Work Too Hard, Get Sick, Be Dead

The Natural Connection

One sultry summer evening in 1985, my husband and I feasted on spring rolls in the Siam Restaurant in Little Rock, Arkansas. The Vietnamese owner/chef waited impatiently at our table for our verdict. “These are fabulous!”, I said. “Can we return again tomorrow night?” We were both Internal Medicine residents at the University of Arkansas. Indispensable cogs in the medical care system, we worked 80-100 hours a week, and it was a rare weekend off. We felt like we were on vacation.

The chef scowled at us, and answered in broken English. “No. Tomorrow Sunday. No work Sunday. Six days work plenty. Work too hard, get sick, be dead!” And with that proclamation resounding in our ears, he stalked back to the kitchen.

We looked at each other in amazement. Was this man suffering from some sort of brain disease brought on by years of protein-calorie malnutrition in Viet Nam? Did he need some of that then-new drug, Prozac? Suddenly, the Zen Buddhist saying, “When the student is ready, the teacher will appear”, came to my mind. I returned to the University Hospital where I worked, and much to the horror of my superiors, wrote those very words on a chalkboard, to serve as my mantra to sanity. Work too hard, get sick, be dead.

Nearly fifteen years later, the National Institute for Occupational Health and Safety (NIOSH) sponsored a conference in Baltimore on “Work, Stress, & Health” where numerous studies by international governments, universities, and private industry validated the statement of the Vietnamese chef. There is a relationship between job stress and health, and the physical, psychological, and economic price we pay as a nation is only beginning to be understood.

In Japan, long revered by corporate America as the model of high worker productivity, April heralds both the start of the business year and the peak incidence of karoshi, the Japanese term for “death from overwork”. Karoshi deaths are usually sudden deaths caused by fatal, acute cardiac events. Japanese researchers have shown that in male white-collar workers, overtime work is associated with increases in 24-hour average blood pressure, and increases in heart rate, and possibly a cause of karoshi.

Studies presented at the March 1999 NIOSH meeting suggest that American workers may be headed for their own form of karoshi. Extensive research has been done in this country, as well as Japan, and Europe, that implicates job strain and job stress as causal factors in a variety of medical and psychological maladies. Job strain, defined as high psychological demands with low job latitude or control, is on the increase in America, as corporations continue to downsize and attempt to increase productivity to continue to fuel the boom economy.

The NIOSH conference attributed job strain in both men and women to multiple forms of cardiac disease, such as high blood pressure and heart attacks. Skill under-utilization, a contributing factor to job strain, was found to be associated with a gastrointestinal condition called chronic atrophic gastritis, which predisposes patients to a variety of stomach problems including ulcers. Psychological job stress was found to contribute to the development of musculoskeletal disorders, even in jobs that were not physically demanding. Pregnant women with high levels of job stress were found to have increased rates of miscarriages, preeclampsia, and premature births. Job strain was even found to cause problems in the immune system, and a decrease in the number of T-cells needed to fight infections.

Job stress has been estimated to cost American industry $150 billion per year in absenteeism, health insurance, diminished productivity, compensation claims, and direct medical costs. Over 500 million work days are lost each year due to illness and disability.

All this information has not been lost on the people who often pay for medical care in the United States—the private insurance companies. Northwestern National Life reported in a study on employee burnout that “One fourth of employees view their jobs as the number one stressor in their lives.” The St. Paul Insurance Company studied American workers under pressure and found that “Problems at work are more strongly associated with health complaints than are any other life stressor”.

The average American worker now works one month more per year than they did in 1969. Our leisure time is shrinking, and along with it our health status, as we are “too busy” to exercise, eat properly, or spend time with family or on creative pursuits. This month our President signed legislation to encourage older Americans to remain in the workforce longer. If this is a benefit or an increased risk of karoshi remains to be seen. As a culture, we need to examine ways to help workers work healthier—not just longer. We need to remember that some of life’s teachers are found in unusual places. This summer, take time for your health and go visit them!

For more information on combating Job Stress, and information on how to how to receive the NIOSH publication “Stress…at Work”, please write to:

The Natural Connection, c/o Dr. Pauline Bellecci, Southeast Internal Medicine, PO BOX 777, Waycross, GA 31502 or visit www.swampdocs.com

4/24/00