EHS Management and the Intersection of Chronic Disease, Occupational Injuries, and Productivity

Which came first? The chronic health condition or the occupational injury? Are workers who suffer from chronic health conditions like obesity more prone to cumulative trauma disorders—or is it the other way around? How do the demands of the job affect both the condition and the injury? And what is the overall effect on absenteeism, presenteeism, and productivity?

These questions are the focus of new research published in February 2017 in the journal Health Affairs. In “Chronic Conditions, Workplace Safety, And Job Demands Contribute To Absenteeism And Job Performance,” researchers at the San Francisco, California-based Integrated Benefits Institute and at the Colorado School of Public Health in Denver, Colorado, have attempted to untangle the complex webs of causation that link these issues, and to provide some practical advice to EHS managers on how to help an aging workforce live longer, healthier, more productive lives.

Measuring Health and Productivity

Absenteeism has long been the default metric used to assess the impact of health conditions—both occupational illnesses and injuries, or nonoccupational chronic illnesses—on productivity. But presenteeism—when workers are present in the workplace, but their job performance is poor because of a health issue—probably accounts for a greater loss in productivity. It’s not typically used as a metric in the workplace because it is difficult to measure, and most academic studies that have attempted to quantify presenteeism and productivity have focused on specific conditions—for example, rheumatoid arthritis or asthma—rather than looking at chronic health conditions in the aggregate.

Add to that the fact that the cause/effect relationship between chronic health conditions and workplace safety is difficult to pin down. An obese worker is more likely to suffer a cumulative trauma disorder—but a worker who suffers a cumulative trauma disorder (for example, a back injury) is also at higher risk of becoming obese. Like the “chicken and egg” question, the answer to the question of “which came first” is not simple and obvious, and without clear cause-and-effect, it’s difficult to identify possible interventions. To sort out the effects of these factors on each other, the researchers chose three interconnected factors to examine: personal health, job safety, and job demands. To measure the impact of each factor on productivity, they traced each factor at the individual employee level, in a logical time sequence.

The researchers measured both absenteeism and presenteeism over a 4-year period (from 2010–2014) for more than 16,000 workers in Colorado who were enrolled in a specific worksite wellness program, and who completed a basic health risk assessment during the study period. In the study, presenteeism was measured on a self-reported performance scale of 0 (best) to 10 (worst). As a proxy for the overall safety of the workplaces, the researchers matched workers enrolled in the study with workers’ compensation claims data.

Patterns in the Data

Some of the results were unsurprising. For example, when the researchers looked at whether workers’ reported chronic health conditions affected presenteeism and absenteeism, they found that the more chronic health conditions employees reported, the higher their reported rates of both absenteeism and presenteeism. In other words, workers who are diagnosed with both obesity and diabetes are less productive than workers who are diagnosed with only one or neither of those conditions.

Parsing the data more finely, they found that physically demanding jobs suffered higher rates of absenteeism, while jobs that were both physically and cognitively demanding showed the highest rates of presenteeism. From the data, the researchers concluded that employers that want to ensure that workers are both present and productive should be aware that:

• Segregating employee health and injury information impedes progress. In order to fully characterize and address issues arising from the interrelated factors of chronic illness and occupational injuries, employers should combine available data on employee health and related outcomes.
• Both injury prevention and return-to-work matter. Injury prevention strategies reduce occupational injuries at the front end; an effective return-to-work program that matches a worker’s progress with the physical and cognitive demands of the job enables workers to perform optimally during their recovery.
• Information about worker health and occupational hazards should be considered in context. A worker’s productivity is dependent on his or her health and injury status as it relates to their performance of a specific job. Learning to better align these factors with the physical and cognitive demands of the workplace will improve productivity.

Tomorrow we’ll look at strategies for optimizing productivity using an integrated approach to occupational health and safety and workplace health promotion.