Working Too Much Seriously Harms Your Health: The American Example

Why do Americans live shorter lives than Europeans, even though they spend far more on healthcare? This is the paradox explored by economists Tanguy Le Fur and Alain Trannoy, who ask: could working time be part of the explanation?

In France, “working more” has become an unavoidable refrain in public debate. Sometimes it is said to boost competitiveness or support growth; at other times, to preserve the balance of the social welfare system. But what is the real cost of this extra effort so many successive governments have called for?
 

In 2019, the United States devoted nearly 17% of its GDP to healthcare, compared with an average of 11% in Western Europe - yet Americans had a shorter life expectancy and a higher prevalence of chronic illnesses. For years, this paradox has fuelled criticism of a system seen as unequal, overly expensive and inefficient.
 

Economists Tanguy Le Fur and Alain Trannoy propose a new explanation. What if the amount of time spent working was damaging Americans’ health? Their economic model shows that beyond a certain threshold, additional working hours become counterproductive: people earn more to pay for healthcare, but their health deteriorates more rapidly. This hypothesis could account for around one-third of the observed health gap between Americans and Europeans.

 

More Expensive Care, but No Better Outcomes

In 2019, before the COVID-19 pandemic, the United States performed poorly on many health indicators. According to the OECD’s Health at a Glance report, out of 38 member countries, the US ranked 29th for life expectancy at birth, 28th at age 65, 29th for avoidable premature deaths, and 35th for the prevalence of chronic diseases.
 

Several factors have been put forward to explain Americans’ poorer health: “deaths of despair”1 , the devastating opioid crisis, obesity, smoking, and inequalities linked to a costly private health insurance system2.
 

However, these poor rankings are not a matter of spending. The US ranks first for resources devoted to healthcare. Since the 1980s, Americans have consistently spent more on health than Europeans, and the gap has widened to six percentage points of GDP today.
 

• 1

   Case A., Deaton A. , 2015, “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century” Proc Nat Acad Sci 112(49):15078–15083

• 2

  Avendano M., Kawachi I., 2014, “Why do Americans have shorter life expectancy and worse health than do people in other high-income countries?” Annu Rev Public Health, 35:307–325

Despite having much greater health expenses, American workers have worse health than their European counterparts. Picture: Karolina Grabowska via Pexels

This is partly because health is considered a “superior good”: as a country grows wealthier, its citizens invest more in healthcare. Another factor is technological progress, which has led to more innovative — but also more expensive — treatments. Yet these explanations do not fully account for the scale of spending across the Atlantic.

The major difference lies in the price of care. In the US, healthcare costs are on average 20% higher than other goods, compared with only 4% in Europe. These prices explain between one and two-thirds of the spending gap between the two continents.3 Aware of this imbalance, President Donald Trump even sought to pressure pharmaceutical companies to lower drug prices in the United States, bringing them closer to European levels.

• 3

  Fonseca R, Langot F, Michaud P-C, Sopraseuth T. , 2023, “Understanding cross-country differences in health status and expenditures: health prices matter”, J Polit Econ, 131(8):1949–1993

Overwork: A Proven Health Risk

While high healthcare costs and social inequalities explain part of the American paradox, they do not tell the whole story. This is why the two researchers examined another factor: working time. 

Americans today work much longer hours than Europeans. According to the OECD, in 2024 the average American employee worked 1,796 hours per year, compared with 1,491 hours in France and 1,512 in the United Kingdom - the equivalent of about 12 additional weeks of full-time work.

This gap did not always exist. Until the early 1980s, Americans and Europeans worked roughly the same number of hours. Their paths diverged thereafter, for several reasons: cultural preferences more favourable to work, a less redistributive and more incentive-driven tax system in the US4, weaker trade unions5, and a social ideal that celebrates overwork — particularly among white-collar workers.

• 4

  Prescott E.C., 2004, “Why do Americans work so much more than Europeans?” Fed Reserve Bank Minneapolis, Q Rev 28(1):2–13

• 5

   Alesina A., Glaeser E., Sacerdote B., 2005, “Work and leisure in the United States and Europe: why so different?”, NBER Macroecon Annu, 20:1–64

Stress at work, working late or on weekends... Overworking has harmful effects on health. Picture: Vitaly Gariev

This intense activity comes at a cost. Numerous studies in public health, epidemiology and the social sciences show that long working hours harm health and contribute to chronic disease. Building on this finding, Le Fur and Trannoy developed an original economic model treating health as a form of capital. They sought to measure how the amount of work performed affects both population health and total healthcare spending. 

They tested several versions of the model, each based on different assumptions about how work and rest influence health. Then, they calibrated it using American data (working hours, health expenditure, life expectancy, and so on) to simulate what would happen if Americans worked as much as the French or the British. 

Their results show that if Americans worked as the French or British do, their healthcare spending would fall by 2 to 3 percentage points of GDP, and their health deficit would shrink by one-third.

Surprisingly, the model also suggests that France and the UK are above the optimal threshold - meaning we are all working too much, to the detriment of our longevity.

As debates continue about the four-day week, remote working, or even the removal of public holidays, this study turns the discussion on its head: perhaps the best public health reform is not to spend more — but simply to work less.

This hypothesis also raises a broader question about how we finance healthcare: should we continue to rely mainly on income from work, or should a greater share come from capital — profits, dividends, and so forth — if working less leads to better health for all?