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Employers who support improving the well-being of their employees can greatly impact the performance of their organization and increase their bottom lines. Great employers know the challenges facing their workers and actively engage in activities to foster healthy, productive work environments.

One problem employers grapple with is "presenteeism," or on-the-job productivity losses resulting from poor overall well-being. 

It is estimated that the cost associated with presenteeism, due to poor employee health, is at least two to three times greater than direct health care expenses. But, while these costs dwarf the cost of health care, they aren't given the same scrutiny because they are not tracked in corporate financial metrics and reporting. A new study, published in Population Health Management, shows that the benefits of a healthy workforce extend beyond reducing health costs to improving employee productivity.

The Health Enhancement Research Organization assembled a diverse consortium of industry researchers in a collaborative effort to better understand how employee well-being affects productivity. Researchers from HERO, Brigham Young University and the Center for Health Research at Healthways, measured the presenteeism of nearly 20,000 employees at three companies.

The study revealed that those with unhealthy behaviors were more likely to be less productive on the job. For example, smokers were 28 percent more likely to have high presenteeism than non-smokers. In addition, those with an unhealthy diet were 66 percent more likely to have high presenteeism than those who regularly ate whole grains, fruits and vegetables. Employees who exercised occasionally were 50 percent more prone to presenteeism than those who exercised regularly.

These findings reveal that unhealthy individual lifestyle choices result in substantially higher levels of lost productive work time, confirming that presenteeism is associated with poor health behaviors as well as elevated health risks and the presence of chronic disease.

This information is crucial, given that the number of employees with excess body fat, poor diets, diabetes and sedentary lifestyles has never been greater. This is especially troubling because increases in lifestyle-related chronic diseases suggest that costs associated with presenteeism and poor health are likely to grow if effective strategies are not implemented to reverse these trends.   

Employee health management programs are the best solution. In the study, employees were also asked a series of questions that referenced their lifestyle habits. Those who found it difficult to exercise during the day were 96 percent more likely to have high presenteeism. Those who reported it was difficult to eat healthy foods at work were 93 percent more likely to have high presenteeism.

In addition, employees who reported that management had little interest in supporting employee efforts to become more physically active were 123 percent more likely to have high presenteeism. Even more striking, employees who said their employer did not support helping them become emotionally healthy were 320 percent more likely to have high presenteeism.

These results suggest that presenteeism isn't just connected to health behavior, health risks and chronic diseases, but that employer efforts to support healthy behaviors provide a powerful opportunity to curb presenteeism. There is strong evidence that properly implemented health management programs can dramatically improve health and morale, while reducing presenteeism and employee health care costs.

Assuming health care reform moves forward, U.S. companies will be able, beginning in 2014, to continue providing health care benefits or opt to have employees obtain their own insurance in health care exchanges. Some have suggested that this shift may cause employers to lose the financial incentive to justify wellness programs. However, this research demonstrates that the substantial estimated cost of presenteeism won't disappear when insurance exchanges are activated. Employees will not suddenly become healthy and stop losing productive time due to poor health.

Presenteeism will only get worse if current trends continue. The one viable way to improve employee health and lower presenteeism is to implement an effective health management strategy that engages employees and supports them in improving their health.

Ray Merrill is principal research investigator for The Health Enhancement Research Organization and a professor in the Department of Health Science at Brigham Young University.