Running Head: A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

A Healthy Workforce, A Heightened Productivity

Jordan T. Betz
Texas A&M University Commerce

A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

Table of Contents
Abstract3
Introduction..4
Literature Review.5
Methodology8
Findings.10
Summary12
References..13
Appendix A15
Appendix B16

A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

Abstract
Throughout the course of time, organizations everywhere have sought out the means to comprise
a well-oiled, working machine. In order to be successful and effective, one would suggest that
productivity serves as a key component. Indeed, a number of studies suggest a likely reciprocity
between productivity output and the health of individuals. In this study, an assessment of the
United States working class is made in terms of healthy and unhealthy. My goal is to discern
how much productivity differs, in the two classifications. Furthermore, insight into what
components nurture overall health and suggestions as to what enhancements can be made in
order to combat unhealthy habits and environments is also discussed. Although improvements
are suggested, some may prove more costly and effective than others. By addressing the sources
of lost productivity such as absenteeism, disability, presenteeism, or unhealthy circumstances;
organizations have the opportunity to attain a variety of benefits. Opportunities such as lower
healthcare costs, a dependable workforce, increased productivity, and a more stable organization
are achievable through such adjustments.

A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

Introduction
Background
Everyday many Americans head out the door to complete another day at the office.
Whether they do so in a suit or sweatpants is not the focus of this paper, rather the physical and
mental wellness of such workers. Documented research suggests that the health of employees has
an influence on worker productivity (Envick, 2012).
Purpose
Through research produced by individuals such as Rebecca Mitchell and Paul Bates
(2011), the connection of lifestyle factors and health conditions to productivity has been made.
The purpose of this study is not to solidify that which has been concluded; but to expand on the
relation between productivity levels and employee health over the course of two years.
Problem Statement
In the United States the growth of economic productivity has slowed, falling behind
growth rates of many foreign countries (Polakoff & ORourke, 1990). This causes a raised
mindfulness to the economic success of companies everywhere. As a result, a question arises. If
there is a correlation between health and efficiency, how much of a difference in productivity
levels is there between a healthy workforce and an unhealthy workforce?
Hypothesis
To my knowledge, there are currently no controlled studies that have focused specifically
on the effect health promotion programs can have on productivity levels. The following study
examines the results of a multifaceted experiment used to support the belief that productivity of a
healthy workforce is at least two times that of an unhealthy workforce.

A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

Literature Review
While outlining the traits of a healthy workforce I noted two important sides of health,
the first being mental. Organizational theorists, scholars of the organizational behavior of
individuals and collections, have remarked that psychological wellbeing is directly tied to
effective performance (Envick, 2012). In fact, a dysfunctional wellbeing stemming from
hypertension or depression could be associated with negative performance (Envick, 2012).
Although a work environment may contribute heavily on the psychological competency of an
individual, the outside factors of everyday life causing unhealthy stress and coping methods are
in part to blame (Polakoff & ORourke, 1990). Daily obstacles include job dissatisfaction,
controversy with other employees, and lack of motivation, mental exhaustion, and work
environment (Polakoff & ORourke, 1990). A tremendous increase of 68% in feelings of stress
was noted in a study from ComPsych from the year 2009 to 2010; in which workers expressed
feeling extraordinary levels of stressors creating a sense of chaos (Harte, Mahieu, Mallett,
Norville, & VanderWerf, 2011). The psychological welfare plays a key role in the composition
of a healthy worker, therefore necessary for increased productivity.
According to the Centers for Disease Control and Prevention, two thirds of America is
classified as overweight with half of those being further classified as obese (Sliter, 2013). The
deprivation of routine exercise, unbalanced diet, and excess amounts of fat allocate numerous
circumstances including chronic illness. Four behaviors linked to early death and unnecessary
sufferings caused by chronic illness are poor nutrition, tobacco use, physical activity, and alcohol
consumption (Harte et al., 2011). By simply addressing nutritional needs, physical fitness,
tobacco use, and exorbitant alcohol consumption, conditions including cancer, diabetes,
respiratory diseases, blood pressure problems, cardiac concerns, and conditions related to strokes

A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

could decrease in number (Harte et al., 2011). Even though physical conditions dont always
mandate time off from work, which in turn leads to guaranteed loss of productivity, they can lead
to presenteeism. Presenteeism is a state of being at work without the capability of preforming at
a fully functional level in part to medical conditions (Envick, 2012). Factors such as insufficient
training or difficult work relations with managers and coworkers can contribute to presenteeism
(Merrill, Aldana, Pope, Anderson, Coberley, Whitmer & HERO Research, 2012). Estimated at
producing a $150 billion obstacle, presenteeism appears to be an existing drain on productivity
(Envick, 2012). Indeed, many studies suggest that costs incurred from both absenteeism and
presenteeism is three times the cost than medical and pharmaceutical costs (Loeppke, Nicholson,
Taitel, Sweeney, Haufle & Kessler, 2008). It has also been suggested that the efficiency of the
United States workforce is diminished by 5% to 10% due to health correlated problems (Harte et
al., 2011). Such tribulations leave employers with minimal productivity, excess expenses, loss of
probability, and the overall inquisition of what can be done.
There are several employer options to combat unhealthy employee risk factors. The
implementation and application of wellness programs and Employee Assistance Programs
(EAPs) to actively address negative health behaviors may prove beneficial in the long run (Mills,
Kessler, Cooper & Sullivan, 2007). Research has shown that 21% lower absenteeism rates, as
well as an increase of 14% productivity rate can be associated with those organizations that do
offer some type of EAP (Harte et al., 2011). Programs that focus on risk assessments,
communication, self-help opportunities, and group forums suggest the highest investment return
(Benavides & David, 2010). By promoting healthy lifestyles and illness prevention, the reduction
of fiscal funding spent on health care costs decline as productivity and profit increase. Movement
towards preventative screenings and early intervention, programs enabling others to quit

A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

addicting habits such as tobacco or alcohol use, appraisal of possible health imperilments, and
incentive programs to encourage healthy lifestyles can all be rewarding over time (Polakoff &
ORourke, 1990). Integration of such ideas may take three to five years of application in order to
understand the entity of impact such programs may have (Cyboran & Goldsmith, 2012).

A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

Methodology
Survey Design
In order to estimate productivity amounts due to health conditions, a multifaceted
experiment in which two groups participated was conducted. In January 2011, those participating
in the control and intervention groups were asked to complete an initial Health Risk Appraisal
(HRA) that was later reissued in January 2012 for comparison. At this point in time, the
overseeing managers were given the task of rating employee productivity based on a variety of
aspects such as the number of days missed, number of patients seen, and the on time completion
of work documents. Once the initial HRA was completed, employees in the intervention group
received a Personal Wellness Profile (PWP) in which a personalized health score and tailored
health tips were provided via email communication. Each month, a health pamphlet reviewing a
topic catered to each individuals needs was provided; along with access to online health forums,
group fitness classes, and smoking cessation meetings. Unlike the intervention group, those who
participated under the control group did not receive any type of wellness promotion resources.
Both the intervention and control group were offered the incentive of a $25 gift card to
participate in the initial and follow up HRA.
Study Population
The sample groups recruited for this experiment consisted of 400 full time employees
working 35 hours or more a week from six United States physical therapy clinics. The six office
based clinics specialized in both outpatient and inpatient care, along with home health services.
Employees ranged from ages 18 to 55 years old. In order to ensure a more comparative study, the
intervention and control groups were assigned after the initial assessment as to attempt to
equalize overall group health scores.

A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

Data
The HRA was compiled of 37 questions regarding various physical and mental health
topics such as tobacco, alcohol, nutrition, physical activity, life satisfaction, and current health
conditions. General health questions including weight, blood pressure, cholesterol level, height,
and waist measurement were asked. Besides the general health questions, most questions were
structured as multiple choice, or point scale. Each multiple choice and scale questions were given
a point system from 0 to 5; 0 meaning healthy and 5 meaning at risk. The information gathered
during the general health question section was compared to the health standards provided by
Health.gov. To calculate BMI the utilization of the following calculation of BMI = Weight (lb) /
(Height (in) X Height (in)) X 703 was used. The blood pressure was compared to the suggested
standard of 120/80 and cholesterol under 200. HRAs and manager surveys were provided
electronically. Out of the 400 individuals, 95% (n=380) responded to the initial HRA. Once two
equivalent groups were determined, 190 individuals were labeled the intervention group leaving
the other 190 respondents as the control group. During the January 2012 follow up HRA, the
intervention group had a 70% (n=133) response rate, while the control group had a 60% (n=114)
response rate.

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Findings
Out of the 380 individuals who initially participated, 45% (n=171) were men, leaving
55% (n=209) women. The mean BMI for both the control and intervention group upon initial
appraisal in 2011 was 23 (Figure 1.1). While both groups were on the higher end of the HRA
Score, both left room for improvements. According to the data, the initial survey suggested that
the average employee missed 1-5 days of work due to illness, as well had 6-10 days in which
they found it difficult to concentrate on work related tasks due to stress. Employers noted during
the year 2011, a total of 3,000 collective days missed due to sickness.
Initial Health Risk Appraisal (January 2011)
Control Group
Intervention Group
Mean BMI
24
22
Mean HRA Score
74
76
Mean Age
35
37
Figure 1.1

Overall Mean
23
75
36

When asked to report various health related conditions during the initial assessment, more than
half (85%) of all participants conveyed having at least one health ailment at some point in time
(Figure 1.2). Looking at some of the more serious conditions such as cancer, you can see that it
only affected 8% (n=30) whereas something such as a sleep disorder affected a much larger
portion (85%) of employees. Productivity was recorded through the number of days missed both
through the HRA as well as employer records. A comparison between the initial days missed
during 2011 and the overall Health Risk Appraisal Scores provided a productivity rate.
Health Conditions (January 2011)
Condition/Risk
Allergies
Arthritis
Asthma
Back Pain
Cancer
Chronic Pain
Depression

% Currently Have
52%
2%
23%
34%
<1%
16%
10%

% Previously Had
14%
1%
11%
25%
8%
70%
68%

A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

Diabetes
Emphysema
Heart Problems
High Blood Pressure
High Cholesterol
Migraine Headaches
Osteoporosis
Sleep Disorder
Stroke
Thyroid Disease
Other Condition
Figure 1.2

66%
<1%
5%
30%
17%
70%
2%
85%
<1%
12%
40%

11

13%
<1%
19%
13%
9%
5%
<1%
20%
2%
31%
20%

After the follow up HRA in 2012, in which 65% (n=247) of original participants
responded; a shift among intervention group was noted (Figure 1.3). Not only was a change
present in BMI and HRA scores, but also in the number of days reported to be taken off of work.
Employers noticed a drop from 3,000 collected days to 2,260 collected days taken off due to
illness. An increase of 14% productivity was logged among the intervention group, versus a
small 5% logged by the control group.
Follow-up Health Risk Appraisal (January 2012)
Control Group
Intervention Group
Mean BMI
25
18
Mean HRA Score
73
86
Mean Age
36
37
Figure 1.3

Overall Mean
22
80
37

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Summary
Employers are fighting an epidemic of lost productivity in association with periods of
sick leave, disability, or presenteeism. Although the factors of what entails a worker to be both
psychologically and physically well are up for further dissection, it can be said that there is
prominent link to the workforces health and the workplaces productivity. Health Risk
Appraisals, wellness promotion, and support groups offer necessary support while combating
unhealthy habits. The room for improved productivity is evident among workers in all fields of
expertise. The study outlined in this document supports increased productivity levels among
individuals possessing healthier lifestyles. By studying 400 full time employees varying by
gender, age, and health score; the opportunity to explore what affects health may have on work
tasks was achievable. Based off of my findings, I believe productivity levels can increase
anywhere from 8% to 15% by implementing a health plan that gives employees the tool to meet
their personal wellness goals.

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13

References
Benavides, A. D., & David, H. (2010). Local government wellness programs: A viable option to
decrease healthcare costs and improve productivity. Public Personal Management, 39(4),
291-306.
Cyboran, S. F., & Goldsmith, C. (2012). Making the case: New study shows it does, indeed, pay
to become a healthy enterprise. Benefits Quarterly, 28(1), 26-37.
Envick, B. R. (2012). Investing in a healthy workforce: The impact of physical wellness on
psychological well-being and the critical implications for worker performance. Academy
of Health Care Management Journal, 8(1), 21-32.
Harte, K., Mahieu, K., Mallett, D., Norville, J., & VanderWerf, S. (2011). Improving workplace
productivity- it isn't just about reducing absence. Benefits Quarterly, 27(3), 13-26.
Loeppke, R., Nicholson, S., Taitel, M., Sweeney, M., Haufle, V., & Kessler, R. (2008). The
impact of an integrated population health enhancement and disease management program
on employee health risk, health conditions, and productivity. Population Health
Management, 11(6), 287-296.
Merrill, R., Aldana, S., Pope, J., Anderson, D., Coberley, C., Whitmer, W., & HERO Research
Study Subcommittee, (2012). Presenteeism according to healthy behaviors, physical
health, and work environment. Population Health Management , 15(5), 293-301.
Mills, P., Kessler, R., Cooper, J., & Sullivan, S. (2007). Impact of a health promotion program
on employee health risks and work productivity. The Science of Health Promotion, 22(1),
45-53.
Mitchell, R., & Bates, P. (2011). Measuring health-related productivity loss. Population Health
Management, 14(2), 93-98.

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14

Polakoff, P. L., & O'Rourke, P. F. (1990). Healthy worker - healthy workplace the productivity
connection. Benefits Quarterly, 6(2), 37-57.
Sliter, K. A. (2013). Development and validation of a measure of workplace climate for healthy
weight maintenance. American Psychological Association, 18(3), 350-362.

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15

Appendix A
Health Risk Appraisal
The following survey is regarding your individual overall health and lifestyle habits. It has been
developed in order to understand what types of health promotion would benefit yourself, as well
as others the most. The information you provide will be anonymously used to develop Employee
Health Programs.
If you do not feel comfortable completing any questions on this survey, please leave the
item blank. We ask that you are honest with your answers, as it will help us understand which
areas need the most attentions. This survey is entirely voluntary and personal information such as
your name and address may be left blank.
This survey may take 5-10 minutes. Please be sure to read each question carefully before
answering. Please choose the answer that most closely applies.
Thank you very much for your time.

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16

Appendix B
Health Risk Appraisal
______________________________
Name (Last, MI, First)
______________________________
Address
________________________________________________________
City
State
Zip

Please complete each section to the best of your ability. In order to receive the most
accurate report, answer all questions. Thank you for your participation, all results will be
kept strictly confidential.
Questions 1-3 provide classification.
1. Gender
2. Age

3. Are you currently pregnant?

**If YES, complete survey based off of lifestyle and health
conditions before pregnancy.
Questions 4-8 ask about general health.
4. Height
5. Weight (in pounds)
6. Waist Circumference (in inches)
7. Blood Pressure

8. What is your total cholesterol level

Male
Female
<25
25-30
31-40
41-50
>50
Yes
No
Not Applicable

Inches

Pounds
Inches
Systolic (high number ____________
Diastolic (low number) ____________
Im not sure
mg/dl ____________
Im not sure
Feet

Questions 9-14 ask about tobacco use.

9. Have you ever smoked a cigarette?

10. Do you currently smoke cigarettes?

No (Go to question 15)

Yes (Go to question 10)
No (Go to question 12)
Yes (Go to question 11)

A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

11. On average, how many cigarettes do you

smoke per day?

12. How many years has it been since you

smoked on a regular basis?

13. Thinking back to the last 2 years before

you quit smoking, on average how many
cigarettes a day did you smoke?

14. Now consider other forms of tobacco, do

you smoke or use:
Cigars
Pipes
Smokeless Tobacco

17

1-2
3-7
8-14
15-20
>20
<1
2-5
6-10
>10
0-5
6-10
11-15
16-20
>20

Yes
Yes
Yes

No
No
No

Questions 15-18 ask about drug and alcohol use.

16. In the past month, how many times did you drive or ride as a

passenger when the driver might have had too much to drink?

17. During your lifetime, how many times have you used any form of
illegal drugs such as cocaine, methamphetamines, heroin, ecstasy, or
steroids?

18. During your lifetime, how many times have you taken a

prescription drug (such as OxiContin, Hydrocodone, Ritalin, Vicodin,

Xanax, etc.) without a doctors consent?

15. On average, how many alcoholic drinks do you have in a typical

week?
(1 Drink = 1 beer, glass of wine, shot of liquor or mixed drink)

0-5
6-10
11-15
16-20
>20
0-5
6-10
11-15
16-20
>20
0
1-2
3-9
10-19
20-40
>40
0
1-2
3-9
10-19
20-40
>40

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18

Questions 19-22 ask about your nutritional habits.

(1 Serving = 1 slice of wheat bread, cup oatmeal, cup brown

rice)

20. On average, how many servings of fresh fruit do you consume per
day? (Please do NOT include fruit juices)

(1 Serving = 1 apple, 1 banana, 1 cup grapes)

21. On average, how many servings of fresh vegetables do you

consume per day?

(1 Serving = 2 cups cooked spinach, 1 cup raw broccoli, 1 large

tomato)

22. On average, how many servings food do you consume each day

that are high in cholesterol or fat such as fried foods, fatty meats, or

cheese?

(1 Serving = 3 oz. meat, 1 slice of cheese, 1 egg)

19. On average, how many servings of whole grain do you consume

per day?

Rarely/Never
1-2
3-4
5-7
>7
Rarely/Never
1-2
3-4
5-7
>7
Rarely/Never
1-2
3-4
5-7
>7
Rarely/Never
1-2
3-4
5-7
>7

Questions 23-25 ask about your current physical activity.

23. Thinking back on the past 7 days, how many days were you
physically active (exercise that is hard enough to make you breath
heavier and increase your heart beat) for at least 30 minutes?
(Examples: Running, lifting, swimming, etc.)
24. During the past 7 days, how many days did you do exercises to
strengthen and tone your muscles?
(Examples: Pushups, weightlifting, crunches, etc.)
25. On an average day, how many hours do you spend on sedentary
activities?
(Examples: Watching TV, on the computer, sitting on the couch, etc.)

0
1-2
3-4
5-6
7
0
1-2
3-4
5-6
7
0-2
3-4
5-8
9-13
>13

Questions 26-30 ask about general feelings towards work and home life.

26. Generally speaking, how satisfied are you with your personal life?

27. How satisfied are you with your professional life?

Not satisfied
Somewhat satisfied
Mostly satisfied
Completely satisfied
Not satisfied
Somewhat satisfied

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19

28. In the past year, have you suffered any type of personal loss (such
as divorce, job loss, death of close acquaintance, etc.)?
29. How often do you experience feelings of stress, anxiety, or
tension?

30. Thinking back on the past year, how much impact has stress had
on your health?

31. On average, how many hours of restful sleep do you get per
night?

Mostly satisfied
Completely satisfied
No
Yes, 1
Yes, 2 or more
Never
Rarely
Sometimes
Often
None
A little
Some
A lot
0-3
4-5
6-8
>8

Question 32 asks about various health related conditions.

32. Do You Have:

Allergies
Arthritis
Asthma
Back Pain
Cancer
Chronic Pain
Depression
Diabetes
Emphysema
Heart Problems
High Blood Pressure
High Cholesterol
Migraine Headaches
Osteoporosis
Sleep Disorder
Stroke
Thyroid Disease
Other Condition

Never

In the Past

Currently
Have

Taking
Medication

Under
Medical
Care

A HEALTHY WORKFORCE, A HEIGHTENED PRODUCTIVITY

Question 33 asks about health related checkups.
33. Please specify the last time
Less
you had the following
1-2
than 1
preventative services or health
years
year
screenings.
Blood Pressure

20

3-4
years

5-6
years

7 or
more
years

Never

Dont
Know

Dental Checkup

Dermatologist

Eye Exam

Cholesterol Test
Colon Cancer Test

Flu Shot
Mammogram (Women only)
Pap Test (Women only)
Prostate Exam (Men only)

Questions 34-37 ask about current work related situations.

34. Thinking back over the past year, how many days of work have
you missed due to personal illness?

35. Over the past year, how many days of work did you find it hard
to concentrate on your regular tasks due to loss of concentration or
stress?

36. During the past month, how often did a health condition
(physical or mental) get in the way of work productivity?

37. On average, how many hours do you work each week?

0
1-5
6-10
11-15
>15
0
1-5
6-10
11-15
>15
Never
Rarely
Sometimes
Often
<10
11-20
21-34
35-44
45-55
>55

Thank you for your participation! Remember, the personal information provided will be held
confidential and is used for the sole purpose of providing a personalized health risk assessment.
This is part of research study in which your provided answers will remain anonymous.