One hundred eighteen million people work in the United States. When we think about health issues affecting this population, what comes to mind for most people is the issue of company-paid health insurance.
For those people professionally involved in workforce health issues, occupational safety and health springs to mind. Rarely do we think of the general health of the worker. After all, he or she comes to work -- doesn't that mean that the working person is healthy? Or at least healthy enough?
Yet it seems reasonable that health is necessary in order to come to work, to be productive at work, and to remain a member of the working population. The data, however, have been limited -- until now.
The Health Survey
Using publicly available data from national probability samples, specifically the Third National Health and Nutrition Examination Survey (NHANES III) and the National Health Interview Survey (NHIS), we now have new insights into the impact of health on work productivity
NHANES III is a nationally representative survey of approximately 34,000 people, and NHIS is a nationally representative survey of approximately 24,000 households, which includes 63,000 people.
First, let's take a look at who these 118 million workers are. Accounting for 73 percent of the adult population aged 18 through 64, the U.S. workforce is comprised of more men than women, 56 percent men compared with 46 percent women.
What men and women have in common is their disproportionate youthfulness: 40 percent of men and woman in the workforce are under the age of 35, and 69 percent of the workforce is under the age of 45. This disproportionate youthfulness contributes perhaps to the lack of interest in employee health on the part of employers. After all, young people are healthy, in fact, they often think they're invincible.
On average, workingpeople miss five days of work each year because of their health. While men are absent for a variety of reasons,absences due to injury and respiratory illness overshadow any other health problems.
On average, each man loses 1.8 days each year because of injury, and 0.9 days per year because of respiratory illness. The injuries are related to motor vehicles, and sports and home activities, but rarely are they related to on-the-job exposures.
Among women, again we see the same top two reasons for absence, but in reverse order. On average, each woman loses 1.5 days each year because of respiratory illness, and 1.2 days each year because of injury. Acute conditions account for 57 percent of the work loss, but as people age, the likelihood of being absent for chronic conditions increases.
Absenteeism is expensive -- 65 billion dollars are lost each year because of absenteeism, but this is just the tip of the iceberg. Just because a worker shows up at work does not mean that a day's work is done. Ill health does limit productivity. Using NHIS data we are able to assess the relative risk of chronic disease in limiting a person's work capacity.
Let's explore limitations associated with chronic disease among two age groups: 18-54 and 55-64. The strongest risk of work limitation for the younger group is associated with ischemic heart disease (IHD), defined as angina or past myocardial infarction. Working people under the age of 55 who have IHD are eight times more likely than workers in this age group without IHD to report that they are limited in the amount or kind of work they are supposed to do on the job.
For arthritis, workers under 55 years of age are four times more likely to report work limitations. Diabetes poses an almost six-fold increased risk, and migraine poses a 2-fold increased risk among workers under 55.
When we assess the older population, those aged 55 through 64, we see that chronic disease continues to result in work limitations, but it's not as dramatic as in the younger group. Instead of an eight-fold increased risk associated with ischemic heart disease, the older group with IHD is three times more likely to report limitations than are their age counterparts without ischemic heart disease.
Older people with arthritis are three times more likely to report limitations, as are older people with diabetes. Older people with chronic conditions are at risk, but the risk is lower than the risk we see for the younger workers.
What's the explanation? It's probably survival of the fittest, both literally and figuratively. Only the healthiest of ill workers make it into the age group 55 through 64. So, in a figurative sense, you have to survive the workforce. In a more literal sense, you just have to survive. Perhaps the reason that the risk of work limitations associated with IHD drops from eight-fold to three-fold is that workers having heart attacks just don't survive long enough to even get into that older age group.
Illness By Numbers
It's evident now that poor health results in productivity loss. But just how wide spread is poor health? Let's look now at information about the prevalence of various conditions among the U.S. Workforce for four age groups:18-34, 35-44, 45-54 and 55-64.
Hyperlipidemia is the most prevalent condition affecting the US workforce, affecting over 37 million workers, or 31 percent of the workforce. Sixty-seven percent of those with high cholesterol are uncontrolled; 41 percent of the workers with high cholesterol don't even know about it.
Specifically, 48 percent of working men and 31 percent of working women with hyperlipidemia are not even aware that they have this condition. This is a silent condition just waiting to make noise.
Hypertension affects 18 million workers in the United States, or 12 percent of the workforce. Seventy-eight percent are uncontrolled; 35 percent of those with hypertension don't even know they have it. Specifically, 41 percent of working men and 25 percent of working women with hypertension don't even know they have hypertension. Sixty-seven percent of workers with diagnosed hypertension are treated with prescription medications, but only 51 percent of those treated are controlled.
We're painting a picture here -- the working population is at risk of serious, work disabling -- and life disabling disease. They are at risk of ischemic heart disease and other vascular complications. In fact, using the NHANES data on with the Framingham Heart Study equations, we find that as many as 90,000 heart attacks and revascularizations occur among workers each year due to undiagnosed and uncontrolled hypertension and hyperlipidemia. In comparison, 74,000 ischemic events occur due to smoking. It's time we pay more attention to the silent risk factors.
Let's take a look now at diabetes, a very serious and costly disease that often goes undetected. Almost 5 million workers -- 4 percent of the workforce -- have diabetes, and as people age, the prevalence rate increases. Over 40 percent of the workers with diabetes are unaware of their condition. Specifically, 41 percent of both working men and working women are undiagnosed. But awareness does not equal control.
Goal attainment is greatest for the youngest age group, those aged 18-34, but still, 40 percent of them fail to reach treatment goal. Eighty-nine percent of diagnosed diabetics in the 45 through 54 year age group fail to reach goal. Not all diagnosed diabetics are on drug treatment -- 65% of employed persons with diabetes report taking medications. But let's not get complacent yet -- only 18 percent of drug treated diabetic employees reach treatment goal.
Let's leave cardiovascular and metabolic disease now and take a look at the impact of arthritis on the workforce. Thirteen million workers have arthritis and people with arthritis are absent from work three times as often as workers without arthritis. Seventeen percent say they are limited in their ability to work, and as noted before, workers with arthritis are three to four times more likely to report that they are limited in the amount of kind of work they are supposed to do. People in the age group 35 to 44 are the least likely to be treated with prescription medications they are also the age group most likely to be absent from work.
Migraines affects 6 million workers in the United States, most of whom are women Migranes are also associated with work loss. Workers with migraines are 2 1/2 times more likely to miss some workdays each year compared to workers without migraines.
With respect to the number of days lost, people with migraines lose three times as many workdays as people without migraine. Workers under the age of 55 with migraines are twice as likely to report that they are limited in their ability to work compared to workers without migraines.
Our information on the prevalence of depression is limited to people aged 18 through 39 because NHANES III data collection in this area was limited to this group.
Eight percent of the working population in this age group -- 7 million workers -- screen positive for major depression based on the Diagnostic Interview Schedule. Depression is more common among women than men --12 percent of working women and 6 percent of working men under age 40 screen positive. Treatment rates are poor -- only 12 percent are on drug therapy, with treatment rates higher in the 34 through 39 year old group. Suicide attempt rates are high -- 2 percent of employed men and 5 percent of employed women report that they have at one time or another attempted suicide. Clearly there is a need for better diagnosis and treatment.
In summary, it seems clear that the workforce is not as healthy as we might have thought. Health cannot simply be measured in terms of absenteeism. Workers with a variety of conditions do not perform optimally while at work. Disease often goes undetected and uncontrolled. When treated, workers frequently fail to reach treatment goal. This is a call to action. Complacency will not result in success for the individual or for the organization. Organizational success requires productivity, creativity, and appropriate resource allocation. Poor health results in poor organizational performance. It's time to optimize worker health and organizational health.
Hertz is Pfizer's senior director of Outcomes Research -- Population Studies. Her responsibilities include the design and implementation of observational studies to enhance awareness of the health status of specific populations. She is also active in evaluation of physician-, community- and employer-based interventions designed to enhance health awareness and outcomes. Hertz joined Pfizer in 1995 after 20 years experience in the non-profit research sector. She earned a Ph.D. in occupational and environmental epidemiology from The Johns Hopkins University.