KENJI HAMADA WAS FORTY-TWO years old when he died of a heart attack at his desk in a Tokyo office. His widow said that Hamada was working seventy-five hours a week and spent almost four hours a day commuting back and forth to work. He had worked forty straight days prior to his death. “He was so stressed out, working day and night,” she maintained.1 In late 2016, a twenty-four-year-old employee of the large advertising firm Dentsu jumped to her death after telling friends about enduring harassment and long hours on the job. The employee was working Saturdays and Sundays and put in more than one hundred hours of overtime a month.2
The Japanese even have a word for death from overwork—karoshi. The first reported case of karoshi occurred in 1969 when a twenty-nine-year-old, married male worker in the shipping department of Japan’s largest newspaper died from a stroke. After that, karoshi became much discussed and worried about in Japan, where death from overwork has been formally recognized as a cause of death by the Workers Compensation Bureau in the Ministry of Labor. “In 2012, the Japanese government compensated 812 families who were able to show a link between overwork, illness, and death, including 93 suicides.”3 By 2015, claims had risen to 2,310, “but the true figure may be as high as 10,000—roughly the same number of people killed each year by traffic.”4
One Japanese study noted: “Nowadays, there are almost no workers who do not know the word. . . . Many Japanese workers and their families are anxious about karoshi.” Notwithstanding the public discussion and scrutiny, the problem persists. A survey conducted in October 2016 found that nearly one-quarter of the companies surveyed said that some employees were working more than eighty hours of overtime a month.5 Starting in 1987, Japan’s Ministry of Labor began to publish statistics on karoshi, although these statistics are not considered completely reliable because it is difficult in individual cases to unambiguously attribute sudden or premature death to overwork as contrasted with other causes.6
Long work hours and the adverse health consequences they cause are a problem in many countries besides Japan. A forty-eight-year-old Chinese banking regulator, Li Jianhua, died of a heart attack after twenty-six years of hard work as he rushed to finish a report. Gabriel Li, who worked in the Beijing office of advertising firm Ogilvy, died in May 2013, on his first day back from medical leave. Other deaths attributed to overwork in China include “a 24-year-old employee at Ogilvy Public Relations Worldwide” and “a 25-year-old auditor at PricewaterhouseCoopers.”7 Chinese factories, particularly those assembling electronics products for many iconic companies such as Apple, HP, Cisco, and others, are notorious not only for their low wages and stressful, inhumane working conditions but also for their extremely long and sometimes unpredictable working hours. Indeed, customer-facing companies such as Apple can keep their supply chains lean while introducing new products and new models so quickly after their designs are finalized explicitly because their subcontractors are willing to do whatever it takes—literally waking workers in the middle of the night—to ramp up production.
Not surprisingly, China also has a word for death from overwork—guolaosi. Overwork apparently is an enormous problem in China: “About 600,000 people a year die from toiling too hard, according to the China Youth Daily. State-controlled China Radio International puts the toll at 1,600 a day.” A survey of Chinese employees working in Beijing, conducted by the dean of the School of Labor Economics at the Capital University of Economics and Business, reported that 60 percent of the respondents said they were working more than the legal limit of two hours a day of overtime.8
Sometimes people believe that long work hours only bedevil emerging economies. That is because advanced industrialized countries often regulate work hours. Such regulations include restricting the hours that younger, school-age people can work, mandating overtime pay for certain employees working more than some prescribed number of hours per day and/or per week, and requiring a number of weeks of paid vacation or paid time off to delimit the hours people work on an annual basis.
But not all jobs are effectively covered by such regulations. Vulnerable groups such as immigrants worried about deportation or low-wage workers concerned about losing their jobs may be reluctant to assert their rights. Some positions, such as managerial and supervisory jobs as well as professional work are often exempted from overtime pay provisions. As one person told me, at Airbus, the French-headquartered airplane manufacturer with substantial operations in a country with a supposed thirty-five-hour workweek, midlevel managers typically work sixty hours per week and often stay until 8 p.m. Professional and managerial work hours have increased as Airbus has grown and become more successful. However, unlike in some countries such as the United States, at Airbus managers seldom work on the weekend and they do take their five weeks of vacation.
Some industries and occupations are particularly prone to excessive work hours. For instance, investment banking, regardless of where it is located, is notorious for long hours and associated adverse health effects. As previously described, in 2013, Moritz Erhardt, a twenty-one-year-old intern at Bank of America’s Merrill Lynch unit in London, died after working until 6 a.m. for three nights in a row. He apparently had worked all night eight times in two weeks. A report about his death noted that “Mr. Erhardt appears to have been one of the many interns caught on the so-called magic roundabout—a process whereby a taxi takes an intern home, waits outside while they shower and change, and then drives them back to the office to begin another long day.” Another intern commented, “They get you working crazy hours and maybe it was just too much for him in the end.”9
Long work hours characterize law practice, too, with its billable-hours culture so that the more people work (and bill), the more money the firm makes. Writing about her ex-husband who died from complications associated with drug use, Eilene Zimmerman noted that “he had been working more than 60 hours a week for 20 years, ever since he started law school and worked his way into a partnership in the intellectual property practice of Wilson Sonsini Goodrich & Rosati.”10
High technology, with its Red Bull–fueled all-nighters, is another place where overwork reigns. The Palo Alto Medical Foundation operates a mobile medical facility in the Silicon Valley with two examination rooms and a laboratory. The van serves more than two dozen of the area’s largest employers. Why a mobile van? As the head of PAMF’s employer health services explained, “People are so freaking busy they can’t even imagine going out to the doctor.”11 Forty percent of the people the van sees don’t have a primary-care physician, even though they earn high incomes and work for companies that offer health insurance. The employees are simply too busy to take care of themselves. “Some patients don’t even get off their mobile devices while being examined.”12 The result: “30-year-old engineers with 50-year-old bodies, complete with potbellies, curved spines, dulled skin tones, joint issues, reduced vitality, and elevated risks of diabetes and heart disease.”13
Thus, the problem of excessive work hours and the resulting deleterious health effects can be seen at least to some extent in most if not all countries and in many different jobs and industries. “Working long hours is common and has increased in many developed countries in recent years.”14 Working hours in the United States are particularly long and irregular, a situation that has gotten worse over time. As David Waldman, vice president of human resources at the Robert Wood Johnson Foundation, noted, “Overwork is not new in this country. . . . But in some ways, it seems like it’s hitting critical mass.”15 In the United States, “the average number of hours worked annually . . . has increased steadily over the past several decades and currently surpasses that of Japan and most of Western Europe,” so that while in 1979, the United States did not have the longest work hours, by the 2000s the country stood out for its long working time. A study using time-diary data found that almost 30 percent of US employees reported working on the weekend, a proportion higher than that seen in France, Germany, the Netherlands, and the United Kingdom, and more than twice as high as Spain. That study also examined the proportion of US employees who reported working at night, between 10 p.m. and 6 a.m. In the United States, more than one-quarter of all people reported working at night, a proportion substantially higher than that in any other country included in the study.16
Long hours have become the norm for successful employees interested in advancing their careers. As one executive coach told me, almost all of her clients work a ten- to twelve-hour day, like from 8 a.m. until 6 p.m., take some time off for dinner, and then go back to work from, for instance, 8 p.m. until midnight or even later. And most will also work at least one day on the weekend. These hours are so much a regular part of people’s work patterns that the coach no longer even offers sympathy when people complain about the strains such working arrangements put on their health and their relationships. It is just expected as part of the “price” for career success—and in many instances, exceptional levels of income and responsibility.
Moreover, even when people are presumably not “at work,” the separation between work and nonwork time has decreased because of the omnipresence of electronic devices that leave employees always on call and potentially working even when they are not physically in the workplace. One survey reported that 81 percent of respondents said they checked e-mail on the weekends, 55 percent said they logged in after 11 p.m., and 59 percent said they looked at e-mail while on vacation.17 People check e-mail at funerals and at the birth of their children. Describing the scene at her lawyer ex-husband’s funeral, Eilene Zimmerman poignantly wrote:
Quite a few of the lawyers attending the service were bent over their phones, reading and tapping out e-mails. Their friend and colleague was dead, and yet they couldn’t stop working long enough to listen to what was being said about him.18
Employees are frequently expected to be potentially available for work-related calls and e-mails while at home or even while on vacation. At Uber, the ride-sharing company notorious for its hard-charging, demanding culture, an employee told BuzzFeed:
“I got texts on the weekend. E-mails at 11 at night. And if you didn’t respond within 30 minutes, there’d be a chain of like 20 people. . . . There was a three- to four-month period when I was getting woken up every Friday, Saturday, and Sunday at 3 or 4 in the morning to fix something,” said an engineer. . . . “Months of that, on top of working 10-plus hours a day.”19
It’s not just high technology, I-banking, or law. This always-on, always available expectation is increasingly pervasive. Dean Carter, the head of human resources for Patagonia, told me about something that happened while he was working for the department store chain Sears years ago:
I remember when I was at Sears I got an e-mail on Christmas Eve at 7. I responded Christmas day, the next morning, at 8 a.m. The response from one of the executives to whom the e-mail was sent was, “Dean, I don’t understand why you took so long to respond. We’re in a transformation, and you need to be a lot more responsive.”
Recognizing that work intrudes on nonwork time, in 2016, France passed a law that embodies a “right to disconnect.” Although the law does not ban after-hours work-related e-mails, it does “require that companies with more than 50 employees negotiate a new protocol to ensure that work does not spill into days off or after-work hours.” In justifying the need for the law, France’s minister of labor noted how “employees were more and more connected to work outside of the office.”20
While people may joke about France and its working-time regulations, a study of 365 working adults reported that “off-hour” e-mailing negatively affected employees, leading to burnout and diminished work-family balance. The study noted that the expectation to be constantly available on e-mail was a job stressor.21
There are many manifestations of long, excessive, or irregular work hours, all of which have health effects. One manifestation would be working very long hours in a day or week, thereby depriving the body of sleep and weakening the immune system. A Gallup study of more than seven thousand US adults found a positive relationship between more hours of sleep and self-reported well-being, with some 40 percent of the sample getting less than seven hours of sleep a night, the minimum number recommended for good health.22
A second example would be working excessive hours over the course of a year, by not taking paid time off, if such time is even available, to go on vacations and take holidays to get away. One study reported that about a third of American employees do not use all the vacation days to which they are entitled,23 while a more recent survey found that more than half of US workers eligible for paid vacation did not use all the time allotted, leaving a median of seven vacation days unused.24 About a quarter of Americans do not get any paid vacation at all.25
A third symptom would be not taking time off when a person is ill, under the belief that taking care of oneself while sick could put one’s job or income at risk or in some way demonstrates that the worker is insufficiently concerned about the company’s well-being. The BBC reported on a 2014 survey that found that more than 25 percent of US employees said “they always go to work when they are ill,” while “nearly a quarter of US adults have been fired or threatened with the sack for taking time off to recover from illness or to care for a sick loved one.”26 A representative survey of one thousand American adults reported that 62 percent said they had gone to work sick.27 Working while ill is not just bad for the individual’s productivity and for possibly making coworkers sick. Mexican fast-food chain Chipotle “partly blamed a 2015 outbreak of the norovirus vomiting bug on employees who had come to work sick.”28
A fourth case of work-hour problems would be shift work, working hours at variance with normal bodily rhythms such as working at night. As one fifteen-year longitudinal study of paper mill workers found, the incidence of heart disease increased by more than two times for people who worked shifts for more than ten years.29
Companies Have a Choice
It is important to understand that long work hours and not taking sick or vacation days are not some inevitable result of contemporary economic realities such as global competition and technological change. We know that because firms vary dramatically in their work-hour policies, even companies operating in the same country and in the identical industry. Work time is the result of managerial decisions and discretion. “There is a long-hours culture in some workplaces; long hours are used even when they are not strictly needed for business reasons.”30 One study using survey data from Britain reported that about one-third of the variation in weekly hours of work came from firm-level differences, with such differences being particularly important in the private-services sector.
In Dublin, Ireland, a few years ago Google tried an experiment called “Dublin Goes Dark.” In the experiment, staff were invited to leave anything that beeped at the front desk when they left for the day. “Phones, iPads, and computers stayed at HQ and so, it seems, did the stress. ‘Googlers reported blissful, stressless evenings,’ wrote Laszlo Bock, the head of Google’s People Operations” at the time.31
Clothing company Patagonia has standard work hours and offers on-site childcare. Their head of HR commented, “When childcare closes at 5:30, basically the parking lot empties. Everyone leaves. I rarely see cars in the parking lot after six.” The company moved to a nine-hour workday so that every other Friday, people can have an extra day off—twenty-six three-day weekends a year. And people do not get calls or e-mails during their three-day weekends. As one person said, “It just doesn’t happen.”
Zillow Group, which operates a real estate website, is yet another example of a company seeking to encourage people to limit their hours so they have a healthy work-life balance. As one person noted, “It’s not until you’re a part of the company, and not until you realize that a lot of people don’t take their laptops home, or they are able to drop their child off at day care and come in at 9:45, that it hits home that this culture really, actually does value work-life balance.”
Landmark Health, a start-up providing in-home care to people who are often dealing with five or more medical conditions, trains its employees as part of their onboarding process to be sensitive when they send e-mails. Unless the communication concerns patient care, people are told not to send e-mails at night or on weekends or holidays. Obviously, numerous other companies have adopted progressive practices that try to manage work hours, limit times when employees are on call, and provide flexible work schedules.
If work hours and the ability to separate oneself from work vary according to company decisions and culture, not just because of business necessity, then work hours—and their consequences—are a policy variable controllable to some extent by employers and potentially modifiable by changes in social norms and labor market regulations. Therefore, employers and governments have discretion over work hours and also the health effects of those work hours on people.
SOME CAUSES OF LONG WORK HOURS
Both employers and employees conspire to make work preeminent among competing life priorities and, as one consequence, encourage and venerate long working hours. Many people, both employees and their bosses, see putting in long hours as demonstrating commitment and loyalty to the employer and the job. Furthermore, employees often see their work as important. People who work hard and make sacrifices for their work would tend to see that work as important because of pressures for cognitive consistency, as a way of justifying and making sense of their effort. But if that work is important, indeed essential, then it should take priority. That is possibly one reason that some research has found that people who work in nonprofits work longer hours, because they see their work as being driven by a higher purpose.32 But, of course, nonprofit employees suffer burnout and the other consequences of long work hours, too.
Employees see long work hours as signaling their toughness and strength. An accountant told me, “You see this a lot, particularly in the Silicon Valley culture. People say, ‘I can last longer than you. I can work harder than you.’” So, in the contest for promotions, work hours become one way of competing. The accountant, while working for a health-care organization, commented:
When I started there, I would come in and say, “I got four hours of sleep last night.” My boss, the VP of finance, would tell me, “I got three.” It was never like, “You should take a day off.” And of course then this is how I would treat my staff. I would say, “This is not acceptable. Why didn’t this get done? I don’t care how late it is.”
Employees see putting in “face time” as necessary in an increasingly competitive labor market with ever more people competing for fewer promotion opportunities, a result of companies having reduced middle management layers and jobs. Even high-earning professionals—or maybe particularly high-earning professionals—work ever longer hours and pay the price for doing so. Sylvia Ann Hewlett’s 2004 survey found that 62 percent of high-earning respondents worked more than fifty hours a week and 10 percent worked more than eighty hours weekly. Almost half said they were working more than fifteen hours a week more than as recently as five years ago. These folks forgo vacations regularly. And although seemingly successful, at least in financial terms, some 69 percent believed they would be healthier if they worked less, 58 percent stated that work interfered with relationships with their children, and 46 percent thought that their work hours affected their relationship with their spouse.33
Decades ago, leisure time was a marker of social class. A tan meant that you could afford to take a nice vacation, and beach attire was a status marker. Today, higher-class, higher-earning individuals actually work more than their lower-income counterparts. In a perverse twist, longer work hours have become a status symbol—a marker of how important, indeed indispensable, someone is. Summarizing this phenomenon for Arianna Huffington’s new venture Thrive, Drake Baer wrote:
Busy is now cool. It’s even become an aspirational bit of American culture. . . . The higher up you go, the busier your calendar gets. . . . References to “crazy schedules” in holiday cards have . . . shot up since the 1960s. . . . When Americans hear “busy,” they think status. . . . Displays of busyness show that society values you, that everybody wants a piece.34
As such, people want to put in long hours to signal how valuable they are.
Why Companies Like Long Hours
Notwithstanding the nil to negative relationship between work hours and performance reviewed below, many companies have cultures that seemingly venerate long hours and forgone vacation. After all, who could be against “hard work”? Most employers seek loyalty and commitment from their employees. They want employees who are willing to devote the extra effort required to triumph against the competition. It is, of course, difficult to directly observe someone’s loyalty and commitment. It is much easier to assess indirect indicators of employee dedication, and the hours someone puts in on the job is one such indicator, and so is whether employees use all their allotted vacation and paid time off or give their lives to the workplace. Employers often use work hours, something readily observed, as an indicator of an important employee attribute more difficult to observe, dedication.
Because employers see long work hours as a signal of employee effort and loyalty, employers reward those who put in long hours, in part because employers favor those who are willing to make sacrifices for the organization. What could show more organizational commitment than being literally willing to work yourself to death for the company? Studies consistently demonstrate an effect of work hours on salaries and changes in wages over time, even for people who are ostensibly not paid by the hour (in the case of hourly pay, obviously, income varies directly as hours increase).
Employers also prefer longer rather than shorter hours because of the implicit belief that work output is related to the number of hours worked—the more hours, the higher the output. This relationship certainly holds for some sorts of jobs and particularly in the past when there was less technology, creativity, and mental concentration involved in production. But for creative work, for work that requires thought, for innovation, it is scarcely obvious that, beyond some point, more hours will result in more productivity. Indeed, for many jobs, there comes a point at which output suffers from just putting more time in. That’s because after a while, long work hours produce fatigue and boredom, which lead to making more mistakes and also to being less thoughtful and insightful.
If employers like long hours and those who work endlessly, then employees learn that long work will be rewarded and respond accordingly. Before the key cards we use to open doors and access equipment such as printers became ubiquitous and low-tech sign-in sheets were more common, stories abounded in the Silicon Valley of employees who would sign in to their workplace on the weekend and then leave, nap, or do other, nonwork things while supposedly in the office. Even today, employees will reset their computer clocks to show they are sending e-mails in the middle of the night, leave office lights on and coats or sweaters on the backs of their chairs to indicate they are at work, and engage in numerous other such ploys to make their boss think they are always working. The purpose of the deceptions—to show employers and, more specifically, the employees’ direct supervisors, how hard they were working. Of course, face time does not equal work time, and time spent at a workplace is not highly correlated with the work that someone does. But the signaling, symbolic outcomes from apparently putting in long hours remain important for people’s careers.
Because women generally tend to have more family responsibilities than men, women are sometimes able to put in fewer hours at work. The reduced hours result in diminished career success. One study by business school professors Olivia O’Neill and Charles O’Reilly found that statistically controlling for hours worked eliminated the oft-observed male-female earning differential.35 They argued that this effect would become even more important over the course of a career. Initially, people are hired on the basis of promise and there is variation in knowledge and competence. But careers are for the most part organized as tournaments—at each level, people compete for promotions, and those who lose fall out of contention for even higher-level promotions. Over time, the less competent or those who have less time to put into their work get weeded out. Consequently, at higher organizational levels, differentiation is based mostly on motivation and effort—hours—as there are few remaining differences in capability. In other words, hours matter even more as careers unfold. Although not every study of this issue reported that controlling for work hours eliminated the effect of gender on salaries, numerous studies do find that controlling for hours worked reduces the male-female earnings differential.
Employees, then, become complicit in the long-work-hours culture. Seeking to stand out and demonstrate commitment, each individual puts in more time. Even when employers provide paid vacation and ostensible flexibility, few employees may avail themselves of these benefits. For instance, at IBM peer pressure abounds so that many employees never take their full vacation and check e-mail and voice mail while away on vacation.36 But dedication and commitment are relative concepts—demonstrated mostly in comparison to others. The dynamic of a rat race is created, in which, to show how valuable and dedicated someone is, that individual puts in more time than his or her peers, and as they ratchet up their work hours correspondingly, so does the individual trying to stand out. Until finally people are pulling all-nighters until they get sick or die.
Much as in the case of layoffs, there is good epidemiological evidence of the harmful effects to human health of long work hours and also shift work, but little evidence that long work hours actually benefit employers. As such, long working hours impose often unrecognized and unaccounted for costs on human beings without apparent offsetting benefits for their employers. Here is yet another management practice that could be changed to positively affect employee physical and mental health without jeopardizing organizational performance. Indeed, a different approach could even improve company results.
LONG AND IRREGULAR WORK HOURS HARM HEALTH
“Paul” (not the individual’s real name) worked for a major television network producing news shows for about fifteen years. As Paul explained, “Working in the news business, in order to get a promotion, you have to work the worst shifts. I worked weekends, I worked prime time, I worked in the field. I did breaking news.” For instance, Paul covered the Tucson shootings when Congresswoman Gabrielle Giffords was severely wounded and six people were killed. On such assignments, Paul sometimes wound up sleeping in the greenroom for three hours and then going back to work. Because of the irregular sleeping patterns, Paul said that he lost the ability to sleep for any longer than three to four hours at a time, even when he wasn’t on call or wasn’t working. He continued:
As a result of the sleep deprivation, I faced what I called a three-punch: hypothyroidism, no exercise, and bad food. You had no time to prepare your own food. At 6:30, you’d be sitting there going, “I’m really stressed out. Man, I really need some Doritos,” and you’d hit the vending machine. I went through eight different presidents of the network.
Between when I became a senior producer in 2008 and I finally quit because I couldn’t take it anymore in 2012, I gained sixty pounds. My metabolism was bad and all the things that would keep me healthy—my bodily functions—were just breaking down.
Whether long work hours are voluntarily embraced as a way of advancing one’s career or forced on people by their employers, or whether the long hours arise from the fact that people earn so little on an hourly basis that they must work multiple jobs and excessive hours to get by, the evidence is clear—long work hours adversely affect physical and mental health and increase mortality. Moreover, research has begun to identify some of the specific pathways through which long work hours adversely affect health.
First, as the case of Paul illustrates, long work hours often result in sleep deprivation and disrupted sleep patterns, and a lack of sleep is unhealthy. One study in the province of Quebec, Canada, reported that short sleep duration had a bigger effect on obesity than did high lipid intake or lack of exercise.37 Another article noted the many metabolic effects of sleep deprivation, including elevated levels of the stress hormone cortisol and impaired carbohydrate tolerance, increasing the risk of diabetes.38
Second, long work hours have been related to drug abuse, particularly of stimulants or hard drugs such as cocaine, which can act as a stimulant.39 Between 2005 and 2011, “emergency room visits related to nonmedical use of prescription stimulants among adults aged 18 to 34 tripled,” while between 2010 and 2012, people who entered substance rehabilitation centers citing simulants as the primary drug they abused increased by more than 15 percent compared to the prior three-year period. One start-up founder, ironically working on a health technology application, had on average just three hours and twenty-five minutes of sleep per night over a nine-month period, before entering an addiction center to address her health problems. Medical experts note that stimulants can cause anxiety, addiction, and hallucinations, and worry “about added pressure in the workplace—where the use by some pressures more to join the trend.”40
Third, long work hours are stressful, as excessive work hours exacerbate work-family conflict, which has its own negative health effects, as we will see later in this chapter. Long hours are often a response to excessive job demands in the workplace, reflecting the stress of work pressures. Fourth, long work hours leave people without time to relax and refresh.
And fifth, the longer the time spent at work, the greater the possible exposure to possible stress-inducing workplace exposures such as workplace bullying and nasty bosses. It is little wonder, then, that in occupations where fatigue can have potentially fatal consequences if people fall asleep or are not alert, such as airplane pilots, truck drivers, and medical personnel, regulations mandate rest periods and limit work hours and work schedules. And yet even in these occupations, employers often push back seeking to relax or eliminate work-hour restrictions.
The evidence of the effects of work hours on health is reasonably extensive and has been around for many decades. Nonetheless, insufficient attention has been paid to incorporating this research into policies and practices that would limit the costs and harm that long work hours cause.
The Evidence
More than a half century ago, a study found a higher incidence of coronary heart disease among men who worked more than forty-eight hours per week.41 A study of almost 7,100 British civil servants aged thirty-nine to sixty-two without heart disease found that over a ten-year period, people who worked ten hours per day were about 45 percent more likely to have suffered a heart attack, and those who worked eleven hours per day were 67 percent more likely to have had a heart attack than those who worked eight hours per day. Working hours predicted future heart attacks even when typical risk factors such as age, gender, blood pressure, and cholesterol levels were statistically controlled. Because of the longitudinal design of the study, it is easier to establish causality—work hours cause heart attacks, not the other way around.
Using 2001 California data from more than twenty-four thousand working-age individuals, analyses showed a positive correlation between hours worked per week and self-reported hypertension, itself a risk factor for heart attack and stroke. Compared to people working between eleven and thirty-nine hours per week, individuals who reported working between forty-one and fifty hours per week were 18 percent more likely to report having high blood pressure, and those who worked more than fifty-one hours per week were 29 percent more likely to have elevated blood pressure.42 A study of almost one thousand employees at a Japanese construction manufacturing company explored the effects of workaholism on health. Workaholism is defined as voluntarily choosing to work and having trouble disengaging from work activities. The study reported that workaholism was negatively related to both job performance and life satisfaction and was positively associated with ill-health.43
A meta-analysis of twenty-one study samples reported small but statistically significant correlations between hours of work and overall symptoms of ill-health as well as physiological and psychological ill-health.44 And a National Institute of Occupational Safety and Health review of fifty-two research reports investigating the association between long working hours and illnesses as well as job performance concluded:
In 16 of 22 studies addressing general health effects, overtime was associated with poorer perceived general health, increased injury rates, more illnesses, or increased mortality. One meta-analysis of long work hours suggested a possible weak association with preterm birth. Overtime was associated with unhealthy weight gain in two studies, increased alcohol use in two of three studies, increased smoking in one of two studies, and poorer neuropsychological test performance in one study.45
Long work hours also adversely affect mental health, as long working hours increase stress and fatigue and preclude adequate time to recover. For instance, a study of 473 nursing assistants working in nursing homes reported that there was a 400 percent increase in the odds of experiencing depression for people working more than fifty hours per week, more than two weekends per month, and more than two double shifts per month.46 Another study compared 1,350 employees who worked overtime with 9,092 employees who did not work overtime. Both men and women who worked overtime had significantly higher anxiety and depressive disorders. Moreover, the extent of the psychological problems was linearly related to the amount of overtime in a dose-response fashion, with more overtime causing more severe anxiety and depression.47
When Boeing fell years behind schedule on the 787 plane, there was enormous pressure on engineering employees and work hours went up significantly as the company struggled to complete work on this important new product. An individual close to the engineering community told me that burnout went up as employees struggled with the long work hours and physicians in the area reported much higher levels of illness among employees associated with the 787 program.
None of this should be surprising. After all, when people get sick and go to the doctor with ailments ranging from flu to more serious medical issues, I don’t know any doctor who would prescribe more work (as contrasted, for instance, with bed rest) as a remedy. Stress weakens the immune system, and overwork is an important form of stress.
THE PERFORMANCE EFFECTS OF LONG WORK HOURS
As the evidence makes clear, we don’t have to trade off longer working hours against better economic results. All too many companies seem to love employees who put in long hours, but the evidence makes crystal clear that organizations would be better off with employees who don’t overwork themselves. Employees would be healthier, the health-care costs borne by both employees and employers would be lower, and employee productivity and innovation would not falter. Indeed, the latter is likely to improve.
When people work exhausted, they make mistakes. As one Uber engineer noted about a mistake with a master database in 2015 that took the service down, “If you’ve been woken up at 3 a.m. for the last five days, and you’re only sleeping three to four hours a day, and you make a mistake, how much at fault are you, really?”48
Researchers at the OECD prepared a chart for the hours worked per person in OECD countries between 1990 and 2012 and the GDP created per hour worked. That chart “reveals that productivity is highest when people spend fewer hours working.”49
During World War I, the British Health of Munition Workers Committee undertook a study to see how to increase the productivity of munitions plant employees. When Stanford economist John Pencavel analyzed those data, he found that the optimum number of work hours was about forty-eight per week. Below that number, output declined proportionately with the decline in hours worked. But “once workers clocked . . . more than 48 hours, output started to fall.”50
In 2012, the International Labour Organization (ILO) published an extensive review of the research literature examining the effects of working time on productivity and firm performance.51 That report highlights extensive research demonstrating that longer hours often decreases performance. For instance:
Thus, the simplistic idea that more work hours produce more output is incorrect. After a while, exhausted workers produce more errors. Extensive empirical evidence is consistent with the idea that above a certain threshold, reducing work hours would increase both employee health and productivity and job performance. There is no economic trade-off required to improve people’s well-being by having them work less.
WORK-FAMILY CONFLICT AND ITS EFFECTS
Paul, the news producer, worked in a unit where most of the employees were women, and most of the women were single. “We call them news nuns. I don’t think any of them would like that term, but it’s a long-held name.” Of the forty-two people in the department when Paul arrived, within about five years there were only twelve left. Paul was the only person married with kids. For good reason. After Paul left the network, one day he talked to his daughter, who had been quite proud of his job as a news producer.
I said, “Are you sorry that I’m not working there anymore?” And she said, “No, I’m glad. Because now you’re here to listen to me and now you’re here to tell me stories.” Then she caught herself. She said, “Of course you did those things before, except you had Mr. Scrolly with you when you did it.” Mr. Scrolly was my BlackBerry.
When people are in a situation in which they have more to do than they have time to do it, that is called role overload. When people have demands for behavior emanating from one role, such as that of employee, that are incompatible with the demands of another role, such as family member, that is called role conflict. Long-standing research literature on role conflict and overload consistently finds that people who confront conflicting expectations for behavior or more demands than they can handle are more stressed.57 Thus, not surprisingly, role conflict and role overload are associated with poor outcomes ranging from increased turnover to lower job performance.
Work-family conflict takes two forms: family demands can interfere with job performance, as when an employee is distracted or loses time on the job attending to family-relevant issues such as caring or arranging for the care of an ill family member; this is often called family-to-work interference. The second form of work-family conflict, called work-to-family interference, is when job demands interfere with an individual’s ability to fulfill family obligations such as meeting with teachers, coaching their children’s sports teams, or having time to spend with spouses and other family members.
As would be expected, empirical research consistently shows negative physical and mental health effects of both work-to-family and family-to-work conflict. For instance, one study of almost two thousand adults in Erie County, New York, found that, even after statistically controlling for gender, race, education, family income, marital status, and number of children, higher levels of work-family conflict were associated with higher levels of depression, poorer physical health, and higher levels of alcohol consumption. A second study of about seven hundred households in Buffalo, New York, replicated these results. And both studies found that men and women were affected similarly by work-family conflict.58
A study of some 2,700 employed adults noted that people who reported experiencing work-family conflict were between two and thirty times more likely to experience a clinically significant mental health problem compared to people who reported no work-family conflict, with the magnitude of the effect depending on the specific mood or substance abuse disorder examined.59 Of course, one possibility is that the health and psychological problems cause the work-family conflict rather than the reverse. To explore this possibility and better establish causality, a four-year longitudinal study reported that family-to-work conflict was related to poorer physical health and more depression while work-to-family conflict was related to elevated alcohol consumption.60
The role overload characteristic of work-family conflict affects marital interactions61 and marital satisfaction.62 Role conflict more generally has been found to relate to lying in organizational settings—a finding that makes sense because one way of balancing conflicting, incompatible demands is to lie.63
Physical and mental health problems, lying, diminished marital satisfaction, and similar outcomes are instances of what IESE professor Nuria Chinchilla has referred to as social pollution. To what end? Work-family conflict drives up sickness absence, something that harms employers.64
Providing more flexible work arrangements, giving more generous family leave, and working people less are all in the interests of both employers and the general public, each of whom face increased costs from the social toll of excessive work hours and work-family discord.
WHY SOME COMPANIES AND COUNTRIES ARE DIFFERENT
Not every employer and not every country encourages long hours and work-family conflict, of course, and evidence suggests they may be onto something. Patagonia’s head of human resources, Dean Carter, described the very generous, family-oriented benefits the company provides:
Family is really important here. We have integrated on-site childcare. Any parent, at any time, is encouraged to go hang out with their kid. You can eat lunch with them, eat breakfast with them. If you want to just sit on the ground with them for a play break, you can do that. We have really generous [paid] maternity and paternity leaves, twelve weeks for dads and sixteen weeks for new moms. You can have up to twelve weeks of paid leave to take care of an elderly parent.
If I could pick one thing about the culture at Patagonia that has a bigger impact than anything else, I would pick that our childcare and family policies are really extraordinary. For example, if you’re a mom and you’re nursing and you need to travel for work, we will pay for the child to travel with you as well as a nanny to care for the child while you’re working.
Countries and companies compete for talent with other locales and employers. Those that make it possible to reconcile the demands of work with the rest of life do better in that competition. At Patagonia, “We know that about 99 percent of our moms return to work, which is about 20 percent above the national average, because we make it super easy.”
The “war for talent” is an already long-established phrase. Countries invest, through education and training mandates, in building the quality of their human capital. Companies, too, invest not just in training but also in identifying high-potential employees and instituting policies and programs to ensure their retention. Interestingly, work hours, scheduling flexibility, and policies that foster work-family conciliation are important means for accomplishing these goals.
At the company level, firms on Fortune’s Best Places to Work list regularly outperform their peers on shareholder returns. And these companies are more likely to offer job-sharing programs, compressed workweeks, telecommuting opportunities, and more generous family benefits to create environments more supportive of employees seeking work-family conciliation rather than conflict. Numerous organizations including Deloitte Consulting, Google, and some management consulting, accounting, and other professional service firms have sought to address issues of work hours and flexibility in order to attract and retain employees who increasingly do not want to trade off their life for a career. Family-friendly work environments offer companies an edge in recruiting and, possibly more important, in retaining employees.
Google, frequently rated as the best place to work in America, has a vision “of making its staff the healthiest and happiest on the planet.” As described in a 2011 article:
Google launched its “optimize your life” programme in 2010, as an extension of a new healthcare plan. . . . Google’s emotional wellbeing benefits include an employee assistance programme . . . life coaching, deep-sleep sessions, brain training, support groups, and recharging spaces . . . within the office for 20- or 30-minute breaks.65
Of course, that’s Google—they can afford it. But it is not just software companies that have chosen to take care of their people by providing reasonable working hours. At Whole Foods Market, in the hideously competitive grocery business and ranked fifty-eighth on the 2017 Best Companies to Work For list, 85 percent of surveyed employees said that they were able to take time off from work when they thought it was necessary.66
Companies vary with respect to work-hour issues and for that matter on other dimensions affecting employee health mostly because of the values—and behavior—of their leaders. The CEO of Landmark Health believes that his employees must take care of themselves if they are going to take care of others. Patagonia’s founder wrote a book entitled Let My People Go Surfing and strongly believes that work should not be all-consuming.
But leaving decisions about work practices that will affect employee health to the discretion of a founder or a CEO puts employees’ health and psychological well-being at risk to the vagaries of executive succession and founder whim. We don’t leave food safety, for instance, to the discretion of the CEO, nor do we leave it up to the CEO to determine whether or not to pollute the environment. If employee health is as fundamentally important as these other things, it, too, should not be subject to a particular CEO’s values, as it currently is. This is a subject to which I return in Chapter 8, the concluding chapter.
Both individual companies and countries vary in how they approach work-family conflict. The United States, as is well known, is different, and not in a good way—being the only advanced economy not to require employers to provide paid time off for either vacations or illness and also having fewer mandates that make balancing work and family easier. A report from the Center for WorkLife Law at the University of California’s Hastings College of the Law noted:
Of 20 high-income countries examined in comparison with the United States, 17 have statutes to help parents adjust working hours; 6 help with family care-giving responsibilities for adults; 12 allow change in hours to facilitate lifelong learning; 11 support gradual retirement; and 5 countries have statutory arrangements open to all employees, irrespective of the reason for seeking different work arrangements.67
Although causality is difficult to prove, it is interesting to note the possible effects of these policies, or their absence, on female labor force participation. “US labor force participation for prime working age women (age 25 to 54) has stalled and is now lower than it is in 14 of the 20 high-income countries. . . . Labor force participation for college educated women in the United States is lower than in any of the other 20 countries.”68
Systematic evidence and numerous anecdotes suggest that working hour and work-family policies and practices affect companies’ and countries’ ability to attract, develop, retain, and utilize all of their human capital—something that is increasingly important in a world in which more and more work requires more and more creativity and skill.
WHAT WORKERS SHOULD DO
It is possible that public policy will address the social costs of excessive work hours and work-family conflict, but with a move toward decreasing labor market regulation worldwide, I would not hold my breath. Maybe employers will voluntarily take steps to remedy these problems, as some have already done. But once again, I wouldn’t bet on it.
Simply put, workers—be they freelancers or employees—need to take care of themselves. And this means not just economically, although that is obviously crucial. In my research for this book, I often heard comments of the following form: “I know that my working unsustainable hours and neglecting spending time with my family can lead to bad outcomes, including physical and mental health problems. But I’m [only going to do it for a while longer, really don’t have a choice, am not going to suffer the consequences for various reasons such as being young, having good genetics, and so forth].” Lots of people engage in various forms of magical or wishful thinking about how they will mystically avoid the health consequences of toiling in toxic work environments. Unfortunately, things seldom work out well, rationalizations and wishes notwithstanding.
My advice: Stop telling yourself stories about how bad consequences from poor choices won’t happen to you, and stop making excuses for why you can’t do what you know you should do to take care of yourself at work. Instead, limit your work hours to what is sustainable, understanding that people have different levels of stamina and that endurance levels can be modified. Take vacations and time off and spend sufficient time with family and friends to obtain the social support that so much research has shown is important to well-being. Don’t schedule your baby’s delivery for your employer’s convenience by having a medically unnecessary caesarean section—holding aside physical considerations, the high rate of surgical deliveries is one factor (among many) driving up health-care costs.
And most important, as you think about possible jobs, employers, and other aspects of working life, recognize the profound mental and physical health consequences of your choices and actions. In other words, while plenty of people are suffering—and even dying—for a paycheck, you don’t have to be one of them.