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“The entire modern deification of survival per se, survival returning to itself, survival naked and abstract, with the denial of any substantive excellence in what survives, except the capacity for more survival still, is surely the strangest intellectual stopping-place ever proposed by one man to another.” — William James*

Imagine a future of work, care, and wellbeing where all humans could not merely survive, but flourish. Take a breath, a step outside the limited horizon of the current moment, and imagine, what if:

• What if work sustained human thriving, health and wellbeing, with equitable, living wages, supportive benefits, and flexible cultures, with opportunities to grow and time for life, love, care, civic engagement, leisure and joy in the hours we spent outside work?
• What if, instead of work-family conflict, we supported and truly valued care and enjoyed work-family enrichment, each part of our lives complementing, not competing, with the other?
• What if technology, rather than as a force to replace workers and send them spiraling ever further down and out of the middle class, made human lives better?
• What if, in a future with perhaps less work to go around, we valued those who can’t or don’t work, because we believed the work you do and what you produce in the economy is only part of who you are or the only way you can enrich and enliven your community and society?
• And what if we measured the economy itself with the metrics that, unlike GDP, reflect that which truly makes life worth living?
• What if we were able to harness the dynamism and creativity that capitalism promises but, rather than focus on profits for a few, we aspired higher, to human and planetary health, purpose, valuing care, and wellbeing?

These are some of questions that �鶹������ý’s Better Life Lab has been grappling with in , podcast conversations, and virtual convenings of community-based organizations, public and private sector leaders, scholars, parents, caregivers, advocates, and dozens of employed and unemployed workers, from a warehouse picker, ride share driver, home care aides and high-tech workers, to nurses, furloughed field managers, lawyers, and many more.

Can a future of work contribute to rather than compromise wellbeing? Knowing that workers, many of whom are already struggling to survive on low wages and precarious contract work, can not and should not absorb any more risk and responsibility, what should we ask of systems—employers, financial institutions, government—in order to improve working conditions and human wellbeing in the future? What does a new “social contract” between workers, the business community and the government look like?

Brittany Williams is a home care aide and member of SEIU 775 who makes $20 an hour, about twice what other home care workers make. Williams says, “I really like my job, because with my union, they give us that sense of stability: we won first-in-the-nation retirement. We won health insurance. We won dental coverage. … They’re saying, ‘Let’s make sure you have protection on the job, that you’re not slipping because your shoes have no grips on them, so let’s make sure we provide you with a free pair of tennis shoes every year. Let’s make sure you have the mental support you need.” Because she lives in Washington State, Willaims has access to the state’s paid sick days, paid family and medical leave and first-in-the-nation long-term care benefits.

We started with what we know: The way we work isn’t working.

• Acute and chronic psychosocial work stress has become so common that, long before the COVID-19 pandemic, work itself was already the fifth leading cause of illness and death in America. That’s why we called our podcast series American Karoshi, after the Japanese term for dying from overwork. It’s largely driven by the increasing power gap between workers and employers.
• Since the mid-1970s, economic factors and business decisions favoring owners, not workers, and a wan public policy response have led to increasing inequality that has hollowed out the middle class and split the workforce into two: high-wage professional workers and low-wage care and service workers, where women and people of color are overrepresented, who often have no control over the unpredictable schedules they’re given that lead to destabilizing income volatility and disorganized time.
• Too many non-college-educated workers are working harder and harder and falling farther and farther behind, fraying trust in institutions, destabilizing democracy and draining the real job creators—not the ultra-wealthy 1 percent or business leaders, but the middle class. A strong middle class is what drives prosperity in an economy where consumer spending accounts for 70 percent of economic growth.
• Businesses increasingly focused on short-term profits for shareholders have squeezed labor, relying on layoffs, outsourcing, forcing all workers, professional and service, to do more with less, or pushing workers into precarious contract and gig work to meet these profit goals.
• The U.S. style of free market “Cowboy Capitalism,” in the words of MIT Economist David Autor, provides little to no protections or supports in law, regulation or public policy—like guaranteed paid time off to give care or rest, affordable child and family care, the right to organize and have a voice—that workers in peer competitive economies see as basic rights.

If current trends continue and the unprecedented gap between rich and poor continues to grow, we’re setting ourselves up for a grotesquely unequal future, as Autor calls it, of “the servers, and the served.” Brigid Schulte calls it “the Blade Runner scenario.” And it may be a uniquely American challenge.

“If I were to be really rich, I would want to be in the U.S., probably. If I didn't think I was going to be so affluent, I would probably want to be somewhere else. Many countries face the same headwinds…[here] there's no expectation of guaranteed health insurance, of paid vacation, sick leave. You might not know your hours a week in advance. You might not know how many hours you're gonna get that week. Those things are much, much more common in the United States than in other high-income countries.” — David Autor, MIT Economist

Then we thought about what we don’t know—yet—about how the future of work and wellbeing will unfold, especially in a U.S. context:

• Automation and advances in technology are expected to destroy millions of jobs, and create millions of new ones. But will these new jobs be “big enough” to support a human life? Or will the gap between high and low wage jobs—and work stress—continue to grow?
• What will future generations expect from work and workplaces? What will a new social contract look like?
• Will there be enough work to go around? And if not, will public policy create a safety net bouncy enough not only to keep people from spiraling into poverty, but to launch them into something better and more stable?
• Can we avoid the Blade Runner scenario and create a better future of work that’s fair and equitable, and makes human health and wellbeing and time for family, care and quality of life a priority? And if so, how do we do it?

We asked that question of the people who know best—workers, organizers, scholars, and employers—convening a community practice focused on a more human, balanced, and equitable future of work. This is the beginning of what needs to be a continuing wide-ranging effort to challenge status quo mindsets and neoliberal economic assumptions about the supremacy of the free market and limited government, surface bright spots, unleash our imaginations and put humans, equity, the value of care and time for dignified life—rather than the “cool” factor of robots and AI—at the center of the future of work and wellbeing conversation. The American Karoshi podcast project and convening and this roadmap form the early stages of a diverse, multi-disciplinary community of practice of various stakeholders who will be key to shaping this better future.

There’s so much we don’t know. But there’s a lot we do. We’ve been here before, at the precipice of major transformation to work, our society and our economy. We’ve risen to the challenge before. The challenge of automation in the agriculture sector at the turn of the 20th century led to unprecedented public investment in high school and led to the most educated workforce on the planet. From the depths of the global depression in the 1930s rose a new social contract, with public support for safety nets for those who fall on hard times and a guarantee of decent work with the first-ever minimum wage rate and the 40-hour work week.

So let’s rise to the challenge again. Here are some of the solutions we’ve started to gather for how to get from here—with rampant inequality and work stress—to a better future of work and wellbeing. Some will have high impact, but require a lot of political will and will be hard to do. Others are small steps that we can begin to take now.

We all agreed: Everyone has a role to play. Policymakers. Business leaders. Workers and advocates. Academics, researchers, and journalists and storytellers. The future of work and wellbeing is not a foregone conclusion. It’s very much a choice. And we can work together to make better choices to build a better, healthier, more equitable future.

The stress is killing us. In Japan, generations of workers have given their all to the code of karoshi. It’s a word that literally means “work till you die.” Few Americans know the word karoshi. We don’t think it happens here. But it does. With work stress and insecurity leading either to acute or long-term chronic ill health, the workplace now ranks as .

“The stressors that are created by modern work are basically ignored in our society, and therefore most people are not aware of what the impact of work is on their health.” — Peter Schnall, Co-Director, Healthy Work Campaign

Wellbeing and economic mobility is only for some. The current structure of work, wages, and care (for self and family) is unpredictable, inequitable, increasingly precarious for workers across industries and sectors and exacerbating the gap between the haves and have-nots. The gap in income and opportunity between those with college educations, able to work in generally good-paying jobs in the knowledge economy, and those without that credential has grown exponentially in recent decades. The old social contract between government, business, and workers that enabled both businesses and workers to thrive is broken and needs to be reimagined.

Work is changing rapidly but our responses to workers’ needs are not. Automation will destroy some jobs and create others, but the fastest growth is among those that are currently the highest and lowest wage jobs. So will all these new jobs be good jobs, “big enough” or good enough to support a worker? The availability of middle skill, middle wage, accessible jobs is shrinking. In fact, technology may result in fewer jobs to go around overall. So with automation, technology, and the knowledge economy driving the widening chasm between the highest and lowest paid workers, will we become an increasingly unequal society of, as MIT economist David Autor writes, “The servers. And the served?” And what role should public policy/the government play in ensuring human wellbeing and flourishing when work isn’t providing the income and stability it once did?”

All jobs need to be better. Yes, counseling people on education, skills, and providing training—“more ways to get to good jobs”—is important. But all jobs should get the basics right: provide safe working conditions, pay living wages, and offer flexible, stable schedules and access to supportive benefits like health care and paid family leave. Beyond that, good jobs require providing workers more autonomy and voice, creating supportive social relationships and cultures at work, right-sizing tasks and providing resources to meet job demands as well as opportunities for growth and advancement that allow not just survival, but thriving and flourishing.

But what drives work stress?

The consequences of work stress are dire, including : making work stress the fifth leading cause of death in the United States.

Why Wellbeing Matters

What could wellbeing for workers mean?

• A more humane, just economy.
• The ability to have more agency—choose work that’s more fulfilling, balance earning opportunities with personal pursuits and time for family, care, and life.
• Better physical, mental and emotional health due to lower stress, stability, and
• access to benefits.
• More work productivity among and earning opportunities for parents and caregivers (especially women).
• More opportunity for non-white workers, reducing the racial wage and wealth gaps.
• More purchasing power for basic needs like safe, quality housing.
• The opportunity to have a say in creating flexible, reasonable, predictable, and stable schedules.
• Business benefits of a more stable, healthy, motivated workforce.
• Societal and economic benefits of a stable, healthy middle class, with opportunity for growth and advancement, purchasing power, and hope for the future.
• Benefits for a democratic society with stable families, engaged citizens with time for civic involvement and trust in institutions.

“The first [key driver of a good job] is fair treatment. And so that includes pay, that includes scheduling, that includes benefits. That is very important..but we’re at an all time high of people quitting right now. And if you actually ask people why they quit, .” — Warren Valdmanis, Author/Partner, Two Sigma Impact

What are the consequences of a lack of wellbeing?

• Stress and a reduced quality of life or physical/mental/emotional illnesses
• Stress-induced ailment, injury or mental health toll/crisis
• Community and civic disenfranchisement
• Loss of spending power/ability to support self or family
• Relationship and family stress, especially for children
• Loss of ability to have or enjoy leisure time
• Loss of joy
• Sense of low impact/meaning in work or contributions
• Leaving the workforce

“So what they produce as care workers, if workers produce things, what they produce is dignity itself. And you have to understand that the jobs are poverty-wage jobs that don’t have benefits, don’t have health care. You are doing a job that is about caring for others and ensuring the well-being, the safety, the health, the dignity of others. But you struggle on poverty wages without any paid time off, paid sick days, paid family medical leave, health insurance or benefits to take care of yourself and your own family. And that is a huge dignity gap. And yet, still, they do the work.” — Ai-Jen Poo, President, National Domestic Workers Alliance

What Are Barriers to a Future of Worker Wellbeing?

What did the workers we spoke to identify as problems and stressors?
We interviewed workers from white collar, blue collar, care and service sector jobs and asked what might make them leave a job if they were financially able to do so. They identified several major stressors.

“To be driving around under a looming threat of a possible car accident without coverage or family leave or medical leave or be accosted based on the color of my skin. There’s no flexibility in those things that I’ve just mentioned. And so this idea of flexibility was actually just a hoax or wasn’t true at all.” — Pastor Cherri Murphy, Rideshare Driver

It’s not an easy fix—curbing the decades-long trend of growing power for owners and shareholders, diminished power for workers, and a lack of accountability for wellbeing in the economy more broadly. It will take multiple sectors and multiple approaches. Some solutions will likely have higher impact, but also require more effort than others. Some may be politically infeasible right now. Still, when we asked employers, scholars, workers, policymakers, and organizers what they believed would change the future of work, they shared their best thinking and calls to action.

“Let’s figure out a way to give every American access to decent health care. And by the way, let’s figure out how to give every American access to some form of child care. Both of those things have the virtue of satisfying our moral sense, but they’re also just cold, hard nosed, economically smart. You know, a single mom who doesn’t have good access to child care is not going to be in the labor force… in 21st century America, we ought to have a safety net that doesn’t look like something out of Dickens.” — Congressman Jim Himes (D-Conn.), Chair of the House Select Committee on Economic Disparity and Fairness in Growth

Note: The following figures capture solutions presented by employers, workers, academics, and advocates participating in a 2022 convening on creating an equitable future of work and wellbeing. We asked each participant to discuss the solutions they thought might: (1) have the greatest impact or spur the greatest change, and (2) require the least or most effort. These collective suggestions of impact and effort are reflected below.

Thank you to all the interviewees for the American Karoshi podcast, both on air and off, including Joe Liebman, Jeremy Al-Haj, Brittany Williams, Danielle Williams, Nahsis Davis, Pastor Cherri Murphy, Zeynap Ton, Congressman Jim Himes, Ai-Jen Poo, David Autor, Michael Tubbs, Peter Schnall, Marnie Dobson, Adia Harvey Wingfield, John Summers, Cate Lindeman, Kiarica Shields, Quan Mai, Scott Shieman, Warren Valdmanis, Mark Attico, Roxanne Felig, Ashley Nixon, Sarah Damaske, Dorian Warren, Maddie Swenson, Kari McCracken, Theresa Boyle, Beth Gutelius, Erin Kelly, LeRon Barton, Natalie Foster, Adrian Ugalde, Michelle Holder, Francisco Diez, Sarika Abbi, Carol Graham, Tammy Allen, Paul Glavin, Paul Spector, Tahira Probst, Mindy Bergman, Amanda Lenhart, and Roger Kerson.

We are also grateful to participants in and contributors to our virtual convenings including Brittany Williams, Mark Attico, Jackie Dabo (Cambridge RISE), Pastor Cherri Murphy, Misty Bell Stiers, Paul Tarini (Robert Wood Johnson Foundation), Sarita Gupta (Ford Foundation), Livia Lam (Ford Foundation), Shannon Grimes (Pivotal Ventures), David Autor (Author/MIT), Peter Schnall (Healthy Work Campaign), Francisco Diez (Center for Popular Democracy), Adia Harvey Wingfield (Author/Washington University), John Summers (author/�鶹������ý Research Fellow), Cate Lindeman, Karla Lopez-Owens, Danielle Williams, Kiarica Schields, Kari McCracken, Emily Bouch West (Amazon), Megan Cornelius, Lucas Muñoz (Lyft), Alix Gould-Werth (Washington Center for Equitable Growth), Kathryn Zickuhr (Washington Center for Equitable Growth), Amanda Silver (Good Jobs Fellow), and Chirag Mehta (Community Change), Madeline Neighly (Economic Security Project), Shelly Steward (Aspen Institute), Sarah Smith (Deloitte).

An enormous thanks to David Schulman, producer of the Better Life Lab podcast.

Thanks also to Haley Swenson, Vicki Shabo, Shalin Jyotishi, Taylor White, Autumn McDonald, Elizabeth Garlow, and all of our Better Life Lab and �鶹������ý colleagues for their thought partnership in this work.

Thanks also to our partners at Slate, including Torie Bosch, editor of Future Tense, and Alica Montgomery, executive producer, podcasts, for all her help in shaping and shepherding the podcast through the production phase and getting it out in the world.

Note: The opening quote by William James was suggested by podcast and convening participant John Summers.

Support for the podcast, convening, and this publication was provided by a grant from the Robert Wood Johnson Foundation. We are grateful for the Foundation’s support and for the Foundation’s commitment to improving health and health equity in the United States. For more information, visit .