Why presenteeism is a strong predictor of future sickness absence

21 November 2011

Jan Hutchinson answers six of the most commonly asked questions about presenteeism. Why does presenteeism cost organisations more than absenteeism? What causes presenteeism? How does workplace culture affect sickness absence and low productivity?

What is presenteeism?

To put it simply presenteeism is the act of attending work while unwell. Given that poor health reduces productivity there is a broad consensus that presenteeism is a better overall predictor of health and performance than absenteeism.

What is the impact of presenteeism?

Even though sickness absence is visible and easily measured, evidence shows that presenteeism is the more significant cause of lost output. In a recent report Centre for Mental Health calculated that presenteeism from mental ill health alone costs the UK economy £15.1 billion per annum, while absenteeism costs £8.4 billion.  

Productivity losses caused by health problems are more likely to take the form of presenteeism rather than absenteeism among white-collar workers, particularly professional and executive staff, than they are among blue-collar workers. This pushes up the costs of presenteeism, as the balance of employment in the UK shifts away from manual to non-manual jobs.

How common is presenteeism?

A recent UK study found that 45% of employees reported one or more days of presenteeism in a 4-week period, with just 18% reporting one or more days of absenteeism. International studies have shown 60-85% of employees have reported going to work when they are unwell at least once during the previous year.

What causes presenteeism?

The balance between instances of presenteeism in relation to absenteeism at work varies according to type of occupation (high for white-collar workers, low for blue-collar workers) and the type of health condition (high for mental health problems, low for respiratory infections.)

There are a number of more specific determinants of presenteeism including organisational factors (e.g. generosity of sick pay, absence management policies and an ‘organisational culture’ of presenteeism, where coming into work when unwell is seen as a demonstration  of commitment.)  Job-specific factors could relate to the organisations willingness to accommodate an employee’s health problem and the level of peer/supervisor support on offer;  while personal factors might include the individual’s financial circumstances. Labour market factors such as job insecurity are also likely to increase instances of presenteeism in the short term.

Who is most likely to be “present”

Mental health problems such as depression are particularly likely to take the less visible form of presenteeism because employees don’t want to be labelled ‘mentally ill.’ Even though mental health problems account for almost one GP consultation in four and 23% of the burden of illness in the UK, there is still a degree of stigma associated with disclosing a mental health problem in the workplace.   A recent study from Mind found that workers who admit to feeling stressed or depressed fear being sacked or forced out of their jobs, with 41% of those surveyed stating stress is a ‘taboo’ topic.  Tellingly, 48% are scared to take time off sick.

Does presenteeism lead to absenteeism?

Yes. Workers who struggle with common mental health conditions like depression and anxiety are far more likely work long hours and perform at lower levels than to be absent. Choosing to ignore presenteeism will result in it “tipping into” absenteeism at some point, and although in the short-term presenteeism replaces absenteeism – if action is not taken it will lead to greater levels of absence at a later date.

Read our top five tips on managing presenteeism

Take a look at these resources for employers on managing mental ill health at work.