexts in developing countries beyond issues focusing solely on
the working environment. Work-related psychosocial risks and the emerging priority of work-related stress should urgently
be included in the research and political agendas and action frameworks of developing countries.
Key words:
Psychosocial risks, Work-related stress, Developing countries, Health outcomes, Policy development, Globalization
Address reprint request to E. Kortum, Institute of Work, Health and Organisations, International House, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
(e-mail: lwxek1@nottingham.ac.uk).
1 As of here referred to as ‘developing countries’.
INTRODUCTION
Over the past decades, the world has seen a shift of in-
dustry and services to developing countries. This often
seems to be connected to higher productivity and multina-
tionals have been reported to often enjoy the absence of
(or presence of weak) regulatory systems to benefit their
profit margins [1,2] resulting in jobs hazardous to workers’
health. Generally, the growth of large multinational com-
panies has been accompanied by greater decentralization,
outsourcing and flexible work environments, with wide
variations in the conditions of work and in exposure to oc-
cupational hazards [3] and linked to poor working condi-
tions followed by high incidence of occupational diseases
and accidents. Voyi stresses that poorer countries remain
indebted to the rich, so resources are ever-scarce for their
own development, which causes an ethical vacuum and
a negative impact on workers’ health. Without effective
interventions internationally, the process of globalization
could be used to take advantage of vulnerable people [4].
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IJOMEH 2010;23(3)226
controlling emerging health concerns such as work-related
stress and its consequences.
On the one hand, there is no one common global denomi-
nator and language on the topic of stress, but only a more
general understanding of the phenomenon (especially
when comparing industrialized countries with develop-
ing countries). On the other hand, it is well documented
in industrialized countries that have an abundance of
research that psychosocial hazards have the capacity to
affect the physical, mental and social well-being of work-
ers and that there are a number of real risks involved.
However, there is a true gap of coherent research in de-
veloping countries to provide an insight into the nature
of work-related stress and the psychosocial working con-
ditions that may cause it.
Knowledge in this area in industrialized countries is
a result of the accumulation of data consistently point-
ing to the high prevalence of these issues in the modern
workplace. In Europe, for example, the fourth European
Working Conditions Survey [13] found that from a sample
of 21 000 wor kers, 28–29% reported that work-related
stress affected their health. Mental health problems and
stress-related disorders are the biggest overall cause of
early death and overall health concern in Europe [14].
In 2001, the European Council of Ministers concluded
that “stress and depression related problems […] are of
major importance […] and significant contributors to the
burden of disease and the loss of quality of life within the
European Union”. They underlined that such problems
are ‘common, cause human suffering and disability, in-
crease the risk of social exclusion, increase mortality and
have negative implications for national economies’. Sub-
sequent action by the European Social Partners resulted
in two framework agreements on work-related stress [15]
and on harassment and violence at work [16].
Awareness and action in developing countries is far off the
successes experienced in the industrialized world. Undoubt-
edly there are potential differences in the awareness and
knowledge about prevention of work-related stress and psy-
chosocial hazards in industrialized as opposed to develop-
ing countries. The scarcity of research does not facilitate the
understanding of these differences, although some studies
Voyi’s argument becomes even stronger with the fact
that 80% of the world’s GDP is produced in industrialized
countries and only about 20% in developing countries.
In other words, one fifth of the world’s working popula-
tion produces four fifths of the world GDP [5]. It follows
that wealth and prosperity are extremely unequally shared
between developing and industrialized countries. This is
despite the fact that 80% of the global workforce resides
in the developing world [6], and is employed in unhealthy
and unsafe working conditions [7].
Already in 1995, the World Health Organization alerted
that approximately 30–50% of workers report hazardous
physical, chemical or biological exposures or overload of
unreasonably heavy physical work or ergonomic factors
that may be hazardous to health and to working capacity;
an equal number of working people report psychological
overload at work resulting in stress symptoms [8]. World-
wide there is no evidence that there has been any improve-
ment of this unacceptable situation.
So why is still so little being done? Some experts reiter-
ate that the inadequacy of funding allocations impedes the
development of international occupational health, partly
due to the fact that other health issues compete with occu-
pational health [9]. Another general issue pertains to the
fact that occupational diseases emanating from physical
and psychosocial hazards are not included in the definition
of easily preventable diseases. In fact, decision-makers
in most developing countries still perceive occupational
health as a luxury, which is one reason for lack of politi-
cal action [10], poor data collection, and weak enforce-
ment of occupational health and safety regulations. These
emerging trends are accompanied by the growth of service
industries which has been associated with an increase in
stress-related diseases [11].
Work-related stress in developing countries is one of the
areas which have not yet been quantified owing to lack of
data on exposure or causality, important exposures and
outcomes [12]. The lack of research in this field and the
struggle with other well-known and traditional occupa-
tional risks (chemicals, biological and physical hazards)
may present one major barrier that prevents developing
countries from developing awareness and addressing and
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respondents’ understanding and conceptualization of
work-related stress and psychosocial risks, one question
that assessed the level of concern attributed to these
issues within the context of the developing world, one
question that asked about effects on health of psycho-
social risks and work-related stress, and a last question
that addressed urgent workplace priorities for action.
Twenty nine individuals from developing countries were
interviewed. Table 1 outlines the participants’ demo-
graphics. Thematic analysis was applied to analyse the
interview data.
Delphi surveys
A two-tiered investigation based on the Delphi sur-
vey methodology aimed at further exploring key issues
identified in the interviews to complement the empirical
exploratory data. The goal of the Delphi process is to
systematically facilitate communication of information
via several stages and to define priorities with respect to
the research area. Seventy four individuals responded
to the first online survey. Before the second round, the
survey answers were analyzed and a choice of ten an-
swers for each question retained, which represented the
highest results yielded from the first round study. These
were used to design the questionnaire for the second
round of the Delphi study to which 5� respondents re-
plied.
Table 2 outlines the demographics of the participants. Re-
spondents were asked to rank their answers in the order
of most important to least important. The ten top choices
were prioritized and the five highest results were retained
from developing countries have replicated findings of stud-
ies in industrialized countries [e.g., 17–19]. To obtain a bet-
ter general understanding, and pave the way for including
these emerging issues into the research and political agenda
of developing countries, this research drew on developing
country expert knowledge pertaining to the importance and
impact of psychosocial risks and work-related stress in the
developing country working environment.
MATERIALS AND METHODS
Study population
Experts from developing countries were actively recruited
from all global regions as proposed by the WHO categoriza-
tion2 to collect a suitable breadth of data, and yield a more
holistic representation of the developing world context. They
completed an online registration form with the following cri-
teria: (a) expertise in a field related to occupational health;
psychology, sociology, epidemiology, medicine, psychia-
try, etc.; (b) number of years of experience in their respective
field; (c) basic knowledge on workplace interventions and/or
legalisation on psychosocial risks at work; and (d) a degree
of practical experience in the application of methods or in-
terventions that concern psychosocial risks at work.
Expert interviews
An interview schedule was developed based on a sci-
entific literature review. This paper discusses key find-
ings in relation to three questions that explored the
2 The Americas (AM), the African (AF), Eastern-Mediterranean (EM),
European (EU), South-East Asian (SEA), and Western-Pacific (WP) regions.
Table 1. Interview participant demographics (participant distribution — 29 expert interviews)
Global region* N Countries discussed
African region 8 Namibia (4)**, Nigeria, South Africa (2), Zambia
Americas 5 Trinidad and Tobago, Chile, Colombia, Mexico, Puerto Rico
Europe 2 Albania, Macedonia
Eastern-Mediterranean 5 Iran (�), Tunisia, Pakistan
South-East Asia 6 India (3), Malaysia, Thailand (2)
Western-Pacific � China, Federated State of Micronesia, Vietnam
* According to the WHO Global regions.
** The number in brackets are the number of nationals who participated in the study if more than one participant.
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IJOMEH 2010;23(3)228
involves the use of in-depth group interviews and discus-
sions about a particular topic. At this stage, preliminary
findings are presented.
RESULTS
Understanding of psychosocial risks
Findings from interviews, a two-tiered Delphi survey,
and focus groups contributed to a reasonably good un-
derstanding of psychosocial risks and work-related stress.
The two concepts seemed interchangeable and par-
ticipants did not make significant distinctions between
for data analysis and development of graphs. The analy-
sed results yielded indications for priorities for research as
identified by the participants.
Focus groups
Four focus groups with multi-disciplinary experts, with ex-
pertise, or related expertise, in occupational health were
held between March and November 2008. Thirty seven ac-
tive members contributed to the discussions. They were
from, or had broad knowledge about, developing country
working environments. Table � outlines the participants’
backgrounds. Focus groups are based on a technique that
Table 2. Delphi I and II participants
Regions
Participants
Professional background*
Delphi I Delphi II
Primary region AF (11)** AF (�) Psychiatry, social work, medicine,
psychology, epidemiology,
OH expert, sociology, ergonomics
Others:
environmental management/
OH&S (hazard identification/risk
assessment); HR development
& organization development;
work-organizational psychology;
environmental health,
OH psychology; anthropology
and development; organizational
behaviour/HR management;
OH&S; social epidemiology; health
psychology; social psychology;
stress & health; work physiology,
occupational medicine
AM (14) AM (8)
EM (4) EM (5)
EU (29) EU (24)
SEA (7) SEA (7)
WP (9) WP (6)
Secondary region,
if indicated
AF (11) AF (6)
AM (1�) AM (10)
EM (5) EM (5)
EU (30) EU (19)
SEA (7) SEA (9)
WP (8) WP (4)
Countries including
primary and
secondary regions
AF: Angola, Botswana, Burkina Faso, Ghana, Kenya, Namibia, Nigeria,
South Africa, Uganda, Zimbabwe
AM: Australia, Canada, Chile, Colombia, Haiti, Mexico, Panama,
Puerto Rico, Trinidad and Tobago, United States of America
EM: Afghanistan, Brunei Darussalam, Egypt, Iran (Islamic
Republic of), Pakistan, Tunisia
EU: Albania, Belgium, Bosnia and Herzegovina, Bulgaria, Czech
Republic, Denmark, Finland, France, Germany, Ireland, Kyrgyzstan,
Lithuania, Netherlands, Poland, Portugal, Norway, Spain, Sweden,
Switzerland, Turkey, UK, USA
SEA: India, Indonesia, Nepal, Republic of Korea, Sri Lanka, Thailand
WP: Australia, China, Malaysia, Micronesia (Federated States of),
Viet Nam
According to the WHO classification of the world: AF — African region; AM — Americas; EM — Eastern Mediterranean; EU — Europe;
SEA — South-East Asia; WP — Western Pacific region.
* The Delphi survey provided the possibility for several choices.
** The number in brackets are the number of nationals who participated in the study.
OH — Occupational Health, OH&S — Occupational Health and Safety.
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Work context includes the organization of work, work
schedule, physical safety provisions and interpersonal
relationships. Macro issues, beyond the workplace, were
also reported and included socio-economic conditions
such as conflict, poverty, job insecurity, unemployment,
social, political, economic, cultural and religious struc-
tures, the prevalence of HIV/AIDS, and the impact of
globalization. All participants responded that psychoso-
cial risks are of concern to workers’ health and should
be addressed in developing countries. Table 4 provides
the details.
them. They were explained in terms of work content and
work context. Work content pertains to the working en-
vironment and conditions� and employment conditions4.
� General conditions of work define, in many ways, people’s experience of work.
Minimum standards for working conditions are defined in each country but the
large majority of workers, including many of those whose conditions are most
in need of improvement, are excluded from the scope of existing labour protec-
tion measures. Source of extract: http://www.ilo.org/public/english/protection/
condtrav/wordcond/index.htm
4 Conditions or circumstances in which a person is engaged in a job or occupa-
tion. Very frequently this involves an agreement or relationship between an em-
ployer that hires workers and an employee who offers his/her labour power… in
poor countries agreements are not explicitly subject to any contract, and the in-
formal sector employment forms a high proportion of total employment. Source
of extract: World Labour Report 2000. Income security and social protection in
a changing world. Geneva: ILO; 2000, and other sources.
Table 3. Focus group participants
Sex
Primary country
or country of origin
Secondary country
or developing country
best known
Professional
background
N
F Australia Occ Psychologist �
F Australia Malaysia Ergonomist 1
F Chile OH expert 1
M China Occ Health Medicine 1
F China OH expert 1
M China OH expert 2
F Colombia OH expert 2
M Colombia OH expert 1
F, M Egypt OH expert 2
F Germany Occ Psychologist 1
M Germany India Occ Health Medicine 1
F Hong Kong Occ Psychologist 1
M India Occ Psychologist 1
F India OH&S expert 1
M Mexico OH Expert 4
M Nigeria OH Expert 1
M Panama OH Medicine 1
F Peru OH Expert 1
F Philippines OH&S expert 1
F Poland OH Expert 1
M Portugal Occ Psychologist 1
F Serbia Occ Psychologist 1
F South Korea Occ Health Medicine 1
F Taiwan OH expert 1
F Turkey OH&S expert 1
F UK Occ Psychologist 1
F Ukraine Psych Therapist 1
F USA African country Occ Psychologist 2
Total �7
F — female, M — male.
Occ — Occupational, OH — Occupational Health, OH&S — Occupational Health and Safety.
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