Is your employer killing you?

职场压力成为美国人死亡的第六大杀手

McDonald's recent decision to raise the pay for workers at company-owned restaurants to an average of $9.90 an hour and provide employees, once they have worked a year, some paid time off made news for what that action says about the tightening labor market and the campaign to get low-paid people a living wage.

麦当劳近期决定将餐厅员工的平均时薪提高至9.90美元，并为工作时间满一年的员工提供带薪假期。该项决定对趋紧的劳动力市场，以及为低收入人群提供基本生活工资运动的影响，引起了媒体的关注。

But pay levels and other working conditions such as vacation and paid sick days affect more than just standards of living. People spend a lot of their time at work and, unsurprisingly, what happens in the workplace profoundly influences people's mental and physical health. So if you think your job may be killing you, recent research suggests you just might be right.

但工资水平和其他工作条件，如假期和带薪病假等，影响的不仅是生活水平。人们在工作上投入了大量时间，工作场所中发生的事情会对人们的身心健康造成巨大影响，这一点并不意外。如果你认为你的工作正在杀死你，近期的研究证明你的想法可能是对的。

It's not simply overwork, which the Japanese call Karoshi and the Chinese call Guolaosi, that is a problem, although excessive work hours do adversely affect health. Aside from the numerous colorful cases such as the Merrill Lynch intern working in London who collapsed and died after working 72 hours straight, a report from the Chinese Labour Bureau cited an estimate that one million Chinese die from overwork each year, and a study of California employees reported a positive relationship between work hours and self-reported high blood pressure.

尽管工作时间过长确实会严重影响健康，但问题远不止工作过度或者过劳死那么简单。过劳死的案例不胜枚举。比如，美林集团在伦敦的一名实习生连续工作72小时之后猝然倒地，不治身亡。除此之外，中国劳动局的一份报告引用一份估算称，每年有100万中国人过劳死，一项对加州员工的研究显示，工作时间与自我报告的高血压存在因果关系。

After a Harvard Business School graduate told me about going on antidepressants within a few weeks of starting work at a high-tech company, a senior person who worked at an organization providing health care described how she and colleagues coped with workplace stress by becoming addicted to alcohol and drugs. Another individual from television news related that she gained 60 pounds after she took on a new, more stressful job with more travel. So I decided to find out if there was systematic evidence that work environments really can be hazardous to people's health.

一位哈佛商学院毕业生告诉我，他在一家高科技公司工作几周之后便不得不服用抗抑郁药。一位在医疗服务机构工作的资深员工表示，她与同事经常通过酒精和药物来应对职场压力。一位电视新闻行业从业者称，她在接受了一份需要经常出差、压力更大的新工作之后，体重暴增60磅。因此，笔者决定弄清楚，是否有系统性的证据能够证明，工作环境确实会对人体健康造成危害。

Harvard Business School Professor Joel Goh, my Stanford colleague Stefanos Zenios, and I conducted a meta-analysis-a statistical procedure that analytically combines the results of, in this case, more than 200 studies-to explore the effects of 10 workplace conditions on four health outcomes: mortality (death), having a physician-diagnosed medical condition such as diabetes, cardiovascular disease, or other illness, and self-reported physical and mental health problems. Research shows that self-reported physical health predicts subsequent mortality and illness.

哈佛商学院教授乔尔·高，以及笔者在斯坦福大学的同事斯坦福诺斯·善尼欧斯和笔者进行了一次荟萃分析，研究10种工作场所状况对四种健康结果的影响：死亡、医生确诊的糖尿病和心血管疾病等病症、其他疾病，以及自我报告的身体与精神健康问题。所谓荟萃分析是指一种在分析时综合多项研究结果的统计过程。此次荟萃分析共总结了超过200项研究的结果。研究发现，自我报告的身体健康问题往往预示着随后将出现死亡和患病。

The 10 workplace conditions included some that affected people's level of stress, such as work-family conflict, economic insecurity (fearing for one's job and income), shift work, long working hours, low levels of organizational justice (fairness), an absence of control over one's work, and high job demands-and one factor, whether the employer provided health insurance, that, particularly prior to the passage of the affordable care act, affected people's access to health care.

10种工作场所状况包括一些影响员工压力水平的情况，如工作-家庭冲突、经济不安全感（担心工作和收入）、轮班工作制、长工作时间、组织不够公正、对工作缺乏控制和高工作要求等。还有一个因素，即雇主是否提供医疗保险--尤其是在《平价医疗法案》通过之前，这一点会影响员工能否享受医疗保健服务。

Unsurprisingly, extensive epidemiological evidence shows that stress has both a direct effect on health and also affects individual behaviors such as smoking, overeating, drug abuse, and alcohol consumption that in turn affect an individual's health and mortality.

毫无意外，大量流行病学证据显示，压力不仅对健康有直接影响，也会影响个人行为，如吸烟、暴饮暴食、滥用药物和饮酒等，这些行为反过来又会影响个人健康，甚至导致死亡。

Our summary of existing research shows that job insecurity increases the odds of reporting poor physical health by about 50%, high job demands raise the odds of having a physician-diagnosed illness by 35%, and long work hours increases mortality by approximately 20%. To put these and the many other results reported in the paper in some perspective, we compared the health effects of harmful workplace practices to that of second-hand smoke, a known carcinogen and risk factor for cardiovascular disease. In almost all cases, the health effects of the individual workplace exposures were comparable in size to the effects of second-hand smoke on health and mortality.

我们总结现有研究后发现，工作不安全感使劳动者报告身体健康不佳的可能性提高了约50%，高工作要求使患有医师诊断疾病的几率提高了35%，长工作时间使死亡的可能性提高了20%。为了更形象地理解这些结论以及论文中报告的其他结果，我们将有害的工作场所与二手烟对健康的影响进行了对比。二手烟是一种已知致癌物，也是引发心血管疾病的风险因素。在几乎所有案例当中，暴露于有害工作环境与二手烟对健康和死亡的影响不相上下。

We used these results, along with estimates from nationally representative survey data on the prevalence of the various harmful workplace conditions in the working population, to build a model that estimated aggregate mortality from these conditions. The results showed that approximately 120,000 deaths occurred per year from exposure to harmful workplace circumstances. Comparing this number to the leading causes of death as reported by the Centers for Disease Control shows that harmful workplaces, in aggregate, would be the sixth leading cause of death in the U.S., just behind accidents and strokes but greater than kidney disease, suicide, diabetes, and Alzheimer's disease.

我们利用这些结果，并结合具有全国代表性的调查数据，创建了一个模型，用于估算各种有害工作场所造成的死亡人数总和。结果显示，有害工作环境每年导致的死亡人数约为12万人。将这一数字与疾病控制中心报告的主要死因进行对比后，我们发现有害工作场所是美国第六大死亡原因，仅次于意外事故与中风，超过了肾病、自杀、糖尿病和阿兹海默症。

Three obvious implications emerge from these estimates and the enormous amount of epidemiological research showing the connection between workplace stress and health problems. The first concerns employers. Many organizations have instituted wellness programs to improve employee health. Self-insured workplaces recognize that they bear the cost of illness and all employers seek to reduce the productivity losses from time lost to sickness and from employees who are at work but not feeling well enough to do their best, a condition called presenteeism. The evidence on the effectiveness of these programs is mixed. Meanwhile, if employers intervened more directly to remedy workplace conditions that adversely affected health, they would reduce health costs and also increase productivity and performance.

这些估算结果以及证明工作场所压力与健康问题之间存在联系的大量流行病学研究，具有三方面的显著意义。首先是对雇主。许多公司启动了健康项目，以改善员工身体健康。自我保险的工作场所认识到，他们需要承担疾病费用，所有雇主都在努力减少因员工病假或"出勤主义"而造成的生产力损失。所谓出勤主义是指员工虽然在工作，但感觉并不舒服，无法做到最好。这些项目的效果参差不齐。但如果雇主能够更直接地干预，纠正严重影响员工健康的工作场所状况，他们便可以减少健康成本，提高生产率和绩效。

Second, if public policy is truly concerned with preserving life, enhancing people's well-being, and with reducing the U.S.'s very high health costs, the workplace would seem like a good place to focus more attention.

第二，如果公共政策真正想做到保护生命，提高公众健康水平，同时减少美国高居不下的医疗成本，政府或许应该加大对工作场所的关注。

And third, if employees are concerned about their lifespan and physical and psychological wellbeing, they need to pay attention to their work environments and how much exposure they get to workplace-induced stress. Just as employees are rightfully concerned about aspects of physical safety and exposure to toxic chemicals at work, they should be equally vigilant in their choice of employer to assess the psychological environment in their workplace and whether they are excessively exposed to workplace stressors.

第三，如果员工关心自己的寿命和身心健康，他们需要关注工作环境，以及工作场所产生的压力。就像员工关心工作中的人身安全和接触有毒化学品一样，他们在选择雇主时同样要保持警惕，必须评估工作场所的心理环境，以及他们是否会承受过大的工作压力。

Similar to the case of environmental pollution, the costs incurred by toxic workplaces adversely affect both individuals and the companies for which they work. Which means it is in everyone's interest to reduce the toll of harmful workplace practices.

与环境污染类似，有害工作场所不仅会影响个人，也会对公司造成不良影响。这意味着，减少有害工作场所造成的死亡，符合所有人的利益。