Author Addresses Dying for a Paycheck — Literally

Jeffrey Pfeffer takes a direct approach when talking about the harmful health effects a negative workplace can have on employees. The professor of organizational behavior at the graduate school of business at Stanford University points out that these effects can happen to someone in any industry.

In his new book, “Dying for a Paycheck,” Pfeffer provides evidence and examples to support his claim that negative workplace environments are hurting — and in some cases killing — employees. Workforce intern Aysha Ashley Househ spoke to Pfeffer about why he thinks wellness programs don’t work and how the government should regulate management practices.

Workforce: What do you think sets your book apart from the other information out there on this topic?

Jeffrey Pfeffer: I think there’s several unique contributions. Number one, we did this aggregate estimate of the workplace exposures and their total effect on health in the U.S. and compared the U.S. to other countries and tried to show how much of the inequality and health outcomes comes from people getting sorted into jobs with these different characteristics.

And secondly, we look at the health insurance or health programs that they [employers] offer and whether those programs prevent people from accessing medical care. And I think there are the two dimensions of whether or not companies offer health insurance at all and the costs. And of course, the percentage of companies offering employer-sponsored health has gone down while the costs born by employees has gone up.

But even for the companies that are offering employer sponsored health insurance there’s often a financial burden for employees, and so you can see data that suggests a significant fraction of the U.S. workforce is unable to get their prescriptions filled or access medical care. A fair percentage of those people are in fact insured. And in fact, a reasonable number of people who file for bankruptcy because of medical expenses also have health insurance.

Number one, if you are concerned about health care costs, which everybody seems to be, you ought to focus on the work environment because that’s a source of a lot of the stressors, which create chronic disease. Number two, we ought to take human sustainability as importantly as we’ve come to take environmental sustainablity. This idea that we can use people and spit them out I think is just not a very humane, not a very good way to do things. And third, I wanted to highlight in this book that this is a problem that extends well beyond a single industry or a single occupation, that this is really an extensive problem that cuts across industries and occupations.

WF: What do you think is the ideal wellness program?

Pfeffer: I think wellness programs fundamentally don’t work; that’s what the evidence shows. And that is because they are an attempt to remediate the effects of a bunch of bad working conditions including things that we didn’t even study in the statistical estimate. Things such as gender and race discrimination and workplace bullying.

So, you have workplaces in which people are working long hours, people don’t have job control, people are facing economic insecurity because of layoffs and scheduling issues. And then what employers have tried to do is put on what I would call a Band-Aid. We’re going to offer you yoga or a little exercise. And what we have learned from the quality movement is that prevention is much better than remediation. So instead of trying to put in health and wellness programs to try and remediate the effects of toxic work environments, you ought to prevent the toxicity in the first place and then you wouldn’t need to try and remediate it.

And the other reason why health and wellness programs don’t work is because they are focused on individual behavior. So, I want you to stop smoking, I want you to stop drinking, I want you to exercise, I want you to eat better. But the evidence suggests that alcohol abuse, drug abuse, eating disorders are affected by one’s environment.

I remember the quote [in the book] from the woman I called Kim who worked at Amazon. She said, ‘I would basically do anything, take any drug, to try and numb the psychological pain I was feeling from my workplace.’ So, the idea that I’m going to give you some kind of diet and exercise program independent of removing the workplace environmental stresses that have caused you to engage in these unhealthy behaviors, it can’t possibly work. You need to change the environment, and then the health and wellness programs will work.

WF: What’s your advice for people in a stressful job, but can’t leave?

Pfeffer: Leave. [Laughs] The first thing I would tell people is you need to get social support and spend time with friends, and spend time with your family, and spend time in other environments. I mean the macro suggestion is if you’re in a toxic environment at work, spend time to the extent possible in nontoxic environments outside of work, which will give you relief from that. But in order to do that, you need to be able to have time to actually do that.

My facetious suggestion of leaving is not completely facetious. Once you have ruined your physical and psychological health by being in these harmful, toxic environments, it is very hard to reverse that damage. If I said to you, you’re in a place where they’re poisoning you, and you can’t leave the place… there’s no answer.

WF: What do you think it will take for businesses to realize they need to put their people first?

Pfeffer: You know what it’s going to take? You’re not going to like this answer. I think your readers will really not. It’s going to take a big lawsuit. Somebody is going to get sued. But somebody will bring a case and basically say you have a workplace that is causing people demonstrable, physical harm and we’re going to sue you on that.

WF: How can organizations put their people first?

Pfeffer: Employers need to recognize that they have a stewardship responsibility for the well-being of their employees and they ought to monitor things like prescription drug use, and they ought to monitor things like people’s physical and mental well-being. Employers doing surveys — it’s really pretty easy to put on an item that says what is your current health status on a five-point scale. And you can see this again, my parallel with the physical environment I think is a pretty reasonable one. They could do reporting on their human well-being as well because human sustainability is just as important as environmental sustainability.

WF: You mention how government should play a role. What should it do?

Pfeffer: Years ago, the government said if you put toxins into the air and the water and the soil it’s not just that you harm people, but you have externalized cost. Preventing the discharge is much cheaper than cleaning it up once it’s out there. And therefore, the government said we’re going to regulate and place regulations on this and we’re not going to permit you to externalize your cost on the larger society. And I think the parallel is direct. If I work you to the point where you are now physically, or psychologically, or some combination of the two unable to work, you’re now a cost that has been externalized onto the larger society.

And I have data in the book from studies not done by me, on how companies that don’t provide health insurance or don’t provide adequate health insurance, or adequate wages — you then rely on some form of public assistance. Again, the larger society pays. I think the government has a role to make sure that companies are not able to externalize their cost of employment on the broader society.

WF: Are there warning signs employees can look out for before they accept a job?

Pfeffer: So it’s kind of a funny one. When you interview, the people who are going to be your co-workers. Ask them what drugs they take. There’s a woman from Salesforce, and I quote her in the book and [she says], “I joined Salesforce and one week later I went on anti-depressants.” And she and I were talking more recently, and she said, “most of my friends at Salesforce are on anti-depressants. I should’ve asked, ‘Are you on anti-depressants?’ for my job interview.” [Laughs]

And it’s kind of facetious, but it’s kind of not. In some kind of subtle way, ask people, are you taking sleeping pills, are you on ADHD medicines, are you on anti-depressants? And you know if the percentage is pretty high maybe that tells you something.

WF: What is one thing you want people to take away from the book?

Pfeffer: The Bob Chapman quote: Your employer’s more important for your health than your family doctor. Employers really are the cause of the health care crisis. Most health care spend is on chronic disease; Chronic disease mostly comes from stress and stress comes from the workplace. So, if we want to fix the health care crisis and the health care cost crisis in this country, the place to begin is with the work environment.

Aysha Ashley Househ is a Workforce intern. Comment below or email editors@workforce.com.