Work and life: balancing or integrating?

Do you live to work or work to live? It is great if you enjoy your work (most of the time) and particularly if, as most health professionals do, it is benefiting others.   

A healthy work-life balance (WLB) is defined by the United Kingdom (UK)-based Mental Health Foundation as meeting work deadlines while still having time for a social life, hobbies, good diet, and adequate sleep.[1] Philanthropic factory-owner Robert Owen, who campaigned for better working conditions during the Industrial Revolution in 19th century England, advocated for a day to consist of eight hours each of labour, recreation and rest, in an era when men, women and children were expected to work for between ten to sixteen hours a day, six days a week.  A century later, Henry Ford introduced the five-day, 40-hour work week in his car manufactories, which was subsequently adopted in many industries and in certain countries.  

However, many surveys demonstrate that people across the professions work more than forty hours a week in the 21stcentury. This is despite evidence that productivity decreases significantly after fifty hours, while stress, tiredness, accidents, errors, and poor health increase.[2]  Technological advances including the internet and smart phones mean that employees rarely disconnect from work pressures. In addition, the covid-19 pandemic has further distorted the boundaries between work and home for many. 

The term work-life balance first appeared in the 1960-70s in the UK when working mothers were entering the workforce in greater numbers.[3] This led to a focus on family life specifically with research on work-family balance and recognition of the heterogeneity of groups of workers.[4]  Contemporary research on WLB includes flexible work arrangements, gender differences, work-life interface, and WLB policies and practices.[5]

The medical, health and academic professions are notorious for their long hours.   Doctors’ being available around the clock has been seen as a sign of altruism. A New York Times cigarette advert in the 1950s with a picture of a man in a white coat reads ‘He’s one of the busiest men in town.  While his door may say Office hours 2 to 4, he’s actually on-call 24 hours a day. The doctor is a scientist … a friendly, sympathetic human being, all in one, no matter how long and hard his schedule.’[6]  However, tired health professionals are affecting their own health as well as risking their patients’ care.  Health professionals may be working fewer hours than they did 60 years ago, but the hours they do work are likely to be busier and more intense.  This has been particularly the case during the Covid pandemic. 

Self-care is a topic included in many professionalism courses for health professional students and postgraduates.   The content typically includes mindfulness, resilience training and the importance of WLB.   This individual maintenance of good health may not be so simple in a practical sense;  and the onus should not be placed solely on the employee.  In her observation of graduates applying for jobs in corporate America, Gershon argues that individuals are now expected to feel a sense of drive ‘to prioritise work over all other obligations’.[7] This prioritisation is where the boundary between professional and personal life blurs.  

WLB is typically about keeping one’s work and personal lives separate whereas the more recent term, work-life integration, implies that there is no distinction between the two: blending rather than blurring.  This surely comes down to semantics.  Work is part of life but the ‘life’ in WLB is referring to life outside work.  The University of California, Berkeley, defines work-life integration as an approach that ‘creates more synergies between all areas that define ‘life’: work, home/family, community, personal well-being and health.’[8]   Sounds great but how this can be achieved is open to question. It is as likely to be possible as WLB is to achieve for the many people globally who are working more than those 40 hours of the ‘working week’ for their family and themselves to survive. 


[2] Penceval JH.  Diminishing returns at work: the consequence of long working hours. Oxford: Oxford University Press, 2018.

[3] Thilagavathy S, Geetha SN. Work-life balance -a systematic review. Vilakshan – XIMB Journal of Management 2021;  early online.

[4] Gragnano A, Simbula S, Miglioretti M.  Work-life balance: weighing the importance of work-family and work-health balance. Int J Environ Public Health 2020; 17:907.

[5] Rashmi K, Kataria A. Work-life balance: a systematic literature review and bibliometric analysis.  Int J Sociology and Social Practice 2021; early online


[7] Gershon I. Down and Out in the New Economy: how people find (or don’t find) work today. University of Chicago Press, 2017.


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