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Hierarchies of Health: Health and Work-Related Stress of Managers in Municipalities and County Councils in Sweden

Björklund, Christina PhD; Lohela-Karlsson, Malin PhD; Jensen, Irene PhD; Bergström, Gunnar PhD

Journal of Occupational and Environmental Medicine: July 2013 - Volume 55 - Issue 7 - p 752–760
doi: 10.1097/JOM.0b013e318295681c
Original Articles

Objective: The aim of this study was to investigate the risk of poor health and stress among male and female managers working at different levels in the public sector.

Methods: A cross-sectional study using register data. A modified Poisson regression approach was used to examine the risk of stress and illness in relation to management level and sex; 1088 managers participated and were categorized into different management levels and sexes.

Results: The results showed a clear hierarchy of health in relation to managerial level and sex with several significant statistical differences. Women with lower-level management positions suffered to a greater extent from poor health and stress.

Conclusions: Organizations should focus not only on developing individuals in their managerial roles but also on improving the conditions that allow managers to remain healthy and less stressed.

From the Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden.

Address correspondence to: Christina Björklund, PhD, Karolinska Institutet, Institute of Environmental Medicine, SE-17177 Stockholm, Sweden (

This study was financially supported by Afa-Försäkring, Stockholm, Sweden.

Christina Björklund and the coauthors have no financial interest related to this research.

The authors declare no conflicts of interest.

Copyright © 2013 by the American College of Occupational and Environmental Medicine