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We know health affects productivity, but do we understand how work affects health?
We know health affects productivity, but do we understand how work affects health?
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In the past few years, researchers have scrutinized how workers' health has a direct bearing on productivity, but research on the flip side of the issue remains largely unrecognized: How do work environments affect workers' health?
Most human resources managers and corporate wellness directors intuitively understand that neither the sleep-deprived employee slumped at her terminal nor her caffeine-powered manager who hasn't taken a day off in three years is working at peak capacity. But what is "peak?" Lacking a definition, Americans have fallen into the "more is better" rut, with untold implications for their health.
While at first corporations may appear to benefit from workers' added effort during long, stress-filled days, rising health care premiums may show otherwise. One study based on the Multiple Risk Factor Intervention Trial, for instance, showed men who skipped their annual vacation were more likely to die from coronary heart disease than were couch potatoes or smokers who do get away for a little annual rest and relaxation.
For most employers, the idea of a downside to working hard presents an inherent conflict. While a good book and a hammock in the shade may reduce stress, they don't produce widgets. Anyone marching into the executive suite with a plan to reduce work hours, increase vacation time and the like had better have a compelling business argument.
To make a case for change, human resources managers must establish two points: that corporate culture affects worker health and that diminished worker health directly affects corporate expenses. Fortunately, a growing body of evidence supports both points.
A Health Enhancement Research Organization study showed that smoking, stress, exercise and body weight together affect 20 percent of a company's overall medical costs. And workers on the wrong side of any of those risk factors cost their employers between $300 and $600 a year more in medical costs than other employees. Another study showed the cumulative cost of smoking in terms of sick days, time lost to smoke breaks, added cleaning costs, increased property loss and burn damage, and employer-paid insurance premiums exceeded $7,000 for a smoker, compared to less than $2,000 for a nonsmoker.
Wayne Burton, senior vice president and corporate medical director at BANK ONE, Chicago, found that employees with good health habits or only one health-risk habit cost employers 4.1 hours per week in reduced productivity, short-term disability and sick time. Costs for those with three or more risks jumped to 5.6 hours per week. That 1.5 hour-per-week difference translates to eight lost days per year, per person.
Beyond poor health habits, of course, there is a whole range of medical conditionsallergies, migraine headaches and depressionthat impair productivity, as can failure to take prescribed medicines for these conditions.
The point is, once you add together medical spending, absenteeism, impaired performance and disability, poor health is no longer a human resources issue. It is a business challenge with major financial consequences, and the way some companies are managed is clearly increasing the damage.
Environmental factors have a profound effect on health. Poor air quality can affect the respiratory system. An ergonomically flawed workstation can affect the musculoskeletal system. Can there be any doubt that the culture of the place where a person spends 40 to 50 hours a week can likewise affect his or her health?
When the boss schedules a 7 a.m. breakfast meeting or the technician grabs a bag of chips and works through lunch, these work decisions impact health. Every day at 3 p.m., when a working mother worries whether her latchkey kids got home all right, or at 7 p.m., when the salesman foregoes a trip to the gym to return a few more calls, small but important trade-offs are made. Whether it's sleep, food, time with their families or exercise, workers forsake something when they spend extra time at work. These trade-offs may superficially benefit the business in the short run, but in the long term they can start to cause problems.
We hold up the image of the hard-driving executive as the model. And technological advances make it easier to turn this model into a round-the-clock reality.
An informal survey by the Disney Institute of visiting executives found they averaged 11.6 hours a day working, excluding the three or four nights a week they entertained for the company. On paper it sounds unsustainable. In reality, it's the path we've defined for getting ahead. Want to become executive vice president? Work harder. Work longer.
Those executives are no anomaly. The image of the stressed-out American has become a cliché. TV is crammed with advertisements for minivans and cellular phones featuring frazzled working parents and wired "multitasking" employees. "Face time" is hard currency in many offices. Whether working productively or not, employees feel their supervisors must see them at their desks to be considered management material or to garner a big year-end bonus.
Many argue the extra hours are needed to get the job done. Are they? Anyone who ever pulled an all-nighter for a final exam understands the law of diminishing returns. When does the physical and psychological toll outweigh the productivity gain of another hour in the office? We don't know.
No one has identified the point where productivity plummets and work becomes a health hazard, which is exactly the type of data HR professionals need to make a case for changing the culture of a workplace. We need a better handle on the costs associated with excessive work. Assessing the impact of Americans' long hours on their health might be a good place to start.
Think about what gives when work doesn't. Sleep is an obvious loser and one with clinically demonstrated ramifications. Even moderate sleep deprivation can cause mood disruptions, irritability, low motivation and slowed response. Shift workers are particularly vulnerable; between 5 and 20 percent suffer from Shift Maladaption Syndrome, which can result in sleep disturbances, gastrointestinal problems, depression, personality changes and decreased interpersonal skills. To cope with those problems, sufferers are more likely to self-medicate with alcohol or drugs.
If all this talk about the dangers of missing a few Zzzs seems overblown, consider the Federal Aviation Administration, which long ago recognized the effects of sleep deprivation and now strictly regulates the amount of time off pilots and crew members must have between flights.
Sleep isn't all that suffers. Family relationships deteriorate, as does the sense of well-being associated with a socially, emotionally, spiritually, physically and intellectually balanced life.
The negative affects of work are particularly acute for employees in high-strain jobs with little control over their workdays. A study of 21,000 nurses in high-demand, low-control jobs found that over a four-year period their health declined more than would be expected if they were smokers or led sedentary lives. After adjusting for age, body mass, smoking, exercise, chronic disease, education, isolation, marital status and virtually every other conceivable factor, the group still ranked considerably lower in physical functioning, vitality and mental health than did those in medium- and low-strain jobs. In other words, independent of what employees did individually, the organizational structure of their workplace affected their health.
Those stresses encourage people to go to extraordinary, sometimes illogical lengths to exercise some control over their work lives. A young nurse recently told me she actually took up smoking years ago when she noticed that smokers got cigarette breaks while nonsmokers had to keep working. It seems that managers in her hospital appreciated the effects of physical addiction, but like many others, had forgotten the simple human need for a little downtime.
In their book Healthy Work, published in 1990, Robert Karasek and Tores Theorell found 10 percent of people in high-demand, high-control jobs exhibited symptoms of depression. That figure ballooned to 57 percent for workers in high-demand, low-control jobs. Likewise for cardiovascular symptoms, such as chest pain and shortness of breath: Three percent of those in high-demand, high-control jobs complained of such symptoms, compared to 20 percent in high-demand, low-control positions.
Add a bad manager to the high-demand, low-control mix, and the situation becomes even more toxic. Employees who received little social support while working high-strain jobs were considerably more likely to suffer from depression than were those who had support on the job, according to Karasek and Theorell's study.
Not surprisingly, the result of all this is elevated stress: Ninety-nine percent of workers in high-demand, low-control jobs say they feel it, according to one study. What's disconcerting is how they deal with it. Thirty-five percent said they had missed five or more days of work in the past yearnearly three times more than reported by respondents in high-control jobs. The implication: If you can't control what you do at work, you're going to control whether you go at all.
Indeed, the number of people missing work because of stress more than tripled between 1995 and 1998, climbing from 6 to 19 percent. Meanwhile, the number of workers taking unscheduled time off for personal needs jumped from 13 to 20 percent.
To a growing number of employers, none of this is news. They have responded with stress interventions. They sponsor on-site aerobics and yoga classes. They subsidize memberships to local fitness clubs. They have employee assistance programs and may even spring for on-site massages.
Such individually targeted interventions fall far short of the mark, however, if the problem is systemic. If the workplace causes the stress, sleepless nights, jangled nerves, heart attacks and depression, then all the fitness programs add up to little more than a heap of dumbbells. For systemic problems, nothing short of a corporate cultural revolution will suffice.
To understand the problem, compare the pace of life today with that of just a decade ago. Today's workers do more in less time than ever before, helped by e-mail, faxes, the Internet, cell phones, beepers and voice mail. This arsenal of efficiency also makes escaping the workplace far more difficult.
An influx of women to the workforce has caused another dramatic change. In 1998, the average family worked 82.6 full-time weeks, 14.3 weeks more than in 1969, according to the Economic Policy Institute, a nonprofit think tank in Washington, D.C.
In response to employee complaints and high turnover, most companies have introduced alternative work schedules. One survey found 83 percent offer part-time work options, 39 percent have flextime, 30 percent allow telecommuting and 39 percent say they have job sharing. In other words, they've done their part.
Or have they? One survey of work trends shows only a handful of workers actually use those options. Many fear they will be perceived as slackers or will not be able to advance with less workplace visibility or fewer hours worked.
Seeing workers shun alternative work schedules, employers might shrug and say, "Hey, we tried." But washing their hands of responsibility won't solve the problem. Like a squeezed water balloon, employee dissatisfaction and its associated problems will merely slip to another part of the balance sheet.
If employees can't get any relief on the job, they'll simply avoid the job. If alternative work arrangements are seen as unacceptable ways to get a little personal time, they'll opt for sick time and disability or quit. Illness becomes an unassailable means of escape and quitting the best way to manage stress. Under the current system of incentives and rewards, their behavior is perfectly rational.
Any hope of addressing work-related health problems must demonstrate that change is in the company's best economic interests. Even with incontrovertible evidence that work can negatively impact health, businesses won't change their norms unless someone shows them their practices cause them to lose good people or result in lower output.
For the moment, employers are stuck in the mindset that more hours worked is better. The challenge is to shift their focus toward what is optimal.
For machinery, engineers diligently search for the point of diminishing returns. Once found, they take the equipment off line, service it and get back to business. The same should hold true for our human capital.
Shelly Reese. Health affects work, and work affects health. Business and Health 2002;1.