Karoshi – death by overworking


Who said hard work never hurt anybody?

The Japanese courts have ruled you can die from overwork.

By Esther Addley and Laura Barton:

Talk about a bad day at work. Nobuo Miuro was simply getting on with his job, when he keeled over and died. It had been a busy few weeks for the interiors fitter from Tokyo; he was struggling to get anew restaurant ready for its launch and had been putting in a fair bit of overtime.

The day before he collapsed he had worked from 11am until 4.30am the next morning, but had managed to snatch a few hours’ sleep before starting again. But when Miuro, 47, tried to pick up his hammer and nails again, he suddenly took ill. He died a week later. Last week a coroner returned a verdict of “karoshi”: death by overwork.

In Japan at least, it seems, the old adage that no-one ever died from working too hard has been proved comprehensively false. We know that the Japanese often show an unenviable dedication to the office – a typical office worker can leave home at 7am and return after 11pm, spending two hours commuting. But there is something rather more unsettling in the blithe recognition that working too hard – and nothing more – can be enough to kill you.

Karoshi is not a new concept in Japan, though assessments of quite how many salarymen keel over having shot a horrified glance at their diaries vary between trickle and a torrent. In 1996 the Nagoya high court upheld a ruling that Yoshikazu Abo, a salesman for an electrical company in central Japan, had died from overwork 13 years earlier. In the 17 days before his death, Abo had been sent by his company on 20 sales missions around Japan; the last, to South Korea, was ruled to have killed him.

Hundreds of civil lawsuits are now being filed every year by the relatives of those believed or found by the coroner to have died from karoshi, seeking compensation for the deaths of their loved ones. But Japanese companies have until now managed to escape criminal charges. The expected prosecution of Junichi Ochiai, the president of the interiors fitting firm, over Miura’s death will, if successful, be the first case of a company being held criminally responsible for the death of an employee. With some estimates for karoshi deaths running at 10,000 deaths a year, however, it is possible that a ruling could have a significant impact on Japan’s notoriously draconian work ethic.

So much for Japanese employers, but what about those of us for whom Miura’s 17-hour shift is a daunting, but not entirely unfamiliar, prospect? The British Medical Association estimates that junior doctors frequently work more than 100 hours a week – equivalent to 16 hours 40 minutes a day for six days out of seven. That’s alarming enough for anyone about to go into hospital, without now expecting the chap in the white coat to drop dead as soon as he starts to yawn. So just how many hours’ sleep do you have to miss before you risk dying?

The good news is that the bleary-eyed have no cause to fear their impending demise, according to professor Jim Horner, director of Loughborough University’s sleep research laboratory.

“Lack of sleep kills quite a few people at work because they fall asleep at the wheel and crash their lorry,” he says, “but apart from that there is no evidence that someone can just spontaneously die from lack of sleep. In humans the effect of sleep loss is pretty uneventful.

“The studies that have been done show that where people have been deprived of sleep they get more and more sleepy, but from the neck down there is no evidence of anything going wrong, even in the immune system. There is no effect on any organ other than the brain.”

The important factor, he notes, is whether the lack of sleep is caused or accompanied by a situation of high stress, the more likely reason for sudden, unexplained death being heart failure.

However, according to Belinda Linden, a cardiac nurse at the British Heart Foundation, “There is very little evidence associating stress with coronary heart disease”.

The illnesses that doctors can confidently relate to anxiety, such as gastric problems or eczema, are rarely life threatening. And while the factors we know cause heart attacks – smoking, obesity, inactivity – are often found among those who spend long hours at their desks, they are certainly not unique to them.

Linden has never heard of someone spontaneously dropping dead because of stress. “Much more likely is a cumulative effect, or other lifestyle issues, or an underlying disorder. In that case, working sustained long hours might just tip the balance.”

Which is comforting – up to a point. Because we British know ourselves to be the hardest workers in Europe, and while we may pity a Japanese workforce that allows itself to stay in the office until it expires, the facts show that we are not so very far behind them. The average Japanese employee works 2,000 hours per year, which sounds a lot until you realise that it works out at roughly an hour a week longer than we do in the UK.

Worry not, says Roger Mead, a stress management consultant who advises individuals on dealing with work-related anxiety and companies on the legal ramifications if they are not looking after their employees’ emotional welfare.

He acknowledges that the implications of a Japanese-style rash of karoshi cases in this country would be “enormous”, but is confident that it is unlikely to happen.

Work-related anxiety, he says, “depends on the way we look at things rather than the things themselves. The crucial difference is that in this country we don’t have anything like the same working culture that there is in Japan. Obviously you can’t work forever, but if you get into a situation where you feel you can’t cope, I believe in this country we do not have the general expectation that you will carry on working regardless.”

Nonetheless, says Linden, it is important to carry out a careful assessment of whether your working environment, hours or, perhaps most crucially, attitude, is affecting you health. Recent studies have found that there appears to be an association between a feeling of powerlessness at work and an increased
risk of heart disease.

While some of this may be explained by lifestyle factors; unhealthy coping mechanisms and likelihood that workers isolated from decision-making are likely to be poorer. Early results have shown that a feeling of powerlessness or stress in itself may irritate the coronary arteries, encouraging the development of the fatty deposits that lead to heart attacks. It is possible that Japan’s less questioning work ethic may in itself explain its high incidence of karoshi.

Similarly, there is some evidence that frequent, temporary instances of high blood pressure, due to occasional stressful episodes, can encourage the blood pressure to rise permanently, which is known to contribute to heart attacks.

If the case of Nobuo Miura prompts a change in Japan’s working culture, he will have died for more than the interior of a new Tokyo eatery. And even while the country attempts to side-step economic crisis, there are signs that the tide may be turning. Some Japanese companies are introducing “no overtime” days, meaning that for one day a week you get to actually go home when you have done your contracted hours. Whether employees take any notice or not, it’s a start. And it might even save a life or two.

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