Work, vacations, and retirement: Will they affect your health?

Content provided by the Faculty of the Harvard Medical School

Work, vacations, and retirement: Will they affect your health?

In the old days, many men began to work during boyhood and carried on until they could work no longer. Vacations were little more than brief interludes as the seasons changed on the farm or the laws of supply and demand required less productivity. Not anymore! Industrialization, educational opportunities, affluence, greater life expectancy, and pensions have swept away the old patterns. Men go to work later, they have time for vacations, and most live long enough to face years of retirement.

It's remarkable progress — but work can still be demanding and stressful, vacations can be disruptive, and retirement a mixed blessing. How do these new rhythms affect your health?

Caution: Men at work

In addition to its obvious economic implications, a productive work life is vital to a man's self-esteem and psychological well-being. That's why Freud said a man's mission in life is to work and to love. Love can cement the social networks that protect a man's health, but careless love can be very risky indeed. And work can also be a double-edged sword.

Occupational illness and injury. From a strictly physical point of view, work can pose health hazards. In 2004, for example, private employers in the United States reported 4,365,200 work injuries and occupational illnesses. In 2004, 5,703 civilian workers died from injuries in the United States; 93% were men. According to the National Safety Council, occupational injuries and illness drain the economy of more than $125 billion annually.

The combined efforts of the Occupational Safety and Health Administration (OSHA), responsible employers, and concerned workers' groups have greatly improved workplace health. Still, all employees must protect themselves from accidents and injuries. It's a particular problem for men, who make up the vast majority of the workforce in the ten most dangerous occupations. Long working hours and overtime increase the risk of injury. Add risk-seeking behavior and alcohol and drug abuse, and you'll see that work can be physically hazardous to men.

Work and the mind: Stimulating or stressful? From a psychological point of view, work can either boost a man's health or hinder it. Men tend to be more competitive than women, often dividing the world into winners and losers as if there were no middle ground. Striving for success (and struggling to avoid failure) can turn men into workaholics. Men who succeed derive emotional satisfaction from work, particularly if their jobs entail creativity, independent judgment, and challenge without undue stress. But work can also deprive men of the family relationships and social networks that are particularly important when illness or retirement keeps them from their work.

Can a man actually work himself to death? The Japanese think so; in fact, karoshi, "death from overwork," is a recognized diagnosis that is backed up by compensatory payments to survivors in Japan. But does overwork also affect Western men? A British team performed a meta-analysis of 21 studies of work and health. The researchers confirmed an association between hours of work and ill health; the effect was small, but consistent and significant.

Although working hours are important, working conditions have an even greater impact. For example, a 2001 study from California and a 2005 study from Finland both linked work-related stress to thickening of the carotid arteries, an early manifestation of atherosclerosis. The effect was strong in men but not in women. In addition, research from Europe and America demonstrates that men who have low control over their jobs, men who have high mental stress but low physical activity at work, and men who have low social support from their supervisors and co-workers face an increased risk of hypertension, heart attacks, and death. Perceived injustices at work are also linked to an increased risk of heart disease. According to a 2005 British study, men who continue to show up at work when they are ill face similar risks. And a 2005 Canadian study found that exposure to excessive noise at work can also increase a man's risk of heart disease.

How does work stress take its toll? Scientists are not sure, but adrenaline probably plays a role. It's the "stress hormone," which speeds the pulse and raises blood pressure. In fact, several studies demonstrate a link between work stress and high blood pressure. Adrenaline also activates platelets, the fragmentary blood cells that initiate clot formation, sometimes causing heart attacks and strokes by blocking arteries already partially narrowed by cholesterol-laden plaques. Although OSHA and its friends have improved the physical safety of work, the mental aspects are not getting better. On the contrary, changing gender roles, globalization, evolving technologies, economic imperatives, and rising productivity standards are adding to the stress men face. Worst of all, perhaps, is the erosion of autonomy and control.

Long hours at work and high stress on the job pump out stress hormones, raise the blood pressure, and increase the risk for atherosclerosis. But they can do even more, sometimes producing a profound sense of fatigue and exhaustion. Is exhaustion itself a cardiovascular risk factor? A study of 5,053 male college graduates suggests that it may be. When the research began in 1980, each volunteer answered a simple question: How often do you experience a sense of exhaustion (except after exercise)? The scientists also collected information about each man's height, weight, smoking habits, and medical problems such as diabetes and hypertension. Over a 12-year period, men who reported a sense of exhaustion were twice as likely to die from heart disease as men without the complaint, even after their other risk factors were taken into account.

Men who face excessive job stress should work with their employers to improve the situation. They should also use stress-reducing techniques such as exercise, meditation, sleep, support networks, and counseling to lower stress on and off the job.

Vacations

When Mae West said, "Too much of a good thing is … wonderful," she wasn't thinking of work. A productive work life is a good thing, but most men try to balance work and play by taking a break during the day, a weekend out of harness, and a change of scene when vacation time finally rolls around. But are vacations actually good for health?

An analysis of the landmark Multiple Risk Factor Intervention Trial (MRFIT) suggests that vacations live up to their billing, for health as well as pleasure. The subjects were 12,338 men between the ages of 35 and 57; all were free of heart disease when the study began. Each man provided information about his vacation habits, and the scientists collected detailed information about each man's education, socioeconomic status, medical history, and cardiovascular risk factors, ranging from smoking and cholesterol to blood pressure and diabetes. Over nine years, men who took the most vacations were 29% less likely to be diagnosed with heart disease and 17% less likely to die than those who did not take regular vacations. The protective effect of vacations remained valid after socioeconomic considerations and well-established cardiovascular risk factors were taken into account.

Vacations are good for health — but they may not be equally good for all men. A 2003 study linked stressful vacation driving and unpleasant accommodations to an increased risk of heart attacks during the first two days of vacation. In addition, psychologists in the Netherlands have identified a group of men with "leisure sickness," a set of psychosomatic symptoms that are triggered by time away from work and relieved by getting back to the job. It's the flip side of workaholism; some men actually feel best when they are working. Affecting only about 3% of men, according to the Dutch estimates, it's not a common problem. And at present, there is no evidence that symptoms of "leisure sickness" — which include headaches, muscle aches, nausea, and fatigue — can actually lead to medical illness, much less heart disease and premature death. For most men, at least, leisure time and vacations really are good.

Out to pasture

Working men often look forward to retirement as one long vacation, but it's really very different. It's a permanent change in status with important effects on a man's self-image as well as his daily schedule. While vacations are a plus for nearly every man, the retirement equation is much more complex. Surprisingly, perhaps, a 2005 study found that early retirement does not prolong a man's life. In fact, if retirement is involuntary or unexpected, it will reduce a man's self-esteem and add to his stress. But if it is preceded by realistic anticipation and planning, it can mark a happy and healthy new chapter in his life.

Three major changes accompany retirement: the loss of income, the loss of work relationships, and the loss of identity as a worker. A successful retirement requires that you anticipate all three and plan accordingly. The need for financial planning is obvious. Not so obvious, but just as important, is the need to build relationships to replace those at work. It's also important to include your spouse in the process; your retirement is an adjustment for her, too. Similarly, a man should cultivate interests and activities to make the leisure of retirement as rich and rewarding as the challenges of work.

The key is a gradual transition, ideally extending over a period of years. Men should think of retirement as a career change, not the end of productivity. People who develop hobbies, interests, and relationships in advance should be able to anticipate retirement with eagerness, not dread. Above all, perhaps, men should heed the lifestyle lessons that can make those golden years shine. Diet, exercise, and good medical care head the list. Men who stay healthy and age successfully will have the physical and mental resources to enjoy retirement. And in turn, mental stimulation and physical activity should help keep them healthy and happy during their new careers.

What works for you

Today's average American man is not a beast of burden. He should not be hitched mindlessly to his job, only to be turned loose for two weeks each summer and set out to pasture at age 65. Instead, each man — and his family — should evaluate how he is affected by work and leisure and take steps to make work a positive, healthful experience balanced by enjoyable, healthful leisure and vacation time. Early planning for retirement is equally important. All in all, men should strive for a career that has room for both work and play, a lifestyle that is based on good health habits, and an environment that features strong interpersonal relationships and interesting activity. It's the way to good mental and physical health during those long working years and the many years beyond.

Last updated:	September 05, 2008