Dying for a Paycheck

Key Concepts

Management decisions have a big impact on human sustainability

“Some of the most problematic, stress-causing aspects of work environments include low wages, shift work, and the absence of job control. For example, low wages produce stress from having to survive with little income, and inadequate income impairs access to health-care services. Not surprisingly, a number of research studies find that low wages predict obesity, anxiety and depression, low birth weights, and hypertension.” (p. 10)

“My fundamental message is simple: employers have a choice. They can implement practices that enhance human well-being—physical and mental health—thereby reducing their own costs from employee medical expenses, absenteeism, workers’ compensation insurance costs, and the productivity loss from having employees who are physically at work but not “really there” (a problem called presentism in the research literature). Such employer actions will also reduce the costs to society from people’s poor physical and mental health and the harm done to individuals. Simply put, employers can make decisions to improve people’s lives in fundamentally important ways. Or, alternatively, employers can, either intentionally or through ignorance and neglect, create workplaces that literally sicken and kill people.” (p. 35)

Many companies have measures of environmental impact and workplace safety, but not the underlying health impact on employees

“Want more evidence of this neglect of people in the sustainability reporting movement? If you go to the website where automobile manufacturer General Motors presents its sustainability bona fides, you can learn that GM is number one in clean energy patents, is among the top five in the world in the number of solar arrays hosted, has eleven landfill-free sites, and operates in twenty-six sites certified by the Wildlife Habitat Council. What you won’t learn is the number of jobs the company has cut over the past decade, what GM has done to reduce wages and benefits for new and experienced employees, and how the company manages its office and plant work environments in ways that affect people’s well-being. Nor does General Motors in its sustainability reporting present data on the aggregate physical and mental health of its current or former employees.” (p. 21)

“Monitoring the most basic aspects of physical safety such as workplace accidents and deaths has, over time, driven down workplace fatalities and injuries substantially, and some aspects of chemical exposure have been regulated. But otherwise employers in the United States and elsewhere are mostly free to impose layoffs, require flexible hours and shift work, and inflict other hardships that have important consequences for human health without considering the effects of these decisions.” (p. 24)

Workplaces may be responsible for 120,000 excess deaths per year

“In total, workplace environments in the United States may be responsible for 120 thousand excess deaths per year—which would make workplaces the fifth leading cause of death—and account for about $180 billion in additional health-care expenditures, approximately 8 percent of the total health-care spending.” (p. 38)

“The absence of health insurance is the employment condition leading to the greatest number of excess deaths, followed by being unemployed and then by job insecurity. Shift work is associated with thirteen thousand excess deaths. An absence of job control and discretion at work is also an important contributor to excess mortality, causing some seventeen thousand excess deaths each year.” (p. 49)

“The workplace, as it is currently being managed by many if not most employers in the United States, exacts a toll for both employees and their employers—a situation that cries out for remediation.” (p. 64)

Generating economic insecurity hurts employees’ health, even though actions like layoffs don’t actually help company performance 

“Economic insecurity is stressful, and stress adversely affects physical and mental health. It should scarcely be surprising that research consistently finds evidence that working in less secure, more contingent employment arrangements is adversely related to physical and mental health—and not just for the people directly facing economic insecurity. In part because of social contagion effects—people working with those facing economic insecurity themselves feel less secure—“the effect of job insecurity on health was the same in the exposed and unexposed groups,” suggesting that job insecurity can lead to adverse health effects for both temporary and permanent employees. These effects occur even in countries with generous social welfare and income maintenance policies.” (p. 70)

“In this instance, however, the problem is even worse. That’s because the evidence on the effects of layoffs on corporate performance is extensive and tells a largely, although not completely consistent, story—there is little evidence that layoffs provide benefits and much evidence that layoffs can harm the companies doing them.” (p. 81)

“Layoffs often do not provide business benefits, because layoffs by themselves seldom if ever solve any underlying business problem, for instance, of quality, productivity, or market acceptance.” (p. 81)

Employers and employees would be better off without long work hours

“Notwithstanding the nil to negative relationship between work hours and performance reviewed below, many companies have cultures that seemingly venerate long hours and forgone vacation. After all, who could be against “hard work”? Most employers seek loyalty and commitment from their employees. They want employees who are willing to devote the extra effort required to triumph against the competition. It is, of course, difficult to directly observe someone’s loyalty and commitment. It is much easier to assess indirect indicators of employee dedication, and the hours someone puts in on the job is one such indicator, and so is whether employees use all their allotted vacation and paid time off or give their lives to the workplace.” (p. 129)

“When people are in a situation in which they have more to do than they have time to do it, that is called role overload. When people have demands for behavior emanating from one role, such as that of employee, that are incompatible with the demands of another role, such as family member, that is called role conflict. Long-standing research literature on role conflict and overload consistently finds that people who confront conflicting expectations for behavior or more demands than they can handle are more stressed.57 Thus, not surprisingly, role conflict and role overload are associated with poor outcomes ranging from increased turnover to lower job performance.” (p. 139)

Job control is a critical element of a healthy workplace

“What matters—for employee engagement and productivity and, more important, for employee physical and mental health—is the work environment and the work itself. Not having a boss who heaps scorn and abuse, because the health hazards of workplace bullying and incivility have been well documented. Having a private office or at least a workplace with comfortable temperature, good lighting, and acoustical privacy, so that the physical work environment does not impose stress. And, most important and the focus of this chapter, two crucial elements of a healthy workplace that any company, in any industry, can provide without breaking the bank—and therefore ought to offer to enhance employee well-being: job control and autonomy and social support.” (p. 146)

“When leaders act capriciously, people do not know what to expect or what to do. The results are both psychologically and physically devastating. The learned helplessness literature makes the case that although there are many events that we cannot control, “such uncontrollable events can significantly debilitate organisms; they produce passivity in the face of trauma, inability to learn that responding is effective, and emotional stress.” Little wonder that job control predicts morbidity and mortality, with higher levels of job control creating better health and longer life spans.” (p. 151)

“Think about the difficulty of driving a car if randomly from one moment to the next the brake became the accelerator and then the transmission.” (p. 152)

Leaders should create a culture of community

“First, fix the language, so that people are less separated by title, and use language that is consistent with the idea of community. DaVita sometimes refers to itself as a ‘village.’ The company’s CEO often calls himself the ‘mayor’ (as a leader of a village might be called). Employees are constantly referred to as ‘teammates,’ and certainly never as ‘workers,’ a term that denotes both a somewhat lower status and also people who are distinct from the ‘managers’ or ‘leaders.’” (p. 166)

“Second, encourage shared connections through social and other events.” (p. 167)

What keeps people from leaving bad situations: ego, pride, and rationalization

“If you quit, you are, by definition, a “quitter.” Who wants to be known, even to oneself, as a quitter? His GE bosses told him, “If you were a leader, you’d be able to figure out how to get things done and navigate the environment.” The implication: If you were any good, you’d be able to successfully cope with the job demands and achieve success. So what’s wrong with you? And who wants to admit that they aren’t any good?” (p. 177)

“Few people want to admit to themselves or others that they aren’t good at something, particularly if that “something” implicates their self-esteem. And for many people, work is integral to their self-concept and self-image. Particularly for people doing relatively high-prestige work in high-prestige organizations, there is no price too high or circumstance too difficult to face—because the alternative is to admit some weakness or failure. So, toughing it out in impossible circumstances becomes something to be sought, to be able to demonstrate one’s competence, energy, and dedication.” (p. 179)

“Once people have made a decision, particularly if the decision is public—such as choosing a job, which someone’s friends and family know about—and voluntary, in that the individual wasn’t forced to make the choice, that person is psychologically committed to the decision. That means the individual becomes psychologically identified with the choice and its implications and motivated to continue behaving in ways consistent with the committing decision.” (p. 180)

“One way of rationalizing commitment to a bad environment entails telling oneself that as bad as the current circumstances are, they aren’t going to be forever, and there are other reasons to stay. One finance person noted, “They were paying me crazy money and the job was close to home.” A consultant commented that we have it better than our ancestors and not loving one’s job is a “total first world problem.” I heard rationalizations that tried to make sense of being in harmful work environments, scads of them.” (p. 181)

Companies to should start to measure employee health and well-being

“If there is one thing I learned in my research, and I learned a great deal, it is this: there is little to no systematic (or even nonsystematic) attention to measuring employee health and well-being in companies.” (p. 194)

“So let’s begin with a single-item measure of self-reported health: “How good is your health in general?” Response scales could be: “Excellent, very good, good, fair, or poor,” or “Very good, good, fair, bad, or very bad.” This single item measure has extremely strong reliability and predictive value.” (p. 195)

Quotables

“I can summarize this learning in a few short sentences. The workplace profoundly affects human health and mortality, and too many workplaces are harmful to people’s health—people are literally dying for a paycheck. Most important, the situation is worse than I had imagined, affecting people in numerous occupations, industries, and geographies, and cutting across people of various ages and levels of education.” (p. 8)

“It is possible to do well and to do good at the same time. But the data on work stress, employee health, and employee engagement suggest that many more company leaders need to get—and heed—the message.” (p. 19)

“It is important to understand that long work hours and not taking sick or vacation days are not some inevitable result of contemporary economic realities such as global competition and technological change. We know that because firms vary dramatically in their work-hour policies, even companies operating in the same country and in the identical industry. Work time is the result of managerial decisions and discretion.” (p. 125)

“Lots of people engage in various forms of magical or wishful thinking about how they will mystically avoid the health consequences of toiling in toxic work environments. Unfortunately, things seldom work out well, rationalizations and wishes notwithstanding.” (p. 145)

“One answer as to why people stay on in harmful work environments is obviously sheer economic necessity. Unless people have inherited wealth, they need gainful employment to earn the wherewithal to pay their bills.” (p. 171)

“Second, we need to call out “social polluters” for their toxic practices and workplaces, in the same way we highlight companies that harm the environment. What’s more, we need to start celebrating those workplaces that encourage employees to thrive. We can use public admonition and social pressure to produce healthier workplaces.” (p. 193)

“So if doing things that produce healthier work environments pay off for both employees and employers, why don’t more companies do it? Suffice it to say that, for one thing, companies do not invariably implement their knowledge, something my colleague Bob Sutton and I have called the knowing-doing gap. Second, the pull of conventional wisdom is strong, and few companies want to risk being different. Years ago, I commented on the paradox of wanting to earn exceptional returns but to do so by doing what everyone else was doing—something not likely to happen.” (p. 206)

“Third, there is a time discontinuity. In order to earn a return on investment, it is necessary, by definition, to first make the investment. You cannot earn a return without first doing something. The delay between changing management practices to increase health and well-being and seeing a return is not likely to be that long. But in today’s world, anything more than a quarter or two for a publicly traded company may be unacceptable, and the uncertainty of the payoff and timing leaves many leaders pursuing seemingly less risky strategies such as acquisitions—even though these seldom pay off—or relentless cost cutting.” (p. 207)