Is the modern, computerized office as hazardous to health as yesterday’s workplaces were to an earlier generation?
Earning one’ s daily bread has involved hazards to health since hunters first chased animal herds across savannas. For millennia, farmers have lived with the physical effects of too much exposure to the sun in summer and too little of its warmth in winter. Miners have suffered serious lung disorders from breathing air fouled with the dusts of minerals. And hatters, since the early 1800’s, have been the proverbial standard against which “madness” is judged-all because of occupational exposure to the poisonous fumes of mercury.
Today, more than half of all workers in industrialized nations toil in offices. According to the United States Bureau of Labor Statistics, white-collar workers-most of whom work in offices-make up 58 percent of the total labor force, up from 38 percent in the mid-1950’s. While we tend to think of working in a modern office as relatively harmless, much of today’s office work is ill-suited to the human body.
In offices across the country, workers sit for hours staring at a computer screen requiring their fingers to repeat the same motions countless times. Hours of sedentary concentration can lead to health problems. And then, there is the air itself.
The U.S. government estimates that one-third of all office workers in this country are exposed to indoor air that is appreciably more polluted than the air outdoors in the country’s largest cities. So toxic have some buildings become that the Occupational Safety and Health Administration (OSHA) not only officially recognizes that buildings can be “sick”-and capable of making their inhabitants so-but also admits that the agency’s own Washington headquarters once suffered from what has since been dubbed “sick building syndrome.” OSHA is a U.S. Department of Labor agency that promotes safe and healthful working conditions.
Hazards of working at a computer
At the core of the contemporary business office-and of the way people feel at the end of the working day-is the computer terminal, which makes it possible to do one’s job without ever getting up from a chair. Surprisingly, sitting exerts more pressure on the spine than standing does. To relieve this pressure, people typically slump forward in their chair, which simply transfers the stress to ligaments and joints. More than 75 percent of people who work at a computer terminal experience back pain, according to the National Institute of Occupational Safety and Health (NIOSH), an agency of the U.S. Department of Health and Human Services. NIOSH investigates working conditions to determine the causes of employee illness and accidents.
Prolonged sitting can also lead to circulation problems as pressure exerted on the buttocks by the chair seat cuts off the circulation of blood to the legs. This can cause legs and ankles to swell. The problem can be especially severe for those already at risk for swelling, including pregnant women and people who are overweight.
Long hours spent staring at a computer screen, especially if there is glare or poor contrast, can lead to dry, weary eyes. People engaged in other tasks normally shift their gaze, focusing on objects at various distances. However, someone working at a terminal may focus for long periods of time on a screen at a fixed distance. The eyes can tire from this fixed focal distance, a problem that age accentuates. Prolonged concentration can also slow the rate of blinking, producing dry eyes. According to another NIOSH study, 75 percent of all people who work at computer terminals experience occasional eye problems.
Lowering the risk of strain
Bifocals can constitute an additional problem for those who work at computers. People who wear bifocals may lift their chin to view the computer screen through the lower part of their glasses. And they typically lean forward if the screen is too far away for the bifocals to work properly. Holding the head in this awkward posture often results in a stiff neck and sore back. The problem is compounded by progressive bifocals, which may have too narrow a field of vision for the wearer to scan the entire width of the screen. To compensate, people move their head from side to side but try not to move it up and down, so as to keep the screen in focus. This practice adds to neck and back pain.
These computer-related problems are relatively easy and inexpensive to prevent or correct. As a first step, employees should take frequent breaks. NIOSH recommends that people working at a computer break at least once every two hours, getting up from their work- stations and walking about. Walking loosens tight muscles and improves circulation. Tired eyes also get a break and a chance to focus on distant objects.
It’s also a good idea to alternate computer work with tasks that require more movement-delivering a memo by hand, for example, or taking papers to the copying machine. Experts also suggest that people make a conscious effort to relax their shoulders and back while working at a computer. Setting the alarm on the computer clock can provide a reminder to take an hourly break.
A well-designed workstation
As a second step toward correcting computer-related problems, many employers have examined the immediate work environment for ways to make improvements. They have been helped in this task by experts in the relatively new field of ergonomics, which seeks to adapt the working environment to the human body, instead of the other way around. There are three key components to an ergonomically sound computer workstation: the chair, the keyboard, and the terminal or screen.
The key to an ergonomically designed office chair is solidity and adjustability. The height of the seat should permit the feet to rest flat on the floor and the thighs to form a 90-degree angle with the lower legs. The seat should be padded with a rounded edge; a sharp edge can cut off circulation. The chair should have a contoured back that extends almost to the shoulder blades and tilts backward slightly. Armrests can take some of the pressure off the lower back, but they should not prevent the chair from being pulled in close to the desk or work surface. Nor should they be so high that the shoulders are hunched.
In your own office, after evaluating your chair, take a look at the computer keyboard. An ergonomically correct computer keyboard is detachable, so that it can be placed in a comfortable position-ideally, directly in front of you and stationed at elbow height or lower. This position allows you to keep your shoulders relaxed rather than elevated. The mouse or track ball should be kept in easy reach beside the keyboard. Finally, if the keys are sticky and have to be pounded to function, the keyboard should be replaced immediately. Typing should require no more than a light touch, and the mouse should move with a gentle push.
Tips on adjusting computer
A few simple adjustments on or around the computer terminal can often prevent or remedy eye strain and back and neck problems. First, ergonomics experts say, adjust the light. Sources of light, whether natural or artificial, should be above or beside the screen, and artificial light should strike the screen at an angle to prevent glare and distracting reflections on the screen. If possible, have the screen fitted with an antiglare filter, preferably of glass. A flat screen is generally more desirable than a curved screen, as it creates less glare. Mounting the terminal on a stand that tilts and swivels allows you to make periodic adjustments to the position of the screen throughout the day as natural light shifts.
The computer terminal is too high if you have to look up at it. Place the terminal so that the top of the screen is at eye level and the line of sight for the rest of the screen is 10 to 20 degrees below eye level. Keep the screen at a distance of 18 to 24 inches (46 to 61 centimeters) from your eyes. The closer one gets to the screen, the more difficult focusing becomes. If the type on the screen is hard to read, enlarge it or change fonts. Finally, dust can blur the screen. Computer screens, like television screens, attract dust and require regular wiping with a damp cloth.
A tool that makes working at a computer easier is a document holder, a vertical stand against which papers can be propped or clipped in place. The holder should be placed at the same height as the screen and at the same distance from the viewer.
If vision problems persist after making these adjustments, schedule an appointment with an eye specialist. Vision problems unrelated to the computer may have developed. But there may be a simple solution. For example, a person who wears bifocals can be fitted with lenses designed for computer work.
Computers and repetitive-stress injuries
Repetitive-stress injuries (RSI’s) constitute the most serious health hazard associated with computer work. RSI is a catchall designation for injuries to muscles, tendons, and other tissues caused by the wear and tear of a repeated motion. Doing any one task over and over, whether typing at a keyboard, tightening bolts on an assembly line, or slicing meat, can lead to an RSI. According to OSHA, repetitive stress injuries accounted for nearly 67 percent of all occupational illnesses in 1994. OSHA also said that the incidence of RSI’s is growing at an alarming annual rate of 5 to 10 percent.
The RSI that most often troubles people working at a computer is carpal tunnel syndrome. The syndrome affects the median nerve, one of three nerves that control movement and sensation in the hand and fingers. It develops when this nerve is compressed as it passes through the carpal tunnel, a narrow passage formed by the bones of the wrist and the ligaments connecting them.
Difficulty arises when tendons that surround the median nerve swell due to repeated flexing and extending of the wrist. Swollen tendons can be painful in themselves, but the problem worsens when the tendons press against the median nerve. At first, the pressure usually produces numbness and a tingling or “pins-and-needles” sensation in the arm and hand. The tingling sensation is typically replaced by burning and pain, often localized in the thumb and first two fingers as well as in the palm and wrist. Because symptoms often occur at night, when the wrists naturally bend during sleep, many people do not connect the discomfort to occupational tasks.
Risks of carpal tunnel syndrome
Carpal tunnel syndrome can be intensified by other conditions that place pressure on the median nerve. Either broken or dislocated bones, for example, can crowd the tunnel. Women seem more likely to develop the syndrome, possibly because they have narrower wrists-and hence less room in the carpal tunnel-than men. Fluid retention caused by pregnancy can produce pressure on the median nerve. Disorders such as diabetes and thyroid problems can also render people more vulnerable to carpal tunnel syndrome.
Manual dexterity can decrease if carpal tunnel syndrome goes untreated. Performing such everyday tasks as buttoning clothes or tying shoelaces often becomes difficult. Eventually, the muscle at the base of the thumb can weaken to the extent that the ability to clench the hand is lost. The more advanced the carpal tunnel syndrome, the more difficult it is to treat.
Treating carpal tunnel syndrome
Treatment of carpal tunnel syndrome usually begins with a light- weight splint to keep the wrist in a neutral position and reduce pressure within the carpal tunnel. The physician may recommend wearing the splint only at night or, rarely, during the workday as well. Anti-inflammatory drugs, such as aspirin and ibuprofen, can reduce swelling and relieve pain. If these measures fail to help, the physician may inject drugs called corticosteroids directly into the swollen tissue to lessen swelling.
Surgery is recommended only when conservative treatments do not improve the condition, pain is severe, nerve damage is occurring, or diagnostic tests show serious abnormalities in the tunnel. In the procedure, called carpal tunnel release, the surgeon cuts the ligament that encircles the passageway to make more room and relieve pressure on the nerve. The surgery is generally performed on an outpatient basis, and the patient wears a splint for a number of weeks after surgery, before gradually increasing activity.
If you spend long hours at a computer, you can best avoid carpal tunnel syndrome by taking regular breaks and making certain that the keyboard is positioned directly in front of you and at the correct height. While typing, be sure to keep your arms and wrists straight, with your elbows tucked in and your wrists above the keyboard. It is essential that your wrists do not bend upward during typing.
In the early 1980’s, safety questions about computer screens arose after several clusters of miscarriages were reported among women who worked at computer terminals. In 1988, a study of 1,600 women in California indicated that women who worked in front of computer terminals for 20 or more hours a week had an increased incidence of spontaneous abortion. A health maintenance organization, the Northern California Kaiser-Permanente Medical Care Program, conducted the study. But a 1994 study by Great Britain’s National Radiological Protection Board demonstrated “no significant association” between the use of computer screens and spontaneous abortions. Other studies were in progress in 1996.
Americans consistently rank work as the number-one source of stress in their lives. A moderate amount of work-related stress can be beneficial and even lead to higher productivity. But too much stress can trigger health problems, including depression and sleep disorders, as well as such stress-related behaviors as overeating and drinking to excess.
Work-related stress seems to be particularly acute among office employees. Well over half of workers’ compensation claims filed in California, for example, are for stress-related complaints. In part, the present high level of stress is due to the introduction of computers and other new technology. While computers can be liberating, providing users with access to nearly limitless sources of information and making many jobs much easier, they can also be confining. Typists and secretaries once had a certain amount of discretion over how they did their jobs, but today’s human data processors are subjected to electronic monitoring and increased pressure to perform, which can leave them feeling they have little control over their work.
Frank Landy, a psychologist and management consultant, attributes most job-related stress to three factors: unpredictability, lack of control over working conditions, and conflict. Layoffs and downsizing have created an environment of chronic unpredictability. New technologies have led to a generation of workers who feel they have little or no control over their jobs. And the influx of women into the workplace has blurred traditional male/female roles and created a population of employees torn between job responsibilities and family obligations.
Reducing job strain
Experts in occupational health say that on-the-job stress is a fact of modern life. But it has not gone unnoticed. Many companies, large and small, now offer stress-reduction programs. Noting that exercise is an effective stress antidote, some large companies have outfitted on-site fitness centers with exercise equipment and part-time trainers. However, offering strategies for managing the symptoms of job strain is only half the battle.
According to Landy, a company that is serious about reducing job strain-rather than just managing its symptoms-needs to be honest, forthright, and flexible with employees. Landy notes the need for more flexible working hours, for wider opportunities for working at home, and for office day-care centers so working parents are less torn between commitments. He also emphasizes the importance of providing employees with information about future company plans, including layoffs. Landy points out that anxiety decreases as information increases.
Coping with job stress
Until companies start making such changes, stress experts say, employees need to take action themselves. People basically cope with job-related stress in two ways, according to Arthur Brief, a psychologist at Tulane University in New Orleans. A person can deal with the actual problem or with the emotions evoked by that problem. Brief says that people who feel their jobs are being threatened often attempt not to think about the problem or try to distract themselves through shopping, alcohol, or other measures. But suppressing feelings of anxiety is usually far less effective than confronting those feelings. According to Brief, someone who is worried about losing a job can best confront that worry by immediately starting to look for a new job.
Brief applies this formula to other tense work situations. If there is conflict with a boss, he advises, search for a solution rather than avoiding the boss, and then calmly talk it out. Rather than resenting a rigid schedule that makes it impossible to take a child to the doctor, ask for flex-time. If a supervisor has not addressed rumors about a company restructuring, ask if the rumors are true. If a two-hour commute is exhausting or a crowded workspace triggers headaches, request permission to work at home one or two days a week. You may not get everything you ask for, but solving a work problem, however small, can make a significant difference to your psychological well-being.
Finally, Frank Landy emphasizes communication-that is, plain old talk with fellow workers-to reduce stress. The more isolated people feel, the more anxious and depressed they become.
Air quality in the modern office
Office workers also are subject to a relatively new and increasingly disturbing source of stress in the workplace-poor air quality. The resulting problems range from the mildly irritating effects of low humidity to the debilitating symptoms produced by sick building syndrome.
One reason for the dry air in offices is the computer. Office computers produce heat, and the warmed air draws moisture from whatever sources are available-including the eyes, nose, throat, and skin of people working in offices. Most offices need to increase humidity to compensate for the drying effects of computers. This can easily be accomplished with humidifiers, though environmental scientists warn that humidifiers pose their own dangers. They act as factories for mold and require regular cleaning.
But the major cause of poor air quality in an office is the nearly airtight modern office building. Many of these buildings went up in the 1970’s and were designed to conserve energy by shutting out the elements. Windows were sealed, entrances were equipped with revolving doors that minimized natural ventilation, and air was recirculated through the building by mechanical systems.
In response to the energy crisis of the 1970’s, the recommended standard for fresh air in office buildings was lowered by the American Society of Heating, Refrigerating, and Air-conditioning Engineers (ASHRAE), a professional organization based in Atlanta, Georgia. Building owners happily complied, and the reduction saved energy, which was patriotic and economical. In this energy-efficient environment, however, not only is the supply of fresh, outdoor air limited but contaminants become trapped indoors.
Approximately one-third of the 70 million Americans who work indoors breathe air that may be twice as polluted as the air outdoors, according to a 1995 U.S. government estimate. Although ASHRAE upgraded its fresh-air standard in 1989, the amount of fresh air circulated through many airtight buildings remains well below the new standard. A recent ASHRAE analysis of major European and U.S. studies of indoor air quality confirmed that buildings that effectively meet the new standard are much less likely to cause health problems.
Pollutants in modern offices
Scientists have identified more than 1,500 chemical and bacterial air pollutants in modern, sealed office buildings. These include chemicals from floor coverings, contact cement, and cleaning agents; formaldehyde from glues and particle-board furniture; acetone from paints and caulking; and perfume, pesticides, and everyday dust. Building systems are simply not designed to vent out fumes from these substances, according to the indoor-air division of the Environmental Protection Agency (EPA), a government agency that sets and enforces standards for controlling pollution.
Gases given off by molds and fungi can also contaminate the air, researchers at the Georgia Institute of Technology have found. Molds such as aspergillus and mildew produce gases that “tweak the immune system into severe allergic reactions or a suppressed response to infection,” says Charlene Bayer, director of Georgia Tech’s Indoor Environment Research Program. Air conditioning systems serve as particularly fertile breeding grounds for molds and fungi. Such microorganisms are too small to be removed from the air by the inexpensive filters used in many air conditioning systems. The common practice of shutting office systems down over weekends produces what Bayer calls a “Monday morning cocktail”-a mixture of air contaminants all too familiar to office workers.
Many larger offices use fiberglass-lined ductwork to control noise. Dirt trapped in the fibers creates a rich breeding ground for microbes. “Add a little moisture and you can have a mold garden in your ductwork,” says Bayer. “The microbes can grow and multiply and then get blown all over the building to infest other areas.
Sick building syndrome
In the media, issues of poor indoor air quality have revolved around sick building syndrome, a term coined in the 1970’s to describe a variety of nose, throat, and skin complaints from workers in airtight buildings. OSHA lists the symptoms of the syndrome as eye, nose, and throat irritation; dryness of mucous membranes and skin; nosebleeds; skin rash; mental fatigue; headache; cough, hoarseness, and wheezing; nausea; and dizziness. These symptoms typically disappear when people leave the building. In 1986, the World Health Organization estimated that 30 percent of new and remodeled buildings could be “sick.” (Sick building syndrome should not be confused with building-related illnesses, in which the outbreak of a specific disease can be traced to a particular building.)
Because office workers spend so much of their time indoors, air quality has become a major cause for concern. In 1980, only 6 percent of all requests for NIOSH investigations involved indoor environmental quality; in 1992, such investigation requests made up 44 percent of the total; in 1995, 75 percent of the total. Although air quality accounted for some 80 to 90 percent of these problems, experts prefer the term indoor environmental quality to indoor air quality. Noise, vibration, and lighting, they point out, can also play a role.
The search for the source
The myriad possible causes for sick building syndrome make finding and solving the problem difficult. In about 25 percent of cases, investigators can identify a single specific cause. But most of the time, problems with indoor air stem from several sources, experts say. Inadequate fresh air might not be a problem, but in combination with high temperatures and low-level chemical contamination, it could lead to symptoms.
Illness triggered by poor indoor air quality is not life-threatening, with the exception of a few very rare conditions. However, the EPA estimates that poor air quality does lead to enormous economic loss, as many as 13.5 million lost workdays annually. According to the EPA, someone who feels chronically ill and suspects that an indoor environment is responsible should first find out if others are experiencing the same symptoms. Recognition of a problem typically entails a complaint filed by more than one individual. If a building seems to be causing widespread discomfort, the issue should be raised with a manager. He or she can have the ventilation checked or bring in an industrial hygienist to study the air quality.
The source of the problem might be something obvious and easily remedied. For example, are surfaces cleaned and carpets vacuumed regularly to remove dust? Dust in offices (and in houses as well) causes more health problems than most people realize. Are shelves where office products are stored closed off to prevent fumes from circulating? Is the temperature kept between 72 and 76 degrees F (22 to 24 degrees C)? Finally, an individual who believes that he or she has a serious health problem related to the office environment should visit a primary-care physician, who can suggest a course of action and, if necessary, recommend an occupational specialist or allergist.
The tools of our jobs and how we use them can affect how we feel at the end of the day. Although health hazards at the office are not likely to be lethal, they can be serious-even crippling in the case of repetitive-stress injuries. And office-related health problems are becoming far more numerous as the number of Americans working in offices rises. Awareness of these problems is the first step toward combating them.