“Having a Say” at Work — Why “job control” matters! — Marnie Dobson Zimmerman, PhD

“Working on Empty” (WOE) is a multimedia project on how the U.S. workplace is making Americans sick and what must change to protect the health of our workforce.

Healthy Work Campaign
8 min readOct 3, 2017


When Martin arrived at work as usual for his part-time (30 hour a week), telecommunications call center sales job, something was unusual. Instead of everyone sitting in their cubicles with their headsets on, everyone was gathered in the conference room area. The head manager was standing beside a man he had never seen before. He introduced himself and explained he was a consultant brought in to improve work flows and increase the productivity in the unit. He explained that there would be new scripts to follow for all calls, and they would be expected to outperform the previous quarter’s sales goals. Martin felt a sinking, nauseous feeling in the pit of his stomach. He had barely made last month’s sales goals. And he knew many of his coworkers had not made them at all. Several had already quit or been fired. There had been rumors the company was going to shut down this center and move more of its call center sales operations to the Philippines. Martin was 55 and didn’t want to think about what would happen if he lost this job. His wife had just recovered from breast cancer and wasn’t back to work yet.

His palms felt sweaty, and he felt a headache bearing down on him as he sat down in his stark, white cubicle, put on his headset, and stared at the computer screen. He clicked to a new screen to review the most recent script he was required to follow when calling customers and another when he was selling to customers who had called to cancel or upgrade their services. Three years ago when he’d started this job, he’d had more freedom to say what he wanted based on his intuitive sense of the customer on the other end of the phone line; now he felt like a robot, parroting back the exact words he was supposed to use to turn a “no” into a “yes.” Since his calls were monitored, he could be pulled in for getting a “no.” He’d made the mistake of going off-script once, and been chastised, blamed for not getting a “yes.”

His frustration with the job was growing — the scripts took away the opportunity to use his years of sales skills. The sales goals continued to go up while his commission percentages would go down from month to month. The auto-dial call speed was also increasing; no sooner than he would be off one call, the next one would be there, with no time in-between to clear his head. He would find himself racing through the calls to get the customer off the line, so he could get onto the next customer — a never-ending stream of semi-irate people wanting more from him than he was allowed to give or not wanting what he was trying to sell. By the end of his 6-hour shift, his shoulders and neck ached, he was so exhausted. His blood pressure was higher than it had ever been and his waist line, like many of his colleagues, had expanded considerably since he’d started the job.

Telemarketers often work in call-centers, selling products and answering customer service calls. It is a high-pressure, high-demand sales industry. The median hourly wage is only $11.69/hour (US Bureau of Labor Statistics), and 1 in 5 workers are part-time.

What Martin’s story tells us, is that while his telemarketing job has become more and more demanding, with higher sales targets and faster call speeds, he also has little to no say over how he does his work. There are scripts to follow. He is monitored. The speed of calls, the products that are sold and how they are sold are all determined by marketing managers. He also has no say over his work schedule and lives under constant threat that he may be laid off. Having no say over the pace and completion of your work tasks, having no say over the more global details of how many calls one can reasonably handle, or being unable to use creativity or skills to help complete tasks, is called having a lack of “decision authority” (i.e. the freedom to make decisions or autonomy) while the ability to learn new things or use or develop your skills on the job is called “skill discretion.” In the academic world, the combination of these important elements of decision authority and skill discretion are called “job control.”

In this clip (5:21–5:33) WOE Executive Producer, Peter Schnall, MD, MPH, describes job strain.

Why does not having “job control” or “a say” at work increase stress?

Being able to “control” uncertainty in what is frequently an uncertain world is a fundamental part of being human. Yes, we are equipped to deal with sudden changes and adversity. Our biological systems — including our nervous system and cardiovascular systems are built to respond to uncertainty. If you have ever peeked into a dark cave and not known what could be in there, or become lost, or ever been on a job interview — the uncertainty in these experiences can provoke our body’s “fight or flight” response to potential threat. Our blood pressure rises, our breathing and heart rate increases, our palms get sweaty, and our digestive system shuts down to push blood to our muscles, so we can be ready for whatever might happen. This is a “natural” response, and once we shine a light in the cave, find our way home, or know the outcome of our job interview, our bodies normally return to normal. Our blood pressure declines, our breathing and heart rate decrease and our muscles start to relax. But in a situation of constant uncertainty (impending lay-offs), or when we cannot control uncertainty (impossible sales goals make for an uncertain future — ”Will I get fired?”), our body’s natural biological response does not readily return to normal.

When we have no say over setting reasonable work goals, or we are not allowed to find our own creative ways or develop new skills to complete a demanding task, but instead are constantly micromanaged by someone else and told that there is only one way to do it, this could lead us to believe we can’t complete the task on our own. The stress response — our normal, natural biological response to uncertainty — may continue indefinitely throughout a work day and oftentimes on into our private lives.

Job Strain: One way in which work stress makes us sick

Scientists Robert Karasek and Tores Theorell, beginning in the 1970s, developed the “job strain” model of work stress, pointing to the combination of highly demanding work and low job control as particularly stressful. They described the importance of “job control” in psychologically healthy workplaces:

“We believe that the true potential of our model lies in the centrality of the concept of control: influence by employees in the work process decision. Changing the distribution of control opportunities… is the central strategy for changing the structure of an organization.”[1]

Since the 1970s, many scientists have “tested” the job strain model in large population studies, showing that it mattered to both worker health and productivity. In scientific study after scientific study, job strain has been linked to anxiety, burnout, depression[2, 3], “musculoskeletal disorders,” such as tendonitis and low back pain[4], high blood pressure[5] and heart disease[69], as well as to sickness disability[10].

One way of preventing job strain? Increase job control, and healthy work can be achieved. Call center workers have poor mental and physical health and high levels of sick days[11]. If workers like Martin were given “a say” by their management or through a union, given the opportunity to discuss ways they could use their skills better to sell products, and asked why performance goals weren’t met so that the company might set more realistic goals, they might not get sick and be more productive. As workers like Martin get sicker, they become less productive at work, raising the indirect costs to businesses. They must see their doctors, as well, for treatment for work-related medical illnesses such as high blood pressure, raising health care costs. Jobs with “job strain” have real costs, not just to the health of workers — which matter to us all — but also to the bottom line of the company.

For ways individuals, companies and other organizations can learn about reducing job strain and increasing job control, see: this article on UnhealthyWork.org.

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With your help, we will have created more than hope — we’ll have cemented lasting, positive change in the name of healthy working conditions.

Marnie Dobson Zimmerman, Ph.D., WOE Associate Producer of Research and Associate Director of the Center for Social Epidemiology, is a medical sociologist and a work stress researcher for more than 15 years, studying the effects of work organization on worker stress and health. She has worked to give voice to many worker populations, interviewing and conducting focus groups with firefighters, bus drivers, hotel room cleaners, communication workers, publishing academic research articles and co-editing the book Unhealthy Work: Causes, Consequences, Cures. (Baywood, 2009) (LinkedIn, Twitter)


1. Karasek, R. and T. Theorell, Healthy Work: Stress, Productivity, and the Reconstruction of Working Life. 1990, New York, NY: Basic Books.

2. Theorell, T. and G. Aronsson, A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health, 2015. 15: p. 738.

3. Siegrist, J., Chronic psychosocial stress at work and risk of depression: evidence from prospective studies. Eur Arch Psychiatry Clin Neurosci, 2008. 258 Suppl 5: p. 115–9.

4. Lang, J., et al., Psychosocial work stressors as antecedents of musculoskeletal problems: A systematic review and meta-analysis of stability-adjusted longitudinal studies. Social Science & Medicine, 2012. 75: p. 1163–1174.

5. Landsbergis, P., et al., Job strain and ambulatory blood pressure: A meta-analysis and systematic review. American Journal of Public Health, 2013. 103(3): p. e61-e71.

6. Theorell, T., et al., A systematic review of studies in the contributions of the work environment to ischaemic heart disease development. The European Journal of Public Health, 2016. 26(3): p. 470–477.

7. Kivimaki, M., et al., Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. Lancet, 2012. 380: p. 1491–97.

8. Sultan-Taıeb, H., et al., Fractions of cardiovascular diseases, mental disorders, and musculoskeletal disorders attributable to job strain. Int Arch Occup Environ Health, 2011. 84: p. 911–925.

9. Schnall, P.L., M. Dobson, and P. Landsbergis, Globalization, Work, and Cardiovascular Disease. International Journal of Health Services, 2016. 46(4): p. 656–92.

10. Laine, S., et al., Job strain as a predictor of disability pension: the Finnish Public Sector Study. J Epidemiol Community Health, 2009. 63(1): p. 24–30.

11. Charbotel, B., et al., Working conditions in call-centers, the impact on employee health: a transversal study. Part II. Int Arch Occup Environ Health, 2009. 82(6): p. 747–56.