Cesar Chelala
A physician and writer

The high price of excessive and stressful work

When Luo Yang, who was in charge of research and development on the J-15 carrier-based fighter jet, died of a heart attack, he was under extreme stressful work conditions. He died on the day that the J-15 had completed a successful landing on the Liaoning, China’s first aircraft carrier. For many experts, Luo Yang’s death after such stressful conditions and overwork, was 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, death by overwork lawsuits 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. Increasingly, workers in more than 126,000 Chinese factories are organizing and demanding better work conditions. In Korea, where the work ethic is Confucian-inspired, and work usually involved six-day workweeks with long hours, this phenomenon is called “gwarosa”.

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 $1m 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. It is not however, the only cause.

A growing body of evidence indicates that workers in high demand situations, who also have low control of their work and who also have 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. 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’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% 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 jobs 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.

Cesar Chelala, MD, PhD, is an international public health consultant and a winner of an Overseas Press Club of America Award.

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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