Policy changes for preventing and recognizing overwork‐related cardiovascular diseases in Taiwan: An overview

Abstract

Objective Overwork‐related cardiovascular and cerebrovascular disease (CVD) has a large impact on workers' rights and labor standards across East Asian countries. This article describes the background and impact of policies regarding overwork‐related CVD in the past decades in Taiwan. Methods We reviewed government policies, guidelines, literature, and news addressing the problems and impact of policy changes to prevent and recognize overwork‐related CVD since the 1990s, and collected data on overwork‐related CVD cases in Taiwan from 2006 to 2017. Results In 2017, overwork‐related CVD accounted for 13% of all cases of occupational diseases, but 79% of all deaths due to occupational diseases. Guidelines for recognizing overwork‐related CVD cases were established in 1991; however, under‐recognition exists in Taiwan due to poor exposure data on working hours and psychological factors and because most medical expenses are covered by the national health insurance system. Amendments on the guidelines, and stricter policies on overwork prevention were enforced following calls from labor unions, nongovernmental organizations, and legislators, but health disparities were introduced when certain industries were exempted from restrictions. Conclusions Long working hours and other work characteristics increase the risk of overwork‐related CVD. By reviewing the changes in policy for preventing overwork and recognizing overwork‐related disease, we identified the need for clearly defined guidance on evaluating overwork‐related CVD, with specific criteria for working hours and other risk factors regarding work characteristics. National policies that lead to better working conditions and prevent overwork‐related diseases must be developed.

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“…The ways the labor insurance authorities handled such disputes ignited public criticisms. Finally, these workers’ family members turned to legislators for help, pushing the governments to revise their policies and regulations concerning overwork [ 6 ]. In response to societal concerns, the Taiwanese government has modified both the policies for workers’ compensation benefits and the prevention policies for overwork [ 6 ].…”

Preventing overwork‐related deaths and disorders—needs of continuous and multi‐faceted efforts

“…However, researchers suggest that a major issue remains in small‐ and medium‐sized companies, which is also an issue in Japan . Chang and Lin reviewed the background, revision, and impact of policy changes regarding overwork‐related CVD in Taiwan and found there were difficulties in implementing effective measures nationwide …”

“…There is room for interventions focused on working hours. Articles in this issue of J Occup Health suggest several countermeasures along with legislation to regulate overtime by setting a limit . One suggested measure is introducing a minimum daily rest period to facilitate recovery from occupational fatigue and ensure workers get sufficient sleep.…”

“…2 Chang and Lin reviewed the background, revision, and impact of policy changes regarding overwork-related CVD in Taiwan and found there were difficulties in implementing effective measures nationwide. 3 Karoshi was first recognized as a social problem in Japan as early as the second half of the 1980s, however, scientific evidence regarding the prospective relationship between long working hours and CVD has only accumulate recently. Meta-analyses based on pooled data from European cohort studies, which included unpublished research, provided the most robust evidence related to the research question.…”

“…Articles in this issue of J Occup Health suggest several countermeasures along with legislation to regulate overtime by setting a limit. [1][2][3] One suggested measure is introducing a minimum daily rest period to facilitate recovery from occupational fatigue and ensure workers get sufficient sleep. However, karoshi and karojisatsu cannot be prevented by decreasing working hours alone.…”