Long Working Hours Can Lead to Premature Death from Cardiovascular Disease on a Global Scale

Last week, the first ever global analysis of fatal health consequences associated with long working hours (at least 55-hours-per-week) was published in the Environment International journal.[i]

Estimates were supplied by the World Health Organisation (WHO) and the International Labour Organisation (ILO), having obtained data on human health from 59 studies and data on working conditions from 2,300 surveys.

In 2016, 488 million people across the globe (8.9% of the population) worked ‘long hours’ and this figure is predicted to grow over time. What the analysis shows is that, of those 488 million people, 398,441 deaths from stroke and 346,753 deaths from ischemic heart disease were attributable to working ‘long hours’.

Combined, these 745,194 deaths equate to a 29% increase in mortality since 2000, which has been disproportionately elevated by working hours-induced heart disease (42% rise), compared to working hours-induced stroke (19% rise).

The employment-related disease burden is also far more significant among men (72% of deaths), people living in the Western Pacific and South-East Asian regions (71% of deaths) and middle-aged or older workers.

Taking all of this into consideration, it is no great surprise that mortality most typically impacted those aged 60 to 79, who had worked in excess of 55-hours-per-week for 30-years (starting aged 45 and ending aged 74).

There is now ‘sufficient evidence’ (not yet a causal connection[ii]), owing to the WHO/ILO study, that long working hours pose a ‘serious health hazard’ that should be taken ‘very seriously’,[iii] with approximations of excess morbidity (compared to working a standard 35 to 40-hour week) being 35% greater for stroke and 17% greater for ischemic heart disease.

Negative health outcomes may stem from the fact that those who work more hours experience higher levels of stress (leading to physiological responses) and are more prone to espousing damaging behaviours, such as tobacco and alcohol abuse, lack of sleep and exercise, and poor dietary choices[iv] – this echoes the academic consensus.[v]

Whatever the reason, working hours are currently responsible for around one-third (the largest contribution) of the total occupational disease burden, which ‘shifts thinking towards a relatively new and more psychosocial occupational risk factor to human health’.

Director of the Department of Environment, Climate Change and Health at the WHO, Dr. Maria Neira, believes that it is now time for ‘governments, employers, and employees wake up to the fact that long working hours can lead to premature death’.

The study authors have proposed the following interventions to protect workers’ health:

  • ‘Governments can introduce, implement and enforce laws, regulations and policies that ban mandatory overtime and ensure maximum limits on working time;
  • Bipartite or collective bargaining agreements between employers and workers’ associations can arrange working time to be more flexible, while at the same time agreeing on a maximum number of working hours;
  • Employees could share working hours to ensure that numbers of hours worked do not climb above 55 or more per week’.

As a geographical region, Europe has the lowest regional prevalence of ‘long hours’ worked, at just 3.5% of its population.

This is not to say, however, that working hours are only a problem for the rest of the world. In fact, 8% of all occupational fatalities in the WHO/ILO study represented European workers and this was a higher proportion than in the Americas or in Africa.[vi]

To shrink the European attributable occupational disease burden, it is presumed that governing bodies will have to better monitor the general upsurge of flexible, temporary and freelance working arrangements, which has been further exacerbated by the coronavirus (SARS-CoV-2) pandemic.

Such arrangements are ‘significantly changing’ how people work and ‘often blurring the boundaries between home and work’, says WHO Director-General, Dr. Tedros Adhanom Ghebreyesus.[vii]

This would tend to concur with an article in edition 327 of BC Disease News (here), which reported increased levels of screen time among homeworkers.

WHO Technical Officer, Frank Pega, has cited evidence that national lockdowns can increase hours worked by around 10% and, in the UK at least, this assumption appears to be fairly accurate.

Figures posted by the Office for National Statistics (ONS), last month, showed that remote workers are working an average of 6-hours unpaid overtime per-week, versus those who do not work from home (3.6 hours of overtime).[viii]


[i] Pega F et al., Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environ Int. 2021 May 14;106595. <https://www.sciencedirect.com/science/article/pii/S0160412021002208/pdfft?md5=eac98538cb154699045e7c0ea3be9dbd&pid=1-s2.0-S0160412021002208-main.pdf> accessed 20 May 2021.

[ii] David Nield, ‘The Global Death Toll From Working Too Much Has Been Calculated, And It's Awful’ (19 May 2021 Science Alert) <https://www.sciencealert.com/working-long-hours-is-killing-hundreds-of-thousands-of-people-who-study-finds> accessed 20 May 2021.

[iii] ‘Long working hours can increase deaths from heart disease and stroke, say ILO and WHO’ (17 May 2021 ILO) <https://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_792131/lang--en/index.htm> accessed 20 May 2021.

[iv] ‘Long working hours killing 745,000 people a year, study finds’ (18 May 2021 BBC) <https://www.bbc.co.uk/news/business-57139434> accessed 20 May 2021.

[v] ‘Only the overworked die young’ (14 December 2015 Harvard Health) <https://www.health.harvard.edu/blog/only-the-overworked-die-young-201512148815> accessed 20 May 2021.

[vi] ‘Working To Death’ (20 May 2021 Electronics Weekly) <https://www.electronicsweekly.com/blogs/mannerisms/politicians/working-to-death-2021-05/> accessed 20 May 2021.

[vii] ‘Long working hours increasing deaths from heart disease and stroke: WHO, ILO’ (17 May 2021 WHO)  <https://www.who.int/news/item/17-05-2021-long-working-hours-increasing-deaths-from-heart-disease-and-stroke-who-ilo> accessed 20 May 2021.

[viii] Josh Martin, ‘Homeworking hours, rewards and opportunities in the UK: 2011 to 2020’ (19 April 2021 ONS)  <https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/homeworkinghoursrewardsandopportunitiesintheuk2011to2020/2021-04-19> accessed 20 May 2021.