The Washington PostDemocracy Dies in Darkness

This professor says the workplace is the fifth leading cause of death in the U.S.

Jeffrey Pfeffer, a Stanford professor, has written a new book, "Dying for a Paycheck." (Eric Risberg/AP Photo)

Stanford professor Jeffrey Pfeffer doesn't mince words. Workplace stress -- the result of conditions like long hours, a lack of health insurance, little autonomy on the job, high job demands -- don't just hit productivity or damage morale. They're killing us.

"It's pretty clear that the human costs -- in terms of death -- and the economic costs, in terms of elevated health care spend, are quite substantial," Pfeffer said in a recent interview about his new book, "Dying for a Paycheck."

Pfeffer's book, released Tuesday, is built around a 2015 paper that said more than 120,000 deaths a year and roughly 5 to 8 percent of annual health care costs may be attributable to how U.S. companies manage their workforces. A core argument: Instead of adding wellness programs or yoga classes, companies need to focus more on the management practices that lead to substantial health issues, such as layoffs, job insecurity, toxic cultures and long hours -- not only for their own bottom lines but so they don't offload those costs to broader society. As he told a Stanford publication: “I want this to be the 'Silent Spring' of workplace health," referring to the 1962 book by Rachel Carson that spurred the environmental movement.

We spoke with Pfeffer about his research, "social pollution," and where your workplace ranks on the list of leading causes of death. The conversation has been edited for length and clarity.

What did your research show?

For decades there has been epidemiological literature that looked at the effect of individual things like not having health insurance or the absence of job control and other work conditions like long hours. What I thought we needed to do is figure out — not for all of them but for many of them — what the total toll of them was on both mortality and health care costs.

I enlisted two operations research colleagues to help, and we did a meta analysis on all the literature and they did some fancy modeling. We found that there are basically 120,000 excess deaths per year attributed to these ten workplace conditions and they cause approximately $190 billion in incremental health care costs. That would make the workplace the fifth leading cause of death in the U.S. — higher than Alzheimer’s, higher than kidney disease.

One of your arguments is that while we’ve dramatically lowered physical accidents and safety issues in the workplace, the health impacts of social or stress-related work conditions have remained unaddressed. Can you elaborate?

We focused on the physical environment, and we now need to focus on the social environment — the human environment. With the Occupational Safety and Health Administration, workplace accidents and chemical exposures and injuries has gone down dramatically because it’s been measured, because it’s been regulated and because those regulations have been enforced.

But regulating and measuring the causes of workplace stress seems much more difficult and much more nebulous than preventing people from, say, falling down the stairs on the factory floor.

I don’t think so. There are validated scales for all of these. It’s not hard to measure hours. It’s not hard to measure shift work. It’s not hard to measure work-family conflict. It’s very easy to measure whether you have health insurance or not.

We have said to companies they cannot pass costs [of environmental damage] on to the broader society. We have not done that with respect to health. I would argue that it’s actually maybe harder to measure smokestack emissions than it is to measure healthy work conditions. If we wanted to regulate it, we could regulate it.

What about wellness initiatives, health risk assessments and smoking cessation programs? Do any of those ideas work?

No. The evidence on that is pretty clear. The reason they don’t help is also pretty clear. Wellness programs are an attempt to remediate the harmful effects of what’s going on in the workplace. Instead of remediation you need to prevent. Instead of causing you to over-smoke and over-drink and over-eat and under-exercise because of what goes on in the workplace, and then giving you a wellness program, they should change the underlying work conditions. If I change the workplace so you didn’t do that stuff in the first place, you wouldn’t need a wellness program.

What was the most startling statistic you discovered in your research?

There are several. The 120,000 excess deaths a year. According to one study I cite, more than a million people are dying due to overwork in China. The American Institute of Stress claims that stress is costing employers $300 billion a year. There are 2 million workplace violence incidents reported a year.

So what needs to be done?

The first thing I would want to do is we need to get a better handle on its scope. We need to measure it. You can see how many people are dying from air pollution a year. In the U.S. no agency does the same thing that we’ve done for water pollution, air pollution or infectious disease, which is to measure the harm — the toll — of the workplace on human health. If I can measure the effect of physical pollution on health, I can measure the effect of 10 workplace practices.

You talk about the phrase “social pollution.” What's that?

Harmful practices, as determined by a large epidemiological literature, that are reasonably widespread and exact a physical and psychological toll. Work-family conflict. Long work hours. The absence of job control. Being micro-managed.

But how do you measure micromanagement?

There are validated scales that measure job autonomy. It’s a concept that has been around in management and leadership literature for decades. We require companies to report on lots of things, and a bunch of political people run around and say human life is sacrosanct and human well being is important. My response to that is if it is, we ought to take it seriously, and if we’re taking it seriously, we ought to measure it.

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