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Stephen  Bevan

Sickness presence makes the heart grow weaker?

Authors: Stephen Bevan Stephen Bevan

10 October 2012

The 2012 CIPD Survey on Absence Management, published this week raises serious questions about the extent of presenteeism in the UK workforce. Just as an example, a senior manager in a large organisation told us at a recent event that increasing presenteeism shows that his ‘crackdown’ on sickness absence is working. My worry is that this is a commonly held view in some organisations and that as job insecurity is eroded and absence levels decline – as suggested by the CIPD data - presenteeism will increase.

So what is ‘presenteeism’ and why does it matter?

As far as we know, the term ‘presentee’ was first coined by Mark Twain in his book ' The American Claimant’ in 1892. He used it to refer to those people who had turned up for a meal, comparing them favourably with those had not attended. In fact this probably the least interesting feature of the book. Much more noteworthy is that Twain decided that it should contain no descriptive passages about the weather. Instead, all references to the weather were relegated to an appendix. An innovative literary device which I wish some modern writers would emulate. But I digress.

There are several definitions of ‘presenteeism’, but this one will serve for the purposes of this blog:

‘Lost productivity that occurs when employees come to work but performs below par due to any kind of illness’

‘Presenteeism’ or sickness presence is now recognised as a significant phenomenon which has business & health impact. If you want to read a brilliant, though academic, review of the literature on presenteeism you could do worse that read the one written by the excellent Gary Johns in the Journal of Organizational Behavior. What we do know is that presenteeism is costly. Mental health-related presenteeism in the UK, for example, costs £15.1 billion each year. This is 1.5 times as much as absence as it is more common among the higher paid and is more common among people with chronic illness. Presenteeism is, in effect, a big cause of lost work productivity. US research, for example, shows that lost productive time at work among obese or overweight workers costs over $42 billion a year compared with about $12bn among workers of normal weight.

The Work Foundation’s own research on presenteeism – conducted on this topic for AXA PPP Healthcare and (bravely) among their own staff unearthed some interesting findings.

First, we found that sickness presence, or presenteeism, was more prevalent than absence: 45% of employees reported one or more days’ sickness presence compared with 18% reporting sickness absence over the same period. Second, we found that physical health, compared to mental health was a slightly better predictor of days off work, whilst mental health was a slightly better predictor of sickness presence. Third, we found that having a greater number of days at work when unwell – higher sickness presence – was significantly associated with a lower performance rating.

Three factors were statistically significant predictors of sickness presence:

1. Having personal financial difficulties;

2. Work-related stress;

3. Pressure from managers and colleagues to come to work when unwell, especially in an environment where attendance management policies are beginning to ‘bite’.

A big concern, therefore is that employers may be at risk of underestimating employee ill health and missing warning signs by focusing on reducing absence alone. Sickness presence may be detrimental to employee health in the long-run because it can ‘mask’ serious illness. In the famous Whitehall II study of the long-term health of UK Civil Servants, Professor Sir Michael Marmot and his colleagues found that:

‘…an elevated risk of serious coronary heart disease was found for those men with bad self-rated health who did not take any sick days at all compared with those unhealthy men who had a moderate number of sick days (ie, 1–14 days).'

We know that, in some organisations, up to 45% of staff (especially senior people) don’t take any absence at all. Up until now this has been felt to be a virtue or an indicator of commitment. In the current climate – especially where absence is being used to select people for redundancy – it may be more to do with fear of job loss.

So – if your organisation is cracking down on sickness absence, and if your employees also have good reason to feel even a tiny bit less secure in their jobs – be careful what you wish for. Presenteeism, which is far less visible, and is far more difficult to manage, may be eroding your productivity far faster than sickness absence.


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