職場壓力成爲美國人死亡的第六大殺手

Is your employer killing you?

職場壓力成爲美國人死亡的第六大殺手

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.

麥當勞近期決定將餐廳員工的平均時薪提高至9.90美元，併爲工作時間滿一年的員工提供帶薪假期。該項決定對趨緊的勞動力市場，以及爲低收入人羣提供基本生活工資運動的影響，引起了媒體的關注。

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.

但工資水平和其他工作條件，如假期和帶薪病假等，影響的不僅是生活水平。人們在工作上投入了大量時間，工作場所中發生的事情會對人們的身心健康造成巨大影響，這一點並不意外。如果你認爲你的工作正在殺死你，近期的研究證明你的想法可能是對的。

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.

儘管工作時間過長確實會嚴重影響健康，但問題遠不止工作過度或者過勞死那麼簡單。過勞死的案例不勝枚舉。比如，美林集團在倫敦的一名實習生連續工作72小時之後猝然倒地，不治身亡。除此之外，中國勞動局的一份報告引用一份估算稱，每年有100萬中國人過勞死，一項對加州員工的研究顯示，工作時間與自我報告的高血壓存在因果關係。

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.

一位哈佛商學院畢業生告訴我，他在一家高科技公司工作幾周之後便不得不服用抗抑鬱藥。一位在醫療服務機構工作的資深員工表示，她與同事經常通過酒精和藥物來應對職場壓力。一位電視新聞行業從業者稱，她在接受了一份需要經常出差、壓力更大的新工作之後，體重暴增60磅。因此，筆者決定弄清楚，是否有系統性的證據能夠證明，工作環境確實會對人體健康造成危害。

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.

哈佛商學院教授喬爾·高，以及筆者在斯坦福大學的同事斯坦福諾斯·善尼歐斯和筆者進行了一次薈萃分析，研究10種工作場所狀況對四種健康結果的影響：死亡、醫生確診的糖尿病和心血管疾病等病症、其他疾病，以及自我報告的身體與精神健康問題。所謂薈萃分析是指一種在分析時綜合多項研究結果的統計過程。此次薈萃分析共總結了超過200項研究的結果。研究發現，自我報告的身體健康問題往往預示着隨後將出現死亡和患病。

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種工作場所狀況包括一些影響員工壓力水平的情況，如工作-家庭衝突、經濟不安全感（擔心工作和收入）、輪班工作制、長工作時間、組織不夠公正、對工作缺乏控制和高工作要求等。還有一個因素，即僱主是否提供醫療保險--尤其是在《平價醫療法案》通過之前，這一點會影響員工能否享受醫療保健服務。

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.

毫無意外，大量流行病學證據顯示，壓力不僅對健康有直接影響，也會影響個人行爲，如吸菸、暴飲暴食、濫用藥物和飲酒等，這些行爲反過來又會影響個人健康，甚至導致死亡。

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.

我們總結現有研究後發現，工作不安全感使勞動者報告身體健康不佳的可能性提高了約50%，高工作要求使患有醫師診斷疾病的機率提高了35%，長工作時間使死亡的可能性提高了20%。爲了更形象地理解這些結論以及論文中報告的其他結果，我們將有害的工作場所與二手菸對健康的影響進行了對比。二手菸是一種已知致癌物，也是引發心血管疾病的風險因素。在幾乎所有案例當中，暴露於有害工作環境與二手菸對健康和死亡的影響不相上下。

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.

我們利用這些結果，並結合具有全國代表性的調查數據，創建了一個模型，用於估算各種有害工作場所造成的死亡人數總和。結果顯示，有害工作環境每年導致的死亡人數約爲12萬人。將這一數字與疾病控制中心報告的主要死因進行對比後，我們發現有害工作場所是美國第六大死亡原因，僅次於意外事故與中風，超過了腎病、自殺、糖尿病和阿茲海默症。

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.

這些估算結果以及證明工作場所壓力與健康問題之間存在聯繫的大量流行病學研究，具有三方面的顯著意義。首先是對僱主。許多公司啓動了健康項目，以改善員工身體健康。自我保險的工作場所認識到，他們需要承擔疾病費用，所有僱主都在努力減少因員工病假或"出勤主義"而造成的生產力損失。所謂出勤主義是指員工雖然在工作，但感覺並不舒服，無法做到最好。這些項目的效果參差不齊。但如果僱主能夠更直接地干預，糾正嚴重影響員工健康的工作場所狀況，他們便可以減少健康成本，提高生產率和績效。

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護生命，提高公衆健康水平，同時減少美國高居不下的醫療成本，政府或許應該加大對工作場所的關注。

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，如果員工關心自己的壽命和身心健康，他們需要關注工作環境，以及工作場所產生的壓力。就像員工關心工作中的人身安全和接觸有毒化學品一樣，他們在選擇僱主時同樣要保持警惕，必須評估工作場所的心理環境，以及他們是否會承受過大的工作壓力。

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.

與環境污染類似，有害工作場所不僅會影響個人，也會對公司造成不良影響。這意味着，減少有害工作場所造成的死亡，符合所有人的利益。