Cesar Chelala
A physician and writer

Health consequences of overwork

Working for long periods under extreme stressful work conditions can lead to sudden death. “Burn out” is now described as an occupational phenomenon, resulting from chronic workplace stress that has not been successfully managed.

This is a phenomenon that in its most extreme manifestation is described by the Japanese as karõshi, literally translated as “death from overwork,” or occupational sudden death, mainly from a heart attack and stroke due to stress. Karõshi has been more widely studied in Japan, where the first case of this phenomenon was reported in 1969.

In 1987, as people’s concerns about karõshi increased, the Japanese Ministry of Labor began to publish statistics on the problem. According to government estimates, 200 people die from overwork annually because of the long hours spent at the workplace.

Death by overwork lawsuits have been on the rise in Japan, prompted by the deceased’s relatives demanding compensation payments. In Japan, if karõshi is considered a cause of death, surviving family members may receive compensation from the government and up to $1 million from the responsible company in damages.

Extension of the phenomenon

This phenomenon is not limited to Japan. Other Asian nations such as China, South Korea and Bangladesh have reported similar incidents. In China, where the phenomenon is called guolaosi, it was estimated in 2010 that 600,000 people had died this way.

Increasingly, workers in more than 126,000 Chinese factories are organizing and demanding better work conditions. In South Korea, where the work ethic is Confucian-inspired, and work usually involves six-day workweeks with long hours, the phenomenon is called gwarosa.

In the United States, workers in some areas such as banking and finance work extremely long hours, despite its obvious negative consequence. A 2018 survey by The Physicians Foundation states that 80 percent of physicians across all specialties report being at full capacity or overextended and 78 percent report experiencing feelings of burnout.

Causes and consequences

The causes and consequences of karoshi have been studied in particular by Japan’s National Defense Council for Victims of Karoshi, 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. It is not, however, the only cause.

A growing body of evidence indicates that workers in high-demand situations who have little control of their work and low social support are at increased risk of developing and dying of cardiovascular disease, including myocardial infarction and stroke. Stressful work conditions are a critical component of this phenomenon. In this regard, it has been found that workers exposed to long overtime periods show markedly elevated levels of stress hormones.

The consequences of long working hours and stressful situations at work are not limited to men. Several studies have shown strong links between women with stressful jobs 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 compared with their less stressed colleagues.

The results of the WHS were confirmed both in Denmark and in China. A large 15-year study conducted in Denmark found that the greater the work pressure, the higher the risk for heart disease among women under the age of 52. In Beijing, a study among white-collar workers found that job strain was associated in women with increased thickness of the carotid artery wall.

Moving forward

Death by overwork affects not only the families themselves who may lose the main breadwinner in the family but also the industries as a result of lawsuits and lost productivity. That, in turn, affects the national economy. It is therefore urgent to devise ways to curb this problem.

It is important for workers to get regular exercise, which will reduce anxiety and depression and improve sleep. Whenever possible, they should practice relaxation techniques and, if they feel overwhelmed by their personal situation, seek help from a mental health professional.

At the industrial level, organizations should provide the workers with the best conditions for their work, a policy that may look expensive but 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 to increase job security and skill training as well as employee’s participation in issues that directly affect them such as transfers and promotions. Workers who have better control of their jobs will increase productivity and suffer less from the stressful component of their jobs. In the long run, prevention is the more humane and cheapest alternative to a very serious social and public health problem.

About the Author
César Chelala is a physician and writer born in Argentina and living in the U.S. He wrote for leading newspapers all over the world and for the main medical journals, among them The New York Times, The Washington Post, The Wall Street Journal, The Japan Times, The China Daily, The Moscow Times, The International Herald Tribune, Le Monde Diplomatique, Harvard International Review, The Journal of the American Medical Association, The Lancet, Annals of Internal Medicine, and The British Medical Journal. He is a co-winner of an Overseas Press Club of America award and two national journalism awards from Argentina.
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