1.

0 BACKGROUND OF THE ORGANISATION

McDonald's is the world's leading food service organization. We generate more than $40
billion in system wide sales. We operate over 30,000 restaurants in more than 100
countries on six continents. We have the benefits that come with scale and a strong
financial position. We own one of the world's most recognized and respected brands. We
have an unparalleled global infrastructure and competencies in restaurant operations, real
estate, retailing, marketing and franchising. We are a leader in the area of social
responsibility. We actively share our knowledge and expertise in food safety and are
committed to protecting the environment for future generations. Yet, we have not
achieved our growth expectations for the past several years. So, our challenge is to
leverage our strengths to profitably serve more customers more ways more often.

The McDonald's business structure is based upon a geographic structure. McDonald's

divided its operations into five geographical divisions; United States, Europe, Asia
Pacific, Middle East and Canada.75% of McDonald's revenue are generated in the United
States and Europe. Based on 2015 survey board, there are 7,920 restaurants in Europe
and 14,157 in Unites States (Mcdonalds Press Office, 2015).
The most important strategic approach for maintaining McDonald's leading edge is to
keep their business targets satisfied at the same time expanding their business into the
emerging markets. The main target customer for McDonald's includes parents with young
children, young children, business customers, and teenagers. Perhaps the most obvious
marketing for McDonald's is its' marketing towards children and the parents of young
children. Ronald McDonald was first introduced in 1963 and marked the beginning of
their focus on young children as a critical part of their ongoing business. Parents like to
visit McDonald's because it is a treat for the kids, and the kids enjoy the cartoon like
atmosphere (History, 2012). McDonald's also targets business customers as a part of their
core business. Business customers may stop during the workday and can count on fast
service, and consistently good food. Another major target of McDonald's marketing is to
teens. Teens find the value menu especially appealing and McDonald's markets their
restaurants as a cool place to meet with their friends and to work.
However, different customer groups in different countries may have different tastes
and/or requirements. So each functional geographic unit of McDonald's was required to
wholly response for producing and marketing its product in that region (Mcdonalds Press
Office, 2015). Through this regional structure, McDonald's could not only satisfy the
local consumers' needs in different geographical areas but also pursuing maximum local
development. McDonald's focuses on the perception of value within it line of products
and therefore takes care to price its menu items accordingly. Different products are priced
differently depending on which target audience those items appeal to most. An extensive
value menu is an essential part of any fast-food menu in recent years (McDonald made
for you the benefits, 2011). The prices and products within the value menu can prove to
be areas that will make or break a fast-food companies' year depending on the
competitions value menus. Regional pricing and periodic low-price specials are also
commonplace at McDonald's, as is the distribution of coupons. In attempt to boost
sagging sales McDonald's has developed its new taste menus, which offer new items at
higher price points. The constant development of new products has boosted the sales and
net income of McDonald's in recent years. It is estimated that their new line of higher
quality premium drinks such as Cappuccinos and gourmet coffees will add over 4 billion
dollar in sales in 2014(Financial Information, Annual Report 2014 , 2014).
For example, China is a big eater of chicken in that region. Therefore, McDonald's
business strategy is to try to adapt more Chinese tastes by adding more chicken meals
into their menu to attract more customers (McDonald made for you the benefits, 2011). In
France, McDonald's has boosted it sales by remodeling restaurants, such as hardwood
floors, wood-beam ceilings, comfortable armchairs. It also increases the revenue by
adding new menu items such as espresso, brioche and more upscale sandwiches. In
addition, the Tours, France McDonald's has added self-service kiosk, which allows the
customers to either control their kids or control their orders. By doing that McDonald's
have successfully responded to the preferences of the local area while increasing their
sales (McDonald's offers customers a bigger taste of technology, 2004).

Pension:
Defined contribution scheme for all salaried employees. Staff can contribute a minimum
of 3% and receive matching employer contributions on a 1:1, 1.5:1 or 2:1 ratio depending
on age and length of service, to a maximum employer contribution of 10%. Salaried
employees who do not wish to contribute 3% will receive the minimum contribution
levels set under auto-enrolment.

The National Employment Savings Trust (Nest) for all auto-enrolled hourly paid
employees, with contributions set at the minimum level required under auto-enrolment.

Healthcare and wellbeing:

Private medical insurance for all hourly paid employees after three years service and
salaried staff after six months service
Dental car
Eyecare vouchers
Dedicated wellbeing section on employee portal, ourlounge.co.uk
Group risk:
Income protection (for salaried members of the pension scheme, excluding those auto-
enrolled)
Personal accident insurance.
Life assurance

Staff travel:
Company cars: available for restaurant managers and staff of equivalent grades, as well
as employees in senior positions
Family-friendly benefits:
Enhanced maternity and paternity policies for salaried employees
Childcare vouchers via salary sacrifice arrangement
Flexible-working patterns
Job sharing
Paid eight-week sabbatical after 10 years service for salaried employees
Recognition schemes:

Employee of the month for each restaurant

Employee of the quarter for each restaurant
Employee of the year (national winner)
Ray Kroc award for the best restaurant managers
Holiday award for non-restaurant staff
Presidents award for non-restaurant staff
Service awards for all employees at five-year intervals from five to 30 years of service
Restaurant of the year
Consultant of the year

Incentive pay/performance-related pay:

Three bonus schemes:
A monthly scheme for hourly paid employees
A quarterly scheme for the restaurant management teams
An annual scheme for office support departments.

Holiday:

28 days including public holidays for hourly paid employees

30 days including public holidays for salaried employees

Other:
All employees receive free meals while at work
Employee discounts scheme
Interest-free emergency loans for salaried employees
2.0 RELATIONSHIP BETWEEN THE HEALTH AND PRODUCTIVITY OF THE
EMPLOYEES OF MCDONALDS

Productivity is essentially the efficiency in which a company or economy can transform

resources into goods, potentially creating more from less. Increased productivity means
greater output from the same amount of input. This is a value-added process that can
effectively raise living standards through decreasing the required monetary investment in
everyday necessities and luxuries, making consumers wealthier and businesses more
profitable.

From a broader perspective, increased productivity increases the power of an economy

through driving economic growth and satisfying more human needs with the same
resources. Increased gross domestic product (GDP) and overall economic outputs will
drive economic growth, improving the economy and the participants within the economy.
As a result, economies will benefit from a deeper pool of tax revenue to draw on in
generating necessary social services such as health care, education, welfare, public
transportation and funding for critical research. The benefits of increasing productivity
are extremely far-reaching, benefiting participants within the system alongside the system
itself.

To expand upon this, there are three useful perspectives in which to frame the value in
improving productivity within a system from an economic standpoint:

a) Consumers/Workers: At the most micro level the organization have improvements

in the standard of living for everyday consumers and workers as a result of
increased productivity. The more efficiency captured within a system, the lower
the required inputs (labor, land and capital) will be required to generate goods.
This can potentially reduce price points and minimize the necessary working
hours for the participants within an economy while retaining high levels
of consumption.
b) Businesses: Businesses that can derive higher productivity from a system also
benefit from creating more outputs with the same or fewer inputs. Simply put,
 higher efficiency equates to better margins through lower costs. This allows for
better compensation for employees, more working capital and an improved
competitive capacity.
c) Governments: Higher economic growth will also generate larger tax payments for
governments. This allows governments to invest more towards infrastructure and
social services.

A healthy workforce is one of our most important economic assets as a nation. While
ensuring that all the employees of McDonalds have health insurance coverage and
receive effective medical services would certainly help protect this vital asset, the cost of
doing so has thus far deterred the nations policymakers. But what about the other side of
the ledger the economic cost of having millions of workers who are too sick to work or
function effectively? Drawing from the Commonwealth Fund Biennial Health Insurance
Survey, this analysis examines three major sources of lost economic productivity related
to health: adults who do not work because of poor health or disability; workers who miss
time from their jobs because of health problems; and workers who, while working, are
less productive than they could be as a result of their own health problems or worries
about sick family members.

Consideration of workplace wellbeing and health in the workplace is an increasing

preoccupation for McDonalds. This preoccupation is mainly attributable to the positive
links that have been found between the health and wellbeing of employees and
productivity and performance. Because of this relationship there are incentives for
employers to intervene to support and promote the health and wellbeing of their
employees of McDonalds. Depending on the intervention, there is potential for the gains
from intervening to outweigh the costs of not intervening. In addition to raising
productivity, interventions to support health promotion in the workplace can reduce the
cost of health care for employees which is particularly important in countries such as the
US where health insurance is paid directly by McDonalds. Such interventions can also be
part of a strategy to respond to duties and regulations around responsible employment.
However, the most cited rationale for intervention in the workplace is to improve the
quality of life and productivity of workers and to reduce economic losses through
absence, sickness, disability and presenteeism: Today many employers associate poor
health with reduced employee performance, safety and morale. The organisational costs
of workers in poor health, and those with behavioural risk factors, include high medical,
disability, and workers; compensation expenses; elevated absenteeism and employee
turnover; and decreased productivity at work (often referred to as presenteeism). In
addition, one workers poor health may negatively affect the performance of others who
work with him or her (Goetzel and Ozminkowski, 2006: 305).

Over the last decades, accelerating technological changes and new forms of workplace
organisation have led to workers assuming increased responsibilities and more autonomy
than ever before (Appelbaum et al., 2000). Although this has increased overall
productivity, flexible modern working practices have also increased daily job demands,
requiring employees to multi-task and leading to increased levels of workplace stress and
unrealistic time pressures (Bevan, 2012). These developments have not only led to
increasing levels of sickness absence but also to the emergence of a phenomenon called
presenteeism, when employees attend work while in suboptimal health. It is estimated
that presenteeism driven by mental ill-health costs the UK economy 15bn per year
(Centre for Mental Health, 2011). What is more, there is growing evidence that problems
related to modifiable health behaviour are becoming more prevalent, driven by a lack of
physical activity, by smoking, or by a rise in obesity levels in the wider population
(Goetzel et al., 2012). This creates economic costs not only to society at large but also,
more specifically, to businesses in the form of lost productivity.

In light of such substantive costs due to absenteeism and presenteeism, we would expect
there to be a strong case for companies to invest in the health and wellbeing of their
employees. However, simple economics tells us that companies only find it profitable to
invest in health promotion programmes when the benefits outweigh the cost of
investment in the longer term. For companies it is crucial to understand the direct link
between wellbeing and productivity. Without a clear evidence base, an optimal
investment level will not be achieved. This report based on data from the Britains
Healthiest Company (BHC)1 Competition contributes to the evidence base on wellbeing
and workplace productivity by exploiting a unique large employeremployee dataset. Our
collected survey data include business information for 82 UK companies plus a thorough
health assessment of their workforce, including a broad variety of physical- and mental-
health indicators for individual workers. Altogether, the sample consists of 21,822
employees. Using multivariate regression techniques we look at the associations between
a variety of health-risk and work-environment factors in association with workplace
productivity lost due to absenteeism and/or presenteeism. We measure work productivity
using the Work Productivity and Activity Impairment Questionnaire (General Health) or
WPAI-GH, which assesses productivity based on self-reported general health and
symptom severity. Our findings suggest that lack of sleep, financial concerns and giving
unpaid care to family members or relatives are negatively associated with productivity.
Mental-health problems are also found to cause 1 BHC is a project funded by
VitalityHealth and academic support is provided by a research team from RAND Europe
and the University of Cambridge. RAND Europe x significant productivity loss,
especially in the form of presenteeism. In line with existing research we also find that
employees with musculoskeletal and other (chronic) health conditions report higher rates
of absenteeism and presenteeism than workers without such conditions. When looking at
work-environment factors we find that workers who are subject to workplace bullying
report significantly higher levels of absenteeism and presenteeism than those who are not.
We also find that more than 45 per cent of those studied reported being subject to
unrealistic time pressures, which we find to be another significant cause of productivity
loss. Other work-environment factors associated with relatively higher levels of
presenteeism were strained relationships at work. Beside the aforementioned significant
associations between certain risk factors and productivity loss in the workplace, some of
our findings are somewhat counterintuitive. For instance, smoking has not been found to
be statistically significantly associated with productivity loss. Also, severe obesity has not
been found to be related to absenteeism and presenteeism. Here we need to take into
account the crosssectional nature of our data. We are not in a position to follow
individuals over a longer time period, where the evidence shows that smoking and
obesity are associated with severe health conditions such as cardiovascular disease or
cancer, both of which are associated with productivity loss. Therefore, our findings
potentially capture more short-term effects, assessed at a given point in time. Similarly, in
our analysis, work-environment factors such as a lack of control or insufficient peer or
managerial support do not show any statistically significant associations with workplace
productivity loss. Our report should be useful to policymakers and practitioners in
identifying the characteristics of employees who are more at risk of work impairment.
Our analysis also indicates the importance of workenvironment factors on productivity,
something of relevance to companies looking to improve their working environment and
reduce its negative effects on employees health and wellbeing. Our analysis
distinguishes in more detail between factors that determine absenteeism and
presenteeism. Based on our (self-reported) data, we find that various factors are slightly
differently associated with absenteeism compared to presenteeism, indicating that
policymakers and companies may want to look more at presenteeism and its associated
risk factors. Knowledge about the effectiveness of workplace health interventions and
programmes is still emerging and our report cannot make direct suggestions about what
type of interventions policymakers or organisations should implement to improve
employee health and wellbeing. Some of our findings suggest that companies which pay
attention to health and wellbeing at board level report lower rates of absenteeism and
presenteeism, although more research still needs to be done into the effectiveness of
health interventions in the workplace.

Health and wellbeing promotion has been integral to international workplace culture in
western developed countries such as the UK and Australia since the early 1980s (Chu et
al., 1997; Kirk and Brown, 2003). However, the related language and discourse has
changed over time and varies internationally to incorporate concepts such as institutional
stress and programs which support positive mental health in the workplace either at the
individual or the organisational level (e.g. Employee Assistance Programs or EAPs and
Health Promotion Programs or HPPs in the USA, Australia and Canada). For the purpose
of this review, the literature was broadly searched using the term workplace wellbeing,
which incorporates health promotion in relation to mental health and the wider structure
of interventions that are intended to have positive effects for wellbeing. Despite many
interventions over the past thirty years it is somewhat surprising to find that there has
been rather limited research concerned with discovering which interventions in this area
are the most effective in workplace settings. However, from early research into stressors
and strains in occupational health, there is a growing awareness that interventions need to
target both individuals, and the organisational environment (Cotton and Hart, 2003;
Stansfeld and Candy, 2006). 3.2 Evidence supporting workplace wellbeing intervention
Poor mental health and illness is one of the leading causes of disability both in the UK
and internationally. An evidence base is building that supports the link between the
incidence of depression and anxiety or poor mental health and low job quality and work
stress (Dewa and McDaid, 2011; Sanderson and Andrews, 2006; Stansfeld and Candy,
2006). As LaMontagne et al. state, job stress and other work-related psychosocial
hazards are emerging as the leading contributors to the burden of occupational disease
and injury (LaMontagne, et al., 2007: 221). In the UK, there are legal frameworks (such
as the Disability Discrimination Act, 1995 and the Equality Act, 2010) that articulate the
responsibility employers have both to support people with mental illness, but also,
importantly to maintain a healthy workplace and in so far as is proportionate, maintain
workplace wellbeing. This section of the review focuses on the literature relating to
mental health and wellbeing, explores the evidence to support businesses taking
responsibility for these areas, and considers the effectiveness of specific interventions.
The review highlights the limited available evidence from the retail and construction
industries. The evidence was drawn from 28 identified sources. The evidence to support
the need to intervene in to support those with mental health disorders , and to encourage
workplace wellbeing through health promotion initiatives is growing, with multiple
reasons cited for intervention including human rights and justice issues, economic
arguments, slipover effects and health insurance considerations (see Figure 4) and Table
A2.2 in Appendix 2 for evidence sources).
In the UK, since the 2008 Black report and related debates concerned with the economic
impact of mental and emotional health problems, government has committed to the
development of a national mental health and employment strategy (Dewa and McDaid,
2011). This pattern is observable in other countries, where often it is the business sector
forming consortiums (as in Canada) to consider developing strategies to curb disability
costs to organisations (Dewa and McDaid, 2011: 34). Dewa and McDaid (2011)
reviewed evidence from a range of studies including studies on depression and argue that
gender effects the relationship between work stress and poor mental health, as men who
have depression indicate high job strain as a factor whilst women who have depression
identify low social support in the workplace. Mental health concerns in the workplace are
complex and further research is needed both to look at different work contexts, but also
the diversity issues within and around those contexts. The relationship between
workplace wellbeing and stress is also far from straightforward. The work of Cotton and
Hart (2003) in particular has implications for the management of occupational stress.
Cotton and Hart state that research has shown that it is a persons level of energy,
enthusiasm and pride that more strongly influences their decision to take time off work,
rather than the level of distress they may be experiencing (Cotton and Hart, 2003: 120).
Their work looking at police officers and teachers, found that organisational factors were
hugely influential, more so that adverse employment experiences, which challenges the
conventional wisdom that significant events are the main stressors (Cotton and Hart,
2003). These research findings are important for understanding the factors that
significantly impact on wellbeing. The implication is that organisational and management
changes should be targeted rather than individual distress since morale within an
organisation is an important protective factor. However, there is no discussion of sector-
wide influences such as wider issues of morale in a professional workforce. This could be
an interesting area for future research particularly in the light of recent policy
interventions in the public sector. Faragher et al. (2005) conducted a meta-analysis of 485
studies with a research sample of 267,995 individuals, and found that job satisfaction
levels are linked to the health of workers (Faragher et al., 2005: 105). However, they also
found that if reviewed superficially, the evidence can easily appear to be both
contradictory and inconclusive (Faragher et al., 2005: 105). They found that job
satisfaction was much more strongly associated with mental/psychological problems than
with physical complaints and very closely allied with burnout. It also correlated but
slightly less strongly with depression, anxiety, self-esteem, general mental health issues.
Whilst the relationship between job satisfaction and strain was also relatively high,
correlation with subjective physical illness was more modest (Faragher et al., 2005).
Interestingly they found the lowest correlations were for cardiovascular disease and
musculoskeletal disorders. This closer association between job satisfaction and mental
health is important for the emphasis placed in relation to policy. Faragher et al. felt a
causal inference was possible from their meta-analysis following the logic that: many
people spend a considerable proportion of their waking hours at work. If their work is
failing to provide adequate personal satisfaction or even causing actual dissatisfaction
they are likely to be feeling unhappy or unfulfilled for long periods of each working day.
It seems reasonable to hypothesise that such individuals are at increased risk of
experiencing a lowering of general mood and feelings of self-worth while at work
culminating in mild levels of depression and/or anxiety. If continued unresolved for any
length of time, such emotions could eventually lead to emotional exhaustion, particularly
if the individual is unable to prevent their feelings from spilling over into their
home/social life (Faragher et al., 2005: 108). This causal link has important implications
for the design and delivery of employee health intervention programmes.
Over the next ten to twenty years, the workforce will become, on average, older. While
demographic change in the population as a whole will lead to an ageing population in
general, the impact on the workforce will be even more marked due to the removal of the
default retirement age and changes in pension provision that are likely to mean people
will either retire later or feel that they are unable to retire at all (see Parry and Harris
2011). Reviews of the research literature suggest that changes in health and wellbeing
across the life-course may be due more to exposure to lifestyle and environmental risk
factors than to chronological age alone (Marcus and Harper 2006; Crawford et al 2009).
This suggests that there is an important role for health promotion across all age groups to
reduce the negative impact of factors such as lack of exercise, poor diet, smoking,
drinking and environmental and psychosocial risks. There are generally higher levels of
chronic health conditions such as musculoskeletal disorders, cardio-vascular disease and
diabetes in older people, and cancer is also more prevalent in this age group. Statistics
suggest that 90,000 people of working age are diagnosed with cancer every year (ONS
2011) and many of them stay in work during, or return to work following, treatment. As
people age, there may be changes to what they most value about work, from wanting to
achieve promotion or pay the mortgage, to valuing the social support and structure
provided by the workplace. Although changes in work capacity over the life-span can
vary significantly, evidence suggests that ageing can bring with it declines in aerobic and
cardiovascular fitness, musculoskeletal strength, cognitive functioning (for example,
reaction times) and sensory acuity (for example, sight and hearing) (Kanowski 1994).
This may affect certain aspects of performance, particularly in more physical jobs, but
deficits can often be mitigated by good ergonomic design. Evidence for different levels of
mental health at different ages is mixed, with some studies showing higher levels of
depression; others a decrease in depression with age. However, it does appear that older
depressed people have higher chances of relapse and poor prognosis (Kanowski 1994). In
addition to the impact of ageing on employees themselves, there will also be implications
for those caring for them. Responsibilities of the sandwich generation, those working and
caring for both children and elderly parents are likely to increase. With increased
longevity there may be more grandparents who are in work, while caring for their own
elderly parents and also dealing with their own chronic conditions associated with ageing.
In times of economic uncertainty, absence levels often drop in relative terms because
employees are concerned about job security and employers may deal with absence earlier
because they cannot afford the employees time away (Podro 2010). One area that has yet
to receive the attention it deserves is the rise of presenteeism, where an individual goes to
work despite suffering ill-health. According to the Sainsbury Centre for Mental Health
there is evidence to suggest that this is a more costly problem for employers than
absenteeism (Sainsbury Centre for Mental Health 2007), partly because it is more likely
to happen amongst higher paid employees. It is by no means easy to identify or measure.
However the recent CBI survey showed that almost three quarters of responding
employers reported that presenteeism had an adverse impact on staff productivity levels,
making this by far the most common problem in terms of poor performance. Job
insecurity may not be the only cause of presenteeism. The culture of the organisation and
the nature of work for example team working may mean people attend work when not
well so as not to let down their team members; a culture of presenteeism may mean that
taking sickness absence is formally or informally frowned upon. It can also be
exacerbated by absence management policies that penalise individuals who take sick
leave. Moreover, individual factors such as commitment to work (or even
workaholism), personality factors and financial need may influence whether or not
someone comes into work when ill. 8 9 It is important to note that many people with a
health problem can work perfectly well for much or all of the time and this is not in itself
presenteeism. Work, after all, is generally good for health (Waddell et al 2006) and people
do not need to be 100% fit in order to continue to/return to work. Indeed, returning to
work following a period of sickness absence can contribute to the recovery process. It
may be that a period of lowered productivity during an initial rehabilitation period or
phased return to work is actually a price worth paying and therefore might be deemed
positive presenteeism. Indeed this is very much what lies behind the introduction of the
fit note. If presenteeism increases over the next few years, however, the likelihood is that
overall, it may lead to reduced productivity and disengagement. It may also lead to
individuals suffering poorer longer-term health outcomes. For some conditions, a period
of sickness absence may be beneficial to aid recovery and/or prevent exacerbation of
symptoms. In addition, those who come to work despite suffering from an infectious
disease risk infecting their colleagues and others in the workplace. While it might appear
to be the opposite of absenteeism, research suggests that presenteeism is more prevalent
in organisations where absenteeism is also high (Sainsbury Centre for Mental Health
2007), perhaps as a result of these latter effects.

McDonalds workers in 19 cities who allegedly suffered severe burns on the job have
filed 28 health and safety complaints with OSHA against the company. The workers
contend that they face hazards such as hot oil, hot grills and greasy, slippery floors.

They allege that understaffing and pressure to work too fast are the main drivers
responsible for the injuries. According to the workers, McDonalds computer system
dictates staffing levels and the pace of work, contributing to the conditions that create a
hazardous work environment.

A statement from McDonald's said the company will review the allegations and that its
franchisees "are committed to providing safe working conditions for employees in the
14,000 McDonald's brand U.S. restaurants. The company noted that it believes the
complaints were filed as part of a larger strategy orchestrated by activists targeting our
brand and designed to generate media coverage.

Fight for $15, a group that is backed by the Service Employees International Union,
publicized the worker complaints and is spearheading the effort to organize fast food
workers into a union.

The complaints filed with OSHA claim that many McDonalds locations lack basic first
aid or personal protective equipment (PPE) such as gloves, aprons, goggles or heat-
resistant sleeves necessary to ensure workers safety, and that managers often tell
workers to treat burns with condiments like mustard rather than burn cream.

My managers kept pushing me to work faster, and while trying to meet their demands I
slipped on a wet floor, catching my arm on a hot grill, said Brittney Berry, who has
worked at McDonalds in Chicago since 2011, and who suffered a severe burn on her
forearm and nerve damage from the accident. The managers told me to put mustard on
it, but I ended up having to get rushed to the hospital in an ambulance.

The complaints, filed with federal OSHA and state safety and health authorities, allege a
wide range of serious dangers at the workplace, including: pressure to clean and filter the
fryer while the oil is hot; lack of proper protective equipment; floors that are greasy or
wet; and missing or empty first aid kits. Complaints were filed at both corporate and
franchised locations.

One of my coworkers and I have to empty the grease trap without protective gear, and
since we were never given the proper equipment or training, we just dump the hot grease
into a plastic bag in a box of ice, said Martisse Campbell, who works at McDonalds in
Philadelphia, and whose hand was severely burned by boiling grease from a fryer. Once,
 my coworker got badly burned, and our manager told him put mayonnaise on it, youll
be good. McDonalds needs to be held accountable

In our first meeting, there were 50 workers in a room in New York City who held up
their arms covered in burns and said this is what it means to be a fast-food worker, said
Kendall Fells, organizing director of the Fight for $15. As this campaign has spread to
cities across the country, its become painfully clear that unsafe conditions go hand in
hand with the industrys low wages.

The group claims that while McDonalds closely monitors nearly every aspect of its
franchisees business operations via regular inspections, it often ignores health and safety
problems. Moreover, the group claimed, workers in corporate-owned stores report the
same health and safety hazards as workers in franchised restaurants.

Its a problem that only McDonalds can fix, and the time to fix it is now, said Fells.

Four In Five Fast Food Workers Burned in the Past Year

According to a fast food worker safety survey conducted by Hart Research Associates
and released March 16 by the National Council for Occupational Safety and Health, 79
percent of fast-food workers in the United States have been burned in the past year, most
repeatedly. A total of 87 percent of fast food workers have suffered some type of injury
in the past year, including 78 percent who suffered multiple injuries. Other frequently
cited injuries include:

Cut: 67 percent

Hurt while lifting or carrying items: 34 percent

Injured by a fall on a wet, slippery or oily floor: 23
Assaulted: 12 percent
Injured in another way: 29 percent
 The survey found that 36 percent of workers report that first aid kits are missing,
inaccessible or empty, and one-third of fast-food workers in the United States had been
told to treat burns with condiments like mustard or mayonnaise rather than burn cream.

Workers who took the survey listed a variety of causes for the hazardous working
conditions, including, in order of importance:

Too few employees to hand the workload safely.

Pressure from managers to work more quickly than the employees thought was
safe.
Broken or damaged kitchen equipment.
Wet, slippery or oily floors.
Not enough training.
Missing or damaged PPE.

Workers plan to hold protests at McDonalds stores across the country March 17 to
demand that the company be held accountable for the widespread dangers at its stores.

The 19 cities where complaints were filed include Kansas City, Mo., Miramar, Fla.,
Nanuet, N.Y., New York, N.Y., New Orleans and Philadelphia.

Companies trying to increase productivity should offer their employees more wellness
programs, a new study finds.

Workers who ate healthful meals and exercised on a regular basis had better job
performance and lower absenteeism, research from the Health Enhancement Research
Organization (HERO), Brigham Young University and the Center for Health Research at
Healthways shows.

Employees who eat healthy all day long were 25 percent more likely to have higher job
performance, the study found, while those who eat five or more servings of fruit and
vegetables at least four times a week were 20 percent more likely to be more productive.
In addition, employees who exercise for at least 30 minutes, three times a week, were 15
percent more likely to have higher job performance.

Overall, absenteeism was 27 percent lower for those workers who ate healthy and
regularly exercised and that their job performance was 11 percent higher than their peers
who were obese, the study found.

Overweight workers experienced lower job performance and higher absenteeism,

compared to those employees who suffer from depression and other chronic diseases or
conditions.

"This latest study investigating the link between employee health, performance and
productivity reinforces the business case for employers to provide comprehensive,
evidence-based health management programs for their work force," said Jerry Noyce,
president and CEO of HERO.

Carter Coberley, vice president of Health Research and Outcomes at Healthways, said
more and more employers are defining individual well-being through the performance
and productivity of their work force.

Well-being is gaining recognition as an important measure that relates both to the quality
of life of individuals as well as to financial measures that are important to business and
government leaders," Coberley said.

"Well-being can also serve as an important business success metric through its
demonstrated relationship to employee absence and job performance as measured in
multiple large employers," he added.

The study was based on data from three geographically dispersed U.S. companies,
representing 20,114 employees who completed a work-related survey each year from
2008 through 2010. It was published in this month's Journal of Occupational and
Environmental Medicine.

Chronic diseases, which include arthritis, musculoskeletal disease, depression and

anxiety, cardiovascular disease, cancer, diabetes and hypertension, make up more than
70% of Australias overall disease burden.10 In 2004/05, 33% of workingage Australians
reported that they suffered from at least one chronic disease.11 Chronic disease, which is
considered to be largely preventable, is identified as the prime cause of lost work time in
the working-age population12 and often leads to disability and early retirement. Health
conditions associated with low labour force participation in the 45-64 years age group
and lost workforce are back problems, arthritis and related disorders and mental
illness.13 Most chronic diseases in Australia are associated with one or more of the
following lifestyle-related risk factors: > unhealthy eating; > physical inactivity; >
alcohol; and > smoking.10 Because a persons likelihood for developing a chronic
disease increases with the number of risk factors they have, reducing the prevalence of
risk factors is key to preventing chronic disease. Unfortunately, while smoking rates are
dropping, ABS data shows other risk factor rates in Australia are rising steadily14 and
72% of working-age Australians report multiple risk factors for chronic disease.15 The
workplace can contribute to some risk factors for chronic disease, for instance via
sedentary work and work-related stress. Work-related stress is becoming increasingly
problematic in Australia, as evidenced by a 54% increase in mental stress claims as a
proportion of all accepted claims by premium payers in the Comcare scheme since
2006/07.16 Protecting the health of workers is becoming more critical as the workforce
ages Australias population is aging. There are fewer workers to support retirees and
younger dependents. In the Australian Public Service (APS) there has been a consistent
long-term trend towards an older age profile, with increasing representation of workers
over 45 years of age.17 Older workers are more likely to develop chronic diseases and
disabilities and may be more vulnerable to the effects of workplace accidents. Therefore,
as the workforce ages health and wellbeing initiatives that support older workers to
remain in the workforce by reducing health risks and preventing or delaying the onset of
chronic disease and disability are becoming more important.12
Turnover: Research has identified an association between health and wellbeing and
employee turnover: where an organisation does not manage health and wellbeing well it
is four times more likely to lose talent in the next twelve months.24 The Australian
Human Resources Institute (AHRI) recently estimated that the cost of staff turnover in
Australia is in the order of $20 billion. AHRI also found that staff turnover rates in
Australia are on the rise. AHRI estimates the cost of replacing an employee is at least
75% of the employees annual salary and may be as much as 150% in some cases.25
Absenteeism: Absenteeism rates in Australia are on the increase, up from 8.5 days per
person in 2006 to 9.87 per person in 2010.26 While absence rates vary widely between
APS agencies, the broader Australian upward trend was reflected in 2009-10, with the
median rate rising to 10.5 days per person.17 Workplace absences are expensive for
employers, costing on average $3741 per employee per year in 2010. As 75% of
unplanned absences are for illness, the link between worker health and absenteeism costs
is obvious. Organisations can calculate their own absence costs using online Absence
Calculators, such as that available at: www.dhs.net.au/. Presenteeism: When employees at
work are not fully functioning due to illness or a medical condition, it is estimated the
cost to the employer is between three and four times that of absenteeism. Economic
modelling of the cost of presenteeism related to 12 chronic diseases in Australia
estimated overall average labour productivity loss in the region of 2.5%.27 Overseas
research indicates that on-the-job productivity losses could account for up to 61% of the
total cost borne by the employer due to employees suffering from chronic disease.28 As
presenteeism is a hidden cost the true cost of an unhealthy workforce is likely to be
much larger than most employers realise. Workers compensation: Body stressing and
mental stress claims accounted for 71% of premium payers claims costs in the Comcare
scheme in 2009/10.29 The incidence of both claim types is strongly influenced by the
psychosocial work environment and levels of worker wellbeing. Research finds the
lowest workers compensation costs are found in work teams where good leadership and
organisational climate factors foster a positive work environment where employees feel
supported and have high levels of wellbeing.30 Investments in worker health and
wellbeing that aim to improve organisational climate and develop supportive leadership
can therefore expect to lower workers compensation costs.
3.0 THE REASONS FOR THE DIVERGENCE
3.2.1. Job- and workplace-related factors
Job-related factors driving absenteeism and presenteeism can be divided into two
elements: workplacedesign indicators, including the work environment, and wider
organisational factors. Workplace policies including sick pay and job stability can
strongly influence the absenteeism and presenteeism of an individual worker (Johns,
2010). However, it is not just through organisational policies. The job role itself (e.g.
manual labour or high-intensity public-facing roles), management issues (including
perceptions of effortreward balance) and the workplace environment can all influence
productivity directly through their influence on worker health (Black, 2008) or
indirectly where sickness absence is a coping mechanism. There exists a direct relation
between job design, family-friendly workmanagement practices, organisational change
and employee health and wellbeing. The 2014 BHC survey includes indicators to
measure work-related stress using six items from the UK Health & Safety Executive
(HSE) Management Standards (MS) Indicator Tool (Health and Safety Executive, 2015).
Stress is measured along the following lines: Demands: unrealistic time pressures
Control: choice in deciding what to do at work Managerial support: line manager
encourages at work Peer support: respect at work from colleagues Relationships:
those at work are strained Change: staff are always consulted about change at work In
line with Gerich (2015), the organisational factors associated with workplace productivity
present in the 2014 BHC survey include further indicators showing the importance of
employee health and wellbeing in measuring a companys success perceived by board
members, as well as whether the organisation supports health-promotion programmes in
the workplace. Moreover, in order to investigate the relation between a companys
provision of health and wellbeing interventions and productivity in the workplace we use
information from both, the employer and employee surveys, and construct an intervention
index measuring the intensity with which a company offers health-promotion and
wellbeing programmes to its employees. To generate the index we add up the number of
interventions a company provides and weight it with the share of employees who
reported actually using the provided intervention.6 We then place companies into three
groups of equal size according to their health-intervention index score: companies with
low provision (low), companies with medium provision (medium) and companies with
high provision (high).

3.2.2. Personal factors Personal factors determining workplace productivity can be

broadly categorised into three elements. Firstly, non-job factors such as work attitudes
and financial or family priorities can influence an individuals absenteeism or
presenteeism (Johns, 2010). Our data include, for instance, measures on whether an
employee suffers financial pressure or provides unpaid care looking after an ill, frail or
disabled family member. Secondly, it has been found that lifestyle risk factors including
obesity, diet and sedentary lifestyle habits influence workplace productivity (Alavinia et
al. 2009; Boles et al. 2004; Cancelliere et al. 2011). A lack of physical activity has been
associated with low workplace productivity. Burton et al. (2005a) compared those using a
fitness centre with those who did not (using a logistic regression model adjusted for age,
gender, location and health risks) and found that the latter were more likely to report
higher levels of presenteeism. More recently, attention has turned to sleep as a
determinant of productivity loss. Recent studies (Bolge et al. 2009; Dean et al. 2010;
Kessler et al. 2011; Sarsour et al. 2011) show the relation between insomnia and
workplace performance. Using the same productivity scale, the study by Katz et al.
(2014) found that (accounting for factors such as demographics and other health risks)
employees who slept less than seven to eight hours per night experienced significantly
more productivity loss compared to employees who slept more than eight hours per night
on average. Thirdly, mild to severe mental-health conditions are found to be major
predictors of productivity loss (Stewart et al., 2003b). Stress at work may increase ill
health and productivity directly through biological stress pathways or indirectly through
influencing individuals health behaviours, such as alcohol consumption and smoking
(Chandola et al., 2008). In the BHC survey, mental health is measured using the Kessler
Psychological Distress scale, a six-item questionnaire intended to provide a measure of
distress based on questions about anxiety and depressive symptoms a person has
experienced in the most recent four-week period (Kessler et al., 2002). Poor scores on
mental wellbeing can impact negatively on both mental and physical health. 3.2.3. Health
and physical factors Chronic and acute health conditions have been found to be linked to
workplace productivity loss (Burton et al., 2004). For instance, a study at a British
university showed that around 40 per cent of employees with a self-reported chronic
illness reported limitations in their productivity when at work (Munir et al., 2005).
Generally, the existing literature measures the impact of co-morbidity by adding up the
number of existing conditions for each individual. Lerner et al. (2003), for example,
added up the number of conditions and found that each additional chronic condition
gradually increases probability of work productivity loss due to presenteeism. In addition
to the literature on productivity loss, which shows a strong association between
productivity and mental health, the link with musculoskeletal pain is also important. In a
systematic review, Schultz and Edington (2007) highlight that only one study (Hagberg et
al., 2002), which they identify as of moderate quality, looks at the association between
musculoskeletal conditions and presenteeism. Using a relatively long one-month recall
period for their productivity scale, Hagberg et al. (2002) show a productivity loss among
Swedish computer workers with musculoskeletal problems. Some studies have also
looked at the associations of biological risk factors, such as high blood pressure, glucose
and cholesterol. However, the overall assessment is that the effect of these risk factors
seems not to matter much as a driver of productivity loss (Burton et al., 2005b ).

A serious workplace injury or death changes lives forever for families, friends,
communities, and coworkers too. Human loss and suffering is immeasurable.
Occupational injuries and illnesses can provoke major crises for the families in which
they occur. In addition to major financial burdens, they can impose substantial time
demands on uninjured family members. Today, when many families are operating with
very little free time, family resources may be stretched to the breaking point.

Every person who leaves for work in the morning should expect to return home at night
in good health. Can you imagine the knock on the door to tell you your loved one will
never be returning home? Or the phone call to say hes in the hospital and may never
walk again? Ensuring that husbands return to their wives, wives to their husbands,
parents to their children, and friends to their friends that is the most important reason
to create a safe and healthy work environment.

But it isnt the only reason.

REDUCING INJURIES REDUCES COSTS TO YOUR BUSINESS:

If a worker is injured on the job, it costs the company in lost work hours, increased
insurance rates, workers compensation premiums and possible litigation. Productivity is
lost when other workers have to stop work to deal with the injury. Even after the injured
employee has been sent home or taken to the hospital, other employees may be distracted
or need to take time off from work in the aftermath of the incident. Even a single injury
can have far-reaching and debilitating effects on your business.

SAFE WORKERS ARE LOYAL WORKERS:

Any business knows that employee attrition and absenteeism can be major obstacles.
When you create a healthy and safe workplace, you reduce those issues in several ways.
By budgeting for safety improvements and making safety part of your operational plan,
you engender trust. By involving employees in safety decisionsthrough reporting,
committees, walk-throughs and meetingsyou show that their opinion matters to you.
By following through on their input and improving safety, you prove quite tangibly that
you care about their well-being. Workers typically respond by working harder, showing
more pride in their jobs and remaining loyal.

SAFETY IMPROVES QUALITY:

Time and again, companies that put safety first turn out higher quality products. In some
cases, thats because a safe workplace tends to be a more efficient one, free of debris and
tangles of cords. In other cases, its a matter of focus. By working in a clean, efficient
environment, workers are able to reduce distractions and truly focus on the quality of
what they do. The results? Better products that create customer loyalty, bigger margins
and increased sales.
 In these ways and others workplace safety is about much more than legislation. Its about
creating the kind of productive, efficient, happy and inspiring workplace we all want to
be part of. Its about creating a highly profitable company. And thats why its important.

On average, for every $1 employers spend on worker medical or pharmacy costs, they
absorb at least $2.30 in HRLP costs in lost work time. Other studies support the
contention that lost job productivity as a result of health problems is more costly than
medical expenditures. Consider:
Duke University research estimated that the cost of obesity among U.S. full-time
employees is $73.1 billion. Presenteeism accounted for as much as 56 percent of the
total cost of obesity for women, and 68 percent for men. Even among those in the
normal weight range, the value of lost productivity due to health problems far exceeded
the medical costs.
Another study found that presenteeism costs an estimated $2,000 a year per
employee.
As we wrote in an earlier post, research from the Michigan Journal of Public
Affairs suggests that most returns on wellness programs investments come from
improved productivity rather than lower healthcare utilization rates.
Since nearly one-third of American adults are obese (and nearly two-thirds are
overweight), you have a great opportunity to boost the productivity of your business by
helping your employees address their health problems. Eric Finkelstein, the Duke obesity
study researcher, recommends that employers:
Promote healthy foods in the workplace
Encourage a culture of wellness from the CEO on down
Provide economic and other incentives to those employees who show clear signs
of improving their health through weight loss or by participating in health behavior
activities that have a strong correlation with health improvements, such as regular gym
attendance.
Other workplace wellness initiatives might include health education and coaching, weight
management programs, exercise programs, smoking cessation, nutritional advice and
medical help. Studies also show that readily available self-help materials are effective
75 percent of people who receive a self-care guide will use it at least one time within six
months.

Causes of presenteeism

Today's workplace has changed from two or even one decade ago. Some of these changes
have contributed to the growing incidence of presenteeism.

Increase in dual-earner and "sandwich generation" households

Dual-earner families now account for about two-thirds of all married couples, this
up from one-third in 1970. With a greater percentage of individuals lacking a spouse
at home to care for a sick child, a number of workers will go to work when ill in
order to save their limited sick days for when their children are sick. Added to the
mix are about one in ten workers, aged 30 to 60, who are now also caring for aging
parents as well as their own children: these individuals called the "sandwich
generation."
Employer expectations

In today's often "leaner-and-meaner" workplaces, some workers trudge off to

work when sick because they fear one or more of the following: appearing less
committed to their jobs, receiving disciplinary action, or even losing their jobs. A day
or more off can also mean burdening coworkers with job duties, coming back to a
heavy backlog of work responsibilities, or missing work deadlines.
Little or no paid sick days

The USDOL Bureau of Labor Statistics reports that in 2006, 57 percent of private
industry workers overall had access to paid sick leave. And according to the Families
and Work Institute, only 39% of low-wage employees are allowed any paid time off
for personal illness. As a result, a number of workers are reporting to work when ill
to avoid loss of pay.

Additionally, many more employers no longer allow employees to accrue sick days.
It's more common today for workers to have a use-it-or-lose-it arrangement.
Employee health affects more than just medical costs. A healthy workforce is a more
productive workforce. Did you know that between 70 to 90 percent of health care
spending is caused by preventable, modifiable health risks such as the ones bulleted
above? Unhealthy lifestyle choices often lead to chronic diseases, costing businesses
more than one trillion dollars in lost productivity alone. What all of this means is that
promoting healthier behaviors can really pay off the reason that workplace wellness is
such a hot topic right now.

There are many different types of wellness programs. The essence of these programs is to
encourage individuals to take preventive measures to avert the onset or worsening of an
illness or disease and to adopt a healthier lifestyle.

As healthcare costs continue to rise, it makes sense that addressing the specific needs of
an employee population and maximizing the engagement and participation of workplace
wellness programs is critical. But how can you change behaviors?

Employers play an important role

Changing our behavior is ultimately up to each of us as individuals. However, employers

have a tremendous opportunity to help their employees see the value of adopting
healthier behaviors so that they can live healthier lives.

A workplace culture sets the tone for its employees. A supportive work environment,
where managers reinforce a sound wellness strategy, can keep employees motivated and
engaged. Wellness and incentive programs can be used to drive and reinforce healthy
behaviors, bringing benefits to the employer, the employee, and to the community.

Employers may utilize a wide range of wellness initiatives such as smoking cessation
programs, flu shots and health fairs, gym memberships, newsletters, and more. While
some businesses have instituted very comprehensive wellness programs, others have
achieved savings or increased productivity with just a few simple activities that promote
healthy behaviors. Whats most important is to commit to wellness promotion in the
organization.

So why is it, then, that employers over the years have not been quick to offer these
programs? Many employers still seem to question whether or not workplace wellness is
worth the investment.

As with anything, wellness programs present organizations with a set of challenges.

Success is largely dependent on factors outside employers control: employee adoption
and maintenance of healthy behaviors, employees keeping health risks low, employees
not getting chronic diseases, and employees not leaving the company. To reap the benefits
of a wellness program, employers must maximize employee buy-in and participation.

Additionally, measuring the success (or ROI) of these programs is difficult to do

accurately and comprehensively. Every program and level of investment is unique to the
employer; participation levels are unique; employee health and health outcomes are also
unique. Nevertheless, most industry literature and research agrees that the typical return
on a wellness program is said to be from $3-$6 for every $1 invested, with savings
realized 2-3 years after implementation.

Worksite health promotion should be viewed as an investment in a business most

important asset, its employees. Studies show that employees are more likely to be on the
job and performing well when they are in optimal health. Benefits of implementing a
wellness program include:

Attracting the most talented workers

Reducing absenteeism and lost time

 Improving on-the-job time utilization, decision making and productivity

Improving employee morale

Reduction in turnover

Improved disease management and prevention, and a healthier workforce in

general, both of which contribute to lower health care costs.
4.0 RECOMMENDAYIPN

A well-designed and well-executed health and wellness program can:

Promote employees mental, physical, and emotional health

Lower incidences of employee disability and serious and / or chronic illness
Reduce employee out-of-pocket expenses, and employers long-term costs, for
healthcare expenditures
Boost employee satisfaction
Improve employees engagement and collaboration levels
Enhance company cohesion and loyalty
Increase job application and employee retention rates
Decrease absenteeism and presenteeism incidents
Raise employees productivity levels
The Bottom Line

The current body of research overwhelmingly suggests that improving employees health
can increase individual and overall productivity. A corporate wellness program can offset
productivity losses if it:

Is well-integrated into the employee workflow (i.e., asks employees to change

their behavior in reasonable, doable ways).
Encourages (not mandates) employees to participate.
Involves social support from coworkers, family, and friends.
Promotes, intervenes, and manages employees health (Education alone rarely
works; a call to action is needed!).
Has an incentive design (i.e., cash rewards, prizes, fitness program discounts,
health expense reimbursements) thats constantly reviewed and changed to keep
employees interested and motivated.
 Can be applied to employees lives outside of the office.
Is constantly evaluated and adapted based on employees interests and progress
(or lack thereof).

According to an estimate from Integrated Benefits Institute (IBI), a leading health and
productivity research provider, U.S. companies lose more than half a trillion dollars a
year in lost productivity. Josh Stevens, CEO of Keas , a leading health and engagement
platform for the workplace, believes that disengaged employees greatly contribute to this
loss and one of the key drivers of disengagement and low satisfaction is health. The first
annual Keas Employee Happiness Index reveals that employees who participate in health
programs are three times more likely to be engaged and satisfied in their work, so this
begs the question: What are employers doing to encourage healthier workers?
According to Stevens, employers are starting to recognize that the key to a productive
workforce is taking a 360-degree approach to engagement. Health, happiness and
productivity are intrinsically linked. Employers have a huge opportunity to boost the
health and happiness of employees through meaningful engagement programs, and reap
the rewards of the increased workplace satisfaction and productivity that result.

Unfortunately, companies have typically relied on tent-pole style events to encourage

healthily habits that include gathering employees together to get educated and compete
for prizes. Although a good start, this isnt a sustainable approach. Health is more than a
one-day event, its about integrating new behaviors into your everyday life in a fun and
social way. To find out what managers can do to help facilitate this change, Stevens
shared some thoughts:

Live the Value of Health

One of the oldest principals in developmental psychology is role modeling. Anyone with
children certainly understands the power of doing vs. talking when it comes to
influencing others. If you want to see real behavioral change, you have to model it first.
As a boss, its your responsibility to lead by doing.
One of the greatest challenges in any office environment is that people are sedentary.
Stevens advocates doing whatever you can to get people up out of their chairs and
moving. For example, its not uncommon for LinkedIn managers to conduct walking
meetings around the Mountain View campus. Even standing or walking while on your
phone can make a difference in your health. Companies like Facebook (FB) are even
experimenting with treadmill desks. Theres nothing like contributing to the bottom line
while burning calories at the same time!
Create a Culture of Health
To truly effect sustainable change, you have to weave that intended change into the fabric
of the culture. In other words, being healthy needs to be a norm that everyone embraces.
As a social platform akin to a Facebook for health at work, Keas helps employees take
responsibility for their own health by engaging colleagues in fun and social health-
oriented activities. One way Keas does this is through encouraging health and wellness
related team activities. Stevens points out that those who are on teams are six times more
active than those who take on health and wellness on their own. The idea is to create
communities of support and accountability where employees will push each other to
make positive change. A little friendly competition doesnt hurt either.

Stevens believes it can even be as simple as getting employees to spend 10 minutes a day
engaging in health-related reading, goal setting and planning. Consider ways to thread
health into the fabric of your team, department, and ultimately your whole company.

Involve Family
As the index points out, health and work are inherently connected. However, most health-
related decisions are made outside the workplace, which means influencing healthy habits
goes far beyond cubicle walls.Consider the following findings from the Keas Employee
Happiness Index:

51% indicated family is the one thing that makes them happiest in life;
 46% indicated spending time with family is the one activity that makes them
happiest;

27% indicated the one material possession that makes them happiest is their
home.

There is no doubt that family is the key influencer when it comes to lifestyle decisions.
Any health initiative must involve the entire family. For this reason, the Keas platform
works to engage and involve spouses and family members in employer health initiatives.
This approach particularly makes sense for workers who have the family enrolled on their
health plan.

Bottom line, if you want your employees to be more engaged, promote personal wellness
in a way that makes health a fun and social affair.

Whatever the shortcomings of current measurement tools and research, most people agree
that presenteeism represents a problem for employers: When people dont feel good, they
simply dont do their best work.

Its one thing to show that theres a problem, though, and another to demonstrate that
theres something you can do about itand, if something canbe done, that the benefits
will justify the investment. A central aim of presenteeism research is to identify cost-
effective measures a company can take to recover some, if not all, of the on-the-job
productivity lost to employee illness.

The first step, clearly, is making your managersand yourselfaware of the problem.
Buzz Stewart recalls doing research in the late 1990s, when he was a professor of public
health at Johns Hopkins University, on the impact of migraines on productivity. He was
initially skeptical about the magnitude of his own findings. Then people at the university
started telling him about how migraines affected their work. The big surprise, though,
came several years later at a party, where he was chatting with the migraine studys
project manager. She told him that about twice a month, she would close her office door
as soon as she got to work, turn off the lights, and put her head on her desk. The problem:
migraine headaches, of course. Here I was, a national expert on the subject, he says,
and I wasnt even aware of what was going on with my own staff.

The next step involves getting to know the particular health issues facing your
employees. This might entail a formal study, but to begin with, you could simply look at
your workforce with health issues in mind. Lerner, at Tufts University, puts it this way:
An employer might say, Were a company with a workforce of mostly women, and our
profitability depends on excellent customer service. Women are more likely than men to
suffer from depression, and depression can affect customer relations. So maybe we
should be doing something about this.

Educating employees is also crucial. You may want to set up programs to ensure that
illnesses arent going undiagnosed because employees dont realize they have a problem
oras in Amy Farlers casethat illnesses arent being misdiagnosed. Comericas study
of irritable bowel syndrome revealed that some employees had for years unsuccessfully
sought help from as many as five or six doctors, who incorrectly diagnosed the condition;
in a misguided effort to ease their pain, many workers had even undergone an exploratory
appendectomy, hysterectomy, or other type of surgery.

Its also helpful to teach employees how to better manage their illnesses. A recent
education program at Lockheed Martin for arthritis sufferers gave explanations of
treatment options and advice on making physician visits more productive. Comerica
sponsored a series of hour-long Lunch and Learn sessions led by a gastroenterologist,
which focused on things employees can do, like changing their diet and reducing stress,
to relieve the symptoms of irritable bowel syndrome. Such programs usually emphasize
the importance of regularly taking ones medications.
These steps seem simple, but the challenge of improving health education is far from
trivial, as findings from the International Truck and Engine allergy study highlight. The
company had augmented its traditional ways of relaying information to employees
(newsletters, brochures, and bulletin board displays) with Web pages and on-site
consultations with allergists. But a follow-up study revealed that the interventions hadnt
boosted the relatively small proportion of allergy sufferersabout 25%who took the
new generation of nonsedating medications. One-shot education isnt going to be
effective, says consultant Harris Allen, who led the research with William Bunn, MD,
vice president of health, safety, and productivity at the company. Even when potential
benefits take the form of such low-hanging fruit as getting people to switch to a more
effective medication, you need to overcome such motivational barriers as a reluctance to
try something new or simple inertia.

Recognize the problem

The first step in solving a problem is often recognizing there is a problem in the
first place. Presenteeism is often unrecognized by employers who may not realize the
extent of loss it can cause. If you're a business owner, it's time to make managers
aware of this problem and that the costs of presenteeism are rising. A business that
ignores the problem of presenteeism is a business that may very well have it
adversely affect its bottom line.
Rethink the use of disciplinary action to control absenteeism

According to the 2004 CCH Unscheduled Absence Survey conducted by Harris

Interactive, disciplinary action remained the single-most used absence control
program, with 91 percent of surveyed organizations reporting its use. Employers
want their employees on the job and using as few sick days as possible, but CCH
says employers that rely on disciplinary action to control absenteeism and abuse of
sick time are unknowingly encouraging presenteeism.

Employers need to examine and ensure that absence control policies are not
 counterproductive. Programs such as disciplinary action may in fact pressure sick
employees to report to work; this inadvertently encouraging presenteeism.
Develop a workplace policy on presenteeism and inform and educate employees

Employees need to know where your company stands on coming to work sick,
and how doing so can infect others. Establish and communicate guidelines. Help
employees understand under what conditions they should stay home, and when it's
OK to return to work.

Keep facilities and common areas clean, and consider the use of posters to educate
employees on how to avoid spreading germs; i.e., proper hand washing procedure for
hand cleanliness.

In workplaces where the protection of the public is critical and essential to staying in
business, employers may want to take disciplinary action or dismiss workers who are
found in violation of company policy. One worker, for instance, went to work ill at a
popular food chain establishment. As a result of doing so, this employee infected
more than 400 customers whose symptoms included vomiting and uncontrollable
diarrhea.

Many companies with presenteeism problems report that they also try to combat the
issue by sending sick employees home. They strive to foster a culture that
discourages employees from coming in sick; where employees are not made to feel
that they must go to work even if they are ill. Where possible, employees are given
the option to telecommute and work from home when not well.
Provide Paid Sick Leave and/or Paid Time Off to Workers

According to the National Partnership for Women & Families, our national
economy would experience a net savings of $8.2 billion per year if workers were
provided just seven paid sick days per year. This in addition to employers benefiting
from reduced turnover, higher productivity and reducing the spread of contagion in
the workplace.
 Paid Time Off (PTO) programs are increasingly being offered by employers. In these
programs, all time off is combined into a single bank of days. Employees have the
flexibility to take these days in a way that will meet their individual needs.

In 2007, San Francisco became the first city in the country to require employers to
provide their employees with paid sick leave. Only time will tell if other cities and
states -- and eventually perhaps the federal government - will follow San Francisco's
lead. Supporters of mandatory paid sick leave claim it benefits the employee,
employer and the community. Detractors say mandatory paid sick leave places an
unnecessary financial burden on small businesses and threaten their very survival.
Make an Effort to Boost Employee Morale

According to the CCH survey, morale had a significant impact on the incidence of
presenteeism. They found that companies with low morale had more ill workers
showing up for work. In their study, 52 percent or organizations with "poor/fair"
morale reported presenteeism was a problem; this compared with just 31 percent of
organizations with "good/very good" morale seeing presenteeism as an issue.

One way to boost morale is to provide some degree of flexibility in employees' work
arrangements. Employers who do so help employees meet the pressing demands of
both work and family, and aid in their achievement of a healthy work-life balance.
Offer a flu vaccination program

One way for employers to combat presenteeism is to pay for medical measures
that can either prevent common illnesses or reduce existing symptoms. One such
illness that can easily infect just about everyone in an office is influenza, aka "the
flu," which is extremely contagious. Recovery from the flu can take three to seven
days, or longer. After that, a persistent cough and tiredness can persist for weeks; this
along with a persistent decrease in productivity.

Paying for employee flu shots or providing an onsite flu clinic is a definite cost-
 effective measure employers can take. Working adults who get a flu shot have 25
percent less upper respiratory infections. Reducing the number of employees who
contract and spread the flu is a win-win scenario for all: increased productivity and
workplace morale, and a healthier bottom line.
The image of an employee who comes to work sick-as-a-dog as a dedicated and valued
worker is no longer apropos. Presenteeism costs are a real and potentially significant
drain on a company's financial well-being. Employers need to make a concerted effort to
develop a workplace with healthy and highly functioning workers. This will go a long
way toward meeting goals for company productivity and profits, and fostering a healthy
work culture and environment for employees.

Benefits

Proper attention to workers' health and safety has extensive benefits:

healthy workers are productive and raise healthy families; thus healthy
workers are a key strategy, i.e. goal, for overcoming poverty.
workplace health risks are higher in the informal sector and small industry
which are key arenas of action on poverty alleviation, where people can work their
way out of poverty;
safe workplaces contribute to sustainable development, which is the key to
poverty reduction;
the processes of protecting workers, surrounding communities and the
environment for future generations have important common elements, such as
pollution control and exposure reduction;
much pollution and many environmental exposures that are hazardous to
health arise from industrial processes, that may be influenced by occupational health
and safety programmes;
occupational safety and health can contribute to improving the employability
of workers, through workplace (re)design, maintenance of a healthy and safe work
environment, training and retraining, assessment of work demands, medical
diagnosis, health screening and assessment of functional capacities;
 occupational health is fundamental to public health, for it is increasingly clear
that major diseases (e.g. AIDS, heart disease) need workplace programmes as part of
the disease control strategy.
Benefits of Workforce Health Promotion

To the organization To the employee

a well-managed health and safety programme a safe and healthy work environment

a positive and caring image enhanced self-esteem

improved staff morale reduced stress

reduced staff turnover improved morale

reduced absenteeism increased job satisfaction

increased productivity increased skills for health protection

reduced health care/insurance costs improved health

reduced risk of fines and litigation improved sense of well-being

These benefits are greater for low-paid workers in high risk occupations and settings,
and in this way occupational health interventions can reduce inequities. Efforts made
by WHO and its partners to strengthen key aspects of occupational health focus on
increasing the coverage of workers in under-served countries and regions with basic
occupational health services.
Workplace health promotion - What is it?

The European Network for Workplace Health Promotion has defined workplace
health promotion as the combined efforts of employers, employees and society to
improve the health and well-being of people at work. This vision of workplace health
promotion places particular emphasis on improving the work organization and
working environment, increasing workers' participation in shaping the working
environment, and encouraging personal skills and professional development.
Workplace health promotion focuses on a number of factors that may not be
sufficiently covered in the legislation and practice of occupational health
programmes, such as the organizational environment, the promotion of healthy
lifestyles, and non-occupational factors in the general environment. Non-
occupational factors include family welfare, home and commuting conditions, and
community factors which affect workers' health.

Workplace health promotion supports a participatory process to help promote a

stronger implementation of occupational and environmental health legislation. It
suggests tools for maintaining or strengthening a national healthy workplace
initiative, such as an awards system as an incentive for participating enterprises, and
creation of healthy workplace networks. To be successful, workplace health
promotion has to involve the participation of employees, management and other
stakeholders in the implementation of jointly agreed initiatives and should help
employers and employees at all levels to increase control over and improve their
health.
While some health promotion activities in the workplace tend to focus on a single
illness or risk factor (e.g. prevention of heart disease) or on changing personal health
practices and behaviours (e.g. smoking, diet), there is a growing appreciation that
there are multiple determinants of workers health. In addition to person-focused
interventions, workforce health promotion initiatives have moved toward a more
comprehensive approach, which acknowledges the combined influence of personal,
environmental, organizational, community and societal factors on employee well-
being. A health-promoting workplace recognizes that a healthy workforce is essential
and integrates policies, systems and practices conducive to health at all levels of the
organization. Rather than a series of projects, workforce health promotion is an
ongoing process for improving work and health. Effective health promotion assists
employers to adopt appropriate administrative procedures and workers to use safe
working practices. Occupational health personnel benefit from training and education
in health promotion to enable them to implement it as a part of their occupational
health practice.
Experience in workplace health promotion has shown that competitions and awards
are valuable in engaging enterprises in occupational health and safety activities.
Firms and enterprises achieve valuable publicity and a boost in staff morale through
competing to become the most healthy and caring company.

https://www.bls.gov/OPUB/MLR/1995/04/art3full.pdf