Karoshi: Is Working Long Hours Worth the Health Risks?
In 1969, a 29-year-old man working in the shipping department of Japan’s largest newspaper died suddenly of a stroke. While at first his case was called occupational sudden death, it was later determined that his stroke was caused by shift work and an increased workload. His was the first documented case of what became known in Japan as karoshi—literally translated, “death from overwork.”
More cases of karoshi were reported during the 1970s. Due to pressure from wives and colleagues of karoshi victims, doctors began to investigate how these deaths were related to work. Most of the victims were shift workers, drivers, newspaper and television workers, construction workers, and salesmen who worked long hours (on average 60 hours per week), night shifts, and irregular schedules.
As public concern increased, Japan’s Ministry of Labor began publishing statistics on karoshi in 1987. Compensation for karoshi deaths peaked in 2002 and has leveled out since then. But compensated cases only tell a small piece of the story—death by overwork can be a difficult thing to prove, so many cases are uncompensated.
Karoshi victims are most often otherwise healthy men with no evidence of disease. They might feel symptoms including headache, dizziness, nausea, and stomachache during the 24 hours leading up to their stroke or heart attack. Karoshi is known as a silent killer; an array of stress-induced physiological changes develop over time, quietly doing damage under the surface, and then suddenly cause a fatal cerebrovascular or cardiovascular event.
While the rate of karoshi due to heart attack and stroke may be leveling off in Japan, the rate of karoshi due to mental disorders continues to climb. Overwork doesn’t just mean physical burnout, strain, and fatigue; it often includes psychological stressors like unrealistic expectations and challenging working relationships with bosses and co-workers. And it can happen at any age. More than half of Japanese workers receiving compensation for mental disorders are in their 30s or younger, and 47% of compensated mental disorders were related to factors other than long working hours.
In 2019, 1949 people in Japan committed suicide due to problems at work. Suicide related to overwork is so common that they have a name for it too: karojisatsu.
Japanese culture has long romanticized overwork and held those with a strong work ethic in high esteem. In many companies, there is a great deal of peer pressure to conform to these ideals. People work long days and take only about half of their paid vacation time because their bosses and co-workers are doing the same. And in general, Japanese companies do not offer paid sick leave—workers must use vacation time if they get sick.
Things are slowly changing, due in part to pressure from the younger generation of workers ages 18-34, who feel vacation-deprived and report increasing rates of mental disorders due to overwork. In 2014, the Japanese government passed the “Act on Promotion of Preventive Measures against Karoshi and Other Overwork-Related Health Disorders,” a nationwide initiative toward the prevention of overwork-related disorders and death. The government has set a goal of increasing the rate of taken annual paid leave to 70% in 2020.
Meanwhile, there is a grassroots movement encouraging workers to take their paid vacation time.
In November 2019 in Osaka, a Buddhist priest led a large ceremony called Yukyu Joka, or “paid holiday purification.” Three hundred lanterns printed with messages of regret about unused paid holidays represented the spirit of missed time off. The messages included a mother who had to postpone her daughter’s nursery school birthday for seven months, a man who missed the birth of his first child, the end of a friendship, and missed funerals—all because work was more important.