Once purely a Japanese phenomenon, 'karoshi' is becoming an increasingly large issue for workplaces across Asia and even Australia, writes Amy Birchall The Japanese call it karoshi, in Korea it is known as gwarosa and the Chinese call it guolaosi. In English, they all translate to "death from overwork". What began as a post-war phenomenon in Japan now claims tens of thousands of lives worldwide each year, including in Australia. Karoshi victims are usually overworked, overstressed and have a less than enviable work-life balance. After years of all work and no play, they suffer a sudden, fatal heart attack or stroke – often at work. Perth-based doctor and medical commentator Dr Joe Kosterich says working too hard can have serious health implications. "Suffering a heart attack or a stroke is an extreme example of what can happen when you work yourself too hard," he says. In Japan in 2002, 30-year-old father-of-two Kenichi Uchino collapsed in his office and later died of a heart attack. It was 4am and he was into his fourth hour of overtime for that shift. His wife later said he had worked more than 80 hours overtime each month in the previous six months. Over 10,000 people die from overwork each year in Japan alone, according to conservative estimates. It affects workers of all ages and occupations, including middle and upper-level managers. The Japanese government now recognises karoshi as a legal cause of death, and victim's families are entitled to compensation. Karoshi is not just a Japanese phenomenon, with incidents reported in neighbouring Asian nations such as Korea, China and Bangladesh. In 2009, a previously healthy 18-year-old Bangladeshi worker died on the job after clocking up 15-hour days, seven days a week. Supervisors had ignored her earlier complaints of exhaustion. A lack of documentation on Australians dying from overwork suggests that most of us are knocking off in time to beat the grim reaper. Overwork is not a legal cause of death in Australia and so conclusive statistics are difficult to find. However, there is evidence overwork is taking its toll on Australian workers. The family of an Australian man in his forties who died suddenly of a heart attack after working 12-hour days for 18 months believe his death could have been prevented by less demanding work hours. Brain tumour and stroke survivor Barbara Gabogrecan also wonders if working too hard contributed to her illness. As a self-employed business advisor and author she regularly worked from 4am until 6pm with few breaks. "The trouble is when you work for yourself, you generally like what you are doing and it seems necessary to just keep working as long as there is a task to complete," she says. When she suffered a stroke in May this year, her doctor suggested overwork may be to blame. "My doctor said it could be stress, it could be overwork. We still don't know," she says. She has since cut back her working hours and takes life at a more leisurely pace. "When you've been unwell you realise that stopping to smell the roses should be a pretty important part of your life," she says. Australians have the longest working hours in the world and put in an average 6.5 weeks of overtime each year. That's more than most people's annual leave entitlements – which we aren't using either. A recent Robert Walters survey found Australians are least likely to use their annual leave entitlements, with 25 per cent of Australian professionals taking no leave at all. Kosterich says working too much overtime and not taking leave can have serious health implications. He says that regular days off and holidays are an important part of de-stressing. "A lot of the physical symptoms of stress are due to a build up of hormones like cortisol. These are fine in the short term, but with chronic stress they stay in the body for longer. Breaks and holidays immediately shut those systems down and release endorphins," he says. He says that long-term stress has been linked to high blood pressure, heart disease, depression, anxiety or even death. Working more hours might seem necessary to get that report finished or finalise a project, but Kosterich suggests the opposite may be true. "Productivity and performance decline when you don't take breaks, because you can't concentrate as well. You can be just as productive, and much healthier, by working fewer hours and taking breaks," he says. Despite this, many employees commit to hours of overtime for fear of missing out on a promotion or losing their jobs. Sydney-based founder and managing director of Corporate Canary HR Consulting Anne-Marie Orrock says there are "a plethora of excuses why people flog themselves to death", but that employees do have a choice about what work they do and what hours they accept. This is especially true in Australia, where legislation prevents workers being exploited. "People [need to] take responsibility for their own lives and stop blaming their employer for their choice to join the company and choose the line of work they do," she says. Organisations can make employees' work lives less stressful by job sizing so that workloads can be distributed evenly, she says. While downsizing staff and expecting them to do more work can seem like an effective way to cut costs, particularly during uncertain financial times, Orrock says this does not save money in the long term. "It seems like companies would rather absurdly deal with the knock-on effects and costs of turnover, lack of productivity and poor overworked souls [than try to distribute workloads evenly]," she says. She suggests organisations can cut costs without compromising on productivity and overloading staff by processes that can be automated, outsourcing specific roles and hiring contractors for one-off or occasional work. Just killing time Post World War II: Japanese economic boom leads to an increase in working hours and an emphasis on lean production. 1969: A 29-year-old worker in the delivery department of Japan's largest newspaper has a stroke and becomes karoshi's first documented victim. 1980s: Several high-ranking business professionals die suddenly from heart and brain complications. Japanese media picks up on the trend and the phrase "karoshi" enters mainstream use. Meanwhile, karoshi is recognised as an official cause of death. Families are legally entitled to compensation. 1987: The Japanese government begins publishing statistics on karoshi deaths. It reveals that upwards of 10,000 deaths each year are related to overwork. 1990s: Karoshi deaths spike as a financial crisis grips Japan. Employers hire more temporary staff, who can be laid off during tough economic times. Fears of being fired leads these workers to work harder and longer. 2000s: Companies in Japan try to tackle karoshi by limiting allowed overtime hours. Workers continue to put in extra hours from home, or stay in their offices and work through the night with the lights off.