The health of countries and the people within them is often measured by economic activity—particularly productivity—often without an examination of the social costs of that activity. Productivity may have some undesirable side effects, of which the most serious is increasing "workaholism," and the health problems that go with it.

While working their longer hours, Americans have a higher average productivity, a figure derived by dividing the country's gross domestic product (GDP) by the number of people employed. According to CBS: Each U.S. worker produces $63,885 of wealth per year, more than their counterparts in all other countries, the International Labor Organization said in its report. Ireland comes in second at $55,986, ahead of Luxembourg, $55,641; Belgium, $55,235; and France, $54,609. The U.S., according to the report, also beats all 27 nations in the European Union, Japan and Switzerland in the amount of wealth created per hour of work—a second key measure of productivity.

But at what cost?

In Japan they call it "karoshi" and in China it is "guolaosi." As yet there is no word in English for working yourself to death, but as more and more people put in longer hours and suffer more stress there may soon be. Ronald Reagan was wrong, it seems, when he said: "Hard work never killed anyone." Death from overwork is not a new phenomenon in Western countries but it is largely unremarked upon. In 1987, the Japanese ministry of labor acknowledged that it had a problem with death from overwork and began to publish statistics on karoshi. In 2001, the numbers reached a record level with 143 workers dying. Now, death-by-overwork lawsuits are common, with the victims' families demanding compensation payments. In 2002-03, 160 out of 819 claimants received compensation.

Overachieving professionals today are seen as road warriors -- masters of the universe. They work harder, take on endless additional responsibilities and earn a lot more than their counterparts in earlier times, and their numbers are growing. And it is these individuals who bring into clear focus the question of work-life balance.

This concept was first coined in 1986 in reaction to unhealthy choices many Americans were making in favor of work. A hundred years ago, the pundits were forecasting that technology would not only do away with household chores, but provide us with unlimited leisure. That prediction has not come to pass. Instead, the work ethic has been elevated to unprecedented heights, which reinforces the low value and worth attached to family, parenting, and building community amid a radical redefinition of the nature of work.

In the Hidden Brain Drain Task Force study in the December, 2006, issue of Harvard Business Review, authors Sylvia Ann Hewlett and Carolyn Buck Luce outlined their conclusions about American's obsession with work. They state that professionals are working harder than ever and that the 40-hour workweek is a thing of the past. In fact, the 60-hour workweek is commonplace. Hewlett and Luce say 62% of high-earning individuals they studied worked more than 50 hours a week and 35% worked more than 60 hours. Most respondents indicated they worked on average 16 hours a week more than they did five years ago. The study also noted that vacations are shrinking, with 42% reporting they take 10 or fewer vacation days a year, which is less than their entitlement.

In a report entitled, "No-Vacation Nation," for the Center for Economic and Policy Research, authors Rebecca Ray and John Schmitt detail the stark contrast between the United States and the 21 other wealthy nations. They provided the following description of vacation time in America:

"The United States is the only advanced economy in the world that does not guarantee its workers paid vacation. European countries establish legal rights to at least 20 days of paid vacation per year, with legal requirement of 25 and even 30 or more days in some countries. Australia and New Zealand both require employers to grant at least 20 vacation days per year; Canada and Japan mandate at least 10 paid days off. The gap between paid time off in the United States and the rest of the world is even larger if we include legally mandated paid holidays, where the United States offers none, but most of the rest of the world's rich countries offer between five and 13 paid holidays per year.

In the absence of government standards, almost one in four Americans have no paid vacation and no paid holidays. According to government survey data, the average worker in the private sector in the United States receives only about nine days of paid vacation and about six paid holidays per year: less than the minimum legal standard set in the rest of world's rich economies excluding Japan (which guarantees only 10 paid vacation days and requires no paid holidays).

The paid vacation and paid holidays that employers do make available is distributed unequally. According to the same government survey data, lower-wage workers are less likely to have any paid vacation (69 percent) than higher-wage workers are (88 percent). The same is true for part-timers, who are far less likely to have paid vacations (36 percent) than are full-timers (90 percent). The problems of lower-wage and part-time workers are magnified if they are employed in small establishments, where only 70 percent have paid vacations, compared to 86 percent in medium and large establishments.

Even when lower-wage, part-time, and small-business employees do receive paid vacations, they typically receive far fewer paid days off than higher-wage, full-time, employees in larger establishments. For example, the average lower-wage worker (less than $15 per hour) with a vacation benefit received only 10 days of paid vacation per year in 2005, compared to 14 days of paid vacation for higher-wage workers with paid vacations. If we look at all workers ? those who receive paid vacations and those who don't ? the vacation gap between lower-wage and higher-wage workers is even larger: only 7 days for lower-wage workers, compared to 13 days for higher-wage workers."

A 2007 report by the World Tourism Organization reported that even Koreans who work hundreds of more hours per year than Americans average nearly twice the number of paid vacation days.  On the other side of the scale, people in The Netherlands, which has weathered the recession quite well, work hundreds of hours less per year than Americans, and averaged 45 paid days off at one time.

Kathleen E. Christensen, the founder of the Workplace, Work Force and Working Families program at the Alfred P. Sloan Foundation and author of the book Workplace Flexibility: Realigning 20th-Century Jobs for a 21st-Century Workforce, states "Many of these countries have strong labor unions and the workers are more protected than in the U.S." It's ironic that the country with the largest economy and greatest wealth in the world does not require any vacation time for the workers who create the wealth with their labor.  When paid annual and holiday leave is offered, it is less than half of what most other countries receive, and of that almost half of Americans do not use all of their days.

By no means is this workaholic behavior limited to the working and middle classes. In an article in the Wall Street Journal, Robert Frank recounts his experiences with wealthy workaholics: "Last week I had dinner with a billionaire in California. During the two hours I was at his house, he took six cellphone calls, sent 18 emails, and thought up two new business ideas...At the end of dinner he took his last sip of wine and said, "It's so nice to be able to have a relaxing dinner at home." I laughed. He didn't get the joke. But another part of the discussion is how the wealthy view work and leisure. For many of today's rich there is no such thing as "leisure" in the classic sense - work is their play. They don't sit around the polo field or lounge around the country club all day like Old Money. The new rich are perpetual-motion machines - young, driven and always working on the next project."

Frank goes on to say, "In short, Thorstein Veblen's famous "leisure class" has given way to what I call the "workaholic rich." Even when they're sitting by the pool at their beach homes in Palm Beach and the Hamptons, they're tapping away at their laptops and screaming into their cellphones....But this new generation of workaholic wealthy has dramatically changed the classic equation between money and leisure time. As my billionaire friend said after our dinner: "I'm the most relaxed when I'm working."

What is the cost of all this excessive hard work, even if it does contribute to production increases?

An American study, published in Occupational and Environmental Medicine, points out that overtime and extended work schedules are associated with an increased risk of hypertension, cardiovascular disease, fatigue, stress, depression, musculoskeletal disorders, chronic infections, diabetes and other general health complaints. In Japan, most karoshi victims succumb to brain aneurisms, strokes and heart attack.

A new study published in the journal Annals of Internal Medicine, concluded that people who work 11 or more hours a day have a 67 percent higher risk of coronary heart disease than people who work seven or eight hours a day.

To begin the study, British, French and Finnish researchers screened 7,095 civil service workers, ages 39 to 62, who had no signs of coronary heart disease. They were screened initially between 1991 and 1993, and then screened every five years afterward until 2004.

Fifty-four percent of the people worked 7 to 8 hours a day, and 10.4 percent worked 11 or more hours as day.

By the end of the study, 192 people had developed coronary heart disease, the study said.

Researchers found that adding information about the study participants' working hours improved predictions of who would develop coronary heart disease in that 10-year period.

The more hours people worked in a day, the higher their risk of developing coronary heart disease, the results of the study suggested. People who worked 10 hours a day had a 45 percent higher risk of heart disease and those who worked 11 hours a day had a 67 percent higher risk of heart disease than people who worked 7 to 8 hours a day, according to the study.

Next, researchers hope to see whether the association holds true across income levels. It also needs to be determined if working long hours is a causal risk factor for coronary heart disease, or if it's just associated with increased heart disease risk.

Past research also suggests a link between working hours and heart disease risk. A 2010 study published in the journal Heart showed that men who did not regularly exercise had an increased risk of dying from ischemic heart disease if they also worked more than 45 hours a week, compared with men who worked less than 40 hours a week.

While commenting on the worrisome findings, lead researcher Mika Kivimaki from Britain's University College of London, said in a press release that study findings can serve as a wake-up call for people who forget about time once they start working.

"Working long days are associated with a remarkable increase in risk of heart disease. Considering that including a measurement of working hours in a (doctor's) interview is so simple and useful, our research presents a strong case that it should become standard practice," added Kivimaki.

And the cost of workaholism may not be limited just to health; it also impacts the quality of family life.

Catherine Ornstein, a U.S. cultural critic, calls extreme jobs the "American Dream on steroids." No longer is the American dream Ozzie Nelson or Father Knows Best, it's Donald Trump and Survivor in the office tower. Ornstein says that is merely reflective of our culture's embrace of an extreme ethos. Extreme sports, extreme reality shows, and extreme video games -- the list goes on. At the same time, the nature of the work itself has changed.

For many professionals, work is the centre of their social life and friendships. Personal connections, once made exclusively through family, friends and civic organizations, are now made in the workplace. Arlie Hochschild, in The Time Bind writes that home life can become seriously depleted. She says, as homes and families become starved for time, overworked people avoid going home and choose "more attractive" social venues associated with work. For many, home and family become associated with stress and guilt, while work becomes a haven.

In his book, written with Jim Loehr, Tony Schwartz, CEO of The Energy Project, and author of The Power of Full Engagement: Managing Energy, Not Time, Is the Key to High Performance and Personal Renewal, argues that productivity means "managing energy in all facets of our lives. Emotional depth and resilience depend on active engagement with others and with our own feelings."

Schwartz says that the issue is not just the number of hours worked, but what happens to employees' energy, and their use of time off work. Schwartz recently conducted a poll on the Huffington Post about people's experience in the workplace. Sixty per cent of 1200 respondents told us they took less than 20 minutes a day for lunch. Twenty per cent took less than 10 minutes. One quarter said they never left their desks at all. That's consistent with a study by the American Dietetic Association, which found that 75 per cent of office workers eat lunch at their desk at least two to three days a week.

What to conclude? First, it's obvious, the American workplace is out of step with every other advanced nation regarding the allocation of vacation time, legislated holiday time off, and regulation of working hours. Second, the achievements in productivity may have come at a developing culture of workaholism.

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