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Jeffrey Pfeffer studied how workplace environments can affect an employee's health.

Is the modern workplace at the center of a massive public health crisis?

Stanford University professor Jeffery Pfeffer explores that possibility in his new book, “Dying for a Paycheck.”

Pfeffer, the professor of organizational behavior at Stanford University’s business school, has been studying and writing about the modern workplace for years. But he’s now looking at how office life can be toxic for your health.

Pfeffer estimates that 120,000 deaths may be attributed to workplace conditions, which include work-family conflict, no health insurance, and unemployment. This would in theory make the modern workplace the sixth-leading cause of death in the United States.

Pfeffer found toxic workplace environments permeate all types of companies across multiple industries and in various countries. He found plenty of issues with both old and newer companies, including places like Salesforce, which is currently listed as Fortune’s “Best Place to Work.”

We spoke to Pfeffer about the book, what companies can do to create a better workplace environment, and what employees should always ask during an interview.

Can you talk a bit about why you came to this topic and why you were inspired to write this book?

Most governments are concerned about healthcare costs, and there’s all this emphasis on controlling healthcare costs. And it struck me just listening to people talk… they were missing a big piece of the problem, or a big piece of the puzzle.

Jeffrey Pfeffer's new book "Dying for a Paycheck" looks at how modern workplaces affect public health.

If you’re going to control healthcare costs, you need to worry about the work environment. People spend a lot of their time at work — work is consequential for income, for people’s sense of social identity, for what goes on with them.

The workplace has become, if you will, a public health crisis. If we were going to get serious about improving people’s health and certainly controlling healthcare costs, we need to do something about the workplace.

The problem was kind of bigger than I anticipated, but I got interested in it because of my interest in hearing people talk about health costs and just thinking they had left something big out of what they were talking about.

Was there anything that was particularly surprising to you as you were working on the book?

I think what I was not quite expecting was how pervasive the problem [is].

I mean, you talk about workplace issues or toxic work environments, people think about chemical plants or oil rigs or coal mines or construction sites or somewhere there is physical danger.

What surprised me is how pervasive this is… which, of course, it reinforces my intuitions — which is, if we are serious about fixing healthcare costs, we really need to focus on work.

You talk about two key elements of the healthy workplace in the book. Can you talk a little bit about the critical elements of what can make people happy in a workplace?

Number one, provide social support... We know that social support buffers people against various forms of stress.

So, organizations that build cultures where people support each other... Getting rid of these fourth-quarter ranking and having company social events and putting people in work groups where they have to perform tasks together.

Anything that brings people into contact with each other. Human beings are social animals, we like to be in groups, and so anything that creates that climate of social support is good.

The other thing is [that] people, as they get older, like to be adults and treated as adults.

So much of what goes on at work infantilizes people and takes away any sense of agency and control.

Therefore, jobs that provide people with a sense of control, a sense of autonomy, a sense of accomplishment, are good kinds of work practices and a workplace where people are going to thrive rather than be distressed.

One of the most striking things to me is when you talk about why people stay in a toxic workplace. The fact that the job itself can be a hindrance to leave. Can you talk about why people stay?

One of the things that fascinates me is why we’re more protective of the physical environment and endangered species than we are about people.

I think one of the reasons for that is that people believe that people have agency, and if they’re in a crappy workplace, they can just leave. But it’s not that easy.

If your present job has exhausted you physically and psychologically, having the energy to go out and look for another job may be a little too much to expect.

The [other] thing that really fascinated me was the stories about people who stayed because either the workplace intentionally or unintentionally plays on the ego. The idea of, ‘Aren’t you good enough? We’re doing important things if you were really up to the task — you would figure it out.’

If you talk to accomplished, educated people — particularly young people just starting out in their careers who want to improve themselves — the idea that ‘I need to leave this place because it’s not good for me’ [can turn into] ‘Well, you know, I can tough it out, I’m tough and smart. I will figure it out.’

This appeal to ego oftentimes gets people to stay in places even though they know they’re not, they shouldn’t be there.

Then the other thing that the managers will say is, ‘Well, what makes you think you can find anything better anywhere else, it’s all the same.’

The idea that every place is equally toxic. So oftentimes people wind up staying even though they know they’re miserable.

I think there’s always a tendency to look to a time when things were better. But was there a time where we had a good balance between work and life in the modern age?

The attachment between people and organizations [has] really gone down. Years ago, people had careers and then they had jobs. And now they have gigs.

Certainly, the level of economic insecurity and tenuousness — or call it what you will — has changed over the years. The other thing I think has changed over the years is the sense of what the CEOs have felt they were responsible for and to.

In the ’50s, we had stakeholder capitalism, and there’s a lot of data on that that talks about how CEOs would talk about how to balance the interest of shareholder and customers and employees.

Now we basically have a shareholder capitalism model that is all about the money and the shareholders, and everyone else is taking second place.

So, in a sense, the two things kind of go together. If you work for me for a long time, and I expected you to work for me for a long time, I would come to know you and I would have a sense of being responsible for and to your well-being.

But to the extent that you’re not going to be with me for very long — maybe you’re just going to be a contract worker — my sense of obligation or feeling of duty to you is going to be much reduced.

I think what has changed is senior leadership responsibility to and for the people who work for them.

For the companies where they seem to be caring for their employees, is there a similarity between them or the CEOs leading them?

I think the similarity is they all have decided to do something. That is, to understand that to achieve competitive advantage and enduring company advantage, you do this through culture and through your people.

I think Patagonia sees itself in a very competitive business, and the only way it’s going to survive is to have people who are really going to engage… who are going to attract and retain the best people.

I think it comes from values, and the case of Jim Sinegal of Costco… the founder has values that say, ‘I really have humanistic values. I do believe I have a stewardship responsibility for the people who come work for me, with me.’

Which is of course true.

There’s this quote in the book: ‘Your boss is more important for your health than your family doctor.’

Which is so true. When someone shows up at work in your organization, they have really entrusted — not all, but a lot of — their physical well-being to who hired them.

If they face discrimination, that’s going to be stressful, and that’s going to hurt their feelings of self-esteem. If they face harassment or workplace bullying, we know that’s going to have an effect.

Therefore, take that responsibility seriously.

For people who are in a toxic workplace and trying to get out and going on job interviews, are there things to look out for when you’re applying for a new job so you’re not in that same situation?

It’s a reasonable thing to ask what their work schedule is like. How they are balancing their work and the rest of the life obligations? If the organization makes that easy or hard.

Even [ask] your prospective boss, ‘If I come to work for your org, what is expected in terms of work hours? Is the norm six days, seven days, 25 hours a day?’

Just ask people what the norms are. I don’t think that is a question that is unreasonable or weird. It’s just to find out what is expected.

How much control am I going to have over my schedule?

This interview has been edited and condensed.