Occupational and Environmental Medicine 1997;54:367-375 367 REVIEW Occup Environ Med: first published as 10.1136/oem.54.6.367 on 1 June 1997. Downloaded from Health and safety problems associated with long working hours: a review of the current position Anne Spurgeon, J Malcolm Harrington, Cary L Cooper Abstract and other aspects of the organisational The European Community Directive on and cultural climate. It is concluded that Working Time, which should have been there is currently sufficient evidence to implemented in member states of the raise concerns about the risks to health European Community by November 1996, and safety of long working hours. How- contains several requirements related to ever, much more work is required to working hours, including the right of define the level and nature ofthose risks. employees to refuse to work more than 48 hours a week. The United Kingdom gov- (Occup Environ Med 1997;54:367-375) ernment attempted to oppose the Direc- tive, arguing that there is no convincing Keywords: long working hours; health and performance evidence that hours of work should be limited on health and safety grounds. Much of the research in this area has By November 1996, the European Community focused on the problems of shiftworking Directive on Working Time' should have been and previous reviews have therefore implemented by all member states ofthe Euro- tended to emphasise this aspect of work- pean Community. This measure has, as its legal ing hours. However, there is much less basis, Article 11 8A of the Treaty of Rome, information about the effects of overtime which is intended to encourage proposals for http://oem.bmj.com/ work, which is a central element of the "improvements especially in the working envi- terms ofthe Directive. This paper reviews ronment as regards the health and safety of its the current evidence relating to the poten- workers". The United Kingdom government tial effects on health and performance of attempted to oppose the introduction of the extensions to the normal working day. Directive and challenged the legal basis of the Several gaps in the literature are identi- original proposal arguing that it should be fied. Research to date has been restricted implemented under Employment Law rather to a limited range of health outcomes- than Health and Safety Legislation. The on October 2, 2021 by guest. Protected copyright. namely, mental health and cardiovascular significance of this is that employment law disorders. Other potential effects which requires unanimous agreement for its imple- are normally associated with stress-for mentation, unlike health and safety legislation example, gastrointestinal disorders, which may be passed on majority voting. Institute of musculoskeletal disorders, and problems The United Kingdom's challenge was, how- Occupational Health, associated with depression of the immune ever, overruled by the European Court of Jus- University of which means that the Directive should Birmingham system, have received little attention. tice, A Spurgeon Also, there have been few systematic now be implemented in the United Kingdom. J M Harrington investigations of performance effects, and However, the British government continues to little consideration of the implications for voice its objections. The basis for such School of occupational exposure limits ofextensions objections seems to be primarily an economic Management, to the working day. Existing data relate one-namely, that certain aspects of the Direc- University of Manchester Institute largely to situations where working hours tive would impose unacceptable restrictions on of Science and exceed 50 a week and there is a lack of employers and hence reduce the competitive- Technology information on hours below this level, ness of British industry. In particular there is C L Cooper which is of direct relevance to the Euro- concern about the section of the Directive pean Community proposal. Finally, it is which gives employees the legal right to refuse Correspondence to: to work more than 48 hours a week. Associated Dr Anne Spurgeon, Institute clear from investigations relating to shift- of Occupational Health, The work that a range ofmodifying factors are with this are the requirements for a daily rest University of Birmingham, likely to influence the level and nature of period of 11 consecutive hours in each 24 hour Edgbaston, Birmingham health and performance outcomes. These period and a minimum weekly rest period of B15 2TT. include the attitudes and motivation ofthe one day. In support of their argument, the Accepted 26 February 1997 people concerned, the job requirements, United Kingdom government maintains that 368 Spurgeon, Harrington, Cooper there is no convincing evidence to support the European Union who work more than 48 view that long working hours are damaging to hours in a normal week. In a recent survey car- Occup Environ Med: first published as 10.1136/oem.54.6.367 on 1 June 1997. Downloaded from either the health or the safety of employees. ried out by Austin Knight9 which sampled What, therefore, is the current status of the employees from 22 large United Kingdom scientific and medical evidence relating to the organisations, two thirds reported regularly effects ofworking long hours? Is there adequate working more than 40 hours a week and one information available in this area? If so does quarter more than 50 hours a week, despite this support the United Kingdom position, or having contracted hours of between 35 and 37 is it actually the case that there are insufficient hours. A survey carried out by the United Road data on which to base firm conclusions? The Transport Union of the hours and conditions overwhelming emphasis ofresearch in this field of 640 professional lorry drivers in the United to date has been on the effects of shiftworking Kingdom found that the average working week and not surprisingly earlier reviews have was tended to emphasise this.2 'However, although of those sampled 62 hours.10 In the United clearly of relevance and importance to the States the average contracted working week Directive as a whole, most of the evidence was 37.5 hours in 1990, although with derived from the field of shiftwork research is overtime the working week of the average male not strictly applicable to the question of long American worker was nearer 41 hours. During hours or overtime. Shiftworking, or any work the same period the average Japanese worker which involves phase shifting, invariably results worked a contracted 41 hour week, but, in in the disruption of circadian rhythms. This addition, averaged nearly 36 hours of overtime presents a more complex situation than that a month.'1 Japan tends to be regarded as an where stress and fatigue result from an example of the extreme in terms of long hours, extension ofthe working day. Similarly, 12 hour but some of the data recently gathered in the shifts which might, in one sense, be viewed as United Kingdom suggest that conditions for at an extension of the working day should also be least some groups of British workers are not so considered in the category ofshiftworking. The different from those of the average Japanese. systematic and often rotational nature of the A growing trend which is not always work pattern in 12 hour shiftworking, together reflected in official statistics is the tendency for with the different motivational and attitudinal professionals and managers in particular to factors involved, merit separate consideration. work unpaid overtime to deal with excessive (These reviews2 include such shiftwork.) Our workloads. Data to support this are generally review therefore is concerned exclusively with collected and published by Unions. A survey the information available on the health and performance effects of overtime work. This is carried out by the National Association of Teachers in Further and Higher Education, for defined as extending the "normal" work day- that is, beyond the traditional eight hours example, showed that lecturers in further edu- which are usually worked between 9 00 am and cation worked averages of 46.7 to 55.9 hours a 5 00 pm or between 8 00 am and 4 00 pm for week on and off site."2 Another survey by the http://oem.bmj.com/ five or six days a week. It includes overtime Manufacturing, Science and Finance Union of working in the evenings, at weekends, and staff in charities and non-profit making organi- occasionally during holiday periods. sations found that most were working up to 10 Relevant papers for this review were identi- hours a week beyond their contractual obliga- fied from seven databases-namely, ABI/ tions without remuneration.'2 INFORM, CINAHL, CISDOC, HSELINE, Many such surveys also highlight the stress medline, NIOSHTIC, and PsycLIT covering experienced by workers who reported long on October 2, 2021 by guest. Protected copyright. the period from 1975. These databases had hours. It is arguable that the relation between been identified as being those which were hours of work and ill health is mediated by relevant in the preparation of a previous review stress, in that long hours act both directly as a by JMH.' Only those papers which referred to stressor, in increasing the demands on a person long hours, as defined above, were considered. who attempts to maintain performance levels However, papers concerned with shiftworking in the face of increasing fatigue, and indirectly were also examined for any additional refer- by increasing the time that a worker is exposed ence to long hours in the course ofthe study in to other sources of workplace stress. A high question. We had previously aquired certain level of stress has long been regarded as a con- other papers-namely, those relating to some tributory factor in the development of certain very early studies.4`6 types of psychiatric problems," coronary heart Current working hours disease,' musculoskeletal problems,'5 and There is considerable international variation in symptoms associated with gastrointestinal attitudes and practices relating to working disorders.' All of these have been considered hours, even within the developed world.