Dying for a Paycheck: How Modern Management Harms Employee Health and Company Performance — and What We Can Do About It

Jeffrey Pfeffer

HarperBusiness (2018)

The author of this book teaches management at Stanford and his intended audience is clearly managers. But a copy of this book should be on the desk of every union official and shop steward in North America — open, dog-eared, and highlighted on every page. It should also be on the desk of every doctor, teacher, lawyer and any other professional who’s beginning to feel overworked.

That’s because “dying for a paycheck” is no mere rhetoric. According to Pfeffer, the American workplace is a killing ground where 120,000 workers die prematurely every year — and not because of poor training or accidents. They die because the modern workplace is too toxic for them to survive, and that’s how management designed it.

Canadian workplaces are proportionally worse: Dennis Raphael, a professor of health policy and management at York University, says 40,000 of us die prematurely every year from bad working and living conditions.

Pfeffer bases his arguments on a meta-analysis, a comparison of many research studies, and finds 10 life-threatening hazards built into the workplace:

Being unemployed or laid off. Not having health insurance. Working shifts or long hours. Working more than 40 hours in a week. Confronting job insecurity (such as surviving a layoff only to wonder if you’re next). Facing conflicts between family and work. Having low control over how you do your job. Facing high job demands. Low levels of social support in the workplace. Working where decisions affecting your job seem unfair.

Apart from health insurance, these are all familiar issues to Canadian workers, who have fought some grim battles to resolve them. B.C. teachers could probably tick off quite a few grievances off Pfeffer’s list, especially number 10 — which took a Supreme Court decision to remedy after 15 years of working under unfair conditions.

CEOs as cause of the health-care crisis

“Any workplace practice that increases stress makes human well-being worse and health-care costs higher,” says Pfeffer. He quotes one enlightened CEO who reamed out a thousand of his fellow bosses at a conference: “You are the cause of the health-care crisis because 74 per cent of all illnesses are chronic. The biggest cause of chronic illness is stress, and the biggest cause of stress is work.”

Chronic illness, however, doesn’t get much attention. We prefer to pay attention to rare, acute diseases like Ebola that leave bodies in the street. But chronic illness kills far more.

As Pfeffer shows in his heavily documented book, the toxic workplace is largely responsible for such chronic conditions as alcoholism, substance abuse, obesity, diabetes, depression and PTSD — not to mention suicide and homicide. The disgruntled employee who slaughters his fellow workers is just another news item these days. Workplace stress, by Pfeffer’s estimate, is the fifth leading cause of death in the U.S.

A worldwide problem

The effect of the toxic workplace is obvious in all the “advanced” nations. In Britain, four out of five of workers in the National Health Service have considered quitting their jobs. Pfeffer cites Chinese sources saying that “at least one million people in China currently die from overwork each year” and “as many as 70 per cent of China’s intellectuals [mostly university professors] faced, to a greater or lesser degree, the risk of premature death from exhaustion.” Scientists are beginning to consider depression as an occupational hazard.

Despite the research Pfeffer’s been throwing at them for years, managers persist in their stupid and usually money-losing practices. Layoffs, for example, are usually a self-inflicted wound that companies take years to recover from (CEOs who lay off workers, however, generally get raises from their equally stupid boards). Productivity suffers as the survivors try to deal with heavier workloads while wondering if they’re next. Journalists in devastated newsrooms are a case in point.

‘Wellness’ doesn’t cure the toxic workplace

So it’s baffling that Pfeffer argues for a management-driven solution to this disaster. Lots of companies and public agencies offer “wellness” programs and other ways to de-stress their workers — but even they don’t look at the source of the stress: the workplace itself. Pfeffer has to keep going back to the same handful of enlightened CEOs for examples of workplace detox. Other CEOs must think he sounds like your mother wondering why you can’t be more like your goody-goody sibling.

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Management has created the toxic workplace and has made a culture of it. Like Stalin praising his worker-superheroes, the Stakhanovites, modern managers demand insanely long work weeks and even provide on-site facilities for sleeping and showering to minimize downtime. Wanting to spend more time with your family means you’re not good enough. Pfeffer shows that managers themselves suffer in this culture: overwork leads to promotion and then to still more overwork. They stick to it because they find the job interesting or they need the health plan, and the corporate culture tells them they’re losers if they quit.

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“While plenty of people are suffering — and even dying — for a paycheck,” says Pfeffer, “you don’t have to be one of them.”

This is where he admits defeat; the culture is too strong to be changed, so it must be evaded by smart and lucky individuals. But his advice — more job control, more autonomy, creating a “culture of community” — is likely to hold true only while some benevolent CEO is in charge.

Detoxing the workplace won’t happen until workers realize they’re fighting for their lives, not just their livelihoods. Unions and professional associations need to bargain harder than ever before, and also win. They also have to teach politicians that mere promises of “jobs, jobs, jobs” won’t cut it any more when we know today’s jobs can kill. So governments will need to legislate management into providing safe, secure, meaningful work for their employees.

As long as employers would rather bribe politicians than respect workers, such legislation will be hard to enact. And politicians, as the managers of public enterprises like health care and education, are likely to be as pigheaded as the CEOs.

But as Pfeffer makes very clear, healthy and happy workers are more productive, save their employers money, and actually lower costs for health care and education. If logic and reason won’t persuade them, some serious arm-twisting might make CEOs and politicians finally see the light.