一 331 一

J． Tokyo Med． Univ．， 58 （3） ： 331’v337， 2000

Session 1： Conditions of work， stress and occupational health： Present conditions and likely future trends

Current Status of Occupational Stress and Health in Japan

Teruichi SHIMOMITSU， M．D．， Ph．D．i Takashi HARATANI， Ph．D．2

iDepartment of Preventive Medicine and Public Health Tokyo Medical University 2National lnstitute of lndustrial Health， Japan

ABSTRACT AIthough the health status of the Japanese population is generally high， those with long work－ ing hours， such as workers in the service sectors are at a greater health risk． Despite the changes in the law to limit the number of working hours to 40 hours per week， there are no limits set on overtime work hours including unpaid service overtime． With Japan being a hard working society， heavy burdens are placed on the employees such as long working hours leading to stress， fatigue， and possibly “karoshi，” or sudden death as a result of overwork． Therefore， greater preventive efforts are necessary to protect the workers from these ill health consequences． With increased awareness and advocacy for those issues， several measures have been implemented to protect the workers including revisions in labor laws and the establishment of health promotion centers and programs which also supports mental health． However， these measures may not be sufficient to protect the workers from ill health． A new strategy is necessary to improve working conditions in Japan．

Introduction its effects on working life and the health sta－ With the 21S‘ century in the near future， the tus of the works． world is facing an unprecedented revolution． In all phases of people’s lives， rapid changes Long working hours and worker’s health are occurring． Especially in the industrial In 1960， the average number of annual net－ scene， change in industrial structure， the inter－ working hours， according to a survey done by net rapidly extending from post－industrial the Ministry of Labor， was at its highest societies such as Japan， EU， and the U．S． to all recorded level since World War II： 2，432 over the world． hours， including 262 hours of overtime work． Consequently， workers have been directly Also， in 1987， due to the criticism to the issues influenced by such rapid changes that have ill of long working hours， ie． the occurrence of effects on the worker’s health including the karoshi， sudden death as a result of overwork， the increase in job－related stress． Therefore， this government revised the Labor Standards Law article examines the current status of occupa－ to gradually decrease the legal amount of tional stress and health in Japan， one of the working hours from 48 to 40 hours per week． post－industrial societies． This paper focuses on The recent economic depression has allowed the issue of long working hours in Japan and work hours to gradually decrease as well． As

Key words ： occupational stress， long working hours， karoshi， legislation Correspondence ： Teruichi Shimomitsu， M．D．， Ph．D．， Director and Professor， Department of Preventive Med－ icine and Public Health Tokyo Medical University， 6－1－1， Shin．juku， Shinjuku－ku Tokyo 160－8402 JAPAN Email ： tshimo＠tokyo－med．ac．jp

（1） 一 332 一 THE JOURNAL O F TOKYO MEDICAL UNIVERSITY Vol．58 No．3 a result． work hours fell to 1．900 hours in 1997． 7 TTVA」LS AAV－A． L」 一N．／JLJL LV ．L） three or more hours commuting each day Overtime hours also gradually decreased， account for 12．790． lf a worker spends three 制ling to 150 hours per year by 1997． How－ hours commuting to work every day， 250 days ever， compared with the number of annual a year， it adds up to 750 hours of commuting working hours of manufacturing industry in time each year． This is time that could have Western， industrialized countries， the number been spent relaxing． Further， because the train of hours in Japan were still higher． The Japa－ commute is often crowded and very unpleas－ nese worked 300 to nearly 500 hours longer ant－a so－called“磁ん2雨乞goん易”or commuting than the Germans and the Frenchi）． hell－workers must expend extra energy to Japan seems to have problems with setting merely endure it． standards for an adequate number of working hours． Overtime work exists that is not Receut changesin working environment and reported in the statistics done by the Ministry worker’s health of Labor． For example， there is work known as Compared with the distribution of time in service overtime， which is done without pay． the work day of male workers in other devel－ Many workers in middle management posi－ oping countries， working hours， including tions， such as supervisors， do not use time－ commuting time， were higher in Japan than in cards． Consequently， even though they may other developed countries by 80 to 150 min－ work longer than normal hours， they are not utes． The result is a decrease in leisure time paid． There is a large discrepancy in the num－ for Japanese workers． They also do not have ber of reported work hours reported by differ－ enough time to spend with their families， to ent sources （Figure 1）． ln a survey of annual exercise， or to enjoy social activities． work hours conducted by the Ministry of Recently， a drastic reorganization of the Labor2）， data was summed up from the company workplace has occurred in Japan． The unique reports． On the other hand， the Management Japanese employment system， including the and Coordination Agency for the Office of the life－time employment system， and seniority－ Prime Minister collected data reported by constrained wage and promotion systems， are employees8）， regardless of the conditions for now falling apart． Thus， workers feel job inse－ unpaid service overtime． According to the curity． Many of the changes that are occurring Management and Coordination Agency， the in the workplace are on－going． Companies recent average value for annual working hours intend to remove layers of management from has consistently been about 800 hours higher the organization． Workers will therefore have than that reported by the Ministry of Labor． to work under less supervision and multiple Unpaid service overtime may be the cause of supervisors． These re－organizations bring the this discrepancy‘）． workers more work and responsibility． All of When we look at the ratio of workers who the following factors bring about an increase work more than 60 hours per week by occu－ in the number of hours worked： the infre－ pation， workers in some occupations work quent number of days off， the inability to much longer hours than others （Figure 2）． switch off， the lack of a sense of control， and This seems to be the case in the service， sales， a sense of a lack of support from their super－ transport and communication sectors． How－ visor． These factors bring about undesirable ever， the ratio decreased in all sectors from levels of occupational stress． They also result 1987 to 19922）． Workers in the named sectors in an intrusion on the worker’s private time， are primarily engaged in providing services to family lives， vacations， and sleep time． customers where there is a shortage of man－ The Policy Planning and Research Depart－ power， so it is difficult to control the number ment of the Ministry of Labor has conducted of employee work hours． a survey on the State of an Employee’s Health Not only are Japanese workers forced to every 5 years since 1982． For example， in the work long hours， employees in major cities 1992 Survey， 12，000 private firms from all over generally live in distant suburbs， thus making Japan were selected from all firms with 10 or for a long commute． 48．290 of workers spend more workers． Then， 16，000 employees within two or more hours commuting to and from the these firms were selected according to a spe－ downtown office each day． Those spending cific method． For the individual study， each

（2） May， 2000 Shimomitsu ： Present Status of Occupational Stress and Health in Japan 一 333 一 hrs／yr 2397 2400

2361 agement and 2309 C prdination Age Dcy 2300 2267

■ ■ 三：．` 2200 ﾋ （ル”s罐ゴ α卿。＞

2100 Min ：stry of Labor

Q052 2000 2016

1972 1900 1913

1800 year

Figure 1 Comparison of Working Hours （Survey of Ministry of Labor and Management and Coordination Agency）

Craftsmen， production workers ＆ laborers

Transport ＆ communications

Agricultural， forestry ＆ fishery 1987

Protective service

Service 1992

Sales

Clerical ＆ related

Managers ＆ officials

Professional ＆ technical

Total

o 5 10 15 20 25 30 350／，

Source：1994’冊ite paper on Labor

Figure 2 Ratio of Workers Classified as 60 Working Hours or more per Week by Occupation （Male）

（3） 一 334 一 THE JOURNAL O F TO KYO MEDICAL UNIVERSITY Vol．58 No．3

year

1997

1992

1987

1982

o 10 20 30 40 50 60 70 （o／，）

Source： wnite Paper on Labor， 1998

Figure 3 Ratio of All Workers Who Complain of Anxiety， Worry， or Stress in Their Working Lives from 1982 to 1997

employee was asked to answer a questionnaire among occupations？ The Ministry of Health by themselves． Figure 3 shows the trend of the and Welfare conducts vital statistics surveys prevalence of workers experiencing anxiety， every five years． Figure 4 shows the age－adjusted worry， or stress regarding working life from death rate of all causes among men aged 20 1982 to 1997i）． The percentage ofworkers who to 64 yrs in 1995 classified by occupation5）． complained of anxiety， worry， and stress in The death rate of the workers in the service their working lives gradually increased from sector was the highest， with the value of 403．5／ 50．690 in 1982 to 62．890 in 1997． The per－ 100，000． We can see the same tendency in the centage of those experiencing occupational death rates of malignant neoplasms， heart stress increased as the actual number of hours diseases， and cerebrovascular diseases in the worked increased． That is the higher the service sector in Figure 4． This sector has the actual number of hours worked per day， the highest rate of employees who worked more higher the percentage of workers who com－ than 60 hours a week （Figure 2）． plained of stress． 7490 of those who worked The problem of karoshi more than 10 hours per day at their workplace Under such conditions， karoshi （sudden felt work－related stress． death as a result of overwork）， has been receiv－ Another recent report， based on 1998 data， ing much attention6N8）． The family and col－ from the Ministry of Health and Welfare states leagues of victims have been engaged in court the number of those who died from suicide battles to have the phenomenon officially has dramatically increased to 25．3／100，000 recognized and covered by workmen’s compen－ persons from 18．8／100，000 persons in 1997． lt sation． ln June 1988， the National Defense is especially high among men in their 50’s and Counsel for Victims of Karoshi set up the has grown by more than SOO／o among this Karoshi Hotline to provide consultation ser－ group injust one year． lt is speculated that the vices to surviving families who experienced severe economic situation and physical and financial hardships after an income earner of mental overload are the main reasons for the the family had died． Subsequently， the Karoshi high suicide rate． Hotline was received more than 4．000 calls for ’ Is there any difference in ill health of workers help in a nine year time period． The issue of

（4） May， 2000 Shimomitsu ： Present Status of Occupational Stress and Health in Japan 一 335 一

Craftsmen， production 144．2 ■■圃malignant neoplasms workers ＆ laborers oheart diseases m＝＝＝＝］cerebrovascular disease 212．6 m＝＝コothers Transport ＆ communications

・：：： Agricultural， forestry ＆ fishery 334．8

・：・ 174．1 Protective service

403．5 Service ：匪：：：i；

Sales 170．0

：・： P89．5 Clerical ＆ related F・：

Managers ＆ officials P74．0

Q04．0 Professional ＆ technical o 100 200 300 400 500 Age－adjusted Death Rate （per 100，000） population

Source： Special Report of Vital Statistics in 1995 0ccupatonal and lndustrial Aspects

Figure 4 Age－adjusted Death Rate of All Causes Classified by Occupation （Males 20 to 64 years old）

Karoshi has also drawn the attention of other Uehata defined Karoshi as “sudden death from countries suffering from trade friction with ischemic heart disease or cerebrovascular dis－ Japan， and the issue has become known ease due mainly to physiologically damaging throughout the world via TV， newspapers and work conditions， resulting in accumulated magazines． For example， in 1988， Chicago physical fatigue， leading to overfatigue which Tribune reported the case of Mr． Hiraoka． This then accelerates hypertension or arteriosclero－ middle manager of a company died of sudden sis．” Regarding classification by disease， 3790 cardiac death after having worked more than were due to cerebrovascular events， while 72 hours a week for 28 years． 26．890 were cardiovascular events． Among The number of inquiries to the Karoshi Hot－ victim’s diseases， acute heart failure ranked line has been decreasing since 1990． However， first， followed by subarachnoidal hemorrhage． there are still more than 100 cases per year． Among 142 cases inquiring about workmen’s The inquiries were generally related to the compensation， the most possible triggering possibility of obtaining workmen’s accident factor for the disease， as answered by the vic－ compensation． However， companies were usu－ tim’s family， was related to long working hours； ally uncooperative． Even labor unions were 54．990． Other factors included heavy norm， sometlmes uncooperaUve， as most were irregular work， time urgency， job trouble， and generally company－based． The standards for so on． workmen’s compensation are strictive as well． Consequently， it is difficult to prove a strong Countermeasures for the prevention of relation between the diseases and the work， worker’s ill－health resulting in very low rate of success in receiv－ By looking at all this information， we can ing compensation． ln 1982， Dr． Uehata stud－ conclude that there have been many problems ied this phenomenon in the context of social in worker’s health and working conditions medicine and first named it， Karoshi6）． Dr． in Japan． How can we protect the workers from

（5） 一 336 一 THE J O URNAL OF TOKYO MEDICAL UNIVERSITY VoL 58 No．3 such ill－occurrences？ Recently， a few strategies to promote health． Conversely， the employers have been proposed． have to consider the recommendations of the First： To reduce long working hours， the gov－ occupational physicians． ernment revised the Labor Standards Law in Finally， in 1998， the Ministry of Labor estab－ 1994． This law stipulates 40 hours a week as lished the 9th Occupational lnjuries and Dis－ the legal limit for working hours． eases Prevention Program， which includes Second： The Ministry of Labor has instituted strategies for managing increasing mental the “Total Health Promotion Plan （THP）”， at stress． Detailed strategies regarding measures work sites for improving the physical and men－ for managing mental stress are listed in this tal health of the employees． The goal of this plan and are as follows； 1） promotion of inter－ plan is not only for early detection and pro－ disciplinary research and investigation to prevent tection from non－communicable diseases but stress related ill－health among all workers， also to enforce the development of healthier especially white collar workers， 2） to maintain workplaces． Each company has an ‘occupa－ a high standard of training for managers tional physician’． These doctors conduct a and supervisors， 3） to provide information medical examination， a lifestyle evaluation， to workers to control or manage their own and exercise test Based on these results they work－related stress， 4） implementation of stress－ give an exercise prescription and lifestyle related consultation systems， and 5） promo－ consultation． And in some cases， also mental tion of stress management at the workplace． health care and nutritional guidance are However， these strategies are not sufficient provided． The Ministry provides financial assis－ to protect workers from ill－health， as there tance to the company to reduce expense． are a few occupational groups with an extra－ Third： The smaller firms in Japan tended ordinary high risk of ill－health as mentioned not to have the same services as compared with previously． The Labor Standards Law also does the health care systems in larger firms due to not stipulate a maximum for overtime hours． a lack of man－power and a lack of finances． The law states that this is to be determined on For example， the law stipulates that small firms an individual basis through labor－management with less than 50 employees are not required negotiations． Therefore， in some firms where to engage a fu11－time， or part－time occupa－ the power of workers is very low， the management tional physician． However， the government has can force overtime work upon employees． established prefectural lndustrial Health Pro－ Such wrong working conditions should be motion Centers and Local lndustrial Health improved． Centers in all parts ofJapan to support heath care including mental health care， in small References firms． These Centers have been in existence 1） The Ministry of Labor： White Paper on Labor since 1993． ［Rodosho： Rodo Hakusho］， 1998 Fourth： The government enacted the lndus－ 2） The Ministry of Labor： White Paper on Labor trial Safety and Health Law in 1972 to assure ［Rodosho： Rodo Hakusho］， 1994 the safety and health of workers in the work－ 3） The Statistics Bureau， The Management and place． A 1992 amendment included a com－ Coordination Agency for the Office of the Prime mitment to facilitate the promotion of the Minister： Annals of the Survey for the Labor “comfortable” working environment Here， F・rce（3・much・Tok吻・ku’R・d・η・々z4 Cん・∫α “comfortable” means not only in the physical NenP o）， 1994 4） lnstitute of Economics， The Economic Planning sense but also psychological and social． lt pro－ Agency： The Economic Analysis （Keizaihikahucho motes an atmosphere in which every employee Keizaihenkpuwfo： Keizai Bunseki）， Vol 138， 1994 can achieve their job without feeling much 5） Statistics and lnformation Department， Minister’s stress． Secretariat， The Ministry of Health ＆ Welfare： Fifth： With the revision of the lndustrial Special Report of Vital Statistics in 1995： Occu－ Safety and Health Law in 1996， contracted pational and lndustrial Aspects ［Koseisho Dai一 occupational physicians now possess the duty ア7Zんαη∂07bん吻ツohobu：linkodo彦ai Shokugyo Sangyo∂etz↓ to act as direct advisors to employers on work－ Tohei］， 1999 ing conditions and worker health in order to 6） Hosokawa M．， Tajiri S．， Uehata T．1Karoshi， prevent occupational illnesses like karoshi and Rodokeizqaisha， 1982

（6） May， 2000 Shimomitsu ： Present Status of Occupational Stress and Health in Japan 一 337 一

7） Uehata T．， Karoshi due to occupational stress 8） Shimomitsu T． and Levi L．： Recent Working Life ［Shokugyosei sutorestt ndyoru karoshi］． ln： Hosokawa Changes in Japan． European Journal of Public T．［ed］． New Theories of Labor Sciences ［Shin－ Health 2 1 76Ay86， 1992 rodokagakuron］， Rodokeizaisha 1988

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