Effect Measure

Presenteeism: spreading disease at work

Whenever the topic of sick leave comes up, employers are quick to raise the specter of malingering to get out of work. But a recent report on CNN suggests that showing up when sick may be costing plenty, too. “Presenteeism” is not just a financial problem but a public health one particularly germane to influenza:

Practically every workplace has one – the employee who comes to the job aching, coughing and sneezing.

So-called “presenteeism,” or going to work when sick, is a persistent problem at more than half of U.S. workplaces and costs U.S. business a whopping $180 billion a year, research shows.

Like its more notorious counterpart absenteeism, it takes on growing importance as employers try to keep an eye on productivity and the bottom line, experts say.

“Employers are increasingly concerned about the threat that sick employees pose in the workplace,” said Brett Gorovsky, an analyst at CCH, a Riverwoods, Ill.-based provider of business and corporate law information and a division of Wolters Kluwer.

“Presenteeism can take a very real hit on the bottom line, although it is often unrecognized,” he said.

Recognition of the issue is growing, however, as CCH research shows 56 percent of human resource executives see presenteeism as a problem. That’s up from 39 percent making the same complaint two years ago, Gorovsky said.

Presenteeism costs employers in terms of lowered productivity, prolonged illness by sick workers and the potential spread of illness to colleagues and customers, experts say.(CNN)

Formally this is a generic problem, decision-making under uncertainty. A perfect policy would be one where only the sick stay home, but there are two ways for the policy to be imperfect: sick people show up to work or well people stay home and say they are sick. There is a cost to both consequences of a less than perfect policy and it can be difficult to estimate them since we don’t know either how many people who stay home are well enough to work at full productivity and without making others sick or the reverse. In the case of an influenza pandemic the costs go up dramatically because sick workers who show up spread the disease in the community as well as the workplace. When that affects the economy, that also adds to the cost of the employer.

We all know this is common. I’ve done it and I’m guessing most of you have, too. As the article at CNN points out, workplaces have gotten leaner, which means that each person believes (rightly or wrongly) that they are more important than before when there was some redundancy for their function:

As often as two-thirds of the time, sick people go to work because they feel they have too much work to do, according to the CCH study.

The second-most common reason is workers believe no one else is available to cover their workload, CCH said.

“With corporate downsizings of the past creating a leaner workforce, employees often feel they have to show up for work, whether it’s out of guilt over staying home or concerns over job security,” Gorovsky said.

In fact, presenteeism is often encouraged, as employees may be honored for perfect attendance, experts note.

Then there is almost half the US work force who have no paid sick leave. In the vaudeville joke where the robber points a gun at his victim with the order, “Your money or your life,” the response of too many workers is, “Take my life, need my money.” There is a move by some Democrats to require employers with 15 workers or more to have a minimum of 7 paid sick days a year.

I can hear the screams of the business community already. A reflex, no doubt, going through their Republican spinal cords without touching any higher centers in the nervous system. Sometimes people just don’t know what’s good for them.


  1. #1 peggy
    January 27, 2007

    Many workers can’t afford to “waste” sick time on staying home when sick. They need this time for when the kids are sick, or the car breaks down, or they need to see a doctor, lawyer, or child’s teacher, or any of a number of good reasons to need time off work. Since most do not have flex time or personal time, and only about 10 vacation days, sick time takes up the slack.

  2. #2 crfullmoon
    January 27, 2007

    San Francisco is going to try something new
    …”more than 100,000 workers in the city who are not currently paid for sick days. That will change Feb. 5, when all employees � full- and part-time, permanent and temporary � will be covered. And they can miss work even when they aren’t sick, but have to stay home to help a domestic partner or a family member”…

    …”Employees will accrue one hour of paid sick leave for every 30 hours of work. There are caps depending on the size of the business.”…

    …”Stone says. “Small business is going to have to pass that cost onto their customers. Which is fine if everyone wants these kinds of things.” …

    (Well, who wants to be Pandflu Ground Zero? Keep sick workers away from work…might give some an extra day’s heads-up…)

  3. #3 M. Randolph Kruger
    January 27, 2007

    On the other hand in a job where you have to show up such as the transportation industry the bodies are going to have to be there or there will be bodies stacking up like cordwood and not from panflu. Revere, what the Democrats and others fail to realize is that we have lost our manufacturing edge, in some cases our technological edge, and above all our ability to compete. Do you think some Honduran (who just got his job from a Mexican who lost it to lower wages) gets 17 paid sick days or even one. Hell no. We keep socializing ourselves to death here in the US. Do people go to work sick? Yep. Do they get others sick? Yep. Do you think that a worker in China gets a sick day?

    So lets just keep raising the minimum wage too and tax it! Yeah, and each time they do they put Americans out of work because we are too stupid to understand that a living wage means you have to have a working job. It means in business you have to compete and it also means that if you are out of work and have UHC someone else gets to pick up your tab. China aint got it…. Too busy building weapons and buying from the French. The French have it, but defend nothing but their own borders and a poor job of it at that. Presenteeism is rife with the facts and they are that we are in decline because of the social programs such as uh, lets give them many days off to be getting the oil changed. I give 5 days a year… period unless they have a doctors excuse. Infectious is my key word, fatigued is the other. You screw up and you are fatigued you die in my business or get someone else killed.

    This presenteesim thing is important I agree. I agree more that it is abused.

  4. #4 Greg
    January 27, 2007

    Take Back Your Time


    “Millions of Americans are overworked, over-scheduled and just plain stressed out.

    * We’re putting in longer hours on the job now than we did in the 1950s, despite promises of a coming age of leisure before the year 2000.

    * In fact, we’re working more than medieval peasants did, and more than the citizens of any other industrial country.

    * Mandatory overtime is at near record levels, in spite of a recession.

    * On average, we work nearly nine full weeks (350 hours) LONGER per year than our peers in Western Europe do.

    * Working Americans average a little over two weeks of vacation per year, while Europeans average five to six weeks. Many of us (including 37% of women earning less than $40,000 per year) get no paid vacation at all.

    … The Girl Scouts recently introduced a “Stress Free” merit badge for today’s harried young girls.”

  5. #5 revere
    January 27, 2007

    Randy: I guess you have some evidence for the abuse of sick leave? I don’t.

    Greg: Yes. Life in Europe is much better for workers and they are not suffering economically any more than we are. They are having a hard time paying for some social benefits but then we are also paying and not getting any benefits.

  6. #6 G in INdiana
    January 27, 2007

    “You screw up and you are fatigued you die in my business or get someone else killed.”

    Same with my husband’s job. Airline pilot.
    He will not fly sick no matter what. Too many people depend on him being 110% and that’s what he gives.
    If he can’t concentrate due to a head cold, bad back, or other ailment, he calls in sick. He has to. That’s part of his job.

  7. #7 C, Corax
    January 27, 2007

    We’ve been passing a rather nasty viral thing around work lately, and many people have been out sick for a week or more. I had to haul myself in one day while ill because the one other person trained to do my job was on vacation. The next day when I sent my supervisor an email saying, “I’m really sick and need to stay home,” she wrote back, “Too bad. I wanted you to do thus-and-such.”

    Perhaps this is a dumb question, but if a person’s contagious before they’re symptomatic, won’t they have spread the illness already, even if they stay home after they begin to feel ill?

  8. #8 revere
    January 27, 2007

    Corax: Not a dumb question. There are two issues. One is the actual pathogen involved. In some you are not infectious before symptoms (e.g., SARS), while for others, like flu, you may be infectious 12 to 24 hours before symptoms. The other is the extent of viral (or other pathogen) shedding before symptoms. In many diseases in which there is pre-symptomatic infectiousness the peak of infectiousness still occurs after symptoms (flu is an example). So it isn’t simple. Sick leave policies may be adjusted during outbreak times compared to non-outbreak times (there is a mathematical justification for this involving a simple application of Bayes Theorem).

  9. #9 DeLuca
    January 27, 2007

    When my kids were in elementary school, I used to go crazy when I’d hear about their fellow pupils spewing from both ends, eyes glazed with fever, who would be back the next day because they didnt want to lose their “perfect attendance” record. That type of award should be prohibited in public schools.

  10. #10 Mathematician
    January 27, 2007

    From a European perspective, the US holiday/sick day situation, with sick days and holiday days seen as nearly interchangeable, is bizarre. In ours, if you are ill, you take a sick day (and only employers used to being taken advantage of have any noticeable limit to the number), AND you cannot take a sick day for any reason other than being ill. (Ill family members complicate the picture a little, but not much – point is, you can’t take a sick day to see your child’s teacher, etc., that needs a holiday day.) I think if the US wants to counter presenteeism, it’s going to have to have this system too: if you encourage people to take essentially unlimited time off when they’re ill, you also have to make sure that they don’t see that as being in effect unlimited holiday.

  11. #11 caia
    January 27, 2007

    It’s not just the employer/employee culture – they train us to this young, and not just with “perfect attendance” awards. I used to get horrible coughs as a kid, and my parents would ask if I felt I “really couldn’t handle school.” I’d try to go, because I knew when I finally had to stay home (and I would have to), it’d be 3-5 days of missed school. If you missed too many classes over the course of a year, you’d lose credit – no matter if you were really sick.

    They didn’t make it easy for you to get assignments or make up work, either. And then there were exams, which you had to be extremely and documentedly ill to miss. I coughed through many.

    The saddest part of presenteeism is that often, if you take a day off to sleep and let your body fight off an illness when you’re first getting sick, you don’t get so sick. I didn’t discover that until college.

  12. #12 tan06
    January 27, 2007

    As soon as some measles or mumps or whatever more vague illness is in town, a lot of parents here will send their kids to their feverish and vomiting little friends in order to catch the same illness and have a controlled ‘immunization’. I do recall a mother who observed my child having smallpox, who consequently ran to her car to call her little daughter and to get hers introduced to mine. In the best situations the pregnant mothers are warned at school to stay away as much as they can especially when they are in their first trimester. So then the kids have had it, that’s the general thought.

    The same goes for the adults. Many mothers in my neighborhood are nurse or are working in homecare and they don’t like the ‘completely controlled’ vaccinations because of the possibility of unwanted side effects (a little superstitious and also in some cases they find it too expensive).
    Many of them are proud of their good health and are convinced they will not catch any flu or other illness because they don’t worry too much.

    I do realize this is a completely different point of view. Like it could be good for your health to get a virus and to have attained a certain degree of immunization to it next time it’s marching in.
    I myself am differentiating between illnesses one can become immune to and the illnesses that are spoiling my time. Although of course it’s not always clear to get a right diagnosis at the beginning of any outbreak, sometimes I did observe those school pupils spewing from both ends, and in the meantime their parents (me included) only felt a bit of dizziness, headache and stomach ache and were able to continue working. To me it happened twice last two months.

    Like a famous Dutch soccer player would say: every advantage has its disadvantage, and the other way around.

    I join in the idea we should prohibit schools to keep a ‘perfect attendance’ record and instead we should promote a rule like: ‘keep the sick and ill children at home at least for 3 days’. My father was a phycisian and my mother sent us to school no matter how ill we felt. We were allowed to return home after we had vomited at school. Not so nice for the teachers, I think but it was the ‘proof’ we were ill.
    As far as I’m concerned a body temperature check would do as well.

  13. #13 Andrew
    January 27, 2007

    I do recall a mother who observed my child having smallpox,

    Smallpox! I certainly hope not, because it is a vicious killer of a disease. Luckily, it was declared eradicated in 1979 (see here).

    Maybe chickenpox?

  14. #14 revere
    January 27, 2007

    tan06, Andrew: I was going to remark on that, too. Little known fact: the last death from smallpox occurred on September 11, 1978. It was from a lab accident in the UK.

  15. #15 attack rate
    January 28, 2007

    I can’t believe so many people don’t have paid sick leave.

    Here, for most workers, paid sick leave is compulsory. You get a certain number of days per year. You can also use those days to care for sick children or other household members (they need not be blood relatives).

    Additionally, 4 weeks of paid recreation leave is compulsory.

    And, many work places (mine included) will allow you to work flexibly so that you can attend parent-teacher conferences, routine doctors appointments, lawyers, or anything else.

    You can also request paid (or unpaid, depending) special leave – this is usually given for things like donating blood, work as a volunteer firefighter/ambulance/rescue squad member (I work in a rural area and such organisations are staffed almost entirely at the ground level by unpaid volunteers), but can also be given because you’ve run out of sick leave and recreation leave.

    Our economy is going very well, best it’s ever been (if you believe the rhetoric of the conservative government), although compared to the USA our taxes are higher. We have socialised medical care, university tuition is initially paid by the government for the vast majority of students (you then pay it back through an extra 5% tax once you start a job, until it’s gone, but the cost of a degree is a lot lower here).

    Even with all of this, we still have presenteeism. I’m not sure why I go to work when I’m sick. Maybe it’s because most people here have a good work ethic and prefer to get things done if they can.

    I think that if telecommuting were more widely available it may solve some of these problems. Lets face it, it’s not exactly natural to stick a large number of humans in a small hermetically sealed environment with air conditioning, day after day.

  16. #16 Patch
    January 28, 2007

    Once BF patients are symptomatic, I doubt they’ll be strolling into work. With 50%(+) CFR I suspect most will be too ill to go anywhere.

  17. #17 orange
    January 28, 2007

    Requiring people to use sick time is idiotic. I rarely take a sick day and I am rarely sick. All my sick time is for Dr. Appointments or for being home with my kid. I did work one place where we had one bank of time for vacations and sick time. I thought that worked well. People were less likely to call in sick if they weren’t, and people who didn’t get sick weren’t punished. Probably did encourage presenteeism, though.

  18. #18 Frank Mirer
    January 28, 2007

    Working while sick is associated with increased cardiac problems, as noted below. Actual data. It would be nice to have a testable mechanism, biologic plausibility. Does the term “uncontrolled confounding” ring a bell?


    Kivimaki, M.; Head, J.; Ferrie, J. E.; Hemingway, H.; Shipley, M. J.; Vahtera, J., and Marmot, M. G. Working while ill as a risk factor for serious coronary events: the Whitehall II study. Am J Public Health. 2005 Jan; 95(1):98-102.
    Abstract: OBJECTIVES: Although sick, some people take no time off work, a phenomenon called “sickness presenteeism.” This study examined the association between sickness presenteeism and incidence of serious coronary events. METHODS: The analyses were based on a cohort of 5071 male British civil servants without previous myocardial infarction. Baseline screening included measurements of health status and coronary risk factors. Absence records were assessed for the 3 years subsequent to baseline screening. The outcome of interest was incident nonfatal myocardial infarction or fatal coronary heart disease (mean length of follow-up=9.1 years). RESULTS: Seventeen percent of unhealthy employees took no absence during the 3-year follow-up. Their incidence of serious coronary events was twice as high as that of the unhealthy employees with moderate levels of sickness absenteeism (after adjustment for conventional risk factors, hazard ratio 1.97, 95% confidence interval=1.02, 3.83). CONCLUSIONS: Employers and employees should be aware of the potential harmful effects caused by sickness presenteeism.

  19. #19 M. Randolph Kruger
    January 28, 2007

    Revere to answer the question, yes I have a lot of absenteeism. Its outside, in the cold, the rain, the failling from the sky whatever. Slick ground from freezing rain. o one forces them to come to work but they have to be at 100%. Difference is that I give them five days and if they need a sprout to go get their drivers license renewed (thats an all day sucker there) I give it to them unpaid. Same with sick. If they are sick and they have used their five days I will give them their vacation time. An employer can end that presenteeism by simply saying in their opinion that they are too sick to be there. I wont let them work if they are coming back in from a known party either. My rules are 8 hours from the last drink to the airport ramp. I also drug test the hell out of them too.

    Frank, its great that you have all oft he time and money to produce these results. I dont know whether they mould themselves to the argument. Most companies are not large enough to have a statistician on board. You might be right, but if someone shows up with a whopping case of strep then he/she goes home…period. They may not get paid for it, but they arent getting everyone sick. Most of the time its inconsiderate employees not using their heads. They make good money here and thats a draw for sure, but to take out a shift with a contagious disease is pretty stupid. My supervisors all have instructions to send them home if they are obviously sick.

  20. #20 Greg
    January 28, 2007

    Most companies are not large enough to have a clinical researcher on board, either.

  21. #21 Greg
    January 28, 2007

    Caia made an important point : if you give your self a rest, allow your body the resources it needs to fight off an invasion, you become healthy again much sooner.

    Sick leave is as much in the employer’s interest to have fully alert functioning workers.

  22. #22 M. Randolph Kruger
    January 29, 2007

    Yep, you are around an airport Greg plenty happens all by itself. Someone tanked up on cold remedies is one of the first things to get you sent home. I can remember when they put belladona in them… Saw a gruesome mistake made on that once.

    On the other hand Greg, sick leave has its limits. Everyone wants a net in this world, even me. I simply acknowledge that its not there, not going to be there and to even have a job that offers some sort of s. leave the employer needs to be compeitive. If you have ever been to the Honduran sweat shops, they go to work there with malaria in a lot of cases. So do we all go to work sick or do we force “somehow” the Hondurans to comply with what we think is right? Do we even have the right to imply that we do?

  23. #23 tan06
    January 29, 2007

    Andrew, Revere, others: I do apologize for the language errors I made in my post. I do mean chickenpox of course, and by the way I was waking up next day and shouted: wasted!
    Of course it’s not ‘spoiled time’, but wasted time. I was puzzling on it but apparently too tired that night.
    Still I hope the point I tried to write down was understood.

  24. #24 brightmoon
    January 29, 2007

    thank you.

    how ironic
    i just spent all morning yelling at a co-worker … gave him my generic “why the #$%^& didnt you just stay home” speech
    ive been complaining about that for decades ..if youre sick, stay home; youll get over the cold faster

  25. #25 M. Randolph Kruger
    January 29, 2007

    Okay, now I have heard it all. Now they are giving sick leave at some companies in the UK for a sick or dead pet. Paid leave is the way I heard it.

    So those of you who have pets can just register them up and once every couple of 7-11 years, you can go out and ensure that you will get a vacation. You no longer have to abuse the system, you can say your cat is sick. No problem

    It was on Fox News today.

  26. #26 revere
    January 29, 2007

    Randy: Ah, yes. You saw it on Fox News! Next step (up): The National Enquirer.

  27. #27 attack rate
    January 29, 2007

    Randy: Although it may sound excessive to you, I don’t have any children, and I will be devestated when my now 14-year-old cat dies. She’s been one of the few constants in my life, through other relationships, job and location changes, study, unemployment, the thick and the thin.

    Honestly, I think I’ll be much less useful to my employer when I am grieving her death than I am when I have a viral upper respiratory tract infection, and would rather have leave to grieve her than to get over a 7-day mild viral complaint.

    But that’s just me.

  28. #28 M. Randolph Kruger
    January 30, 2007

    The Sunday Times January 28, 2007

    Doting owners get ‘peternity leave’ if the dog is feeling ruff
    Will Iredale
    YOU no longer need to be as sick as a dog to take time off work. Companies are allowing employees to work from home or take days off to look after unwell pets.Some have introduced “peternity” policies giving staff paid leave to care for ill dogs and cats or to take them to the vets. Other businesses such as Halifax bank and Bank of Scotland allow staff to take time off work to deal with sick pets so long as they organise cover. Royal Mail will consider allowing “compassionate leave” if a pet dies. Some firms, including the central London office of Google, the internet search company, allow dogs in the office, realising that workers are reluctant to leave them at home or give them to dog walkers, who can charge up to £25 for a two-hour walk.

    Employment experts say that bosses are recognising the importance that people place in their pets, adding that arrangements that allow time off for pet care could make them more attractive as employers.
    Research by Petplan, the insurance company, found that 35% of its customers admitted to having taken time off work to look after pets or settle new animals. Half said they took a week off a year to look after their pets, potentially costing British businesses £19m annually. The Courier Service, a delivery company in Edmonton, north London, has had a “peternity” policy since last July that allows two days’ paid annual leave. “It is awarded if you need to go to the vet or your animal needs an operation, in the same way people might need time off for a baby or to look after a child,” said Denise Fresco, the human resources manager.

    Nadir Farrell, 47, who works for Communications Management, a public relations firm in St Albans, Hertfordshire, was allowed two weeks at home to look after Amber, her six-year-old chow-chow, who had a knee operation last year: “It was a worrying time for me and helpful to know I could do that.” However, Cary Cooper, professor of organisational psychology and health at the Lancaster University management school, advised against seeking time off to care for pets. “When jobs are insecure, telling a boss that you want time off work to look after a pet would not go down well,” he said. oA website, http://www.dogsblog.com, is being launched today, allowing people to look at strays in 30 dogs’ homes in Britain and increasing the chances of the animals being found a home.

    No not FoxNews Revere…. just unbelievable.

    Attack, I have four dogs, five cats, six fish, one hampster, two parakeets that the cats no kiddng ride on their backs, and a half bobcat/cat named Scruffy. I wouldnt part with one of them if I could. But unless its the only thing a person has, I am not going to give them leave for a pet funeral. Its the difference between being an employer and an employee. Pet sick leave? Uh, take the monkey to the vet.

    I wouldnt expect that they have this policy in Korea…..they have lunch instead.

    Ah yes Revere, left wing socialism. Political correctness and all. Would I work at a company that had paid pet sick leave. I would have one very sick dog or cat all the time in my little arsenal.

  29. #29 Greg
    January 30, 2007

    Gosh, Attack Rate, you seem to think you should be treated like a human being.

    Well, you’ve had your little joke. Now get back to your gear-shaft with the rest of the cogs. Let’s not have any more of this, shall we? We might be compelled to reconsider your position in the machine.

  30. #30 Yossarian_22
    February 14, 2007

    Don’t worry about Randy folks. After peak-oil relevels the playing field again, he’ll be stripped out of the protection of his gated exurbian McMansion and be forced to beg for his daily meals. While the rest of us are excercising non-subsidized organic farming and re-establishing local co-operative (eg “socialist”) economies (gasp!), he’ll be trying to find some more gas for his Hummer or whatever penis extension he likes to drive.

    He’ll have to choose to either A) Die off! or B) become a new socialist too. I wonder which I’ll enjoy better? Hard to pick one.

    Attack Rate- I too am a cat lover and know what you will go through when the time comes. Please accept my moral support.

    Have you all heard about the Argentine workers taking over their own factories w/o the management of the likes of a Krugerite Nazi in charge?

    Check this out- http://zmag.org/content/showarticle.cfm?sectionID=42&itemID=2678

    I assume Randy will want to urge a B-52 carpet bombing of Argetnina now.

  31. #31 M. Randolph Kruger
    February 14, 2007

    Watch your mouth Yossarian. No one calls me a Nazi and gets away with it. I dont make personal attacks on anyone here and I expect the same respect that I would give you.

    Have a nice day.

  32. #32 revere
    February 14, 2007

    Yossarian: Randy might be a lot of things (daft comes to mind) but a Nazi isn’t one of them. He’s got a soft core.

  33. #33 Lea
    February 14, 2007

    Triple that, watch your mouth Yossarian_22.
    No ones worried about MRK. He will/would be one of our strongest allies in whatever situation we found ourselves in. And anyone would be darned lucky to have him, anyone!

    You have him all wrong and perhaps should reevaluate your opinion of him OR just take a good hard look at yourself.

    Peace Yossarian_22 Bozo-Beak.

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