Dr. Ann Hawkins of 24hr Virtual Clinic discusses stress, presenteeism and absenteeism and asks, are these health and safety issues?

In 1964, Bob Dylan recorded – “The Times They Are a Changing” – and changes are on the horizon in workers’ compensation. Some elements of the changes involve total employee health – physical and mental – and how health can influence safety and a reduction of on-the-job injuries. Corporate interest in health and safety, like advancing other aspects of employee work environment, almost always translates into a tangible ROI in better company productivity or service. Currently, many companies place health and well being in the Benefits or HR silo and safety in Risk or Work Comp silo –  two different silos within the company  – and in some instances two silos which don’t converse. Integration of total employee health positively affects the corporate bottom line – the silo doesn’t matter!

Industrial Safety and Hygiene News (May 2017) stated: An integrated health and safety program is no longer an operations cost to be controlled but an investment in a company’s overall effort to improved profitability and competitiveness.”

Let’s look at three of the more critical health/safety issues – stress, presenteeism, and absenteeism – and see how integrated total employee health improves a company’s profitability and competitiveness.


If you had to classify stress, would it be a health or safety issue? Yes, stress is both a health and a safety dilemma. For the most part, no one can see stress, but stress definitely affects employees lack of concentration and efficiency, which many times leads to incidents and accidents at the workplace. Stress affects all levels of employees – a mistyped word or miscalculated financial analysis due to stress and lack of concentration at the C suite level, an ongoing “pain in the neck,” a musculoskeletal disorder (MSD) aggravated by stress at the workstation, a lifting injury, or slip and fall on the work floor due to lack of focus or training.

The Mayo Clinic, in a published article (April 28, 2016), determined that stress left unchecked can contribute to many health problems, such as high blood pressure, heart disease, obesity, and diabetes.

Stress.org determined that 46% of workers are stressed about workload, 28% because of people issues at work, 20% due to life/work balance issues and 6% because of lack of job security. The result for the US is over $300 billion spent annually due to:

  • Accidents
  • Absenteeism
  • Employee turnover
  • Diminished productivity
  • Direct costs related to medical, legal and insurance

In these incidents, the cause of stress could be viewed as a safety issue and the effect as a health problem. So, once again, is stress a health or a safety issue?


Presenteeism, not included in the above list, is when employees are at work “in body” but not “in mind.” Causes of presenteeism are typically attributed to, or associated, with illness, injury, pain, anxiety, depression and work/life balance issues related to the employee, the spouse, children or senior parents. Presenteeism is anything that takes the employee’s mind off the “job” at hand. Harvard Business Review reported 80% of workers have experienced presenteeism.

Presenteeism costs employers 10 times more than absenteeism! EHSToday (March 2016), found that employees take 4 days off per year for sick time, but admit being unproductive 57.5 days a year, almost 3 months of being at work but not being at work. Imagine if your workforce, across the board, was not completely focused at work 60 days a year but was still making decisions, manufacturing product and dealing with customers.  It is next to impossible to determine the number or percent of accidents and injuries which happen during those “semi-conscious” 3 months spent at work and not mentally being there!

In the UK, almost nine in ten (86%) of the over 1,000 respondents to the Chartered Institute of Personnel and Development survey, compiled May 2018, observed presenteeism in their organization over the last 12 months. In 2010, the figure was just 26%, rising to 72% in 2016. The British work less hours than the US, 1,676 hours per year and Americans 1,783 hours. Presenteeism is prevalent around the world.

A 2008 academic study completed in the UK determined that stress, depression or anxiety accounted for 13.8 million days lost or 46% of all reported illnesses making this the single largest cause of all absences attributable to work-related illness.[1] From 2003-2008, work-related stress, depression or anxiety remained for each year the single most reported complaint. These studies are compiled in a country which operates under a socialized medicine model where everyone has healthcare access with no deductible or premium.

Psycho-social issues, a state of mental, emotional, social, and spiritual well-being, are reflected in presenteeism. Hartford Insurance analyzed claims from 2002 to 2015 and found that 10% of claims had at least one psycho-social issue which accounted for 60% of claims costs – presenteeism is a costly issue to any company.[2]

Like stress, presenteeism is real and has a negative productivity and financial effect on your company.  Again, the question is – is this cost related to employee health or safety – again the answer is yes.


Absenteeism due to stress, presenteeism, illness or pain hinders productivity and consistency of work.  The workplace would be safer if those who are ill would stay home. When a sick worker comes to work over half the workplace surfaces are contaminated by lunchtime. Productivity drops by only 28% when employees stay home sick compared to a 72% drop when they try to gut it out and keep working.

As an example, worker A comes to work sick and workers B, C, and D get sick. Is that a workplace illness?  Employees B, C, and D come to work sick – and productivity drops by 72% times 3. Then, worker A’s child goes to school sick and contaminates the entire 1st grade – now workers B, C, and D stay home to take care of their sick child. Plus, the average wait time of 29.3 days to see a doctor only adds to the depression, anxiety, and aggravation of the worker (March 2017).[4]

According to “Absenteeism: The Bottom-Line Killer,” unscheduled absenteeism costs roughly $3,600 per year for each hourly worker and $2,650 each year for salaried employees. These costs can be directly attributed to wages paid to absent employees, high-cost replacement workers (overtime pay for other employees and/or temporary workers), using absenteeism as a form of “disengagement” from work and a raise in administrative costs of managing absenteeism. Indirect costs include: lower quality of goods/services resulting from overtime fatigue or under staffing, reduced productivity, excess manager safety issues (inadequately trained employees filling in for others, rushing to catch up after arriving as a replacement, etc.), and low morale among employees who have to “fill in” or do extra work to cover absent coworkers.[5]

Yet again, is absenteeism a result of safety in the workplace because of conditions such as contaminated work surfaces, and the negative impact on the worker staying home and not gutting it out?

The Times Are Changing

“These Times They Are a Changing” invites new opportunities and solutions which are good for employers, employees and their families. The opportunity is for the C suite, Health, Safety and Human Resources to work together, move out of their silo’s into an open floor plan. The solution is Total Employee Health empowering all employees with simple to use and accessible tools which allow them to be as productive as they want to be and understand that – yes – health affects safety and safety affects health.  The result of this well-facilitated program is decreased stress, presenteeism and absenteeism and an employer group who works to the best of their ability thus increasing productivity, commitment to the job and most importantly the bottom line.

If you would like to read more articles by Dr. Ann Hawkins of 24hr Virtual Clinic, click here.

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