Sick in the workplace

In many ways, it has been a welcome trend for employers to be more actively involved in promoting healthiness among their workforce. If employers are serious about lowering the cost of health insurance, it stands to reason they should try to do something about it.

More than a few businesses are getting tough, according to a story in the Wall Street Journal this past weekend:

In an effort to control the escalating cost of care, especially from chronically ill workers, many companies have been increasingly providing financial incentives to encourage workers to lose weight, stop smoking and manage a chronic illness. But a growing number also are starting to penalize workers who don’t – with higher insurance premiums, deductibles and out-of-pocket expenses.

“The passive nature of the work force has been troubling for employers, says Jim Winkler, U.S. leader of the health-management practice at consulting firm Hewitt Associates. “What they’re trying to do is motivate people to change their behavior.”

Leaving aside the question of whether this veers into coercion, I can’t help noticing there’s one thing missing from the list of ills among the work force. That’s right: stress.

Stress can be just as costly - maybe even more so – than chronic conditions, smoking or lack of physical activity, the triad that usually gets singled out in workplace wellness initiatives. Consider some of the statistics contained in a report by the National Institute for Occupational Safety and Health.

- In a survey conducted by Northwestern National Life, 40 percent of respondents said their job was “very or extremely stressful,” and 25 percent viewed their job as the main source of stress in their lives.

- In another study carried out by St. Paul Fire and Marine Insurance Co., problems at work were more strongly associated with health complaints than any other source of stress, including family or money issues.

When the nonprofit Families and Work Institute carried out a national survey in 2008, it found that 41 percent of workers reported experiencing three or more indicators of stress sometimes, often or very often. In the same survey, one-third of the respondents said their job drained their energy, leaving them with little left over for family or personal time.

Layoffs, increased workloads and the need to do more with less have arguably made the workplace even more stressful in the past couple of years.

A certain amount of workplace stress is unavoidable. It can even be beneficial when it revs up people’s energy and creativity. But chronic or unrelenting stress at work can ultimately be very corrosive, not only to the employee’s mental well-being but also to his or her physical health. From the NIOSH report:

Short-lived or infrequent episodes of stress pose little risk. But when stressful situations go unresolved, the body is kept in a constant state of activation, which increases the rate of wear and tear to biological systems. Ultimately, fatigue or damage results, and the ability of the body to repair or defend itself can become seriously compromised. As a result, the risk of injury or disease escalates.

In the past 20 years, many studies have looked at the relationship between job stress and a variety of ailments. Mood and sleep disturbances, upset stomach and headache, and disturbed relationships with family and friends are examples of stress-related problems that are quick to develop and are commonly seen in these studies. These early signs of job stress are usually easy to recognize. But the effects of job stress on chronic diseases are more difficult to see because chronic diseases take a long time to develop and can be influenced by many factors other than stress. Nonetheless, evidence is rapidly accumulating to suggest that stress plays an important role in several types of chronic health problems – especially cardiovascular disease, musculoskeletal disorders, and psychological disorders.

By now, you’re probably connecting the dots. Who has the time or motivation to exercise and prepare healthful, home-cooked meals when they work all day long and come home wiped out? How is someone supposed to successfully quit smoking/lose weight if cigarettes/comfort food have been their emotional crutch during times of stress? How do you manage heart disease or high blood pressure when one of the contributing factors to these conditions is stress?

Workers are being asked to keep themselves healthy (and risk being financially dinged if they don’t measure up), yet when they’re under constant stress at their place of employment, it’s hard to see how the work-related stress won’t often undermine their best efforts. By all means, let’s encourage employers who want to do something about employee health – but if they fail to acknowledge the role of workplace stress or take it into account as they design their wellness programs, they’re missing the boat.

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