Here in body, absent in productivity

Presenteeism hurts output, quality of work-life and employee health

Absenteeism has caught the attention of many employers. It’s on the rise, costly, and one of the most widely measured indicators of a healthy organization.

In the growing field of health and productivity management, there are many health and wellness programs designed to cut absenteeism. But this focus on absenteeism gives a woefully inadequate picture of the relationship between employee health, work-life quality and workplace productivity. This largely stems from the flawed assumption that when people are at work they are being productive.

When people show up for work sick, injured, stressed or burned-out there is a drain on productivity. This is the problem of presenteeism.

Trying to measure and understand presenteeism has quickly become one of the biggest challenges in the field of workplace health research.

This was abundantly clear at the recent Health, Work and Wellness Conference in Lake Louise, Alta. ( I was frequently asked: What is presenteeism, how widespread is it, and how do we address it through healthy workplace strategies?

Digging into this emerging area of research, we can begin to answer these questions.

What is presenteeism?

Presenteeism refers to two quite different employee behaviours.

First, presenteeism can mean putting in excessive work hours as a perverse expression of commitment or a way of coping with nagging job insecurity.

Cary Cooper, professor of organizational psychology and health at Manchester University in the United Kingdom, is credited with coining the term presenteeism to describe the overwork and feelings of job insecurity resulting from downsizing and restructuring in the 1990s.

According to Cooper, “The phenomenon of ‘presenteeism,’ an overwhelming need to put in more hours or, at the very least, appear to be working very long hours, is another dangerous symptom of the explosive degree of pressure in the workplace.”

Second, presenteeism also describes employees going to work sick or injured. This is a growing concern among employers in the United States, in particular. AON Consulting describes presenteeism as “a relatively new term used to describe workers who remain on the job but who are not as productive as usual due to stress, depression, injury, illness or something as simple as a migraine headache.”

Norman Clemens, chair of the American Psychiatric Association’s committee on business relationships, calls this form of presenteeism “a new catchword for an old problem” — people not performing as well as they could because of mental or physical illness.

In 1999, the Employers Health Coalition of Tampa, Fla. analyzed 17 diseases and found that lost productivity from presenteeism was 7.5 times greater than productivity loss from absenteeism. For specific problems, like allergies, arthritis, heart disease, hypertension, migraines, and neck or back pain, the ratio was more than 15 to 1.

Looking just at asthma and allergies, a study of 4,300 employees in one U.S. organization measured lost work hours when asthma or allergies were worse than usual. The researchers recorded three types of lost time: full days missed, part days missed and lost productivity while at work. Presenteeism accounted for the largest share of total lost hours, especially for persons with allergies.

Migraines are also a source of presenteeism. The Web site notes that after a migraine attack, an employee’s productivity may drop for several days.

The first attempt, this year, to estimate the lost work time from these sorts of common health conditions in the U.S. put the figure at (US) $250 billion annually, with two-thirds resulting from presenteeism.


The World Health Organization predicts mental illness will become a leading global problem, second only to heart disease. Depression and other mental and emotional conditions can be caused, or made worse, by workplace and job conditions.

And there is growing evidence linking mental illness to decreased productivity.

One U.S. study found depressed workers averaged 1.8 hours of unproductive time in a regular eight-hour day.

A Yale university research team offers perhaps the most definitive view of depression and presenteeism in a study published in the May 2001 issue of the American Journal of Psychiatry.

Tracking employees in three major U.S. corporations during a two-year period, researchers found employees with chronic symptoms of depression reported twice as many missed workdays but were also seven times more likely to report a decrease in workplace effectiveness. Benjamin Druss, the lead author of the study, concluded “previous reports of absenteeism may represent only a small fraction of the costs of depression in the workplace.”

Work-life conflict

Presenteeism also has been identified in studies of work-life balance. In a 2001 study of work-life balance in Canada, Linda Duxbury from the University of Ottawa and the University of Western Ontario’s Chris Higgins, found high work-life conflict often caused people to go to work when unwell. More than four out of five employees with high work-family conflict reported doing so, significantly higher than other employees.

The Duxbury-Higgins research also underscores how work-life conflict is highly correlated with stress, burnout and depressed mood and therefore, presenteeism. Depression in the workplace may result from unsupportive supervision, job pressures, lack of flexibility and generally unhealthy conditions.

While it’s known for certain presenteeism exists, its causes require investigation. It’s unclear how much depression in the workplace is due to prior mental health conditions, is caused by stressful working conditions or results from some combination of these factors. Until this question is answered, it will be impossible to determine how unhealthy working conditions contribute to presenteeism.

Workload and presenteeism

A study I conducted in a large public-sector organization reveals strong links between workload, unhealthy working conditions and presenteeism.

The survey of non-supervisory employees in a provincial social services department, documented the extent of presenteeism and the reasons for it. The survey asked employees to report absenteeism during the prior 12 months.

Absenteeism in the department was double the provincial average. This was a unionized workforce and the collective agreement permitted two days sick leave per month. Some workers took these days as mental health days. They needed to: 43 per cent of all absenteeism was attributed to job stress.

The survey also asked: “During the past 12 months, how many days did you work despite an illness or injury because you felt you had to?” The typical employee went to work 6.7 days when ill or injured in the 12 months prior to the survey because they felt they had to. When asked the main reasons for this, the three most commonly cited reasons were: not wanting to fall behind, heavy workloads or caseloads, and a commitment and feeling of responsibility to clients.

This was a stressed-out, over-worked group of employees who exhibited multiple signs of poor physical and mental health — much of which could be attributed to the cumulative impact of working conditions. So it is not surprising that presenteeism was high, with roughly one day of presenteeism for every two days of absenteeism.

Lacking national benchmark data on presenteeism, there is no way of knowing whether this ratio accurately describes other similar organizations.


Given the different types of presenteeism and the range of causes, a menu of solutions must be considered.

A first step is to diagnose the problem in your organization. Add a question on self-reported presenteeism to existing employee surveys. Also ask employees to state their reasons for presenteeism.

Beyond this, health experts are advising employers to provide on-site medical support for individuals suffering from the most common chronic health problems such as allergies or asthma.

Presenteeism is often a response to job stress and overwork. One British Web site ( documents that some firms worried about staff “who just won’t go home” have shifted their focus from absenteeism to presenteeism.

British Telecom has tackled presenteeism head on, checking employee timesheets to identify where long hours are being worked and reminding staff that overtime is not acceptable.

The British government is encouraging employers to help reduce stress by requiring employees to take lunch breaks and annual holidays and discouraging them from working long hours or taking work home.

Employers also have to re-examine absenteeism management programs. A study by Lancaster University in the U.K. shows how absenteeism management systems that set “trigger points” designed to clamp down on the use of sick days as “unofficial” holidays can have the unintended consequence of discouraging workers who are legitimately sick from staying home. Indeed, any program that offers incentives for good attendance could encourage presenteeism.

But the roots of the problem run deeper. Some experts argue that presenteeism is the inevitable outgrowth of a traditional face-time approach to management. It also reflects the subtle redefinition that’s occurred in the meaning of commitment. So we need to stop and ask: why do organizations with flextime and telework policies usually have low rates of participation in these programs?

In the end, it all comes down to good people management. To bring presenteeism out into the open and address it effectively, organizational leaders must realize working people harder is not a sustainable recipe for higher productivity. A far better approach is to provide healthy working conditions that support people to work smarter, not harder.

Graham S. Lowe is a sociology professor at the University of Alberta, research associate at Canadian Policy Research Networks, and a workplace consultant. He can be reached at [email protected] and his Web site is

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