In an attempt to live longer and protect against health problems, you may have given up trans fats, started to monitor your cholesterol, or learned to work the elliptical trainer at the gym. But there's increasing evidence that another factor may be just as important: your job. A constellation of work-related factors—whether you're employed, how secure you are in your job, how much you enjoy your work—may influence both your day-to-day health and how long you live. And that has serious implications, not only for those affected by the current recession, but for everyone, all the time. "We spend 8, 10, 12 hours a day at work," says William Gallo, a research scientist at the Yale School of Public Health. "That may be more important than whether you're on the Zone Diet."
Our work is intricately tied up with our well being, says Nortin Hadler, a professor of medicine and microbiology and immunology at the University of North Carolina-Chapel Hill and an attending rheumatologist at that university's hospitals. And we know that losing a job is bad for your health, not only from a financial perspective but from a psychosocial one, too. When you lose your job, you lose social ties and, often, the very structure of your life. After a major downsizing among municipal workers in Finland, the risk of death from a heart attack went up fivefold for those who lost their jobs. It's unclear whether the same mortality trends seen in Europe persist here; studies are ongoing. Gallo says evidence in the United States has been mixed, but research has found that people who lost a job in their 50s were more than twice as likely to have a heart attack or stroke in the next decade.
It's not just those who lose their jobs who are at risk of serious health problems or premature death. In Finland, even those municipal workers who weren't actually downsized were more likely to die sooner, says Hadler. In the United Kingdom, the "Whitehall studies" included a glimpse of a group of civil service workers whose jobs were threatened by a planned Thatcher-era privatization. The research found declines in both physical and mental health after the announcement, says Sir Michael Marmot, professor of epidemiology and public health at University College London and the principal investigator for the studies. Research in the United States led by Sarah Burgard, a sociologist at the University of Michigan's Institute for Social Research, has shown that job insecurity can be as bad for your longer-term health as a bout with a serious illness or even an actual job loss.
Underlying all of this is the fact that a person's socioeconomic position—of which employment is a key part—is associated with differences in longevity, regardless of the economic climate, says Marmot. The Whitehall studies revealed that many causes of death follow a "social gradient"; the higher up on the ladder, the longer your life. It's not that people lower down are dying of any specific ailment. The diseases are generally the same, but the timing is different, Marmot says.
The pecking order. It's pretty clear that something about the workplace pecking order affects health. One factor seems to be how much control employees have over the demands associated with their respective jobs. "Pressure by itself wasn't a key factor," says Marmot. "It's a combination of high demands and low control." That combination—often found in lower-ranking, lower-paying jobs—is associated with an earlier death, and also with cardiovascular disease, mental health problems, sleep issues, and among other maladies, says Benjamin Amick III, a professor of behavioral sciences and epidemiology at the University of Texas Health Science Center's School of Public Health. His recent research suggests that people who work in jobs with low demands are also at risk if they have low control over their work. "If you spend your working life in a job that's basically boring, you're at risk of dying sooner," Amick says.
You might think this comes down to money and access: If you can't afford to buy healthcare, you're likely to be less healthy. But studies show the same trends even in countries where free healthcare is available to all. That means simply ensuring access to care isn't likely to solve the problem. (Though in a country like the United States, where so many lack insurance and the gap is so big, it's an essential step, researchers say.) It's true that some of the difference in the Whitehall studies can be explained by the fact that people lower down the totem pole were more likely to smoke, less likely to be physically active in their leisure time, and less likely to eat fruits and vegetables, says Marmot. Those public health messages are heard but simply aren't being acted on—and we need to learn why, he says.
But if access to care and lifestyle habits can't account for all the early deaths, what's going on? Researchers suspect constant stress is a culprit. Studies of some of our closer animal relatives, baboons, show that both low-ranking animals and those that are socially isolated have higher levels of stress hormones like cortisol. While humans are not baboons, Marmot suspects the same biological mechanisms are at work in the civil servants he studies; constant stress both on and off the job may be contributing to ill health.
Health disparities aren't likely to go away, but the gaps can be narrowed. At a policy level, that suggests a need for broad changes, Burgard says. It would involve getting the unemployed—who are most at risk of health declines—back in the workplace quickly, and, yes, making sure everyone has access to health insurance. That's particularly important for older workers, she says. Social programs can help, says Eunice Rodriguez, an associate professor at the Stanford School of Medicine who studies the impact of such programs on health. "The bottom line is to provide strong unemployment insurance in a way that people can have a feeling of security when looking for a job," she says. Welfare doesn't seem to provide the same protection, perhaps in part because of the stigma involved, Rodriguez adds.
What to do. Individuals can protect themselves by trying to find a job with a positive work environment and being smart about health insurance, says Amick, though he acknowledges that it's tough to do that in the current economy. But when and if you have some leeway in employment or a choice of managers, take your work conditions seriously—don't write them off as "just a job." If you're unemployed or not happy at work, try to stay on a good track with a healthy lifestyle—exercise is particularly helpful for relieving stress and maintaining general physical and mental health, says Burgard. And stress relief can help, too. (Here's some advice on how to manage your stress and even make it work for you.) On the flip side, don't think that because you do have a good job you're free to abuse your body; a study published this week found that affluence provides no protection from the ill effects of tobacco.
Beyond individual behavior, society needs to take as hard a look at helping people pursue nurturing, gainful employment as it has at new drugs and the latest diet trend, says Hadler. "It's important to be comfortable in your own skin," he says. "People need to feel valuable."