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Workers' ailing health problematic

'Presenteeism' bigger problem in tough times, experts say

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LOS ANGELES--Employers need to enhance wellness and mental health services to ensure that employees who remain after workforce reductions are healthy and productive, experts say.

As part of this effort, they also should measure the impact ill health has on employee productivity, focusing particularly on so-called "presenteeism," which many behavioral health experts say may be a bigger problem today than absenteeism. Presenteeism is used to describe employees who are on the job but accomplish little because they are ailing or distracted.

Because many of today's employers are financially strapped and unable to invest in infrastructure that may enhance company profitability, "worker productivity is more important today than ever before," Tom Parry, president of the Integrated Benefits Institute, said during an interview at the IBI/National Business Coalition on Health's 2009 Health & Productivity Forum, which was held Feb. 9-11 in Los Angeles.

"The productivity of our population is significantly impacted by behavioral health issues, such as depression and fatigue, and these are things that we felt we need to heighten and integrate into our overall health delivery system," said David Sensibaugh, director of integrated health at Eastman Chemical Co. in Kingsport, Tenn.

By participating in a multiemployer study that measured total costs of employee illnesses, Eastman learned that only 37% of its employees who were experiencing symptoms of depression were being treated.

The study combined pharmacy and medical claims data with results of a work performance questionnaire completed by employees. The questionnaire, HPQ-Select, was developed by the San Francisco-based IBI and the Midwest Business Group on Health (BI, July 18, 2007) in collaboration with Harvard Medical School researcher and health care policy professor Ron Kessler. It is a streamlined version of a more detailed questionnaire that Mr. Kessler developed for the World Health Organization as part of its Global Burden of Disease Initiative.

Reporting on some results of the recent multiemployer study during a session on health and productivity as a business strategy, Mr. Sensibaugh said the research found that Eastman's health-related productivity costs are three times greater than direct medical costs.

"Health conditions and health risks--conditions that are not well-managed--can have a significant impact on workers' productive capacity," said Dr. Ron Loeppke, co-chair of the American College of Occupational and Environmental Medicine Section on Health & Productivity, during an interview after a panel discussion he moderated.

For every dollar an employer spends on medical and/or pharmacy costs, health-related productivity losses will average $2 to $3, he said.

Mental stress also can significantly affect worker productivity, Dr. Loeppke said. The study found that stress, and related illnesses such as anxiety and depression, may be one reason why so many white-collar workers feel the need to work more than 40 hours a week, he said.

"There is no impact on absenteeism because they'll just work until they get the job done. They'll work on weekends. They'll work nights. And given this economy, it isn't just the executives; it's all ranks. Stress does have negative impacts," he said.

"Given the dire economic situation we're in, that stress may be one of the most unmitigated environmental toxic exposures we face as a society," Dr. Loeppke said. "We have to really focus on being proactive in helping people cope."

To determine lost productivity, employers need to look beyond absenteeism, said Adele Spallone, head of clinical services for disability and absence management at Aetna Inc., during a conference session.

"It's not only about absenteeism, but it is about presenteeism and productivity. How much someone is able to produce on the job while they are dealing with behavioral illnesses. It is costing employers $44 billion a year in lost productive time," she said. "It equates to 5.6 hours lost per week per employee."

For depression, 71% of the economic burden on employers is related to presenteeism, Ms. Spallone said, citing WHO's Global Burden of Illness Initiative findings. "It's very hard for an employer to determine which employee is not fully functioning in their role. A lot of times it is mental stress that is going on in the brain while somebody's doing their job, but they are not performing at capacity," she said.