Lisa Choi ignored the first symptoms. After all, the 53-year-old business analyst was a very active, fit vegetarian, who cycled frequently and avoided high-fat foods. She was far from the typical victim of a heart attack.
However, the Seattle-based Choi was working 60-hour workweeks, including evenings and weekends. She was facing tight deadlines and managing complex digital projects. This workload was utterly normal to her. “I have a really high-stress job… I’m usually on overdrive,” she says.
It wasn’t until several months ago, when she suddenly started feeling an anvil-like pressure on her chest, that she began to take her symptoms more seriously. In the hospital, it turned out that she had a tear in her artery. This is a hallmark of a spontaneous coronary artery dissection (SCAD), a relatively rare heart condition that particularly affects women and people younger than 50. Told that she would need an angioplasty to open up her artery, Choi thought, “I don’t have time for this. I’m scheduled for migrations at work, and I’m doing all this stuff.”
Like Choi, many are also finding themselves in ill health due to intense work schedules. New, sobering research – said to be the first-ever study to quantify the global burden of disease from working long hours – has shown how bleak the situation is.
In a paper published 17 May, authors from institutions including the World Health Organization (WHO) and the International Labour Organization (ILO) suggest that, each year, three-quarters of a million people are dying from ischaemic heart disease and stroke, due to working long hours. (Ischaemic heart disease, also known as coronary heart disease, involves narrowed arteries. Choi’s SCAD is different from conventional ischaemic heart disease, but stress and high blood pressure are major factors in both.)
In other words, more people are dying from overwork than from malaria. This is a global health crisis, demanding attention from individuals, companies and governments alike. And, if we don’t solve it, the problem may not only continue – it could get worse.
How overwork affects health
In the paper, published in the journal Environment International, researchers systematically reviewed data on long working hours, defined as 55 hours or more per week; health impacts; and mortality rates from most of the world’s countries, from 2000 to 2016. The authors controlled for factors like gender and socioeconomic status, in order to tease out the pure effects of overwork on health.
The study establishes that overwork is the single largest risk factor for occupational disease, accounting for roughly one-third of the burden of disease related to work. “For me personally, as an epidemiologist, I was extremely surprised when we crunched these numbers,” says Frank Pega, a WHO technical officer and the lead author of the paper. “I was extremely surprised by the size of the burden.” He describes the findings as moderate, but clinically significant.
I was extremely surprised when we crunched these numbers. I was extremely surprised by the size of the burden – Frank Pega
There are two major ways that overwork can reduce health and longevity. One is the biological toll of chronic stress, with an uptick in stress hormones leading to elevated blood pressure and cholesterol. Then there are the changes in behaviour. Those logging long hours may be sleeping little, barely exercising, eating unhealthy foods and smoking and drinking to cope.
And there are particular reasons to worry about overwork both while we’re still in the Covid-19 pandemic, and looking at life thereafter. The pandemic has intensified some work stresses while bringing new forms of workplace exhaustion.
India has become the epicentre of the global pandemic, with more than 25 million cases of Covid-19. But the pandemic is affecting health in other ways as well. Sevith Rao, a physician and founder of the Indian Heart Association, explains that South Asians are already at high risk of heart disease. Now, “with the Covid pandemic we have seen an increase in work from home, which has blurred work-life balance among many individuals, leading to disrupted sleep patterns and exercise; this has in turn increased the risk for cardiovascular disease and stroke.”
Moreover, the pandemic has resulted in the worst economic downturn since the Great Depression. Previous recessions have actually been followed by increases in working hours. “It seems almost like a perverse effect,” Pega acknowledges, in light of the widespread job losses during a recession. But “the reality seems to be that the people who are still working have to work more to compensate for the job losses.”
Hotspots of overwork
According to the data in the paper, 9% of the world’s population – a number that includes children – is working long hours. And, since 2000, the number of people who are overworking has been increasing.
Overwork affects different groups of workers in very different ways.
Men work longer hours than women in every age group. Overwork peaks in early middle age, although the health effects take longer to turn up. (The study authors used a 10-year lag period to track the effects of overwork on the onset of disease; after all, “death by overwork” doesn’t happen overnight.)
According to the new data, pulling late nights and long hours is no longer just exhausting – it's life threatening (Credit: Getty Images)
The data also show that people in Southeast Asia seem to be working the longest hours; people in Europe, the shortest. Pega explains that there may be cultural reasons for the larger proportion of people in Asia working long hours. As well, many people work in the informal sector in low- and middle-income Asian countries. As Pega points out, “People in the informal economy might have to work long hours to survive, they might be working multiple jobs, they might not be covered by social protection laws.”
On the flip side, many Europeans enjoy a working culture that celebrates lengthy holidays and substantial rest periods. This more relaxed attitude is enshrined in law; for instance, the European Union’s Working Time Directive bars employees from working more than 48 hours a week on average.
But even in some European countries, especially outside of France and Scandinavia, there’s been an increasing proportion of high-skilled workers working extreme hours since 1990 (after the peak of unionisation and the related employee protections). Tellingly, the Austrian health minister resigned from his job in April, saying that he had developed high blood pressure and high blood sugar while overworking during the pandemic. His public announcement was unusual not just because of his high-profile position, but also because he was actually able to leave his exhausting job.
Over in Seattle, Choi has also been fortunate, in that her colleagues have been supportive of her need to slow down at work. Since not everyone can afford to work more balanced hours, and not everyone will get a wake-up call before a fatal stroke or heart attack, there’s an urgent need to tackle this health crisis now.
If trends continue in the same direction, overwork – and the associated health harms – will only increase. This is especially worrying, given how many societies glorify overwork to the point of burnout. And, as our work hours have ticked up during the pandemic, with few signs of stopping, those suffering from spending too many hours on the clock will only increase.
The burden to disrupt the cycle falls on both employers and employees in some way – and all may need to work together in order to rein in overwork and the subsequent issues that follow.
Those logging long hours may be sleeping little, barely exercising, eating unhealthy foods and smoking and drinking to cope
In general, Pega urges workplaces to embrace flexible work, job shares and other means of improving balance in work schedules. They should also take occupational-health services seriously. And Rao comments, “We at the Indian Heart Association believe that increased education and screening is key to prevent cardiovascular disease and stroke.”
There’s clearly a role for individual workers to reshape their attitudes to work as well – we can all try to push back against the pull of overwork that keeps so many of us glued to our phones late into the evening. The sooner workers do this, the better position they’ll be in; since overwork is a risk that accumulates over years, preventing it from becoming chronic may reduce the severity of the worst health risks (although there’s not enough evidence on when the risk crosses over from short-term to chronic).
But the most sweeping changes would need to occur at the governmental level. Pega says, “we already have solutions. People have put in place limits on the maximum number of hours we should be working” – for instance with the European Working Time Directive, or other right-to-disconnect laws. In countries with strong laws on limiting work, what’s key is enforcing and monitoring those laws. And in countries with weak social safety nets, anti-poverty measures and welfare programmes can lower the number of people working themselves to the bone out of sheer necessity.
Ultimately, the problem of overwork – and the ill health it breeds – will continue if we don’t make changes in our working lives. And change isn’t impossible. “We can do something,” insists Pega. “This is for everybody.”