The relationship between stress and health:
a guide for organisers and shop stewards in the bus

This information is produced by the joint working group on health and safety in urban transport (comprising ITF affiliates' representatives and academic researchers).

Stress is a trade union issue

Do the bus drivers you represent experience any (or all) of the following?

• bone or muscle pains (especially back)
• headaches
• frequent tiredness
• swollen or upset stomach
• shortness of breath
• numbed or tingling limbs
• dizziness
• difficulty in sleeping
• high blood pressure
• occasional pain in the chest or heart area
• mental overload.

Do they feel stressed by any or all of the following?

• the possibility of assault by passengers
• traffic congestion and peak running times
• the risk of carrying large amounts of money
• lack of information about company management, and no chance to suggest changes
• no recognition of work well done.

If so, they are not alone.  Read about your rights to fight for:

layout, design and mechanics of the cabin (ergonomics)
timetables, shift schedules and break periods
reducing stress by getting the voice of workers heard and improving relations at work
reducing stress by improving personal safety and fitness.

Rights to fight for

• physical comfort and safety
• sufficient rest
• workers’ voice to be heard
• personal safety and fitness.

Many studies have been conducted amongst bus drivers. The ITF joint working group on health and safety in urban transport is aware of at least 32 studies.  All of them show that bus driving is a high risk occupation.

Bus drivers tend to be absent due to sickness more often than workers in other occupations, and they go on ill health or disability retirement more often.  This means bus companies have very high turnovers amongst drivers.

But bus driving doesn’t have to be this way.  There are many ways in which the health risks can be eliminated or reduced.  There are also many ways in which drivers already suffering from stress related illnesses can be helped to cope with the effects or can be treated.  The improved health of bus drivers is not only in workers’ interests, but can also result in reduced stress for their families.  In addition reduced absenteeism and reduced turnover means reduced costs to the employer.

The studies have shown that there are a number of sources of stress and illness in the workplace for bus drivers, and a number of fairly obvious solutions.  The key areas for change are the layout and design of the bus (ergonomics), working time, and rest periods, and good relations at work, including management listening to the voice of workers.

Layout, design and mechanics of the cabin (ergonomics)

Bus compartments are often uncomfortable, inflexible, and exposed to the elements which makes them too hot or too cold. No allowance is made in the design for drivers of different height or weight. The ideal cabin design should include the following:

• The driver’s seat should be vertically and horizontally adjustable and have adjustable lower back support and adjustable springs. The controls for adjusting the seat must be easy to operate.
  
• The steering wheel should be no more than 460 mm in diameter and be adjustable along the axis of the steering column. Its angle of inclination should also be adjustable.
  
• The pedals should be within easy reach for small and tall drivers alike. They should have equal angles.
  
• The dashboard should have easy to read displays which are arranged according to functions and frequency of use. It should be easy and safe to operate all manual controls, especially emergency controls.
  
• Big and small drivers must be able to enter and leave the working space easily, and effective heating and cooling systems should be provided for the cab.
  
• New drivers should always be provided with proper training and retraining must be provided for all drivers when new models are introduced.

Timetables, shift schedules and break periods

There is a common myth that drivers are the "boss of the bus".  In reality bus drivers often feel themselves to be prisoners of the timetable and unpredictable or unsocial shift times.  They often feel helpless in the face of conflicting demands on them to stick to the timetable, drive safely, and provide a friendly service to passengers.

This powerlessness, or "low autonomy" as the experts call it, is in itself a cause of stress.  Working-time practice should include

• The working week should not be more than 40 hours, and the normal working day not more than eight hours.
  
• No driver should be allowed to drive continuously for more than four hours without a break. Ideally a twenty minute break should be provided after two hours of continuous work. Drivers should be able to use their breaks to refresh and replenish themselves.
  
• There should be enough time in the working day to reduce the conflict between the demand to stick to the timetable and the need to drive safely. This conflict is the underlying cause of a great deal of stress for drivers, resulting in them either driving too fast or being continually behind schedule.
  
• The daily rest of drivers should be at least 11 consecutive hours, and split shifts should be avoided.
  
• Assignments (routes, times, etc) should be regular and predictable, not day-to-day.
  
• Days off should be guaranteed and should be at least two days at a time.

Reducing stress by getting the voice of workers heard and improving relations at work

We talked above of the problem of powerlessness or "low autonomy" experienced by bus drivers.  This problem is made worse through the isolation that many drivers experience as a result of working alone in the bus.  Democratisation of the workplace by the introduction of greater worker participation in decision making can play an important role in reducing stress and illness.  There are also a range of other physical and social interventions which can be pursued in order to help prevent or cure stress and illness. Some examples of social improvements are:

• Improved consultation procedures where the workforce is involved in any changes, e.g. to timetables, and where their views are taken seriously. Improved information flow within the company so that everyone knows what is going on.
  
• Allowances should be made for the workplans to be adjusted for individuals with special needs, e.g. older drivers, those with serious health complaints, and those recovering from an illness. Any such allowance must of course not make conditions worse for the rest of the workforce.

Reducing stress by improving personal safety and fitness

• On certain high-risk routes or during night shifts, various measures should be considered including two persons on the bus and alarm buttons or two way radios. Drivers to be trained in dealing with aggressive passengers and supervisors to be trained in coping with drivers who have been assaulted or intimidated.
  
• A range of re-education programmes should be considered including instruction by medical professionals on improving posture whilst sitting in the driving seat, learning how to stretch muscles and reduce muscular tension; stress management courses; and voluntary physical fitness programmes.

Steps to take

If you have found the above useful and wish to plan a set of proposals to your local management then consider the following six steps.

Gather background information
Do some background work on absenteeism, early retirement, accident rates and so on in the company. If you cannot get the statistics from management then do a simple survey of workers. Statistics may help you to get the company to agree to investigate stress and illness more thoroughly.

Find out what is causing stress amongst workers
What symptoms they are showing. The easiest way to identify the main sources of stress in your company is to ask workers to fill in one or more questionnaires. You could use the list of questions on page three of this pamphlet, or make your own list of questions.

Decide what to aim for
Once you have the results of your mini-survey, report back to the workforce and with the assistance of the union, decide on some clear proposals to put to management. Try to make sure your proposals deal with the four main sources of stress - physical discomfort, lack of rest, relations at work, and personal safety and fitness.

Negotiate the measures to be adopted to solve the problems
Ideally a programme should be agreed which does not put too much emphasis on any one cause of stress and illness, and which does not propose partial or temporary solutions.

Depending on your workplace you may find you cannot tackle all the problems at once. You may have to decide which problem is the most important or serious to be tackled first. You may also decide to prioritise issues on the basis of what is achievable. However try to avoid prioritising demands which on their own create the impression that it is the individual’s responsibility to reduce levels of stress. For example, avoid making an isolated proposal for a workplace gym. This may give the impression that if only bus drivers would get fit, they would be healthy!

Implement the measures
Good communication between all parties and maximum participation is essential in this phase.

Evaluate the programme
Evaluation of the impact of the programme is important as it can produce results which show the cost benefit of the programme to management, and may help to persuade management to make further improvements. Evaluation can include measuring specific improvements in such things as absenteeism and illness.

Finally, feel free to contact the ITF Road Transport Workers’ Section through your union head office for further information on the occupational hazards of bus driving. The ITF would also be very interested to hear from you if you have made significant progress in reducing stress related illnesses in your company. This information will be passed on to the joint Working Group on health and safety in urban transport and will help in developing further advice to bus drivers.

The main source of information for this information is Bus drivers: occupational stress and stress prevention by Professor M A J Kompier and published as working paper CONDI/T/WP.2/1996 by the International Labour Office, Geneva.

Copies of the original full document can be ordered from the Industrial Activities Branch of the ILO.  Fax: + 41 22 799 7967.