Why business is bad for your health

Warning. Expansion may be hazardous to your health. For once, we’re not referring to waistlines, that most visible symbol of the much-discussed epidemic of obesity. Expansion in this context refers to a study in this week’s issue, in which Hugo Westerlund and colleagues report the deleterious effects on workers’ health observed in conjunction with the growth of companies, especially from rapid expansion of more than 18% personnel (p 1193).

At first glance, the whole notion seems curious. The adverse effects of downsizing—reductions in personnel—in the workplace not only seem intuitive but also are well documented. A recent study showed that workers who kept their jobs during major downsizing were twice as likely to die from cardiovascular disease, perhaps triggered by work stress. But why might it be the case that increasing the number of employees results in absence from work owing to long-term sickness and hospitalisation?

Perhaps the terminology that characterises 21st-century work can provide some clues. Accord- ing to Richard Sennett, author of a tellingly titled book, The corrosion of character: the personal consequences of work in the new capitalism (New York: Norton, 1998), today’s employees are expected to be flexible, open to change, take risks, do more with less, tolerate ambiguity, view instability as normal, and accept that a long-term relationship with an employer can no longer be expected, nor that they will benefit from long-term social networks established through shared experience in the same workplace. A young American worker with 2 years of college education, for example, can expect to change jobs at least 11 times during his or her working life, a period of time that is also being compressed because of prejudice against older workers. And job security? A concept that belongs to a former era.

This re-engineering of corporations may sound progressive, especially to shareholders, but the apparent price workers pay is an undercurrent of anxiety and diminished loyalty and commitment, their morale eroded by a chaotic and often dysfunctional work environment in which individuals are devalued or discounted altogether. Modern businesses seem to be continually downsizing, merging, acquiring, and outsourcing. But, through all this lurching from pillar to post, what happens to the workers who actually produce, manufacture, and serve, and whose knowledge and experience provide the intellectual capital that underpins these workplaces? Surely there are many employers of high integrity, who under- stand that people are their greatest asset, and treat them accordingly.

Unfortunately, many people are all too familiar with rather darker stories of contemporary employment: of change for the sake of change, of enormous corporations becoming even larger through fear of competition, of constant restructuring, of abrupt and nakedly cruel terminations, of capricious demands that change the entire character of one’s work, and of family and socially unfriendly policies and attitudes. Even where the letter of employment law is obeyed, there may be subtle or overt pressures to circumvent anything the employer perceives as detrimental to the organisation, perhaps most especially to its finances. An April 4 New York Times article documented the apparently widespread practice of US managers altering workers’ time records, shaving off hours legitimately worked, in order to increase their companies’ bottom line—often after being threatened with being fired themselves if they refuse to perform this illegal activity. Why do they do it? Two explanations cited: «no job security at all», and extraordinary pressures «to control costs and improve productivity».

Such work conditions must exact a physical and mental toll on employees. So while the findings of Westerlund and colleagues might seem initially unexpected, a look at current employment practices leaves little doubt that workplace expansion could certainly cause stress and ultimately illness and hospital stays.

What’s the solution? Value people over profits? Recognise human capital as paramount? These answers are obvious. But given the high-handed, soulless treatment doled out today by many employers, it’s a start. If appeals to integrity and character fail, there’s always the bottom line: depressed and anxious personnel are unlikely to be productive, and absence from work costs employers and society money. The re-engineering of work ought to perpetuate fulfilment and productivity in employees, not illness and disability.

The Lancet, volume 363, number 9416 10 April 2004.