I remember having one particular conversation with my grandparents about ten years ago. They were complaining that I had rarely traveled home to see them during the previous year. I told them about my new job at a large firm in New York and how it generally required seven days a week of work every week. The position initially demanded a few years of grueling work, then it would get better, I explained. Executives in the industry had followed this formula for generations. It was the period of Internet madness, however, and many of my peers were jumping ship to join start-up technology companies with the hopes of quick riches and office perks that included on-site massages and ping-pong tables (if still the long hours).

I then mentioned that my firm had established a committee to figure out how to stop the exodus of young employees, and perks like guaranteed vacation time and remote Internet access from home were offered as solutions to reduce the inevitable stress that came with the demanding hours. My retired grandparents, who lived through the Great Depression and World War II, started chuckling, almost in disbelief. The two of them, who had worked in factories during their careers, couldn't believe the "bosses" in our "shop" would tolerate such requests from workers. And job stress? Give them a break! You just dealt with it back then without complaining. (They sounded just like a passage out of Tom Brokaw's best-selling book, The Greatest Generation, about the modest but extremely productive work ethic of their generation.)

They subsequently proceeded to tell me how many times my grandfather had passed out at work after being on his feet for 12 hours straight in his shop that topped 100 degrees in the summer. He also had a heart attack in his mid-50's after a particularly anxious period at work. My grandmother just needed a few drinks at night every once and awhile to deal with the fact that she was treated like a child at work, having to ask to go to the restroom.

Work Stress - Not New

Work-related stress, discussed much more frequently in recent years, has probably been around since organized work itself. It couldn't have been easy for those eight years olds working in dangerous mills and factories for 16 hours a day in the 19^th century, practices that eventually led to the Fair Labor Standards Act of 1938, banning "oppressive child labor." And the psychological trauma caused during centuries of the brutal, cruel and humiliating systems of indentured servitude and slavery around the world are unimaginable.

A Perfect Storm A Comin'?

In the West, it appears we are now heading toward a virtual perfect storm of the impact work-related stress will have on our society. Factors that are colliding include elevated work-stress levels, scientific proof of their negative impact on long-term health, an understanding of stress' impact on business costs, and the inevitable future burden on an already strained healthcare system that doesn't even cover about 16% of the population in the US (many of whom are working in stressful professional and personal environments) and is becoming more unstable as fewer employers offer health benefits.(1)

As I researched this article, even I was stunned by the statistics provided by objective, research-oriented organizations, like the National Institute for Occupational Safety and Health (NIOSH), various medical journals, and industry organizations that have a real incentive to understand the impact that stress is having on their bottom lines. I use the term "even I" because I've worked in the stress management, mind-body health and wellness education sectors for years now and was not aware of the magnitude of the problem that has been building over the past few decades. I certainly am not the best example of a self-developed solution; I regularly seek out extremely demanding and stressful work opportunities. Before I discuss the issue of job specific stress, I will first offer an overview on chronic stress and its impact on health generally.

Experiences, such as financial insecurity, tight work deadlines, a messy divorce and constant elevated "Threat Levels" for potential terrorist attacks, create stress and anxiety - and therefore the "stress response." The stress response, a complex process of reactions in the body, is developed in every mammal and prepares it to "fight or flee" during actual situations of danger, such as when one of our ancestors was being chased by a saber toothed tiger. Our brain reacts to these situations by pulling blood to the large muscles of our body so we can react. Heart rate, blood pressure, and breathing speed up. We get a rush of adrenaline. All of these changes enable us to fight better or run faster.

However, we rarely face actual situations like these anymore, but in terms of the stress response, our brain cannot differentiate between being attacked and being late for a crucial meeting that could make or break a career. All of these same functions occur, so we feel "stressed out." People who live with goals that are difficult to reach or are just plain unrealistic will almost inevitably face chronic stress. If people can't obtain the "stuff" they want, they may be constantly anxious.

The biological processes of long-term stress are beyond the scope of this article. However, ongoing stress affects virtually every system in the body, including the endocrine and immune systems. Our bodies try to adapt, but eventually stress will likely have a negative impact on our health. Our immune systems can be compromised. We may experience high blood sugar and increased bad (LDL) cholesterol.

Here is a laundry list - established by medical research - of several health conditions that can worsen (or even appear) under conditions of constant mental stress: asthma, depression, heart disease, compromise of the immune system, high blood pressure, sexual problems, diabetes, obesity, itching, hives, gastrointestinal problems (ulcers, colitis, irritable bowel syndrome), reduced resistance to viruses and bacterial infections, arthritis, and many, many other conditions.

In fact, the well-respected non-profit American Institute of Stress (AIS) notes that between 75 to 90% of visits to primary care physicians are for stress-related complaints. You read that right: up to 90%.

Stress in the Work Environment

Let me start by saying not all stress is bad, of course. Short-term "stress" can provide us with the motivation and ambition to get something done, to achieve "peak performance." Then we return to a relaxed state after completion of the task. But many modern work environments in Western society are almost perfectly designed to promote the long-term chronic stress that creates so many health problems. And stressful professions don't just include stereotypical "Type A" personalities: lawyers working 90 hour weeks to hopefully make partner or entrepreneurs who worry about paying their employees during tough financial times. Professions as diverse as teachers, customer service workers who handle complaints all day, home health workers who barely make a living wage, law enforcement officers, and many others positions often make published lists of the "most stressful jobs." Stress, in fact, can show up in any profession.

One insurance company study concluded that problems at work result in more health complaints than financial or family problems.(2) The American Psychological Association (APA) last year released survey results that one third of Americans are currently living with "extreme stress," and that 74% of those respondents said work was the primary cause. In the same survey, 55% of respondents said stress made them less productive. (3) Over half said they had previously left a job or considered doing so because of stress. Another Gallup Poll study found that 80% of workers feel stress on the job and nearly half said they need help dealing with stress (42% said their co-workers need the same help). (4)

Top executives often must have a difficult time understanding the issue. Throughout their careers, they dealt with the same issues and put in the same hours, so what's up with the complaining? They spent time away from their families and sacrificed their personal lives and even may have failed a few times. I've personally experienced and also heard from a bunch of colleagues, particularly at large law, financial and consulting firms, that the top executives with their names on the corner offices, feel like they "made the same sacrifices to succeed," and the younger professionals should suck it up, too - the financial rewards are the pot at the end of the rainbow. Perhaps also they are more stress resilient and actually enjoyed the pressure of deadlines and workloads throughout their careers or even thrived on them.

But what they now should begin to realize (besides the fact that their own health may have suffered and their kids resent them for not being around when they were growing up) is that the prevalent stress, whether they understand it or not, can seriously affect their business' bottom lines.

Why Are So Many Workers Stressed?

As discussed, job stress has likely been around for centuries at this point, and publications and organizations have made pronouncements claiming job stress as an epidemic of recent decades and even the century. A Time magazine cover story called stress "the Epidemic of the Eighties." A 1992 United Nations report called job stress "the 20^th Century Epidemic." A 1996 World Health Organization (WHO) report stated that job stress is a worldwide epidemic. The European Commission found that more than half of workers in the European Union complained of having to work at a very high speed under tight deadlines, and many complained of monotonous or short, repetitive tasks with no opportunity for rotation. (5)

Research now provides insight into why workers become or are so stressed, though there is disagreement in the field, according to the NIOSH. (6) One school of thought is focused on the worker's personality and coping style. In short, a situation that is stressful for one person is exhilarating (or at least not a problem) for another. The other school of thought is that certain working conditions are stressful to most people. These conditions include excessive workload demands, conflicting expectations, little sense of control, routine tasks without change, wearing "too many hats," job insecurity and unpleasant or dangerous conditions. Newer technologies, like cell phones, PDAs and laptops additionally never let us completely leave work.

I certainly can relate to both theories: I can think of nothing I'd rather do professionally than work with a great team non-stop for 12 hours researching, creating and writing up a new business strategy for an innovative company. I get in a groove and don't even notice the time. This type of project would likely make someone else go mad. However, when I see a group of workers in West Virginia descend a thousand feet down a coal mine while I'm watching the news, I can feel the claustrophobia in my gut. I would be a wreck everyday of my life.

Strategies that address both individual skills to deal with stress and organizational efforts that consider work environment changes to reduce stressful conditions seem to be the most successful method to reduce the burdens of stress on employees and employers alike. And it's potentially never been so important for employers to address the issue of work stress as now.

The impact of job-related stress on employers is absolutely enormous. The APA says that 60 percent of work absences are psychologically-related, resulting in a cost of $57 billion annually. Health costs for workers who report high levels of stress (seemingly half the workforce these days) are almost 50% higher.(7) Estimates of the cost of job stress to employers, due to accidents, absenteeism, employee turnover, diminished productivity, medical, insurance and legal costs, and workers' compensation expenses vary between $200 and $300 billion. In the UK, job stress costs the economy £13.5 billion each year through increased illness and lost productivity. (8) Because the costs of insurance premiums often increase by double digits every year, many businesses are cutting back on employer-funded insurance plans or shifting to contract employees, putting both employees and the health system at greater risk.

(The most comprehensive source for statistics regarding the costs of job-related stress can be found on AIS' website, listed in the Notes below.)

Is There a Possible Framework That Can Solve the Problem?

According to the NIOSH, a comprehensive approach that both includes programs for employees and focuses on organizational change are the most promising. (9) Many large companies are providing employee assistance programs (EAPs), which assist employees with counseling for personal and professional issues. Stress management and wellness programs, which teach relaxation techniques and time management skills, are examples.

But most experts believe that organizations must change the work settings for lasting stress reduction and include the buy-in of the top brass. The NIOSH, recommends building awareness of the issue, involving top management, incorporating employee input and involvement in all phases of the program. HelpGuide, a prominent health website, also recommends improving communication, offering rewards and incentives and cultivating a friendly social climate. (9) Finally, the program should be evaluated and updated as needed.

Conclusion

For decades now, we've been publishing information on the epidemic of work-related stress and its impact on employee health and employer costs. Now we have an understanding of the medical impacts of stress and health benefits of relaxation exercises. We also see models of healthy work environments that have reduced stress and employee illness. It's time for employers to incorporate such programs into the core of their human resources strategies - not just for altruism, but to improve the health of both their employees and their bottom lines.

1. National Coalition on Healthcare webpage <nchc.org/facts/coverage.shtml>
2. St. Paul Fire and Marine Insurance Company. 1992. American Workers Under Pressure Technical Report.
3. American Psychological Association (APA) webpage <apahelpcenter.org/articles/article.php?id=104>
4. Source: Gallop Poll, as cited in DHHS (NIOSH) Publication No. 99-101.
5. Various statistics from the American Institute for Stress (AIS) website. <stress.org/>
6. DHHS (NIOSH) Publication No. 99-101. <www.cdc.gov/niosh>
7. Goetzel, RZ, Anderson, DR, Whitmer, RW, Ozminkowski, RJ, Dunn, RL, Wasserman J [1998]. The relationship between modifiable health risks and health care expenditure: An analysis of the multi-employer HERO health risk and cost database. J Occup Environ Med, 40:843-854.
8. Statistics on GoalCoach website <www.goalcoach.net>
9. HelpGuide website <http://www.helpguide.org/>
10. DHHS (NIOSH).