I. 司法從業人員之職業壓力研究 II. 全球化與公共衛生--金融危機與傳染病監控

I. Occupational stress of legal professionals II. Globalization and public health- financial crisis and infectious disease surveillance

蔡奉真(Feng-Jen Tsai)

指導教授 ： 詹長權

國立臺灣大學/公共衛生學院/職業醫學與工業衛生研究所/博士(2010年)

https://doi.org/10.6342/NTU.2010.00003

摘要

本論文包含兩個研究：（1）司法從業人員的職業壓力研究；以及（2）全球化與公共衛生—金融危機與傳染病監控。
律師，法官及檢察官等司法從業人員乃實際執行司法制度之人，如其職業壓力過高，則其工作品質將可能受到影響，例如檢察官的起訴失敗率以及法官的誤判率可能會因此而增加。司法從業人員的工作品質與人民的司法保障權息息相關，然司法從業人員之職業壓力研究卻付之闕如，故本論文對之進行研究，詳言之，司法從業人員的職業壓力研究目的為：（一）了解律師，法官及檢察官之職業壓力與疲勞狀況；（二）了解司法從業人員之職業壓力與疲勞間之關連性；以及（三）了解各族群間職業壓力與疲勞狀況的差異。本研究係在2007年10月到2008年1月間；以問卷調查之方式對428位司法從業人員進行職業壓力與疲勞狀況調查。問卷內除調查司法從業人員之個人資料外，並以中文版之工作特質量表（C-JCQ）及中文版付出-回饋失衡量表（C-ERI）調查受試者之客觀壓力指標，以台灣短篇版之WHOQOL問卷（SF-36）調查受試者之生活品質狀況，及以哥本哈根疲勞量表（C-CBI）來收集受試者疲勞狀況資料。最後共有180位律師，87位法官及98位檢察官完成問卷調查，本研究再就回收之問卷，以卡方檢定，t檢定及邏吉斯回歸等統計方式進行分析，以了解司法從業人員的工作壓力及疲勞狀況；其工作壓力與疲勞狀況間之關連性；以及各族群間職業壓力與疲勞狀況之差異。研究結果發現律師及司法官等司法從業人員之工作控制、工作心理負荷量、一般疲勞及工作相關疲勞狀況，都比全國普查結果及其他族群研究所得數值為高，這顯示司法從業人員屬於工作壓力及疲勞狀況偏高的族群，且因司法從業人員之工作時數過長，私人生活時間不足，導致司法從業人員之工作壓力幾乎同時與其一般疲勞及工作相關疲勞產生顯著關連性。族群間比較結果則發現相較於非訟律師，訴訟律師雖有較高的決策自主權及工作場所的社會支持，但其有較高的風險得到客戶相關疲勞。而在法官與檢察官的比較中則發現，雖然法官的工作回饋較高，但其有較高的風險得到客戶相關疲勞，又將司法從業人員依性別分組比較，發現女性司法從業人員之工作壓力及一般健康狀況較男性司法從業人員為差。本論文除建議勞安主管機關注意司法從業人員工作壓力問題，並推動司法從業人員工作場所的減壓政策外，亦應協同司法主管機關，就司法從業人員之工作壓力所可能衍生之司法品質問題，進行更深度的研究與了解。
在全球化與公共衛生的研究中，本論文係以金融危機對律師及金融從業人員之職業壓力與疲勞狀況影響，及傳染性疾病全球監控系統與法規範之運作，來了解全球化的影響。詳言之，本研究之目的為：（一）了解金融危機前後，律師及金融從業人員之工作壓力及疲勞狀況是否有所改變；（二）了解金融危機前後，工作壓力及疲勞狀況間之關連性是否有所改變；（三）了解傳染性疾病全球通報系統的時間落差問題及其與國家透明度間之關連性；及（四）透過國際衛生條例的運作，來了解世界衛生組織在全球衛生治理中的角色變化及後續因應。本研究包含有量性研究及質性研究，故本研究分別使用公共衛生流行病學之研究方法及法學研究之文獻回顧與個案分析法，來對不同研究進行分析。在金融危機對職業壓力及疲勞狀況的影響研究中，本研究係對金融危機前已接受過工作壓力問卷調查之180位律師及53位金融從業人員，在金融危機後的2008年12月到2009年6月間，以相同問卷進行第二次之工作壓力調查，共有97位律師及38位金融從業人員完成此第二階段之問卷調查。本研究再就回收之問卷，以卡方檢定，配對t檢定及邏吉斯回歸等統計方式進行分析，以了解律師及金融從業人員之工作壓力及疲勞狀況在金融危機前後是否有所變化。研究結果發現金融危機前後，律師與金融從業人員的職業壓力與疲勞狀況呈現出明顯的變化，然而律師與金融從業人員的職業壓力與疲勞狀況變化方向截然不同，律師的職業壓力在金融危機後趨緩，而金融從業人員的工作壓力則在金融危機後劇增。又在傳染性疾病監控的研究中，本研究以2003年到2009年六月間，世界衛生組織以及ProMed-mail通報網絡上關於禽流感及H1N1的配對通報資料為樣本，分析全球疾病通報資料的時間落差及其逐年變化，並以自由之家的言論自由指數及聯合國開發計畫署的人類發展指數及世界衛生組織網站上的醫護人力密度為指標，就疾病通報資料的時間落差與言論自由，人類發展與醫事人員密度間之關連性進行分析，以了解傳染性疾病通報的時間落差是否有改善，以及該通報時間落差與國家透明度間之關連性。並以文獻回顧及個案分析之方式，以印尼拒絕分享H5N1病毒事件，及中國在H1N1大流行中違法隔離墨西哥國民事件為案例，分析國際衛生條例之運作成效，世界衛生組織在全球衛生治理中的地位演變，及全球衛生治理模式的演變，最後並就可能採取之因應進路提出建議。研究結果發現兩全球通報系統之傳染性疾病通報資料時間落差，在國際衛生條例的修正及明確規範應於三日內將資料通報給世界衛生組之後有顯著的變短，又傳染性疾病通報資料的時間落差與言論自由及人類發展呈現負關連性，與醫護人力密度則無關連，此顯示由於透明度越高之國家，其媒體言論自由度越高，故兩全球監控系統間之時間落差越長。在全球衛生治理的研究部分，個案分析的結果顯示，以國際衛生條例作為全球衛生治理工具之制度設計成效不彰，世界衛生組織在全球衛生治理中的領導地位不只被弱化，且強化全球衛生事物所具有之外交事務本質。本研究呈現出職業壓力與傳染性疾病監控等議題在全球化世界中的變化與發展，依據此研究結果，本論文除建議衛生主管機關應注意全球化對於公共衛生問題所造成之影響外，亦應注意傳染性疾病防治之全球衛生治理模式演變，本論文並建議我國應積極在此全球衛生治理模式演變的過程參與全球衛生事務，以求取未來在國際衛生社群中之發言權。

關鍵字

工作壓力 ； 律師 ； 法官 ； 檢察官 ； 金融危機 ； 國際衛生條例 ； 全球衛生治理

並列摘要

There are two issues in this thesis: (1) occupational stress of legal professionals and (2) globalization and public health—financial crisis and infectious disease surveillance.
Legal professionals including lawyers, judges and procurators are the people to practice the justice. The quality of justice highly depends on legal professionals’ working quality. If their occupational stress is too high to maintain the quality of their work, the rights of the people might not be well-protected. Therefore, the occupational stress of legal professionals was worth studying. However, there has not been any study of occupational stress and burnout among legal professionals. Thus, the aims of this study were to evaluate (1) the occupational stress and burnout among legal professionals; (2) the association between occupational stress and burnout among legal professionals; and (3) whether or not such associations differ between groups. The cross-sectional study was conducted on 180 lawyers, 87 judges and 98 procurators from 26 law firms, 1 district court, 1 appeals court and 3 District Court Procurators Bureaus from October 2007 to January 2008 by questionnaire survey. The Chinese version of Karasek’s job content questionnaire (C-JCQ) and the Chinese version of Siegrist’s ERI questionnaire (C-ERI) were used to measure occupational stress, Chinese version of the Copenhagen Burnout Inventory (C-CBI) was used to measure burnout, and Chinese version of the SF-36 questionnaire was used to measure health functioning. Chi-square, t-test, paired-t test and logistic regression were used for further analysis. The study results showed that legal professionals including lawyers, judges and procurators had relatively higher scores of job control, psychological demand, personal burnout and work-related burnout than national survey and other occupations. With long work hours and workload, their occupational stress was significantly associated with both work-related and personal burnout. In addition, litigious lawyers had higher decision authority and workplace social support, but also higher overcommitment and higher risks of having client-related burnout than non-litigious lawyers. Although judges had higher reward than procurators, judges had higher risk of having client-related burnout than procurators. Moreover, female legal professionals suffered higher occupational stress and worse health functioning than male legal professionals. With these findings, this thesis recommended the needs of improving working conditions for legal professionals. Further studies are warranted to estimate the long-term health effects and possible social impacts, such as the quality of verdicts, of legal professionals’ occupational stress and burnout.
In the study of globalization and public health, this thesis evaluated the impact of globalization through financial crisis and infectious disease surveillance. The objects of this study were to (1) evaluate the difference of occupational stress and burnout before and after the financial crisis among lawyers and financial workers; (2) evaluate the reporting timeliness lag before and after the IHR 2005; (3) determine the relationship between reporting timeliness gap and transparency; (4) observe the history of international infectious disease regulations; and (5) observe the trend of global health governance through reviewing the related events. In the study of the impact of financial crisis on occupational stress and burnout among lawyers and financial workers, we conducted the same questionnaire survey again on the previous 180 lawyers and 53 financial workers from December 2008 to June 2009. Then 97 lawyers and 38 financial workers completed the second time questionnaire survey and included in the final analysis. Chi-square, t-test, paired-t test and logistic regression were used for further analysis. The study results showed that lawyers’ occupational stress and burnout significantly decreased after financial crisis while financial workers’ occupational stress and burnout increased after financial crisis. In the study of infectious disease, matched reports of avian flu-related and H1N1 outbreaks reports from website of WHO and ProMED-mail from 2003 to June 2009 were used as study samples to analyze the yearly average reporting timeliness gap. Civil liberties index from Freedom House, human development index from UNDP and health workforce density were used as indicators to evaluate the relationship between reporting timeliness gap and transparency. Then the operation of the IHR 2005 and the role of WHO in global health governance were further analyzed through reviewing Indonesia’s decision to withhold H5N1 virus samples and China’s action to quarantine Mexicans without scientific evidence and informed concern. The study results showed that reporting timeliness of global infectious disease surveillance systems significantly reduced after IHR 2005. In addition, we found that the reporting timeliness gap was negatively associated with civil liberties and human development, but not associated with health workforce density. The better the transparency was, the longer the reporting timeliness gap. The further study of analyzing the operation of the IHR 2005 through virus sharing controversy and health measures controversy found the insufficiency of IHR 2005. The failure of the IHR 2005 weakened the role of WHO to be the leading organization in the global health governance and further strengthened the concept “global health as foreign policy”. With the findings that the impact of globalization was obvious, this thesis not only recommended our governance to pay close attention to the health effect of globalization, but also recommended our governance to act more aggressively to join the global health community in this shaping period.

並列關鍵字

occupational stress ； lawyer ； judge ； procurator ； financial crisis ； international health regulations ； global health governance

參考文獻

1. Chan CC, Tsai FJ, Influenza and Global Governance—global health as foreign policy. Taiwan Democracy Quarterly 2009;2:219-227

1. Europe WHOROF. Mental Health and Working Life. Paper presented at: WHO European Ministerial Conference on Mental Health 2005; Helsinki, Finland.

2. Health NIfOSa. Stress at Work. In: National Institute for Occupational Sfety and Health; 1999.

3. Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content Questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics. Journal of Occupational Health Psychology 1998;3(4):322-355.

4. Siegrist J, Starke D, Chandola T, et al. The measurement of effort-reward imbalance at work: European comparisons. Social Science & Medicine 2004;58:1483-1499.