Long working hours increase risk of death

The COVID pandemic has brought into sharp relief the toll working long hours takes on your mental and physical well being. Now, scientists at the WHO have managed to put numbers to the problem - by combining data from a global, 10 million person survey with reports from countries around the world about causes of death, they’ve calculated that 745000 people died in 2016 due to stroke or heart disease caused by working longer hours. Lead author on the study Frank Pega from the World Health Organisation spoke with Eva Higginbotham...

Frank Pega - Forty professors from around the world looked at a number of different categories of long working hours. And when they crunched the numbers and looked at all the available evidence, they found that there was strong evidence that when people work 55 hours or more per week their risk for chronic heart disease and stroke is increased. And indeed that's very common in health science. And we talk about a risk limit here.

Eva Higginbotham - What's the mechanism, or what's the link between working long hours and having a stroke or having heart disease.

Frank Pega - The first link is in a way, a direct pathway where people who work long hours and all of us who have worked long hours or know somebody who's worked long hours has experienced this, basically feels stressed. Our body has a physiological physical response to working long hours. It releases stress hormones, and these stress hormones directly damage the heart or the brain and thereby they can directly produce heart disease or stroke. A second pathway through which long working hours can cause these diseases is by them increasing other risk factors for heart disease and stroke. So for example, people who work long hours may as a result also be more likely to smoke or to drink alcohol or have sleep deprivation. This in turn could then cause heart disease or a stroke event.

Eva Higginbotham - Is this true for all kinds of jobs or just for jobs that we might traditionally think are very stressful? I'm thinking things like manual labour or people who are like CEOs, running big companies who are under high stress and work long hours?

Frank Pega - We've done some analysis to look at the available data that is broken down by occupations and by industrial sectors. This is how we divide the world. And we found that everybody who works long hours seems to be at the same level of increased risk in as far as the evidence is currently available.

Eva Higginbotham - I'm wondering if there's an age factor here because people will sometimes say, you know, work hard in your twenties, your thirties, your forties, and then you'll be able to relax when you're older. Do we know if working long hours at any stage in your life is damaging or is it just later or just earlier?

Frank Pega - We did not see differences in risk across age groups. In other words, if you're working long hours when you're 20, or if you're working long hours when you're 60, makes very little difference for your actual increase in risk of having a cardiovascular disease or stroke event. However, what we do notice when it comes now again to the number of people dying of cardiovascular disease, so heart disease, stroke, is concentrated specifically amongst middle aged and older people. So when we ran our estimates and we did our modelling, we found not surprisingly that more people died from long working hours in these middle aged and older working age groups than younger people did, but to be clear the risk's the same.

Eva Higginbotham - And is this a global problem? Did you find that there were some places that had a higher resulting risk from longer hours versus others?

Frank Pega - So what we found is that when we looked at the distribution of the number of deaths, for example, from these two conditions, from stroke and heart disease, that these were particularly high in two regions in the Western Pacific region, and in Southeast Asia. There were other regions where the numbers were much lower, for example, in Europe and also in North America. So there's clearly a geographic patterning.

Eva Higginbotham - Is that because there are more people in those regions who work those hours or the type of work that they're doing, or other factors in their lifestyle, do we know?
Frank Pega - One part of the puzzle and one part of this explanation is that there's definitely a higher proportion of people working long hours in these regions. And if you ask why that is, one reason is that these regions have a number of low and middle income countries, for which we know that a large proportion of the workforce of people working are in an informal economy. So they do not have a formal employment contract. That means often these are workers who are disadvantaged, so they may not have a choice, but work multiple jobs at a time, which of course means clocking more and more hours.

Eva Higginbotham - What can we do to try and stem this problem?

Frank Pega - We recommend four arms of action. First, laws and policies to be put in place by governments, but also employers and workers to limit numbers of hours of work per week to healthy limits. The second area of intervention would be to make sure that working time arrangements are more balanced. For example, workers can be offered working time or can be working on flexi time. The third intervention, and this is very important for workers in the informal economy, so those without formal employment contract, they are not covered by the protections of social security and employment that are normally offered to work as in the formal economy. So here we need to, countries are encouraged to offer social protection floors. These are antipoverty programs which enable these workers to not have to work long hours and multiple jobs in order to survive. Fourth, and finally, we recommend that all workers have access to occupational health services where occupational health physicians can make sure that the numbers of hours worked stay below the unhealthy limits.