Work is killing us. We’ve known it for a long time. Yet we do nothing about it. I’m not talking about workplace-related injuries and illnesses, although that’s part of it. The far more important factors are the way we organize work, the benefits that come from work, and how much control we have over our work.
Stanford University business school professor Jeffrey Pfeffer, in his recent book Dying for a Paycheck, estimated workplace stress causes 120,000 excess deaths a year—making it the fifth-leading cause of death, surpassing Alzheimer’s and kidney disease. Stress adds almost $200 billion a year to the nation’s healthcare costs.
Workplaces are growing more stressful because the modern American economy rests on a foundation of chronic insecurity. Lose your job and you lose your health insurance. Defined-benefit pensions have been replaced by individual retirement accounts, which are built mostly from personal savings many can’t afford.
Long hours characterize both ends of the workforce. Low-wage service workers need to put in more than 40 hours a week, often at multiple jobs, in order to make ends meet. Lawyers, consultants and other professionals often put in 50- and 60-hour weeks.
Government-funded social support for workers is almost nonexistent. We do almost nothing to provide daycare and early childhood education. We don’t offer people paid family leave for life-altering events like births and deaths. We don’t regulate shift work to limit its destructive impact on family life.
Then there’s the hidden stressor—the absence of the sense that one’s work matters. Former World Medical Association chief Michael Marmot, in his pathbreaking studies of British civil servants, conclusively showed “that men and women whose work was characterized by high demands, low control and imbalance between efforts and rewards had increased risk of heart disease and of mental illness.”
As President Trump will repeatedly remind us over the coming months, we’re experiencing the lowest unemployment rate in over half a century. Yet workplace participation has been falling for two decades; opioid overdoses and suicides have led to three straight years of declining longevity; and 31% of workers in 2018 were either somewhat or completely dissatisfied with their levels of on-the-job stress, which was up 3 percentage points from the previous year and 8 points from before the Great Recession, according to an annual Gallup poll.
“The absence of job control, work-family conflict, and economic insecurity is obviously stressful,” Pfeffer writes. “The combination of working us to death and stressing us to death is what’s killing us.”
I was drawn to explore these trends after hearing several moving stories at Modern Healthcare’s recent symposium on the social determinants of health. They involved workers at the Evergreen Cooperative Laundry, which serves the Cleveland Clinic.
The not-for-profit not only provides slightly higher wages than the system’s prior private-sector vendor, but its organizers have provided workers with training, access to low-interest housing loans, and opened automatic retirement accounts for its employee-owners with routine profit-sharing payments. The goal is not just to give community residents jobs, but to help them build wealth and well-being.
“When I get up in the morning every day, I really want to go to work,” said Tymika Thomas, an ex-offender who’s been with Evergreen for two years. “My passion is taking care of people. Even though we don’t work directly with patients, I know we’re impacting peoples’ lives.”
Hospital systems looking for new ways to meet the social needs of their chronically ill patients can learn a lot from the Evergreen model. So could any employer wondering why their workplace wellness programs rarely produce the hoped-for results.
The road to a healthier life begins by ending the slow death caused by chronic economic insecurity.