Keynote Address:
International Business Travel and Stress: Common Ground for the Individual and the Organization
April 27, 2000

Bernhard H. Liese MD, MPH, Senior Advisor, Human Development, Africa Region, The World Bank (Former Medical Director, World Bank)

Good morning ladies and gentlemen and welcome to the World Bank.

It is a pleasure to see so many of you who came from various parts of this globe representing a multitude of professional backgrounds and outlooks, occupational health specialists, managers, corporate medical directors and researchers. Last but not least journalists who are interested in the topic. We consider this symposium an experiment in which we invite all of you to participate, an experiment which will allow us to share views, ideas, perceptions, observations about what one could call the "psychosocial dimensions" of modern business travel. Which is a largely uncharted field. There is a key question for us all to consider during the next two days: Is there a chronic stress syndrome due to frequent travel?

One of the premier newspapers in this country, The New York Times, had in 1998 a special issue on business travel. It identified "a new class of nomads," the business class traveler, which was described as "an elite of glazed nomads with all their needs catered to except those that really matter."

Travel: isn't it enriching, isn't it wonderful to see different lands, to experience new people, to become familiar with different cultures? Many people view travel as an opportunity, see it as a privilege. Here in the Bank, we are world class travelers with more than a quarter of a million days on the road each year. The popular view is that travel is a good thing, that it relieves stress, that it gets our colleagues out of the office routine, that it allows us to work in less bureaucratic ways.

These days it is topical to talk about globalization. But in this particular context, dealing with the psychosocial dimensions of "travel", we actually need to understand the effects of globalization. Change and complexity are the signs of our time. Rapid growth, international trade, the communications revolution, have eroded national borders, facilitating the transfer of goods, services, of people, ideas, values and even lifestyle from one country to another. This new shape of the world is clearly reflected in the travel field. In fact, travel is now the largest industry in many countries, soon to be in the U.S. This is a phenomenon that would have been unimaginable thirty years ago. The spectacular growth in travel of the last two decades has been due to peace, prosperity and a seemingly unstoppable increase in the number of travelers—leisure travelers and business travelers. I just want to give a few figures to illustrate that.

Airplane passengers are now more than half a billion, nearly six hundred million a year. Revenue passenger miles—a popular measurement in the industry—have increased to 1.8 trillion in 1999 tripling in two decades. But closer to home, most of you might have arrived at Dulles Airport. Washington Dulles International Airport is the centerpiece of Northern Virginia's surging technology based economy. It grew faster than any other airport in the world. It grew an unbelievable 26 per cent last year but other airports have experienced similar passenger growth. Frankfurt and Seoul have grown 13 per cent. Close to a trillion dollars was spent last year on hotel and infrastructure worldwide to accommodate travelers. In this global economy, there are as well new abstract forms of currencies that have emerged which are not national currencies anymore. You know them well. These are currencies which are actually minted out of the thin air that passenger planes fly through. They are called frequent flyer miles.

I don't want to go into the communications revolution that has made globalization possible. But just to mention that 15 years ago in the airport you met business travelers who were looking around at people walking past. Today business travelers look at their laptop and only at their laptop or if they look around they look where they can plug in the laptop.

Globalization per se is not a new phenomenon. Since time immemorial the force of trade and migration have bound together persons from distant places but what is new is the "pace and intensity of integration." Leading scholars of globalization have stated that this pace and intensity of integration have lead to a "revolution that has virtually annihilated time and distance." Great, one would spontaneously say, but what is the impact of all of this on our own busy travelers.

Since by now you have noticed that my preferred windows to scientific information are the newspapers, let me read to you a quotation that was in The Washington Post, just a week ago.

The writer says, "My wife is an economist at the State Department. She frequently travels overseas, often for two to three weeks at a time. Sometimes the travel time alone is 24 or 36 hours, often occurring over the weekend. She has a new supervisor, and he is requiring her to come to work at 8 a.m. the day after she returns from these trips. He told her if she comes to work at noon, he will dock her for comp time—he gives her no credit for the long hours and travel time that far exceed a regular workweek during her trips. How can the federal government get away with this nonsense? This is causing a hardship for our family. I'm a teacher, and we have two young children. I'm proud of her and support her in what she does, but these long trips are stressful for all of us. So many things need to be done on the home front while she's gone. In previous jobs, she was allowed to take off a day to recover from a trip. Now she is expected to immediately return to work. She's been getting sick more often and so have the rest of us."

It doesn't sound as if the "questioner" is excited that time and distance have been virtually annihilated. It sounds more that he laments that the new border-less economy which has created this "new class of glazed nomads"—business men and women who have to live everywhere at once, who can be anywhere tomorrow, who can be reached nearly everywhere via e-mail or phone. And who have to be in the office the next day as if they had never left.

For these on the move, the business travelers, these nomads, these new breed, globalization is a very personal experience. It takes root "in the stomach and in the heart" and the pain takes also root in the very center of their support system—the family.

We here in the Bank came about this phenomenon when we looked at medical insurance claims associated with international business travel our own staff had filed. In the year which we studied, operational staff of the World Bank went on about 18,000 international business trips and logged a bit more than a quarter of a million person days on mission usually to destinations in Asia, Africa and Latin America.

We wanted to find out whether the staff of the World Bank experienced more disease due to work-related travel comparing travelers and non-travelers.

The result of this study actually is what triggered this symposium. We found the expected. A linear increase with frequency of travel of the typical travel related diseases of the upper respiratory tract, infectious diseases, skin disorders, diseases and conditions which have been reported widely in the literature, and conditions for which we prepare our travelers well with vaccinations, and advice.

What we hadn't expected at all was the dramatic increase in psychological disorders. Psychological disorders increased linearly with the number of missions traveled. For men the ratio tripled with two or more missions. For women the same pattern was found but the increase was less. The increase in stress-related psychological disorders were similar in men and women who traveled four or more missions a year and were almost three times those of non-travelers. The disorders that we found are described as situational disorders, anxiety, acute reaction to stress, adjustments disorders.

Let's keep in mind here that we are talking about claims filed for visits with a mental health provider. That means staff members went to see a physician, a psychologist or a psychiatrist.

If we take into consideration the culture and nationality of our staff—only 30 per cent are from the US and Canada, the remainder are European, Asian, African or from Latin America— the finding becomes more significant. While it is most common here in the United States to occasionally visit a psychologist or even have a family psychologist it takes a long time for a European to make up their mind to seek treatment from a psychologist and it takes an extraordinarily long time and a high degree of suffering for an Asian colleague to do so.

We checked the literature but there was not much published about this phenomenon so we followed up and developed a travel survey. We asked our colleagues "what's going on?"

Our colleagues responded with a sobering account of what travel means. While all of them were highly committed to their work and derived satisfaction in their ability to work with clients abroad, nearly everybody complained about the high work pressures. While on mission travelers work on weekends, they sit at the computers in the evenings and before they fall asleep they worry what happens in the office. Many find on return to the office that everything is waiting on the desk and they find the workload close to unmanageable.

Although isolation from the family came up as a major issue. It seems that the sturdy business traveler with a slight "macho appeal" has a much stronger attachment to "home" than is commonly assumed. Those people who sit in the airports staring at their laptops actually miss the family. To balance work and family life for many of them has become a very serious issue. Interestingly, jetlag per se did not seem to be a key factor. Comparing travelers who traveled within one time zone with travelers who go across several time zones, the complaints were not very different and it seems that the ones who were most concerned about jetlag were also the ones who reported the highest degree of stress.

One of the few studies, which examined similar issues, has been undertaken by Hyatt Hotels. It found similar patterns. People like to travel but they are worried about work not getting done back at the office, being away from home and they identify that as major sources of stress.

Ironically, the hardest part of business travel seems to be coming home. One could call it a "travel hangover". I have recently, after ten years in the more sedate-area of occupational health, rejoined this workforce of nomads. I have rejoined the ranks of operational travelers. When one comes back from Asia - in the morning, slightly tired, jetlagged, one is a bit grumpy. The mail is all sitting there unopened, and I have to pay the bills, in the house things that have fallen apart and need fixing are waiting for repair. There is a friendly question of how things were on the mission. But, there is a limited interest in what happened out there because life has been going on here in Washington. And the children are center stage. I have a cup of coffee, I go to the basement, switch on the computer. There are 450 e-mails or more waiting for me. That's the glamorous life of a traveler

The chronic stress, which the individual business traveler experiences is slowly becoming more visible. Studies are emerging. Lynn Rogers and Jonathan Reed (who are here with us) are doing excellent work and many stories are traded.

But what about the family? Those who have securely remained at home. Is there also an increase in stress, is there also an increase in claims for psychological disorders or does this phenomenon not affect the family?

We have studied this and the preliminary results are just in. I can summarize the results in one line. The business travelers experience, the increase in psychological disorders is mirrored—let me repeat it—is mirrored in the family. The bottom line, this phenomenon does not only affect the traveler, it affects the household. And if it affects the traveler, if it affects the household, it is very likely, almost certain, that it affects the workplace.

To our knowledge, there is no study on the psychosocial effects of frequent travel on the family and the workplace.

I said earlier this symposium is an experiment, one step forward to clarify the effects of chronic travel related stress, for the individual traveler, for the family and for the workplace.

We need to address several key questions during this symposium:

1. What is travel stress and what are the implications for the individual employee?
2. How is health risk described and understood?
3. Why should work organizations be concerned with the stress and health risks to employees who travel?
4. Who is responsible for the good health and functioning of traveling employees and what are the best ways to promote this?

Let me close with a word on corporate responsibilities. The nation state has set work standards and regulated work for such professions as airline pilots and air-traffic controllers. But it can't regulate work for the business traveler, particularly in a world where many of these companies are multinational.

It is often said that the "ungrounded bodies" of business travelers do not know anymore where they belong. I think that travelers know clearly where they belong. They belong to their families and they belong to corporations, at least many of them do.

Surely many private corporations are accountable to their shareholders, but they are also fully accountable to their most valuable resource—their staff—whose welfare and productivity has important repercussions on the shareholders. In other words, the impact of travel on staff and how it is managed has important implications for the bottom line. We invite the corporate actors to seriously address these issues.

Thank you very much.

Disclaimer: These Proceedings have been produced from transcripts made from audio tapes. Efforts were made to check the accuracy of information with the various authors, but this accuracy is not guaranteed. If there is information that you believe requires correction, please send a message to our e-mail address.