Urbanization, Overwork, and Occupational Death: A Scoping Review of Karoshi Syndrome and Japan’s Policy Response
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Abstract
Introduction: Karoshi syndrome, often known as “death by overwork”, became a public health concern in Japan during the 1980s. Since then, Japan has pioneered efforts to address Karoshi by implementing legislative and institutional measures. Karoshi has since become a global issue, with an estimated 750,000 deaths attributed to it worldwide. At the same time, rapid urbanization has introduced new environmental stressors that could exacerbate work-related stress and increase cardiovascular risk. This scoping review aims to investigate the link between urbanization and Karoshi syndrome and assess Japan’s policy responses as potential global prevention models.
Method: Following the PRISMA-ScR guidelines, Embase and MEDLINE were searched. Based on the inclusion criteria, a total of 55 studies were included.
Result: The most frequently reported occupational risk factors for Karoshi included long working hours, high job strain, and smoking. The most frequently reported urbanization-related contributors associated with cardiovascular diseases were air pollution, traffic-related exposure, noise and light pollution, population density, and poor housing conditions. While no study has yet confirmed a direct link between urbanization and Karoshi syndrome, these findings indicate that urban environments might increase work-related stress and cardiovascular risk. The Karoshi Prevention Act (2014) and the 2015 Basic Principles for Preventing Overwork-Related Deaths were Japan's most frequently cited national initiatives. These measures formalized Karoshi as a preventable occupational condition and introduced systems for monitoring, compensation, and raising public awareness. Additionally, Japan introduced new criteria for recognizing Karoshi cases, resulting in a 2.81-fold increase in official recognition and compensation.
Conclusion: Urbanization may contribute to the risk of Karoshi by exposing individuals to various environmental and psychosocial stressors. Coordinated policy initiatives and preventive strategies are vital for reducing these effects globally.
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