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WORKED TO DEATH
It is the thoroughly modern way to die at work. Major occupational diseases of the 21st century will be heart attacks, suicide and strokes. Hazards looks at why so many of us are being worked into the ground.
Dr Sid Watkins died when his body could no longer stand his "crazy" working hours. Stressed out teacher Pamela Relf killed herself. So did mental health nurse Richard Pocock. And postal worker Jermaine Lee. All died because their jobs were just too much to bear.
But these deaths, and hundreds like them each year, are not recorded as "work-related deaths." Dying because the job was beyond a human's capabilities is, in most countries at least, not a workplace problem.
In the real world, it is - and it is a problem that is getting worse. The 2003 Stressed Out survey by the Samaritans, the UK emotional support charity, found: "People's jobs are the single biggest cause of stress with over a third (36 per cent) of Briton's citing it as one of their biggest stressors." (1)
And it is worse at work. The Samaritans found 23 per cent of people working full time get stressed every day compared to just 16 per cent of those who aren't working.
It says the survey provides evidence that "people believe that they are more stressed than five years ago - the majority of people are experiencing similar or greater levels of stress than five years ago."
It adds that 45 per cent of those who have felt stressed in Britain have been depressed as a consequence.
The Samaritans 2003 resource pack says: "It is commonly accepted that high stress, together with easy access to means, are important factors which put people in certain occupations at greater risk of dying by suicide." (2)
Our hearts and minds can face intolerable pressures from work.
Countries renown for their long working hours know this well enough. Japan and China each have a word for death by overwork - karoshi and guolaosi. And both Japan and Korea recognise suicide as an official and compensatable work-related condition. (3)
The problem may not be quite so bad in the UK, but long working hours and runaway stress make both conditions a genuine threat in British workplaces.
The number of people suffering from stress and stress-related conditions caused or made worse by work has more than doubled since 1990, according to latest HSE figures (Hazards 81).
The estimated prevalence of stress and stress-related conditions rose from 829 cases per 100,000 workers in 1990, to 1,700 per 100,000 in 2001/02.
HSE figures show that last year 13.4 million lost working days were attributed to stress, anxiety of depression, with an estimate 265,000 new cases of stress.
The latest HSE analysis of self-reported illnesses rates, published this year, says stress, depression or anxiety affects 1.3 per cent of the workforce. (4)
ILO estimates that 23 per cent of deaths from circulatory diseases - the top UK killer - are work-related (Hazards 81). (5)
In the UK we don't keep statistics on overwork deaths. The situation is different in Japan, where US-style "management by stress" has driven up working hours and pressure (Hazards 51).
There, karoshi - death by overwork - is a government compensated occupational disease. The government pays out to the dependants of workers who died from stroke (cerebrovascular disease) or heart disease.
Figures for 2001/2002, revealed a record 690 claims leading to 143 confirmed cases, 47 related to sudden deaths from heart disease and 96 from stroke. In 2002/03, the number of compensated cases was higher still, with 160 of the 819 claimants receiving compensation.
The increase is in part explained by new rules introduced in December 2001 that took greater account of cumulative fatigue. A May 2002 briefing from the Japan International Centre for Occupational Safety and Health says under the new scheme, overwork over the six months prior to death would be considered. (6)
The new criteria allow deaths from eligible brain and heart diseases to qualify as work-related if the person has worked overtime of "more than 100 hours during the month before" or "more than 80 hours per month during the two months before" they develop the fatal condition.
Less than 45 hours overtime in the months prior to death is considered "weak" evidence of a work link, but the association is assumed to get stronger as the amount of overtime increases.
Under the new rules, factors that indicate a case of karoshi include:
Over two-thirds of the karoshi deaths occur in men in their 40s or 50s.
A UK government survey published last year found there had been a steep rise in the number of people working excessive hours - taking millions of UK workers into the karoshi zone.
The DTI research found 16 per cent of the workers surveyed - 1 in every 6 workers - were working over 60 hours a week, compared to just 12 per cent, or 1 in 8, of all UK workers in 2000. (7)
In February 2002, TUC declared overwork in the UK "a national disgrace." A TUC report, About time: a new agenda for shaping working life, said more people were working in excess of 48-hours-a-week than were 10 years ago. (8)
Overwork is definitely making us sick - the DTI survey found one in five men (19 per cent) had visited the doctor because of stress, rising to one quarter (23 per cent) of over 40s.
Further evidence that we are wilting under the pressure can be found in the number of personal injury compensation claims for stress.
TUC figures for 2000 and 2001 show over the period unions started
almost 9,000 new compensation cases for victims of workplace stress,
accounting for about 10 per cent of all union personal injury cases
for those years and far outstripping the number of asbestos claims.
And things could be about to get worse. In July 2003 the government, facing a pensions crisis, proposed abolishing the mandatory retirement of 65 years. The old notion that "we work to live, not live to work" could soon be superseded by "we work until we drop."
We all have to die of something, of course - and circulatory disease is Britain's top killer. Bad jobs might not determine what kills you, they could just make it happen that bit sooner.
Sometimes periods of exceptional stress and scandal have been linked to high profile "work-related" suicides.
On 3 August 2003 Chung Mong-hun, 55, an executive of South Korean car group Hyundai on trial over a payments scandal, leapt 12 storeys to his death from the company's office building in Seoul.
Another example could be the July 2003 suicide death of David Kelly, the MoD scientist who apparently killed himself after coming under scrutiny as a possible source of information relating to the UK government's contentious Iraq war dossier.
But frequently the cumulative effect of more mundane
working pressures can be enough to drive someone to take their own
In its 2003 analysis of suicide patterns it says: "It is commonly accepted that high stress, together with easy access to means, are important factors which put people in certain occupations at greater risk of dying by suicide."
Evidence suggests workplace problems could explain a shockingly high proportion of suicides. A November 2002 study in the Australian state of Victoria, found work was a significant factor in 109 suicides in the years 1989-2000. (9)
The figures if applied to the UK would suggest there are well over 100 cases of work-related suicide in the UK each year, making it one of the top causes of workplace death. The authors say their total is likely to be an under-estimate because coroner's data is not designed to make work links.
In 2002/03 Japan compensated the dependants of a record 46 victims of karojisatsu, suicide caused by work-related depression.
According to National Police Agency statistics, about five per cent of all suicide deaths in Japan are "company related," the Japan Times reported on 10 May 2003. (10)
In July 2003, the widow of a Toyota Motor Corp employee who took his own life in 1988 as a result of overwork became the latest recipient of karojisatsu compensation.
High Court judge Katsusuke Ogawa, hearing a government appeal against a compensation award, said the 35-year-old's suicide was triggered by excessive hours and workload. "His depression and suicide both resulted from his job," the judge ruled. (11)
Multinationals like Toyota operate similar management regimes worldwide. Earlier this year auto union CAW fought off a bid by the company to force compulsory overtime on workers at a Canadian plant.
None of the causes of work stress are hard to fathom.
Professor Sir Michael Marmot, director of the "Whitehall II" study, which looked at the health of more than 10,000 British civil servants, said: "First, stress at work is not simply a matter of having too much to do, but also results from too little control over the work and from insufficient reward for the effort expended.
"Second, the way work is organised is crucial. The way to address the problem of stress at work is to look hard at the organisation of the workplace." (12)
Any employer wanting to make work survivable just has to create decent jobs. Given that more of us are working longer hours, in less secure jobs, with less control of what we do and when, it seems unlikely that many employers will do the decent thing without a shove. And that's where unions come in.
US work stress expert Dr Paul Landsbergis told Hazards: "Unions can play an important role in reducing work stress among their members, through legislative action, bargaining, grievances, member education, and by health and safety committee activity."
He added: "By increasing job security and skills training, increasing employees' participation and influence on the job over issues such as transfers and promotions, and by bargaining over working conditions, such as health and safety, bullying, and overtime, unions can help increase employees' job control and moderate job demands - and thus reduce the harmful health effects of 'job strain'."
Work that breaks our hearts and blows our minds is not what we bargained for. It is time to bargain for something better.
1. Stressed Out, Samaritans survey. News release 17 May 2003.
Koreans recognise suicide as industrial accident. Ananova, 7 August 2000.
5. Two million killed at work each year. ILO report for Hazards 81.
6. Accumulated fatigue may be considered in the standards for the recognition of "Karoshi."Japan International Centre for Occupational Safety and Health, May 2002.
Factors contributing to Karoshi other than working hours, Japan Labour Bulletin, vol.41, no.2, 1 February 2002.
7. UK workers struggle to balance work and quality of life as long hours and stress take hold. DTI news release, 30 August 2002.
Also see: Risks, no.69, 31 August 2002
8. About Time: a new agenda for shaping working life,
9. Work factors in suicide, Urban Ministry Network, November 2002. OHS Reps online news report
10. Firms turn to counsellors amid rise in work-related suicides. The Japan Times, 10 May 2003
11. Workers' compensation awarded over suicide.
Also see: Risks, no.114, 15 July 2003
Also see: Risks, no.48, 6 April 2002
Drop dead news
China: Call for law to stop overwork deaths
Britain: Payout after work-related heart attack
Suicide note blamed work pressure
Employer to blame for suicide
Work stress linked to constable’s suicide
USA Being downsized increases stroke risk Risks 162, 26 June 2004
numbers worked into the ground
of worktime control makes you sick
up the working time pressure
welcomes expected Euro crackdown on long hours
No sex please, we're British workers
workers win compensation
strain and insecurity is bad for you
the government listened
welcomes HSE stress guide
BRITAIN Outsourcing, staffing and downsizing are safety issues Risks 129, 25 October 2003
is costing British firms £1.24bn
working a dangerous 85 hour week
BRITAIN Red tags
are like "red rags to a bull"
BRITAIN How to
opt back in to a 48 hour working week
workers quit due to stress
EUROPE Stress au travail, Dan Cunniah, Directeur du Bureau de la CISL/ICFTU, Genève, 26 Septembre, 2003
Double trouble from soaring stress
BRITAIN Overworked journalists written off Risks 124, 20 September 2003.
USA Overwork is hurting America Risks 123, 13 September 2003
BRITAIN No more Mr Knackered Guy Risks 123, 13 September 2003
USA Give the workers a
122, 6 September 2003
New Zealand: Suicide at OSH blamed on stress, New Zealand Herald, 27 June 2003
USA: Judge's worked-to-death
claim clears hurdle. Thomas B. Scheffey, The
Connecticut Law Tribune, 17 June 2003.
India: Union blames RTC for heart attacks among staff, The Times of India, 14 June 2003
UK: Beyond the call of duty (overworked hospital doctors), The Independent, 2 June 2003
Japan: Stress ups women's heart disease risk, Risks, no.67, 17 August 2002
Japan: Accumulated fatigue may be considered in the standards for the recognition of "Karoshi." Japan International Centre for Occupational Safety and Health, May 2002
Japan: Karoshi (Kah-roe-she) - Death from Overwork, Asian Pacific Management Forum, May 2002.
Australia: Work factors in suicide, Urban Ministry Network, November 2002. OHS Reps online news report.
Japan: Overwork deaths reach record levels, Risks, no.55, 25 May 2002
China: Worked till they drop; few protections for China's new laborers, The Washington Post, 13 May 2002. Reproduced on the Global Exchange website
New Zealand: Coroner - stress was factor in worker's suicide, Risks, no.53, 11 May 2002
Japan: Sharp increase in acknowledged karoshi (includes work-related suicide statistics), Statistics in Japan, JICOSH, 11 November 2002
Japan: The Ministry of Health, Labour and Welfare to relax standards to recognize "karoshi", ILO News Flash, November 2001.
Korea: Koreans recognise suicide as industrial accident. Ananova, 7 August 2000.
Japan: Caught in the speed trap: Deaths from overwork in Japan. Witness, CBC, Canada.
Japan: Death by overwork: Corporate pressure on employees takes a fatal toll in Japan. Multinational Monitor, vol.21, no.6, June 2000.
Japan: Suicides and karoshi exploded in Japan: In Japan, mired in recession, suicides soar, New York Times, 15 July 1999. Reproduced on Labournet Germany.
Japan: Karoshi - recently certified suicides from overwork. JOSHRC Newsletter, No.15, May 1998.
Japan: Karoshi - Death from overwork: Occupational health consequences of the Japanese production management (Sixth Draft for International Journal of Health Services), February 4, 1997. Reproduced on the Job Stress Network website.
HAZARDS MAGAZINE WORKERS' HEALTH INTERNATIONAL NEWS