Health Promotion & Productivity

It is a rare instance when what will benefit employees (EE) also will benefit employers (ER). This happy union occurs, as recent research has found, when preventive health programs preempt the onset of disease or control disease symptoms, to the benefit of EE and ER alike.

A growing body of evidence has linked worker productivity with worker health. Of particular importance is the recognition that many common chronic illnesses which, when poorly treated, have a profound effect on a worker's ability to either attend to his/her work or to actually be present for the work itself (i.e. loss of work days). It should then be the objective of a company to increase productivity through specific health promotional activities.

It goes without saying that the smaller the company, the greater the impact of any work lost to illness by any individual. Regardless of how cross-trained the workforce, there must be some productivity loss, unless management has built in redundancy of labor, which translates to excess productive capacity, (and that, by itself, represents a loss of productivity). This is most common when the company employs its workers in an overtime capacity.

Implementing a pro-active preventive health policy requires the recognition of specific disease entities that have been demonstrated to affect attendance at and attentiveness to work. Ten of these have been identified: allergy, asthma, breast cancer, depression, diabetes, heart disease, hepatitis, high risk pregnancy, hypertension and other acute and chronic respiratory diseases. Additionally, common migraine has been identified as a major cause of lost productivity (1.)

Types of Productivity Loss

Before identifying those diseases that are most likely to reduce productivity, we should first define what constitutes productivity.

The accountant will define productivity as the value of widgets made by a worker in a given amount of time times the selling price. Any deviation either above or below expected productivity is defined as an increased or decreased productivity, (i.e. widgets/unit time). Illness can upset this definition by either preventing the job from being done, (Absenteeism) or by slowing down the capacity of that worker from making the expected "quota" for that product.

The latter instance is illustrated by an employee (EE) suffering from seasonal allergies who because of a runny nose, itchy eyes and clogged hearing, must slow down his/her output. Similarly, if the EE uses over the counter (OTC) antihistamines, which are usually sedating, this will also slow the widget production. Additionally, an EE who is working in an inattentive manner runs a higher risk of an on the job injury.

We designate this last type of loss of productivity as being due to "Presenteeism". Presenteeism is the condition in which the worker is physically at the job, but for varying reasons, cannot maintain production goals. Kooperman et al. (2), at Stanford University have created a scale that detects presenteeism. This scale can be self-administered and graded for the psychometric characteristics one would find in "presenteeism". Like the SF-36, (a symptom pain index) it presents a 34 question survey which when graded will predict who is likely to fall into the presenteeism category. The researchers have pared this down to a six question survey, which is currently being validity tested.

Research has been done to define the causes of productivity loss. Goetzel et al. examined the presence of mental health problems in industry as a major cause of productivity loss. They found that depression was an especially keen predictor for increased productivity loss (4). Dewa, Goering, et al (3), found that depression was associated with a high degree of short-term disability (STD).

This disability was more prevalent in females than in males. But in examining return-to-work data, women were more likely to return to work than men.

These findings suggest that companies should mine their health information databases to see what afflicts their particular workforce. Those most prominent conditions can be targeted for pro-active intervention via health fairs or voluntary anonymous screening with appropriate Employee Assistance Programs (EAP) referral. Both these methods have proven effective in lowering both absenteeism and presenteeism.

Remedies for Causes of Productivity Disruption:

When we have determined the most intrusive of illnesses or conditions affecting a specific work population, the control of those illnesses should then be the goal of the pro-active human resources department. If allergy medication is found to be a major cause of presenteeism, then the cost of non-sedating antihistamines (NSA) should be contemplated even if the cost to the health plan is much higher. The reason, the 3:1 return on the dollars invested (5). If the company will earn three dollars for every dollar invested to prevent sleepiness, inattentiveness or injuries due to these conditions, then there is a clear motivation for instituting the use of a more expensive, but less sedating medication in the prescribed formulary for the company drug plan.

For migraine too, appropriate diagnosis and treatment will result in reduced incidence of presenteeism - induced productivity loss. Presenteeism is high among migraine sufferers because this population tends to show up at work even if they have a headache. Their reasoning is that if they stayed at home for every headache, they would never hold down a job. Control of symptoms in this conditiondisease is crucial because of the obvious productivity gains that can be made. The proactive ER might have a newsletter that would introduce these EE's to newer, more effective medication are constantly entering the marketplace, empowering them with information to present to their physicians.

Further, by means of the SF-36 psychometric screen, a person's self-assessment of his own health can be used as a comparative measure in month-to-month comparisons. This can be used to follow the progress of the interventions used to treat any of the above conditions or any other intervention among the ten most common conditions.

One must be very cautious not to impose or give the impression of imposing medical care by fiat. This is unsupportable by ethics and law. However, if the workforce can be educated as to the risks of the non- or partial treatment of the above conditions, then the road is clear for the remediation of the most common conditions that will cause increases in absenteeism and presenteeism.

Clearly, this is not just an issue of "Industry" getting the most out of its workers. If the workforce is healthy, then productivity will be at its highest and the fact that the company benefits from this is a happy merging of health priorities and company priorities.

Sources
1. Burton, W; Conti, D et al: "The economic burden of lost productivity due to migraine headache: a specific workplace analysis, JOEM Vol.44, 6,6,2002

2. Koopman, C; Pelletier, KR et al, Stanford presenteeism scale: health status and employee productivity. JOEM 2002 Jan; 44(1): 14-20

3. Dewa, C; Goering, P et al: "Depression-related short term disability in an employed population. JOEM 44, 7,7,2002

4. Goetzel, R; Ozimikowski, R; "The business case for quality mental health services: why employers should care about the mental health and well-being of their employees. JOEM 44, 4, 4, 2002

5. Howell, S: Improved allergy treatment could increase productivity in the workplace, experts say. Insight and Outcomes.com. Fall 2000

Member, American College Of Occupational Aand Environmental Medicine
Diplomate, American Board Of Family Practice