According to the World Health Organization, the U.S. spends by far the most per capita on health care but by most measures ranks not even in the top 30 countries in terms of health-care outcomes. If we want to improve Americans’ health and reduce our health-care expenditures, we need to understand why. There are many causes, of course, but I’m convinced one of the most important — and most overlooked — is our work culture. Working in America is literally hazardous to your health.
There is a vast amount of research linking working conditions to mortality and morbidity. Let’s start with unemployment, or the threat of it. With relatively few government labor market regulations and little protection afforded by the now almost nonexistent unions, the possibility of suddenly being laid off is an unrelenting source of stress for U.S. workers. Average job tenure (particularly for men) had been declining for decades, even before the present recession. What economists euphemize as “involuntary job loss” can be high, regardless of the published unemployment rate. All it takes is a lot of churn in the workforce, and there is a lot of churn in America.
Research shows that being unemployed increases the risk of psychological depression by 200 percent[1] and getting laid off increases an individual’s death rate by about 17 percent during the following 20 years, so that someone laid off at age 40 would be expected to live 1.5 fewer years than someone not laid off.[2] Layoffs also increase violent behavior, with one study documenting a 600 percent increase.[3] Yet other studies show downsizing leading to less spousal support and more smoking.[4]
Shouldn’t employers be free to adapt the size of their workforce to economic conditions? Certainly. But curiously, the single best predictor of layoffs or restructurings at a company isn’t the company’s financial condition. It’s the social influence acting on the organization’s leader. In other words, if firms to which a CEO is tied (for instance, through director interlocks) are laying people off, the CEO is likely to lay people off, too.
Perhaps because we are so worried about job security, we Americans work more than is good for us. A study by the National Institute of Occupational Safety and Health found that hours worked in the U.S. were now longer than in Western Europe and Japan. The study also documented the many adverse health and safety effects of overtime work, long hours, and shift work.[5]
Some of the fault for the overburdened U.S. labor force lies with employers. Only about 60 percent of American workers get paid sick leave and only about 75 percent receive any paid vacation. That obviously leads to more work and more stress. But some of the blame also lies with workplace culture. Even workers who have vacation or sick days don’t use what they have, in the interest of protecting their jobs. Not taking or having sick days leads to more hours at the office each week, but that’s only one problem. It also means that people don’t stay home when they’re sick, which allows disease to spread more easily around the workplace.
There are other sources of stress. Computer monitoring of much work and the pressures of the economic crisis have left many employees feeling that they have little discretion over the pace or content of work. In a simply amazing book, The Status Syndrome: How Your Social Standing Directly Affects your Health and Life Expectancy, British researcher Sir Michael Marmot documented the adverse consequences of not having much power over your working conditions. Marmot’s decades of work show that your working environment may be a better predictor of your risk of having and dying from a heart attack than obesity or other physiological factors.[6]
This is a curable problem: supervisors need to treat people like adults. Google, for example, gives its employees free time to work on what they want and gives them some discretion as to when they do their work. Google is an extreme case, but most companies on the “best places to work” lists get there by giving workers autonomy, decision-making power, and discretion. It’s a lot cheaper than subsidizing open-heart surgery.
In my mind, there’s an irony in the attention now being paid to companies’ unhealthful effects on the physical environment — global warming and air pollution, for example. Yes, we ought to curtail all that. But we ought to be just as concerned with companies’ unhealthful effect on the social environment. If we are serious about cutting health-care costs, we need to look in part to workplace circumstances that are literally killing people. After all, we ought to be as worried about employees as we are about polar bears.
[1] D. Dooley, R. Catalano, and G. Wilson (1994). Depression and unemployment: Panel findings from the epidemiological catchment area study. American Journal of Community Psychology, 22, 745′765.
[2] D. Sullivan and T., von Wachter (2007). Mortality, mass layoffs, and career outcomes: An Analysis using administrative data. Cambridge, MA: National Bureau of Economic Research Working Paper No. 13626,
[3] R. Catalano, R. W. Novaco, and W. McConnell (2002). Layoffs and violence revisited. Agrressive Behavior, 28, 233-247.
[4] M. Kivamki,, J. Vahtera, J. Pentti, and J. E. Ferris (2000). Factors underlying the effect of organizational downsizing on health of employees: Longitudinal cohort study. British Medical Journal, 320, 971-975.
[5] National Institute for Occupational Safety and Health (2004). Overtime and Extended Work Shifts: Recent Findings on Illnesses, Injuries, and Health Behaviors. http://www.cdc.gov/niosh/docs/2004-143/.
[6] M. G. Marmot (2004). The Status Syndrome: How Your Social Standing Directly Affects your Health and Life Expectancy. London: Bloomsbury. See also M. G. Marmot, et al. (1991), Health inequalities among British civil servants: the Whitehall II study. Lancet, 337, 1387-1393.
