Can Wellness Programs Improve Employee Health and Productivity?

Poor employee productivity can be defined as physically being at work but not working.  This type of poor productivity is called presenteeism. It is estimated that the cost associated with presenteeism due to poor employee health is at least 2 to 3 times greater than direct health care expenses. While the estimated cost of presenteeism dwarfs the cost of health care, it does not receive the same level of scrutiny among employers preoccupied with controlling the direct costs of poor employee health.

Presenteeism has shown up less on the employer radar screen because it’s not a measured expense tracked in corporate financial metrics and reporting. Every month employers pay for employee health care and they feel the pain. Checks are written, accounts debited and the expense is scrutinized and increasingly managed. Companies never write a check for presenteeism. Very few companies routinely track employee productivity metrics in a way that could capture the effects of presenteeism. Worksite wellness programs have been touted as strategies to reduce presenteeism, but until now data to support such effects are missing.

Worksites able to reduce presenteeism can experience meaningful gains in employee productivity. To see how worksite wellness programs can reduce presenteeism, it is necessary to first understand exactly what causes it. New understanding of presenteeism has been revealed in recent research published by the journal Population Health Management.

1. New Research Helps Make the Worksite Wellness-Productivity Connection

In 2008, Healthways, a well-being improvement company, and Gallup formed a partnership to monitor well-being among communities throughout the United States by conducting 1,000 daily interviews with a survey called the Gallup-Healthways Well-Being Index (WBI). A survey called the Well-Being Assessment was developed by Healthways to capture a comprehensive picture of well-being at the individual level. This tool, adapted from the community WBI survey, also measures employee presenteeism, health and well-being within an organization.

The Well-Being Assessment has been completed by numerous employers. In the new study cited above, data from three of these companies were used. These companies employed about 20,000 employees in diverse industries including insurance, health care and a customer service call center. Employees were made aware of and asked to complete the survey as a part of their benefits enrollment process. Employees were asked a series of questions about health behaviors such as smoking status, dietary habits, and physical activity.

Employee Health and Productivity

Information was also collected on health risks such as body mass index (BMI), high blood pressure, high cholesterol, diabetes, depression, heart attack, asthma, cancer, chronic neck and back conditions that cause pain or knee or leg conditions that cause pain. To measure presenteeism employees were asked a series of questions around specific productivity barriers within their workplace. Employee responses to these questions were tallied and used to create a total presenteeism score.

2. Elevated Health Risks and Poor Behaviors Are Predictors of Presenteeism

Presenteeism scores among these employees varied widely so, to help detect patterns, employees with a presenteeism score in the top 20 percent were considered to have high presenteeism. Multiple comparisons were made to understand how employee health behavior was associated with high presenteeism. These comparisons help clarify the relationship between employee health and presenteeism.

For example, smokers were 28% more likely to have high presenteeism than non-smokers. Figure 1 shows the increased likelihood of high presenteeism among employees with three health behaviors. In addition to higher presenteeism among smokers, employees with an unhealthy diet were 66% more likely to have high presenteeism than those who regularly ate whole grains, fruits, and vegetables.

Employees who didn’t exercise very much were 50% more likely to have high presenteeism than employees who were regular exercisers. These findings demonstrate that poor health behaviors are strongly associated with high levels of presenteeism.

In short, unhealthy individual lifestyle choices may result in substantially higher levels of lost productive work time.

wellness programs Employee Health and Productivity
This figure displays increased rates of high presenteeism among employees who smoke, don’t eat healthy, or don’t exercise regularly. Poor health behaviors eventually lead to elevated health risks and chronic diseases. The figure below shows how health risks such as excess body weight, elevated blood pressure, and high cholesterol increased the odds of having high presenteeism.

The other health conditions in this figure further paint the presenteeism picture – the presence of risk factors, pain and chronic disease, especially chronic depression, dramatically increase the odds of having high presenteeism.

wellness programs Employee Health and Productivity

These published results confirm several ideas that have previously been assumed but not directly tested. Presenteeism is associated with poor health behaviors as well as elevated health risks and the presence of chronic disease. This information is important because the number of employees with excess body fat, poor diets, and sedentary lifestyles has never been greater.

wellness programs Employee Health and Productivity

The rate of diabetes in the U.S. workforce has also risen to unprecedented levels. The increases in this and other lifestyle-related chronic diseases suggest that the cost associated with presenteeism and poor employee health is likely to grow in the absence of effective strategies to reverse these trends.

3. Leaders Are Seeing the Evidence

Employees who fail to receive a flu shot may get lucky and not get the flu. But those who do get the flu may miss some days of work or, alternatively, will be less productive at work and spread this illness to co-workers. Getting a flu shot can prevent the flu and associated lost productive time. A flu shot is relatively easy to get, inexpensive, and can prevent presenteeism.

This is just one example of how a worksite can implement an employee health management strategy that maintains employee health and improves productivity. Employee health management or wellness programs can have a direct impact on presenteeism and are the best practical solution to curb the hidden costs of presenteeism.

There is ample evidence that properly implemented worksite wellness programs can improve employee health and productivity. The evidence that these programs can also reduce employee presenteeism is growing. Despite this substantial and growing body of evidence, many employers are still reluctant to fully implement wellness strategies. Here are the top 5 workplace wellness statistics every employer should know.

In some cases, management remains skeptical that there will be a tangible improvement in health if they make this investment.

wellness programs Employee Health and Productivity

This is a particular concern among leaders of small and mid-sized companies, who may question whether effective wellness strategies reported by larger employers are practical for them. Fortunately, HERO and others begun to demonstrate that small companies can create leadership-driven wellness efforts that improve employee health and productivity.

Leadership reluctance is also based on the fact that, “companies don’t write checks for presenteeism.” Presenteeism is a hidden cost that contributes to financial reports as increased revenue or profitability only when it is prevented. Even then, the dollar value of this prevention is invisible.

Key to this issue is the fact that standardized, well-accepted tools for measuring presenteeism and workforce productivity have not yet achieved broad adoption in businesses. The adage that “you cannot manage what you don’t measure” is an unfortunate reality when it comes to presenteeism.

Can Wellness Programs Improve Productivity?

Worksite wellness programs have historically focused on reducing heath care costs. This research highlights that the benefits of healthy employees extends beyond reducing health care cost trends to improving employee productivity. Presenteeism is here to stay, and it will only get worse if current trends continue.

The one viable way to improve employee health and lower presenteeism is to implement an effective worksite wellness program that engages employees and supports them in improving their health.

wellness programs Employee Health and Productivity



About The Author

Dr. Steve Aldana

Dr. Aldana is the CEO of Wellsteps, a worksite wellness solution that leads the nation in wellness program deployment and engagement. Dr. Aldana authored over 75 scientific papers and 7 books on health risk management, healthy living, and health promotion programs. He has given over 350 keynote speeches across the U.S. on the ability of good nutrition and regular exercise to prevent, arrest, and reverse many chronic diseases. Email him at: