A growing body of evidence indicates that workers in high-demand situations who also have low control of their work and low social support are at increased risk for developing and dying of cardiovascular disease, including myocardial infarction and stroke. Stressful work conditions are a critical component of this phenomenon.
It has been found that workers exposed to long overtime periods show markedly elevated levels of stress hormones. Death after stressful conditions and overwork is an example of what the Japanese call “karoshi,” literally translated as “death from overwork,” or occupational sudden death, whose main causes are heart attack and stroke due to stress.
Karoshi has been more widely studied in Japan, where the first case of this phenomenon was reported in 1969. It was a 29-year-old married male, working in the shipping department of Japan’s largest newspaper company. It wasn’t until the end of the 1980s that the general media paid attention to this problem, particularly after several high-ranking business executives, still in the prime of their life, suddenly died without any previous signs of illness.
In 1987, as people’s concerns about karoshi increased, the Japanese Ministry of Labor began to publish statistics on the problem. Concomitantly, lawsuits on death by overwork have been on the rise in Japan, prompted by the deceased person’s relatives demanding compensation payments.
This phenomenon is not limited to Japan, however. Other Asian nations such as China, Korea, and Bangladesh have reported similar incidents. In China, where this phenomenon is called “guolaosi,” it was estimated in 2010 that 600,000 people had been killed this way.
In Korea, where the work ethic is Confucian-inspired, and work usually involves six-day workweeks with long hours, this phenomenon is called “gwarosa.”
Prevention is the more humane and cheapest alternative to a very serious problem.
In the 1990s, karoshi deaths increased dramatically as the financial crisis gripped Japan. Increasingly, employers hire more temporary staff, which can more easily be laid off during difficult times. Fear of unemployment leads these workers to work harder and for longer hours.
In Japan, the number of cases submitted for compensation has increased significantly in the last few years. So has the number of court cases when the government refuses to compensate the victims’ families.
In Japan, if a death is considered karoshi, surviving family members may receive compensation from the government and up to $1 million from the company in damages. However, death may be only the tip of the iceberg of this phenomenon, just the most visible effect of overwork in Japan.
The causes and consequences of karoshi have been particularly studied in Japan, where the National Defense Council for Victims of Karoshi was established in 1988. Japan has much longer working hours that any other developed country. The country’s grueling work schedule has been suggested as one of the main causes of karoshi.
The consequences of long working hours and stressful situations at work are not limited to men. Several studies have shown strong links between women’s job stress and cardiovascular disease.
In the Women’s Health Study (WHS)—a landmark study involving 17,000 female health professionals—a group of Harvard researchers found that women whose work is highly stressful have a 40 percent increased risk of heart disease when they were compared with their less-stressed colleagues.
The results of the WHS were confirmed both in Denmark and in China. A large 15-year study in Denmark found that the greater the work pressure, the higher the risk for heart disease among women ages 51 and under.
In Beijing, a study among white-collar workers found that job strain was associated in women with increased thickness of the wall of the carotid artery, an early predictor of stroke.
Deaths by overwork affect not only the families themselves, who may lose the main breadwinner in the family, but also the industries that will increasingly be affected by more lawsuits and lost productivity. The situation, in turn, will also affect the national economy. It is therefore urgent to devise a series of steps aimed at curbing this problem.
At the personal level, it is important for workers to get regular exercise, which will reduce anxiety and depression and improve sleep. In addition, it is important for them to develop supportive relationships with friends, families, and co-workers. Whenever possible, they should practice relaxation techniques, and if they feel overwhelmed by their personal situation, they should seek help from a mental health professional.
At the level of the industries, they should provide the workers with the best conditions for their work, a policy that will be of better economic value in the long run. Business executives should realize that it is counterproductive for them to place excessive demands on their workers.
At the government level, legislation should be passed increasing job security and skill training, as well as employees’ participation on issues that directly affect them, such as transfers and promotions. Workers should have better control of their own jobs, which will increase productivity and reduce the stressful component of their jobs.
In the long run, prevention is the more humane and cheapest alternative to a very serious problem.
César Chelala, M.D., Ph.D., is an international public health consultant and a winner of an Overseas Press Club of America Award.
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