Work till you die – Unions please note


Pressure of work and overtime shortens life Graham Jackson Article first published online: 16 SEP 2011

International Journal of Clinical Practice Volume 65, Issue 10, page 1019, October 2011

‘Term, holidays, term, holidays, till we leave school, and then work, work, work, till we die.’ CS Lewis


The political plan is for men and women to work longer and retire
later. This will reduce pension costs in the short term but will it
also reduce long term costs by precipitating earlier mortality, or is
that just the musing of a cynic? In the 27 member states of the
European Union, it is predicted that between 2010 and 2060 there will
be a reduction of 24 million men aged 64 years or less and an increase
of 32 million men aged 65 or over, with 65 being the widely accepted
age at retirement(1). The size of the problem and challenge is
therefore self evident – the fundamental question relates to whether
this form of reducing cost (lengthening working life) impairs health.

Work stress has been linked to coronary heart disease in a working-age
population of British Civil Servants and particularly those under 50
years of age (2). Work stress was associated with reduced physical
activity, poor diet, the metabolic syndrome and lower heart rate
variability. Interestingly, after an average of 12 years follow up the
older, and therefore more likely to be retired, were less susceptible
to the work induced psychosocial effect. This suggests that early
retirement might be good for health and although the data are
conflicting, fatigue and depressive symptoms do improve but major
chronic diseases are not affected(3).

Stress was one of the nine major risk factors predicting acute
coronary events in the INTERHEART study with stress at work and at
home (general stress) being significantly associated(4). In a
prospective cohort study of 812 healthy industrial employees (545 men,
267 women), those with high job strain after adjustment for age and
gender had a 2.2-fold cardiovascular mortality risk compared to
colleagues with low job strain (mean follow up 25.6 years)(5). Job
strain relates to a combination of high work demands and low job
control, whereas effort–reward imbalance (low salary, low security,
few career opportunities) increased the cardiovascular risk 2.4-fold.
Both predicted increased cholesterol levels and body mass index. It is
also possible that working long hours (over 11 a day regularly) may
increase risk of cardiovascular disease (6). This in turn reinforces
the finding that consistently working overtime (3–4 hours a day)
significantly adversely influences fatal and non-fatal coronary heart
disease with an increasing adverse effect as the overtime hours

Before we can independently attribute work stress to coronary heart
disease, associated well-recognised risk factors need to be taken into
account. However, there is an increasing body of evidence that work
stress is associated with conventional risk factors (hypertension,
raised cholesterol) and cardiac events, and as stress is an
individualised perception it should always be queried and taken into
account in any patient interview.

So we will in general all be working longer, but the working world
will need to take into account the negative impact of work stress,
overtime and long working hours. The need to plan ahead and avoid a
pension crisis is imperative but quality of life should not be
sacrificed as a consequence. After all, nobody on his or her deathbed
wished they had spent more time at the office.


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DOI: 10.1111/j.1742-1241.2011.02777.x © 2011 Blackwell Publishing Ltd