Health psychology

From Wikipedia, the free encyclopedia

Health psychology is the study of psychological and behavioral processes in health, illness, and healthcare. It is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illness. Psychological factors can affect health directly. For example, chronically occurring environmental stressors affecting the hypothalamic–pituitary–adrenal axis, cumulatively, can harm health. Behavioral factors can also affect a person's health. For example, certain behaviors can, over time, harm (smoking or consuming excessive amounts of alcohol) or enhance health (engaging in exercise). Health psychologists take a biopsychosocial approach. In other words, health psychologists understand health to be the product not only of biological processes (e.g., a virus, tumor, etc.) but also of psychological (e.g., thoughts and beliefs), behavioral (e.g., habits), and social processes (e.g., socioeconomic status and ethnicity).

 

By understanding psychological factors that influence health, and constructively applying that knowledge, health psychologists can improve health by working directly with individual patients or indirectly in large-scale public health programs. In addition, health psychologists can help train other healthcare professionals (e.g., physicians and nurses) to take advantage of the knowledge the discipline has generated, when treating patients. Health psychologists work in a variety of settings: alongside other medical professionals in hospitals and clinics, in public health departments working on large-scale behavior change and health promotion programs, and in universities and medical schools where they teach and conduct research.

Although its early beginnings can be traced to the field of clinical psychology, four different divisions within health psychology and one related field, occupational health psychology (OHP), have developed over time. The four divisions include clinical health psychology, public health psychology, community health psychology, and critical health psychology. Professional organizations for the field of health psychology include Division 38 of the American Psychological Association (APA), the Division of Health Psychology of the British Psychological Society (BPS), and the European Health Psychology Society. Advanced credentialing in the US as a clinical health psychologist is provided through the American Board of Professional Psychology.

Overview

Recent advances in psychological, medical, and physiological research have led to a new way of thinking about health and illness. This conceptualization, which has been labeled the biopsychosocial model, views health and illness as the product of a combination of factors including biological characteristics (e.g., genetic predisposition), behavioral factors (e.g., lifestyle, stress, health beliefs), and social conditions (e.g., cultural influences, family relationships, social support).

Psychologists who strive to understand how biological, behavioral, and social factors influence health and illness are called health psychologists. Health psychologists use their knowledge of psychology and health to promote general well-being and understand physical illness. They are specially trained to help people deal with the psychological and emotional aspects of health and illness. Health psychologists work with many different health care professionals (e.g., physicians, dentists, nurses, physician's assistants, dietitians, social workers, pharmacists, physical and occupational therapists, and chaplains) to conduct research and provide clinical assessments and treatment services. Many health psychologists focus on prevention research and interventions designed to promote healthier lifestyles and try to find ways to encourage people to improve their health. For example, they may help people to lose weight or stop smoking. Health psychologists also use their skills to try to improve the healthcare system. For example, they may advise doctors about better ways to communicate with their patients. Health psychologists work in many different settings including the UK's National Health Service (NHS), private practice, universities, communities, schools and organizations. While many health psychologists provide clinical services as part of their duties, others function in non-clinical roles, primarily involving teaching and research. Leading journals include Health Psychology, the Journal of Health Psychology, the British Journal of Health Psychology, and Applied Psychology: Health and Well-Being. Health psychologists can work with people on a one-to-one basis, in groups, as a family, or at a larger population level.

Clinical health psychology (ClHP)

ClHP is the application of scientific knowledge, derived from the field of health psychology, to clinical questions that may arise across the spectrum of health care. ClHP is one of many specialty practice areas for clinical psychologists. It is also a major contributor to the prevention-focused field of behavioral health and the treatment-oriented field of behavioral medicine. Clinical practice includes education, the techniques of behavior change, and psychotherapy. In some countries, a clinical health psychologist, with additional training, can become a medical psychologist and, thereby, obtain prescription privileges.

Public health psychology (PHP)

PHP is population oriented. A major aim of PHP is to investigate potential causal links between psychosocial factors and health at the population level. Public health psychologists present research results to educators, policy makers, and health care providers in order to promote better public health. PHP is allied to other public health disciplines including epidemiology, nutrition, genetics and biostatistics. Some PHP interventions are targeted toward at-risk population groups (e.g., undereducated, single pregnant women who smoke) and not the population as a whole (e.g., all pregnant women).

Community health psychology (CoHP)

CoHP investigates community factors that contribute to the health and well-being of individuals who live in communities. CoHP also develops community-level interventions that are designed to combat disease and promote physical and mental health. The community often serves as the level of analysis, and is frequently sought as a partner in health-related interventions.

Critical health psychology (CrHP)

CrHP is concerned with the distribution of power and the impact of power differentials on health experience and behavior, health care systems, and health policy. CrHP prioritizes social justice and the universal right to health for people of all races, genders, ages, and socioeconomic positions. A major concern is health inequalities. The critical health psychologist is an agent of change, not simply an analyst or cataloger. A leading organization in this area is the International Society of Critical Health Psychology.

Health psychology, like other areas of applied psychology, is both a theoretical and applied field. Health psychologists employ diverse research methods. These methods include controlled randomized experiments, quasi-experiments, longitudinal studies, time-series designs, cross-sectional studies, case-control studies, qualitative research as well as action research. Health psychologists study a broad range of health phenomena including cardiovascular disease, (cardiac psychology), smoking habits, the relation of religious beliefs to health, alcohol use, social support, living conditions, emotional state, social class, and more. Some health psychologists treat individuals with sleep problems, headaches, alcohol problems, etc. Other health psychologists work to empower community members by helping community members gain control over their health and improve quality of life of entire communities.

Origins and development

Psychological factors in health had been studied since the early 20th century by disciplines such as psychosomatic medicine and later behavioral medicine, but these were primarily branches of medicine, not psychology. Health psychology began to emerge as a distinct discipline of psychology in the United States in the 1970s. In the mid-20th century there was a growing understanding in medicine of the effect of behavior on health. For example, the Alameda County Study, which began in the 1960s, showed that people who ate regular meals (e.g., breakfast), maintained a healthy weight, received adequate sleep, did not smoke, drank little alcohol, and exercised regularly were in better health and lived longer. In addition, psychologists and other scientists were discovering relationships between psychological processes and physiological ones. These discoveries include a better understanding of the impact of psychosocial stress on the cardiovascular and immune systems, and the early finding that the functioning of the immune system could be altered by learning.

Psychologists have been working in medical settings for many years (in the UK sometimes the field was termed medical psychology). Medical psychology, however, was a relatively small field, primarily aimed at helping patients adjust to illness. In 1969, William Schofield prepared a report for the APA entitled The Role of Psychology in the Delivery of Health Services. While there were exceptions, he found that the psychological research of the time frequently regarded mental health and physical health as separate, and devoted very little attention to psychology's impact upon physical health. One of the few psychologists working in this area at the time, Schofield proposed new forms of education and training for future psychologists. The APA, responding to his proposal, in 1973 established a task force to consider how psychologists could (a) help people to manage their health-related behaviors, (b) help patients manage their physical health problems, and (c) train healthcare staff to work more effectively with patients.

Led by Joseph Matarazzo, in 1977, APA added a division devoted to health psychology. At the first divisional conference, Matarazzo delivered a speech that played an important role in defining health psychology. He defined the new field in this way, "Health psychology is the aggregate of the specific educational, scientific and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of diagnostic and etiologic correlates of health, illness and related dysfunction, and the analysis and improvement of the healthcare system and health policy formation." In the 1980s, similar organizations were established elsewhere. In 1986, the BPS established a Division of Health Psychology. The European Health Psychology Society was also established in 1986. Similar organizations were established in other countries, including Australia and Japan. Universities began to develop doctoral level training programs in health psychology. In the US, post-doctoral level health psychology training programs were established for individuals who completed a doctoral degree in clinical psychology.

A number of relevant trends coincided with the emergence of health psychology, including:

• Epidemiological evidence linking behavior and health.
• The addition of behavioral science to medical school curricula, with courses often taught by psychologists.
• The training of health professionals in communication skills, with the aim of improving patient satisfaction and adherence to medical treatment.
• Increasing numbers of interventions based on psychological theory (e.g., behavior modification).
• An increased understanding of the interaction between psychological and physiological factors leading to the emergence of psychophysiology and psychoneuroimmunology (PNI).
• The health domain having become a target of research by social psychologists interested in testing theoretical models linking beliefs, attitudes, and behavior.
• The emergence of AIDS/HIV, and the increase in funding for behavioral research the epidemic provoked.

In the UK, the BPS’s reconsideration of the role of the Medical Section prompted the emergence of health psychology as a distinct field. Marie Johnston and John Weinman argued in a letter to the BPS Bulletin that there was a great need for a Health Psychology Section. In December 1986 the section was established at the BPS London Conference, with Marie Johnston as chair. At the Annual BPS Conference in 1993 a review of "Current Trends in Health Psychology" was organized, and a definition of health psychology as "the study of psychological and behavioural processes in health, illness and healthcare" was proposed. The Health Psychology Section became a Special Group in 1993 and was awarded divisional status within the UK in 1997. The awarding of divisional status meant that the individual training needs and professional practice of health psychologists were recognized, and members were able to obtain chartered status with the BPS. The BPS went on to regulate training and practice in health psychology until the regulation of professional standards and qualifications was taken over by statutory registration with the Health Professions Council in 2010.

Objectives

Understanding behavioral and contextual factors

Health psychologists conduct research to identify behaviors and experiences that promote health, give rise to illness, and influence the effectiveness of health care. They also recommend ways to improve health care policy. Health psychologists have worked on developing ways to reduce smoking and improve daily nutrition in order to promote health and prevent illness. They have also studied the association between illness and individual characteristics. For example, health psychology has found a relation between the personality characteristics of thrill seeking, impulsiveness, hostility/anger, emotional instability, and depression, on one hand, and high-risk driving, on the other.

Health psychology is also concerned with contextual factors, including economic, cultural, community, social, and lifestyle factors that influence health. Physical addiction impedes smoking cessation. Some research suggests that seductive advertising also contributes to psychological dependency on tobacco, although other research has found no relationship between media exposure and smoking in youth. OHP research indicates that people in jobs that combine little decision latitude with a high psychological workload are at increased risk for cardiovascular disease. Other OHP research reveals a relation between unemployment and elevations in blood pressure. Epidemiologic research documents a relation between social class and cardiovascular disease.

Health psychologists also aim to change health behaviors for the dual purpose of helping people stay healthy and helping patients adhere to disease treatment regimens (also see health action process approach). Health psychologists employ cognitive behavioral therapy and applied behavior analysis (also see behavior modification) for that purpose.

Preventing illness

Health psychologists promote health through behavioral change, as mentioned above; however, they attempt to prevent illness in other ways as well. Health psychologists try to help people to lead a healthy life by developing and running programmes which can help people to make changes in their lives such as stopping smoking, reducing the amount of alcohol they consume, eating more healthily, and exercising regularly. Campaigns informed by health psychology have targeted tobacco use. Those least able to afford tobacco products consume them most. Tobacco provides individuals with a way of controlling aversive emotional states accompanying daily experiences of stress that characterize the lives of deprived and vulnerable individuals. Practitioners emphasize education and effective communication as a part of illness prevention because many people do not recognize, or minimize, the risk of illness present in their lives. Moreover, many individuals are often unable to apply their knowledge of health practices owing to everyday pressures and stresses. A common example of population-based attempts to motivate the smoking public to reduce its dependence on cigarettes is anti-smoking campaigns.

Health psychologists help to promote health and well-being by preventing illness. Some illnesses can be more effectively treated if caught early. Health psychologists have worked to understand why some people do not seek early screenings or immunizations, and have used that knowledge to develop ways to encourage people to have early health checks for illnesses such as cancer and heart disease. Health psychologists are also finding ways to help people to avoid risky behaviors (e.g., engaging in unprotected sex) and encourage health-enhancing behaviors (e.g., regular tooth brushing or hand washing).

Health psychologists also aim at educating health professionals, including physicians and nurses, in communicating effectively with patients in ways that overcome barriers to understanding, remembering, and implementing effective strategies for reducing exposures to risk factors and making health-enhancing behavior changes.

There is also evidence from OHP that stress-reduction interventions at the workplace can be effective. For example, Kompier and his colleagues have shown that a number of interventions aimed at reducing stress in bus drivers has had beneficial effects for employees and bus companies.

The effects of disease

Health psychologists investigate how disease affects individuals' psychological well-being. An individual who becomes seriously ill or injured faces many different practical stressors. These stressors include problems meeting medical and other bills, problems obtaining proper care when home from the hospital, obstacles to caring for dependents, the experience of having one's sense of self-reliance compromised, gaining a new, unwanted identity as that of a sick person, and so on. These stressors can lead to depression, reduced self-esteem, etc.

Health psychology also concerns itself with bettering the lives of individuals with terminal illness. When there is little hope of recovery, health psychologist therapists can improve the quality of life of the patient by helping the patient recover at least some of his or her psychological well-being. Health psychologists are also concerned with providing therapeutic services for the bereaved.

Critical analysis of health policy

Critical health psychologists explore how health policy can influence inequities, inequalities and social injustice . These avenues of research expand the scope of health psychology beyond the level of individual health to an examination of the social and economic determinants of health both within and between regions and nations. The individualism of mainstream health psychology has been critiqued and deconstructed by critical health psychologists using qualitative methods that zero in on the health experience.

Conducting research

Like psychologists in the other main psychology disciplines, health psychologists have advanced knowledge of research methods. Health psychologists apply this knowledge to conduct research on a variety of questions. For example, health psychologists carry out research to answer questions such as:

• What influences healthy eating?
• How is stress linked to heart disease?
• What are the emotional effects of genetic testing?
• How can we change people’s health behavior to improve their health?

Teaching and communication

Health psychologists can also be responsible for training other health professionals on how to deliver interventions to help promote healthy eating, stopping smoking, weight loss, etc. Health psychologists also train other health professionals in communication skills such as how to break bad news or support behavior change for the purpose of improving adherence to treatment.

Applications

Improving doctor–patient communication

Health psychologists aid the process of communication between physicians and patients during medical consultations. There are many problems in this process, with patients showing a considerable lack of understanding of many medical terms, particularly anatomical terms (e.g., intestines). One area of research on this topic involves "doctor-centered" or "patient-centered" consultations. Doctor-centered consultations are generally directive, with the patient answering questions and playing less of a role in decision-making. Although this style is preferred by elderly people and others, many people dislike the sense of hierarchy or ignorance that it inspires. They prefer patient-centered consultations, which focus on the patient's needs, involve the doctor listening to the patient completely before making a decision, and involving the patient in the process of choosing treatment and finding a diagnosis.

Improving adherence to medical advice

Health psychologists engage in research and practice aimed at getting people to follow medical advice and adhere to their treatment regimens. Patients often forget to take their pills or consciously opt not to take their prescribed medications because of side effects. Failing to take prescribed medication is costly and wastes millions of usable medicines that could otherwise help other people. Estimated adherence rates are difficult to measure (see below); there is, however, evidence that adherence could be improved by tailoring treatment programs to individuals' daily lives. Additionally, traditional cognitive-behavioural therapies have been adapted for people suffering from chronic illnesses and comorbid psychological distress to include modules that encourage, support and reinforce adherence to medical advice as part of the larger treatment approach.

Ways of measuring adherence

Health psychologists have identified a number of ways of measuring patients' adherence to medical regimens:

• Counting the number of pills in the medicine bottle
• Using self-reports
• Using "Trackcap" bottles, which track the number of times the bottle is opened.

Managing pain

Health psychology attempts to find treatments to reduce or eliminate pain, as well as understand pain anomalies such as episodic analgesia, causalgia, neuralgia, and phantom limb pain. Although the task of measuring and describing pain has been problematic, the development of the McGill Pain Questionnaire has helped make progress in this area. Treatments for pain involve patient-administered analgesia, acupuncture (found to be effective in reducing pain for osteoarthritis of the knee), biofeedback, and cognitive behavior therapy.

Health psychologist roles

Below are some examples of the types of positions held by health psychologists within applied settings such as the UK's NHS and private practice.

• Consultant health psychologist: A consultant health psychologist will take a lead for health psychology within public health, including managing tobacco control and smoking cessation services and providing professional leadership in the management of health trainers.
• Principal health psychologist: A principal health psychologist could, for example lead the health psychology service within one of the UK’s leading heart and lung hospitals, providing a clinical service to patients and advising all members of the multidisciplinary team.
• Health psychologist: An example of a health psychologist's role would be to provide health psychology input to a center for weight management. Psychological assessment of treatment, development and delivery of a tailored weight management program, and advising on approaches to improve adherence to health advice and medical treatment.
• Research psychologist: Research health psychologists carry out health psychology research, for example, exploring the psychological impact of receiving a diagnosis of dementia, or evaluating ways of providing psychological support for people with burn injuries. Research can also be in the area of health promotion, for example investigating the determinants of healthy eating or physical activity or understanding why people misuse substances.
• Health psychologist in training/assistant health psychologist: As an assistant/in training, a health psychologist will gain experience assessing patients, delivering psychological interventions to change health behaviors, and conducting research, whilst being supervised by a qualified health psychologist.

Training

In the UK, health psychologists are registered by the Health Professions Council (HPC) and have trained to a level to be eligible for full membership of the Division of Health Psychology within the BPS. Registered health psychologists who are chartered with the BPS will have undertaken a minimum of six years of training and will have specialized in health psychology for a minimum of three years. Health psychologists in training must have completed BPS stage 1 training and be registered with the BPS Stage 2 training route or with a BPS-accredited university doctoral health psychology program. Once qualified, health psychologists can work in a range of settings, for example the NHS, universities, schools, private healthcare, and research and charitable organizations. A health psychologist in training might be working within applied settings while working towards registration and chartered status. A health psychologist will have demonstrated competencies in all of the following areas:

• professional skills (including implementing ethical and legal standards, communication, and teamwork),
• research skills (including designing, conducting, and analyzing psychological research in numerous areas),
• consultancy skills (including planning and evaluation),
• teaching and training skills (including knowledge of designing, delivering, and evaluating large and small scale training program),
• intervention skills (including delivery and evaluation of behavior change interventions).

All qualified health psychologists must also engage in and record their continuing professional development (CPD) for psychology each year throughout their career.

Work–life balance

From Wikipedia, the free encyclopedia

Work–life balance is the lack of opposition between work and other life roles. It is the state of equilibrium in which demands of personal life, professional life, and family life are equal. Work-life balance consists but it is not limited to flexible work arrangements that allow employees to carry out other life programs and practices. The term ‘Work-Life Balance' is recent in origin, as it was first used in UK and US in the late 1970's and 1980's, respectively. Work-life balance is a term commonly used to describe the balance that a working individual needs between time allocated for work and other aspects of life. Areas of life other than work–life can include, but it is not limited to personal interests, family and social or leisure activities. Technological advances have made it possible for work tasks to be accomplished faster due to the use of smartphones, email, video-chat, and other technological software.These technology advances facilitate individuals to work without having a typical '9 to 5 work day.

Studies from the London Hazards Centre indicate that work today is more intense than it was a decade ago creating the need for a balance between work and life. Experiencing being over-worked, long working hours, and an extreme work environment has proven to affect the overall physical and psychological health of employees and deteriorate family-life.Britain's government recognized this reality and started making an effort to balance the work and home life of its employees by providing alternatives such as being able to use portable electronic equipment to do their jobs from a virtual office, or to work from their actual homes.

According to 2010 National Health Interview Survey Occupational Health Supplement data, 16% of U.S. workers reported difficulty balancing work and family. The findings were more prevalent among workers between 30–44 years old.

18% of Workers with a Bachelor Degree and higher education have difficulties balancing work and life outside of work; compared with workers with a high school diploma or G.E.D which is(16%). Workers without a high school education (15%). The results of workers in industries such as agriculture, forestry, fishing, and hunting are (9%) had a lower work–family imbalance ratio compared to adult employees in other industries (16%). Among other occupations, a higher prevalence rate of work–family imbalance was found in legal occupations (26%), whereas a lower prevalence rate was observed for workers in office and administrative support (14%).

Identity through work

By working in an organization, employees identify, to some extent, with the organization, as part of a collective group. Organizational values, norms and interests become incorporated in the self-concept as employees increase their identification with the organization. However, employees also identify with their outside roles, or their "true self". Examples of these could include: parental/caretaker roles, identifications with certain groups, religious affiliations, align with certain values and morals, mass media etc.

Employee interactions with the organization, through other employees, management, customers, or others, reinforces (or resists) the employee identification with the organization. Simultaneously, the employee must manage their "true self" identification. In other words, identity is "fragmented and constructed" through a number of interactions within and outside of the organization; employees do not have just one self.

Most employees identify not only with the organization, but also other facets of their life (family, children, religion, etc.). Sometimes these identities align and sometimes they do not. When identities are in conflict, the sense of a healthy work–life balance may be affected. Organization members must perform identity work so that they align themselves with the area in which they are performing to avoid conflict and any stress as a result.

Causes of work–life imbalance

There are three moderators that are correlated with work–life imbalance: gender, time spent at work, and family characteristics.

Gender differences could lead to a work–life imbalance due to the distinct perception of role identity. It has been demonstrated that men prioritize their work duties over their family duties to provide financial support for their families, whereas women prioritize their family life.

Spending long hours at work due to "inflexibility, shifting in work requirements, overtime or evening work duties" could lead to an imbalance between work and family duties. It has been demonstrated "that time spent at work positively correlate with both work interference with family and family interference with work, however, it was unrelated to cross-domain satisfaction" This could be due to the fact that satisfaction is a subjective measure. This being said, long hours could be interpreted positively or negatively depending on the individuals. Working long hours affect the family duties, but on the other side, there are financial benefits that accompany this action which negate the effect on family duties.

Family characteristics include single employers, married or cohabiting employers, parent employers, and dual-earning parents. Parents who are employed experience reduced family satisfaction due to their family duties or requirements. This is due to the fact that they are unable to successfully complete these family duties. In addition, parent workers value family-oriented activities; thus, working long hours reduces their ability to fulfill this identity, and, in return, reduces family satisfaction. As for the married and/ or dual-earning couples, it seems that "not only require more time and effort at home but also are a resource for individuals to draw from, both instrumentally through higher income and emotionally through increased empathy and support." 

In addition to these moderators that could lead to an imbalance, many people expose themselves to unsolicited job stress, because they enjoy high social recognition. This aspect can also be the cause of an imbalance in the areas of life. However, other occupational activities could also lead to such an imbalance, for example, unpaid labor such as contribution to house and garden work, maintenance and support of family members or volunteer activities. All of these contribute to the perception of a chronic lack of time. Lacking time leads to pressure, which is experienced differently based on the individual's age, the age and number of children in the household, marital status, the profession and level of employment, and the income level. Strong pressure of time leads to increased psychological strain, which in turn affects health. Psychological strain is also affected by the complexity of work, the growing responsibilities, concerns for long-term existential protection, and more. The mentioned stresses and strains could lead in the long term to irreversible, physical signs of wear, as well as to negative effects on the human cardiovascular and immune systems.

Role of gender and family

Work–life conflict is not gender-specific. According to the Center for American Progress, 90 percent of working mothers and 95 percent of working fathers report work–family conflict. However, due to social norms surrounding gender roles, and how the organization views its ideal worker, men and women handle the work–life balance differently. Organizations play a large part in how their employees deal with work–life balance. Some companies have taken proactive measures in providing programs and initiatives to help their employees cope with work–life balance.

The conflict of work and family can be exacerbated by perceived deviation from the "ideal worker" archetype, leading to those with caretaker roles to be perceived as not as dedicated to the organization. This has a disproportionate impact on working mothers, who are seen as less worthy of training than childless women.

Many authors believe that parents being affected by work–life conflict will either reduce the number of hours one works, where other authors suggest that a parent may run away from family life or work more hours at a workplace. This implies that each individual views work–life conflict differently.

Research conducted by the Kenexa Research Institute (KRI) evaluated how male and female workers perceive work–life balance and found that women are more positive than men in how they perceive their company’s efforts to help them balance work and life responsibilities. The report is based on the analysis of data drawn from a representative sample of 10,000 U.S. workers who were surveyed through WorkTrends, KRI’s annual survey of worker opinions. The results indicated a shift in women’s perceptions about work–life balance. In the past, women often found it more difficult to maintain balance due to the competing pressures at work and demands at home.

"The past two decades have witnessed a sharp decline in men’s provider role, caused in part by growing female labor participation and in part by the weakening of men’s absolute power due to increased rates of unemployment and underemployment," states sociologist Jiping Zuo. She continues, "Women’s growing earning power and commitment to the paid workforce together with the stagnation of men’s social mobility make some families more financially dependent on women. As a result, the foundations of the male dominance structure have been eroded."

In recent research by Pew Research Center, it is reported that half of working mothers and fathers believe it is a challenge to simultaneously be a professional and a parent. Generally speaking, men have more interests in financial gain which requires working longer hours. Women tend to report higher desires of flexibility between profession and home life, which can allow them to be at home more frequently.

Changes in perceived gender roles

Today there are many young women who do not want to just stay at home and do housework without having careers. About 64% of mothers whose youngest child was under age six, as well as 77% of mothers with a youngest child age 6–17—were employed in 2010, this indicates that the majority of women with dependent-care responsibilities cannot, or do not, wish to give up careers. While women are increasingly represented in the workforce, they still face challenges balancing work and home life. Both domestic and market labor compete for time and energy. "For women, the results show that only time spent in female housework chores has a significant negative effect on wages".

Many men do not see work alone as providing their lives with full satisfaction, and they often want a balance between paid work and personal attachments, without being penalized at work. These men may desire to work part-time, in order to spend more time with their families.

More men are realizing that work is not their only primary source of fulfillment from life. A new study on fatherhood (2010) shows that more men are looking for alternatives to their 40-hour workweek in order to spend more time with their family. Though working less means a smaller paycheck and higher stress levels, men are looking for flexibility just as much as women. However, with an ever-changing society, flexibility is becoming much more apparent. "It seems that some traditional stereotypes are starting to lessen just a bit in terms of who’s responsible for care of the children," says human resource specialist Steve Moore. Traditionalism is becoming less frequent due to what’s actually practical for each individual family.

Men often face an unequal opportunity to family life, as they are often expected to be the financial supporter of the family unit. According to Garey and Hansen, "the masculine ideal of a worker unencumbered by care-giving obligations is built into workplace structures and patterns of reward."

Consequences of work–life imbalance

Stress

Steven L. Sauter, chief of the Applied Psychology and Ergonomics Branch of the National Institute for Occupational Safety and Health in Cincinnati, Ohio, states that recent studies show that "the workplace has become the single greatest source of stress". Michael Feuerstein, professor of clinical psychology at the Uniformed Services University of the Health Sciences at Bethesda Naval Hospital declares "seeing a greater increase in work-related neuroskeletal disorders from a combination of stress and ergonomic stressors". Seventy-five to ninety percent of physician visits are related to stress and, according to the American Institute of Stress, the estimated costs to industry is $200 billion–$300 billion a year.

Problems caused by stress have become a major concern to both employers and employees. Symptoms of stress are manifested both physiologically and psychologically. Persistent stress can result in cardiovascular disease, sexual health problems, a weaker immune system and frequent headaches, stiff muscles, or backache. It can also result in poor coping skills, irritability, jumpiness, insecurity, exhaustion, and difficulty concentrating. Stress may also perpetuate or lead to binge eating, smoking, and alcohol consumption. 

The feeling that simply working hard is not enough anymore is acknowledged by many other American workers. "To get ahead, a seventy-hour work week is the new standard. What little time is left is often divided up among relationships, kids, and sleep." This increase in work hours over the past two decades means that less time will be spent with family, friends, and community as well as pursuing activities that one enjoys and taking the time to grow personally and spiritually.

According to a survey conducted by the National Life Insurance Company, four out of ten U.S. employees state that their jobs are "very" or "extremely" stressful. Those in high-stress jobs are three times more likely than others to suffer from stress-related medical conditions and are twice as likely to quit. The study states that women, in particular, report stress related to the conflict between work and family. 

In the study, Work–Family Spillover and Daily Reports of Work and Family Stress in the Adult Labor Force, researchers found that with an increased amount of negative spillover from work to family, the likelihood of reporting stress within the family increased by 74%, and with an increased amount of negative spillover from family to work the likelihood to report stress felt at work increased by 47%. Shepherd-Banigan, Basu, Booth & Harris (2016) conduct research on how stress can cause extremely negative effects on new parents. Between trying to balance a new schedule, managing additional responsibilities, and lacking flexibility and support, they can only increase stress, potentially causing depression to the employee.

Psychoanalysts diagnose uncertainty as the dominant attitude to life in the postmodern society. The pressure that society exerts on individuals can cause them to have an uncertain attitude. It is the uncertainty to fail, but also the fear of their own limits, not to achieve what the society expects, and especially the desire for recognition in all areas of life. In today's society, competition manifests itself in various settings. For example, appearance, occupation, education of the children are compared to a media-staged ideal. This idea of perfection is due to this deep-rooted aversion to all things average; the pathological pursuit to excellence. Whoever wants more from the job—from the partner, from the children, and from themselves—could one day burn out. The individual is then faced with the realization that perfection does not exist. To date, burnout is not a recognized illness. It has been noticed that a burnout affects those passionate people who seek perfection. This condition is not considered a mental illness but only a grave exhaustion that can lead to numerous sick days. It can benefit the term that it is a disease model which is socially acceptable and also, to some extent, the individual self-esteem stabilizing. According to experts in the field, the individuals who detain the following characteristics are more prone to burnouts: the hard-working, the perfectionist, the loner, the grim and the thin-skinned. All together, they usually have a lack of a healthy distance to work, leading to work–life imbalance.

Another example related to burnout is decision-makers in government offices and upper echelons. They are not allowed to show weaknesses or signs of disease, because this would immediately lead to doubts of their ability for further responsibilities. Only 20% of managers (e.g. in Germany) do sports regularly, and only 2% regularly attend preventive medical check-ups. In such a position other priorities seem to be set and the time is lacking for regular sports. The highest priority seems linked to the job, and it leads individuals to waive screening as a sign of weakness. Nonetheless, the burnout syndrome seems to be gaining popularity. Nothing seems shameful about showing weaknesses, but quite the opposite, the burnout is part of a successful career like a home for the role model family. In other terms, attributing the highest priority and allotted time to work leads to a higher chance for success, but also interrupts the balance between work and life. Since the description of burnout could be "socially recognized precious version of the depression and despair that lets also at the moment of failure the self-image intact", it concludes that "only losers become depressed, burnout against it is a diagnosis for winners, more precisely, for former winners.".

Although burnout is linked to a more positive view, four out of five Germans complain about high stress levels. In fact, one in every sixth individual under the age of 60 consumes medication against insomnia, depression or to boost energy levels, at least once a week. The phases of burnout can be described first by great ambition, then the suppression of failure, isolation, and, finally, the cynical attitude towards the employer or supervisor. Often, those individuals seem to have anxiety disorders and depression as well, which are serious mental diseases. Depression is the predominant cause of nearly 10,000 suicides that occur each year in Germany. The consequences of high stress levels could lead to depression, which in turns affects the balance between work and life. For example, in Germany, early retirement due to mental illness represented 15.4 percent of all cases in 1993. In 2008, the percentage increased to 35.6 percent. The proportion of failures due to mental disorders seems to be increasing. In 2008, statisticians calculated 41 million absent days that were related to these crises, leading to 3.9 billion euros in lost production costs.

Role of technology

According to Bowswell and Olson-Buchanan the recent changes in the work place are due to changes in technology. Greater technological advancements such as portable cellphones, portable computers, e-mail and cell phone have made it possible for employees to work beyond the confinement of their physical office space. This allows employees to answer e-mails and work on deadlines after-hours while not officially "on the job". 

Having these technological resources at all times and everywhere increases the likelihood of employees to spend their "free time" or outside of work, family time doing work related tasks. Employees that consider their work roles highly important are more likely to apply all these technological advancements to work while outside of their work domain. 

Some theorists suggest that this vague boundary of work and life is a result of technological control. Technological control unfolds from the physical technology provided by an organization". Companies use email and distribute smartphones to enable and encourage their employees to stay connected to the business even when they are not in the office. This type of control, as Barker argues, replaces the more direct, authoritarian control, or simple control, such as managers and bosses. As a result, communication technologies in the temporal and structural aspects of work have changed, defining a "new workplace" in which employees are more connected to the jobs beyond the boundaries of the traditional workday and workplace. The more this boundary is blurred, the higher work-to-life conflict is self-reported by employees. In a review of recent literature looking at the theory of technological control suggests employers and employees often communicate and continue to work during "off hours" or even periods of vacation. This added use of technology creates a confusion as to what the purpose of the technology poses for the individual using it. Questions such as "what is work usage media compared to non-work usage media look like" or "are we working more because it is easier and more accessible or because we want to work more?" 

Employee assistance professionals say there are many causes for this situation ranging from personal ambition and the pressure of family obligations to the accelerating pace of technology. According to a recent study for the Center for Work-Life Policy, 1.7 million people in the United States consider their jobs and their work hours excessive because of globalization.

Working from Home

Technology has also provided the opportunity to work from home rather than from the company's physical office. Working from home is an initiative that arose from the efforts of improving the work-life balance. One of the ways in which the UK government believes the desired work-life balance can be achieved is by working from home. The idea of working from home started in the UK and the number of people working from home is only increasing. By 2000 it was reported that a quarter of Britain's workforce worked from home at least part time. Working from home can be defined as any paid work that is done primarily from home. Working from home is also known as Telecommuting.

In 2017, it was reported that 8 million people in the US are working from home, that is 5% of the entire US work force. This increase has been in response to the demand for more flexibility work environments. A 2017 report by a polling company named Gallup found that allowing their employees to work from home decreases employee turnover and increases employee productivity. Trend suggests the type of workers leading the work from home wave are professionals in industries such as finance, designers, computer scientists, and other high-skill professionals.

Improving work–life balance

Responsibility of the employer

Texas Quick, an expert witness at trials of companies who were accused of overworking their employees, states that "when people get worked beyond their capacity, companies pay the price." Although some employers believe that workers should reduce their own stress by simplifying their lives and making a better effort to care for their health, most experts feel that the chief responsibility for reducing stress should be management. 

According to Esther M. Orioli, president of Essi Systems, a stress management consulting firm, "Traditional stress-management programs placed the responsibility of reducing stress on the individual rather than on the organization where it belongs. No matter how healthy individual employees are when they start out, if they work in a dysfunctional system, they’ll burn out."

Work–life balance has been addressed by some employers and has been seen as a benefit to them. Indeed, employees report increased job satisfaction, greater sense of job security, better physical and mental health, reduced levels of job stress and enhanced control of their environment. In fact, work–life balance does not only benefit the employee, but also the organization. Once work–life balance has been introduced to the employee, the organization faces less absenteeism, lateness and staff turnover rates. In addition, there is an increase retention of valuable employees, higher employee loyalty and commitment towards the organization, improved productivity and enhanced organizational image.

In the literature, “work–family policies, family-friendly or family-responsive policies” are practices intended for work and life balances. In fact, “the primary way companies can help facilitate work–life balance for their employees is through work–life practices, that are usually associated with flexible working and reductions in working time or family-friendly policies”. According to Hartel et al., a variety of policies could be implemented to help manage work life balance just as "flexible working hour, job sharing, part-time work, compressed work weeks, parental leave, telecommuting, on-site child care facility".

Studies from Canadian adjunct professor and psychology researcher Yani Likongo demonstrated that sometimes in organizations an idiosyncratic psychological contract is built between the employee and his direct supervisor in order to create an "informal deal" regarding work–life balance. These "deals" support the idea of a constructivist approach including both the employer and the employee, based on a give-and-take situation for both of them.

As of March 2011, paid leave benefits continued to be the most widely available benefit offered by employers in the United States, with paid vacations available to 91 percent of full-time workers in private industry. Access to these benefits, however, varied by employee and establishment characteristics. According to the data from the National Compensation Survey (NCS), paid vacation benefits were available to 37 percent of part-time workers in private industry. These benefits were available to 90 percent of workers earning wages in the highest 10th percent of employees and only to 38 percent of workers in the lowest 10 percent of private industry wage earners. Paid sick leave was available to 75 percent of full-time workers and 27 percent of part-time workers. Access to paid sick leave benefits ranged from 21 percent for the lowest wage category to 87 percent for the highest wage category. These data provide comprehensive measures of compensation cost trends and incidence and provisions of employee benefit plans.

"It is generally only highly skilled workers that can enjoy such benefits as written in their contracts, although many professional fields would not go so far as to discourage workaholic behaviour. Unskilled workers will almost always have to rely on bare minimum legal requirements. The legal requirements are low in many countries, in particular, the United States. In contrast, the European Union has gone quite far in assuring a legal work–life balance framework, for example pertaining to parental leave and the non-discrimination of part-time workers."

According to Stewart Friedman—professor of management and founding director of the Wharton School’s Leadership Program and of its Work/Life Integration Project—a "one size fits all" mentality in human resources management often perpetuates frustration among employees. "[It’s not an] uncommon problem in many HR areas where, for the sake of equality, there's a standard policy that is implemented in a way that's universally applicable -- [even though] everyone's life is different and everyone needs different things in terms of how to integrate the different pieces. It's got to be customized."

Friedman’s research indicates that the solution lies in approaching the components of work, home, community, and self as a comprehensive system. Instead of taking a zero-sum approach, Friedman’s Total Leadership program teaches professionals how to successfully pursue "four-way wins"—improved performance across all parts of life. 

Although employers are offering many opportunities to help their employees balance work and life, these opportunities may be a catch twenty-two for some female employees. Even if the organization offers part-time options, many women will not take advantage of it as this type of arrangement is often seen as "occupational dead end".

Even with the more flexible schedule, working mothers opt not to work part-time because these positions typically receive less interesting and challenging assignments; taking these assignments and working part-time may hinder advancement and growth. Even when the option to work part-time is available, some may not take advantage of it because they do not want to be marginalized. This feeling of marginalization could be a result of not fitting into the "ideal worker" framework (see: Formation of the "ideal worker" and gender differences). 

Additionally, some mothers, after returning to work, experience what is called the maternal wall. The maternal wall is experienced in the less desirable assignments given to the returning mothers. It is also a sense that because these women are mothers, they cannot perform as "ideal workers". If an organization is providing means for working mothers and fathers to better balance their work–life commitments, the general organizational norm needs to shift so the "ideal worker" includes those who must manage a home, children, elderly parents, etc.

Corporate social responsibility

Work-life balance practices are institutionalized arrangements that make it easier for employees to manage the often discordant worlds of work and personal life. These practices are part of a company's social responsibility with its stakeholders. These practices can be summarized in three major categories: policies, benefits and services.

The term work-life balance has been neglected by employers since it has been the norm to put pressure on employees in the workplace. In the current business world work-life balance is not only a common term but it ranks as one of the most important workplace aspects second only to compensation. According to research conducted by more than 50,000 corporate executive board members, employees who have a better work-life balance tend to work harder than those that don't. These practices result in more productivity and employees reporting higher work satisfaction and company reviews.

The changing global social demands have changed the structure and nature of traditional work practices. Work is not just a matter of necessity or survival but of personal and professional development and family satisfaction. All these factors must balance in order to achieve the best results for both the employer and the employee; this is a characteristic of organizational wisdom. This will engage people to the organization while allowing them to have a balanced life outside of the workplace. This has become an organizational responsibility due to the fact that the demand for flexibility is only increasing and the opposite of it bring dissatisfaction of one of one will impact the other two which is not beneficial for the organization. Executive leaders and Human Resources professionals are recognizing the important of employee engagement or "happiness at work" as a driver of a company's success. Employees that consider the companies they work for invest in them are usually more invested in the success of the organization.

Companies such as Starbucks, Google and Boston Consulting Group who have incorporated these practices as part of their organizations have been recognized by Fortune's 100 Best Companies to work for. Some of the world's best performing organizations understand that creating a work-life balance is a key factor for great business performance outcomes. Work-life balance is a strategic initiative for engaged employees that produce business growth.

Maternity leave

Maternity leave and parental leave are leaves of absence for expectant or new mothers (sometimes fathers) for the birth and care of the baby. These policies vary significantly by country (regarding factors such as the length of the leave and what amount of money is paid). They may help create a work–life balance for families. For example, in Canada there is the Quebec Parental Insurance Program which is responsible for providing maternity, paternity, parental and adoption benefits to citizens of Quebec. According to the government of Canada website, El maternity benefits are offered for a maximum of 15 weeks. Both the biological and surrogate mothers are eligible to get these benefits. Those involved can receive these benefits as early as 12 weeks before the expected due date. In addition, there is also the possibility to be paid 17 weeks after the date of birth. These benefits can be received either by the standard or extended option. The standard parental benefits differ from the extended parental benefits in the percentage of the individual’s average weekly earnings and the number of weeks the individuals are being paid. Indeed, the extended parental benefit’s rate is 33% of the individuals’ average weekly earnings (for a maximum of 61 weeks) compared to 55% (for a maximum of 35 weeks) for the standard parental benefits. There is also the possibility for both parents to apply to the El parental benefits. Men are just as likely as women obtain these benefits.

However, in the United States, most states do not offer any paid time off for the birth of a child. As of 2015, the US was one of only three countries in the world (the other two being Papua New Guinea and Suriname) that does not have paid maternity leave.

Some new mothers (and fathers) in the US will take unpaid time off, allowed by the Family and Medical Leave Act. The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to twelve workweeks of leave in a 12-month period for:

• the birth of a child and to care for the newborn child within one year of birth;
• the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;

Some states will allow paid time off for maternity leave under the states Temporary Disability Insurance (TDI).

State	TDI Benefit
California	55% - 60% of highest quarterly earnings during a 12-month base period up to $959 (2009)
Hawaii	58% of average weekly wages up to $510 (2009)
New Jersey	66% of average weekly wages up to $524 (2008)
New York	50% of weekly wages up to $170 (2008)
Rhode Island	4.62% of employees highest calendar quarter wages in the base year, up to $671, plus dependent allowance of $10 or 7% of weekly benefit for up to five dependents (2008)

At the state level, California was the first state to offer paid family leave benefits for its workers. While the benefits only last for six weeks this is the first major step for maternity leave in the United States and other states seem to be following suit. New Jersey lawmakers are working on legislation that would make their state the second state to add this employee benefit. Under one New Jersey proposal, workers who take leave would be paid through the state's temporary disability insurance fund, "augmented by a 0.1 percent charge on workers’ weekly wages." Traditionally, many conservatives have opposed paid family leave, but there is a sign that this mindset is beginning to change. Reverend Paul Schenck, a prominent member of the National Pro-Life Action Center recently stated that he would support paid maternity leave on the assumption that it might encourage women to follow through with their pregnancies instead of having abortions. According to Heyman, "Across the political spectrum, people are realizing these policies have an enormous impact on working families. If you look at the most competitive economies in the world, all the others except the U.S. have these policies in place."

The United States is not as workplace family-oriented as many other wealthy countries. According to a study released by Harvard and McGill University researchers in February 2007, workplace policies for families in the U.S. are weaker than those of all high-income countries and even many middle-and low-income countries. Other differences include the fact that fathers are granted paid paternity leave or paid parental leave in sixty-five countries; thirty one of these countries offer at least fourteen weeks of paid leave. The U.S. does not guarantee this to fathers.(survey) Sweden, Denmark and Norway have the highest level of maternity benefits—Sweden provides 68 weeks paid maternity leave, Norway provides 56 weeks paid maternity leave and Denmark provides 52.

Diversity

Sexual orientation

Diversity in regard to sexual orientation is often overlooked when implementing terms of family guidelines and agreements in corporate policies. Sexual minorities are often overlooked in establishing these policies. As a result, the needs of non-traditional families, which consist of couples or individuals with lesbian, gay, bisexual, or transgender (LGBT) backgrounds, are not met. The sexual stigma and prejudice are present in managing diversity and inclusion on an international level, and an array of contextual and societal factors define the lack of attention given to sexual minority employees. As a result, these employees can be subjected to exclusion, neglect, and isolation, which have a negative effect on their work–life balance.

Several international studies reveal that LGBT-supportive corporate policies allow for an inclusive environment in the workplace. As a result, this entails benefits for the employees and overall company performance. There is a positive relationship between LGBT-supportive policies and business-related outcomes, such as increased productivity. A decrease in discriminatory behavior amongst employees, enhanced job satisfaction, and employee engagement are associated with increased economic outcomes.

However, individual experiences with these kinds of inclusive policies vary, as there are potential "implementation gaps" between equality and diversity policies, and practice across sectors, workplaces and even within buildings of organizations.

Also, on a macroeconomic level, health promotion and public health policies that adapted and developed to ensure an inclusive and diversified work environment for sexual minorities. These health goals target the social determinants of health and lead to increased population health and an overall decrease in cost in the public health system.

Religion

Religion and spirituality play a role in work–life balance as they are part of diversity management and accommodations in the workplace and religion-based societies in Saudi Arabia or Israel organize religious accommodation with special provisions in government legislation and organizational policies. Some organizations also allow their employees to make up time spent on religious activities out of contractual hours. Religion and spirituality represent an essential issue in diversity management, as the question of accommodating religion at work often raises controversial debate.

An employee’s religious beliefs are often associated with their ethical beliefs, and an important role in self-identity and religion-based societies in Saudi Arabia or Israel organize religious accommodations with special provisions in government legislation and organizational policies. Some organizations also allow their employees to make up time spent on religious activities out of contractual hours. As such, poor management of religious diversity may affect employees’ performances if they feel forced to choose between aspects of their religious identity and their jobs. This may also lead to them dissociating themselves from the organization. Therefore, religious diversity management is essential to ensuring a satisfying work–life balance for employees. The American Title VII of the Civil Rights Act of 1964 states that ‘companies have a duty to provide reasonable religious accommodation’.

Global comparisons

United States

According to a new study by Harvard and McGill University researchers, the United States lags far behind nearly all wealthy countries when it comes to family-oriented workplace policies such as maternity leave, paid sick days and support for breast feeding. Jody Heyman, founder of the Harvard-based Project on Global Working Families and director of McGill’s Institute for Health and Social Policy, states that, "More countries are providing the workplace protections that millions of Americans can only dream of. The United States has been a proud leader in adopting laws that provide for equal opportunity in the workplace, but our work/family protections are among the worst." 

This observation is being shared by many Americans today and is considered by many experts to be indicative of the current climate. However, the U.S. Labor Department is examining regulations that give workers unpaid leave to deal with family or medical emergencies (a review that supporters of the FMLA worry might be a prelude to scaling back these protections, as requested by some business groups). Senator Chris Dodd from Connecticut proposed legislation that would enable workers to take six weeks of paid leave. Congress was also expected to reconsider the Healthy Families Act, a bill that would have required employers with at least fifteen employees to provide seven paid sick days per year.

At least 107 countries protect working women’s right to breast-feed and, in at least seventy-three of them, women are paid. The United States does not have any federal legislation guaranteeing mothers the right to breast-feed their infants at work, but 24 states, the District of Columbia and Puerto Rico have laws related to breastfeeding in the workplace.

At least 134 countries have laws setting the maximum length of the work week; the U.S. does not have a maximum work week length and does not place any limits on the amount of overtime that an employee is required to work each week. (survey) Sweden, Denmark and Norway have the highest level of maternity benefits—Sweden provides 68 weeks paid maternity leave, Norway provides 56 weeks paid maternity leave and Denmark provides 52.

Even when vacation time is offered in some U.S. companies, some choose not to take advantage of it. A 2003 survey by Management Recruiter International stated that fifty percent of executives surveyed didn’t have plans to take a vacation. They decided to stay at work and use their vacation time to get caught up on their increased workloads. More recently, 2018 research from Project: Time Off indicates 52% of employees reported having unused vacation days at the end of 2017. This equates to 705 million unused vacation days in the US annually.

American workers are legally not entitled to any paid holidays. However, most employers will give the 10 days off of national holidays. This is one of the lowest paid holidays total in the world. Brazil has a total of 41 paid days off and Australia has 38 days off.

Some American companies have started to see that to improve employee efficiency they must improve the quality of their time at work and the various other stressors they may be experiencing in their life. Various companies have taken initiatives to drastically improve the employees work satisfaction. Companies such as 3M have introduced free stress management coaches into the work place to aid employees with their busy schedules. Google, Facebook and Sales Force have put areas to be physically active in the workplace as well as providing free food and snacks for the workers. These companies are some of the best in terms of benefits for sick and maternal leave. These business structures are models that can push the government to improve the standards across the United States of America.

European Union

The European Union promotes various initiatives regarding work–life balance and encourages its member states to implement family-friendly policies. In Europe, the Working Time Directive has implemented a maximum 48-hour working week. Many countries have opted for fewer hours. France introduced a 35-hour workweek. Contradictory to the Scandinavian countries, there is no evidence of state policies that absolutely encourage men to take on a larger share of domestic work in France, Portugal, or Britain. In a 2007, the European Quality of Life Survey found that countries in south-eastern Europe had the most common problems with work–life balance. In Croatia and Greece, a little over 70% of working citizens say that they are too tired to do household jobs at least several times a month because of work.

In Britain, legislation has been passed allowing parents of children under six to request a more flexible work schedule. Companies must approve this request as long as it does not damage the business. A 2003 Survey of graduates in the UK revealed that graduates value flexibility even more than wages.

In all twenty-five European Union countries, voters "punish" politicians who try to shrink vacations. "Even the twenty-two days Estonians, Lithuanians, Poles and Slovenians count as their own is much more generous than the leave allotted to U.S. workers." According to a report by the Families and Work Institute, the average vacation time that Americans took each year averaged 14.6 days.

According to Jeremy Reynolds, unions can lobby for benefits, pay, training, safety measures, and additional factors that impact the costs and benefits of work hours. "Unions can also have a more direct impact on hour mismatches through their efforts to change the length of the workday, work week, and work year, and to increase vacation and leave time." This is why workers in countries where there are strong unions usually work fewer hours and have more generous leave policies than workers who are in countries where there are weaker unions.

It is critical to mention that cultural factors influence why and how much we work. As stated by Jeremy Reynolds, "cultural norms may encourage work as an end in itself or as a means to acquiring other things, including consumer products." This might be why Americans are bound to work more than people in other countries. In general, Americans always want more and more, so Americans need to work more in order to have the money to spend on these consumer products.