Dying for a Paycheck

How modern management harms employee health and company performance – and what we can do about it.

Book Author: Pfeffer, Jeffrey
Keeping employees healthy is completely consistent with economic performance. Yet modern workplace culture and managerial practices value monetary gain and status over the physical and mental well-being of employees. Pfeffer’s philosophy is that “the success of an economy and of a society cannot be separated from the lives that members of the society are able to lead” (p. 26). Dying for a Paycheck evaluates the detrimental management practices organizations maintain that are quite literally killing employees from every tier of society and offers an approach to business that prioritizes the individual.

Key Quote:

“When a person perceives the demands of a situation to exceed his or her own … resources, the mind makes sense of this discrepancy by appraising it as a threat…If the stress response is strong enough, the result is elevated cortisol levels…Cortisol is a catabolic (i.e., cell “breaking down”) hormone with links to chronic stress, systemic inflammation, accelerated cellular death, and generally poor health” (p. 52). Jeffery Pfeffer

Key Points and Concepts

Environmental & Managerial Stressors  

Although part-time/contract labor / freelance work is “in” in the increasingly popular gig economy, this type of work creates constant pressure to be “in the market” and greater fluctuations in income, even as financial obligations remain consistent and unforgiving. This gig economy allows for flexibility, but ultimately leads to job insecurity and fewer benefits than a full-time job.

A common stressor across all industries is the feeling of constant assessment/evaluation without “patience with or tolerance for the invariable natural fluctuations in job performance” (p. 66).   

Employees often perceive face time as necessary to succeed, to be promoted, and to show status. Because of this, many people (Americans, specifically) go to work sick or without adequate recovery time for fear of being fired or scolded. This looming threat also increases an employee’s probability of making themselves available outside of work hours.   

Often industries with the longest hours – banking, law, technology – are too busy to mind their health, despite having good insurance and high salaries. There is a high price for career success, including failure to nurture personal relationships, and those who overwork to prove loyalty or earn a promotion burn out faster or experience severe, premature health issues.   

Nonwork time has decreased significantly because of the ever-present access to electronic devices, which give the impression of always being on call. Even if employees are not expected to respond after work hours, off-hour emailing – even the ping of an email notification – “negatively affected employees, leading to burnout and diminished work-family balance” (p. 124).   

The Toll

“When a person perceives the demands of a situation to exceed his or her own … resources, the mind makes sense of this discrepancy by appraising it as a threat…If the stress response is strong enough, the result is elevated cortisol levels…Cortisol is a catabolic (i.e., cell “breaking down”) hormone with links to chronic stress, systemic inflammation, accelerated cellular death, and generally poor health” (p. 52).   

When employees have inadequate or no health benefits, they fall into a vicious cycle of stress. The stress of being uninsured spawns financial stress, which induces unhealthy behaviors or further exacerbates existing conditions, which affects compliance with new or existing treatment regimes, and leads to the risk of premature death.   

The desperation for adequate coverage directly affects the employer, as well. When people take a job primarily for its benefits rather than because it is the right fit for their skills and interests, there tends to be higher turnover and thus a loss of productivity for the organization. In the end, the company spends more time vetting and training candidates, and the employee persists in a workplace that may be a poor fit for both parties.   

The prevalent belief is that output is directly related to the number of hours worked. However, long work hours decrease overall productivity and increase instances of sleep deprivation, disrupted sleep patterns, drug abuse, and work-family conflict. Keeping extended work hours – any number that exceeds 50 hours per week – has widespread effects.   

Productivity – Especially in highly cognitive jobs that require creativity and concentration, long work hours lead to more mistakes, fatigue, boredom, and less thoughtfulness and insight. 

Physical health – Research has also found that excess working hours and the stress employees experience during those hours can predict the percentage risk of heart disease/attack, hypertension, and stroke.  

Mental health – Extraneous hours coupled with the lack of time to relax and refresh (e.g. sleep, exercise, social interaction) leads to a higher incidence of severe anxiety and depression, and an overall lower life-satisfaction. 

Why Do We Stay?  

Economic necessity is the most common reason for remaining at a job regardless of strains on an employee’s well-being. Health and relationships are often overshadowed by the need to pay the bills and put food on the table. Additionally, health insurance or lack thereof is directly linked to job mobility.  

Employees often sacrifice for prestige and the lure of intellectually stimulating work. The “if you can make it here, you can make it anywhere” mentality and the credibility that comes with working at certain institutions incentivizes employees to tolerate difficult working conditions. Moreover, even those who are overworked maintain that the interesting, challenging work is worth the stress.   

Many people remain in toxic work environments because they simply don’t have the energy to leave. A lack of sleep and a surplus of stress leaves little energy to look for another job, which in itself requires significant time and energy.   

Self-enhancement motivation – “the desire to think well of ourselves” – drives many human actions (p. 178). In many cases, pride and ego are easy to succumb to, especially for ambitious people who like to think of themselves as competent. They push themselves to the limit to prove to themselves and to others that they are qualified.   

Employees construct alternative narratives that help them make sense of and justify their environments. Self-perception plays an important role within these narratives. In the narratives employees create, they don’t want to see themselves as a quitter or a failure, so they assimilate new information that is consistent with their own narrative, rather than acknowledge the often unhealthy and unsustainable reality.  

Prioritizing Human Sustainability   

Pfeffer estimates that toxic workplace environments in the United States are responsible for 120,000 excess deaths per year and for approximately $180 billion in health care expenditures. If we shift our focus from economic sustainability to human sustainability (which would, in turn, remedy many economic issues), about 60,000 or half of those deaths and around $63 billion or one third of those costs, are preventable (p. 38).  

What can we do to fix it?  

Measure health and well-being, “just as we routinely measure environmental pollution impact” (p. 193).   

Call out “social polluters” for toxic practices and workplaces.  

Implement policies that reflect the true costs and consequences of management’s decisions.  

Reckon with our excuses and false trade-offs.  

Prioritize human sustainability.  

Companies on Fortune’s Best Places to Work list outperform in “…job-sharing programs, compressed work weeks, telecommuting opportunities, and more generous family benefits” (p. 142).   

There are two key elements of a healthy workplace that are crucial to both human and, in turn, economic sustainability. Both job control/autonomy and social support within and outside of an employee’s work environment contribute to an employee’s experience and tenure at their organization, and most importantly, their short and long-term health.

“Encourage your senior leaders (especially White men) to take ownership of sponsoring your Black associates”. Organizations that prioritize inclusive talent development are more likely to have a leadership team focused on identifying and sponsoring top talent (p. 112).

Wyche, K. (2021). Diversity is Not Enough: A Roadmap to Recruit, Develop and Promote Black Leaders in America. Trinity: Kandelle Publishing. 

Admired Leadership Book Summary of "Culture Renovation" by Kevin Oakes.

“When a person perceives the demands of a situation to exceed his or her own … resources, the mind makes sense of this discrepancy by appraising it as a threat… If the stress response is strong enough, the result is elevated cortisol levels… Cortisol is a catabolic (i.e., cell “breaking down”) hormone with links to chronic stress, systemic inflammation, accelerated cellular death, and generally poor health.” 

Economic necessity is the most common reason for remaining at a job regardless of strains on an employee’s well-being. Health and relationships are often overshadowed by the need to pay the bills and put food on the table. Additionally, health insurance or lack thereof is directly linked to job mobility.

Pfeffer estimates that toxic workplace environments in the United States are responsible for 120,000 excess deaths per year and for approximately $180 billion in health care expenditures. If we shift our focus from economic sustainability to human sustainability (which would, in turn, remedy many economic issues), about 60,000 or half of those deaths and around $63 billion or one third of those costs, are preventable.

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