We've all been there. We head to work even though we're under the weather. It's such a big problem that it's gotten a name — "presenteeism" — and it's costing companies billions of dollars. Here's why you should just stay home when you're ill, and why it's in your boss's best interest.

Illustration by Tara Jacoby.

Most employers focus on absenteeism and its negative effect on productivity because it's easy to detect and measure. But the fixation on absenteeism fails to acknowledge how productivity is impacted by the employee's health and quality of life.


There's an assumption that just showing up at work makes you productive. It's becoming painfully obvious, however, that, when sick or stressed out employees show up at work, they often have a detrimental impact on the company's performance and productivity. Worse, if not addressed and rectified, presenteeism can escalate into a problem that affects a business's output and produces hidden long-term costs.

A simple solution would be to provide more vacation days to employees. But that's not always possible. There are many factors behind presenteeism, so it's important that employers look at the causes and not the symptoms.

A New Consideration For Businesses

As a concept, presenteeism only emerged as a new business field in the 1990s. A study published in BMC Public Health defines presenteeism as:


the decrease in productivity in employees whose health problems have not necessarily led to absenteeism and the decrease in productivity for the disabled workers before and after their absence period. It is defined as being present at work, but limited in some aspects of job performance by a health problem, and it is often a hidden cost for employers. It includes time not spent on job tasks and decreased quality of work (e.g. product waste and product defects).

Presenteeism describes employees who don't perform at their optimal levels owing to any number of problems, such as sickness, a medical condition, or distractions caused by personal issues (e.g. caring for a sick relative, financial worries, or marital problems). Some of these employees often show up at the office or factory owing to a work culture that demands it, or because they can't afford to lose the pay — or worse — their job.

As for employers, It's becoming difficult for them to maintain a healthy and productive workforce owing to an increasing number of people affected by chronic health conditions and an aging workforce that's more likely to be affected by these conditions.



Unfortunately, there's no universal agreement on the most effective way to measure or figure the costs of presenteeism, but it's typically measured as the costs associated with reduced work output, errors on the job, or failure to meet company production standards. It's also difficult to evaluate because every workplace is different. That said, companies are starting to get a sense of the economic costs — and they're massive.

Costs and Consequences

In Canada, for example, it's estimated that presenteeism costs businesses upwards of 15 to $25 billion per year (via Statistics Canada). Figures in Canada are typically about a tenth of what occurs in the United States, so it's reasonable to assume that costs in the U.S. range between $150 to $250 billion each year. Revealingly, a 2003 study published in JAMA concluded that $61.2 billion is lost each year in the U.S. owing to productivity losses stemming from pain-related health issues alone. So a figure around $250 billion is probably very reasonable, if not on the low side. (As an aside, presenteeism seems to be fairly low on the U.S. radar; most of the research I uncovered came from Canada, Australia, and Europe (Sweden especially)).


On average, each employee per year uses 7.5 days or 3% of salary committing absenteeism. But studies on some chronic conditions and health risk factors suggest that lost productivity from presenteeism is far worse — up to 7.5 times greater than productivity loss from absenteeism (Statistics Canada). And when it comes to some chronic conditions and health risk factors such as heart disease, hypertension, migraines, and neck or back pain, the number skyrockets to 15 timesgreater.

Ten years ago, researchers from Cornell University broke down the costs of presenteeism as they correspond to specific health conditions:

Based on average impairment and prevalence estimates, the overall economic burden of illness was highest for hypertension ($392 per eligible employee per year), heart disease ($368), depression and other mental illnesses ($348), and arthritis ($327). Presenteeism costs were higher than medical costs in most cases, and represented 18% to 60% of all costs for the 10 [health] conditions [studied].

The same study estimated that, on average in the United States, an employee's presenteeism costs about $255 each year. Incredibly, about one-fifth to three-fifths of health-related costs faced by employers could be attributed to on-the-job productivity losses.


But there are other costs as well. A recent study by the National Institute for Occupational Safety and Health showed that workers with access to paid sick leave were 28% less likely to suffer nonfatal injuries than workers without access to paid sick leave.

Who's Showing Up And Why?

Presenteeism afflicts all business sectors, but some more than others. A survey done in Sweden showed that:


The highest presenteeism is largely to be found in the care and welfare and education sectors (nursing and midwifery professionals, registered nurses, nursing home aides, compulsory school teachers and preschool/primary educationalists.

As the investigators point out, many of these employees often work with those in more vulnerable populations such as the elderly. Other higher risk jobs for presenteeism include those with more physical workload and stress.

The survey also found that people with high rates of upper back/neck pain and fatigue/slightly depressed are among those with the highest tendency towards presenteeism. The researchers also found a correlation between low monthly income and sickness presenteeism.

Another important factor in presenteeism is work culture. A 2005 study by Gunnar Aronsson and Klas Gustafsson showed that some environments, such as hospitals and factories, are particularly prone to presenteeism. In hospitals, for example, a sense of family often exists, compelling workers to stay when they're sick or overworked. In factories, there's often pressure exerted by management for employees to come to work when sick (I've actually heard the phrase, "We don't get sick here" uttered in a small factory environment).

Presenteeism can also be attributed to workers who feel they have few other employment options, or they believe they can be easily replaced.



Back in 2007, the Canadian firm Desjardins Financial Security conducted a study and learned that almost half of workers (42%) went to work sick or exhausted at least once during the year. The Canadian Mental Health Association proposes a number of specific reasons, including:

Job Insecurity can cause employees to come into the office when they are sick, because they want to be seen as hard workers and committed to the organization.

Unpaid Sick Days can force people who can not afford an unpaid day off to come to work. Also, it encourages people who don't want to use their vacation time to stay home to come to work when they are sick. It is more likely to happen for part‐time workers due to unsound benefit packages.

Bonuses for Unused Sick Days can cause employees to avoid using their allocated sick days because they want to receive a bonus for unused days.

Workload Issues can be related with workplace stress and can make employees feel that it is impossible to take time off without completing individual tasks or adding a burden to other coworkers.

Organizational Culture and Policies can discourage or even penalize employees when they are absent due to sickness, vacation or other reasonable causes. This type of environment can encourage presenteeism as employees come to work to protect their jobs.

Inappropriate Self‐evaluation of Health and Working Capacity can be caused by employees overestimating their competence when they are sick.

Clearly, the onus is on employers. Conditions appear to be such that employees often feel compelled to go to work — for whatever reason — when clearly they should be staying home and/or dealing with their health of life issues.

What's more, when people show up sick at work, they put other employees at risk. Researchers from the University of Arizona in Tucson recently used tracer viruses to learn that the contamination of just a single doorknob or table top can result in the rapid dissemination of viruses throughout office buildings, hotels, and healthcare facilities. After just two to four hours, the virus could be detected on 40-60% of workers and visitors to facilities and frequently touched objects.

And of course, presenteeism can also exacerbate both presenteeism and absenteeism; it's best to stay home and get better. Studies support this assertion, including a 2009 paper showing that sickness presenteeism is a future risk factor for future sick leave.

What To do?

There are clearly many different aspects to presenteeism, so there's no simple solution to the problem. Instead, employers should consider a comprehensive action plan. The CMHA offers these guidelines:



Diagnose and assess existing problems: Add a question on self‐reported presenteeism to anonymous employee surveys and ask employees to state their reasons for presenteeism.

Evaluate organization policies: Make sure that health policies do not encourage employees to come to work when they are sick.

Create an accommodating workplace culture: Offer telecommuting options when employees have to stay home but deadlines need to be met

Encourage work‐life balance: Require employees to take lunch breaks and annual vacation and discourage them from always working excessive amounts of overtime.

One way to reduce stress and boost morale is by allowing employees to have a more flexible schedule in their work arrangements. Employers who do so find that employees meet the increasing demands of both work and personal life, contributing to a healthy work-life balance. And in fact, more and more companies are starting to offer flexible work choices, such as lieu time, telecommuting options, and personal assistant benefit programs.

And as noted by MyPA, "Work flexibility helps employees manage their work and personal responsibilities, and also enhances a worker's effectiveness on the job in terms of engagement, retention, and overall job satisfaction."


So next time you feel awful but still feel the need to go to work — think again. And for you bosses, send your sick workers home should they still come anyway.

Other sources: Canadian Mental Health Association | Statistics Canada | MyPA

Follow me on Twitter: @dvorsky