health matters in business

Health Matters in Business – Health at WorkIoD Research Paper

Geraint Day

This research paper was written by Geraint Day, Business Research Officer. It was producedby Charlotte Williamson and Joanne Walton.

August 1998

ISBN 1 901580 12 1

Copyright © Institute of Directors 1998Published by the Institute of Directors116 Pall Mall, London SW1Y 5ED

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Contents

1 Summary 1

2 Background – health at work

2.1 Health, safety and sickness 2

3 Estimates of work-related ill-health

3.1 Survey evidence: ill-health 4

3.2 Some specific illnesses 6

3.2.1 Stress: a point 6

3.3 Survey of working conditions relevant to health 7

3.4 Working hours, stress and health 8

3.4.1 Introduction 8

3.4.2 Overtime 8

3.4.3 Working hours and health 9

3.4.4 Work...or working hours? 10

4 Costs to business of ill-health 11

5 Directors’ views on health at work

5.1 Survey of IoD Members 12

5.2 Sickness absence 13

5.3 Stress 15

5.4 Advice for worried workers 17

5.5 General health 18

5.6 Smoking 19

5.7 Drinking 20

5.8 Diet and nutrition 20

5.9 Exercise 20

5.10 Health insurance 21

5.11 Promoting health at work 21

5.12 An IoD view 22

6. What can or should business do about it?6.1 Some current programmes 23

Annex A: NOP Survey Results 24

1. Summary

• Issues of health and safety have been prominent in the workplace for many years,but there has more recently been a greater emphasis on health itself, in line with aGovernment focus on “healthy workplaces” (see section 2.1).

• From the organisation’s perspective, absence from work for whatever reason represents a deficiency in one of the factors of production, hence for many employers it has been viewed as good business practice to ensure that there is ahealthy workforce (see section 2.1).

• Surveys of self-reported ill-health have shown that around 2 million people in theUK consider that they have ill-health either caused or made worse by their work(see section 3.1).

• One difficulty with self-reporting is that it is subjective, and is not always easy toestablish cause and effect, because apart from anything else people’s state of healthdepends on a wide variety of factors (see section 3.1).

• Nevertheless there has been an increasing emphasis on such areas as stress andworking hours, although again the evidence linking these to ill-health in the workplace is less certain than some may believe (see sections 3.2.1 and 3.4).

• Absence, including sickness absence, costs British business billions of pounds eachyear (perhaps equivalent to 5-10% of industrial trading profits) – see section 4.

• A recent survey of IoD members has shown a positive attitude towards issuessuch as minimising sickness absence, and of encouraging health-promoting practices (see section 5).

• Some employers work with outside agencies on matters of employee health, and afew large organisations have been assisting smaller firms in this area (see section6.1), although in practice it may be unrealistic to expect the smallest firms to be ableto devote significant resources in this way.

HEALTHMATTERS IN BUSINESS – HEALTH AT WORK

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2. Background – health at work

2.1 Health, safety and sicknessWhenever health at work is mentioned, first thoughts may be of health and safety issues.Thus in the United Kingdom, the Health and Safety at Work Act 1974, the Health and SafetyExecutive (HSE), and matters of occupational health may come to mind. People may associate health at work issues with accidents, spillages of corrosive chemicals, leakages ofnoxious fumes and even radioactive materials. Most of these are fairly noticeable and can leadto sudden injury and incapacity.

However, when thinking of health as a topic in itself, people may more often think of sicknessand disability, perhaps. Increasingly in recent years the concept of health at work has come toencompass not only issues like accidents but also some of the factors associated with sicknessand disease. Other factors such as “stress” have come into everyday workplace parlance.Matters of mental health have increasingly entered into the picture, along with perhaps moreobvious physical health.

When it comes to employment and business, what immediately springs to mind from thepoint of view of the employer and also of colleagues is the fact of sickness absence andabsences for medical appointments. When employees are absent problems can arise for theorganisation, affecting productivity and profitability.

At one time it was believed that sickness absence from work was an indicator of the health ofthe nation. This was because it may have been natural to assume that the amount of time lostwas directly related to the levels of disease existing in the country. The reality is not necessarily so straightforward (Essentials of Preventive Medicine, J. A. Muir Gray and GodfreyFowler, Blackwell Scientific Publications, Oxford, 1984). To be sure, absences from work arecertainly very much influenced by the actual levels of disease. However, disease is only onefactor among many.

These encompass organisational factors (for example, personnel policies, industrial relations,quality of management and working conditions). Personal factors are also important (such asage, job satisfaction, life crises, family responsibilities and social activities – including alcoholconsumption).

Whatever the underlying reason or reasons, from the point of view of a business, an absentemployee means a deficit in one of the factors of production (see, for example, Safety CultureA Clear Guide to the HSE Publications You Are Most Likely to Need, HSE Books, Sudbury).Keeping employees healthy in body and mind is not only a matter of being good to employees, it can actually be vital to business success. This may be especially important whena focus on efficiency means that there is less ability in many organisations to enable effectivecover for the work of absent employees.

HEALTH MATTERS IN BUSINESS – HEALTH AT WORK

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Therefore it is not surprising that governments in recent years have included health at workas an area to be covered by health policies, not only for alleviating sickness, but also in thefields of prevention of ill-health and the positive promotion of healthy living.

We have set out in this report some material connected with health at work. This includessome of the background, some statistics, and also the views of a sample of IoD members. Asa voice of leaders in business and other important organisations, the IoD perspective is thatprogress in key areas depends on the opinions of those at the top, and that is just as true forhealth at work.


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3. Estimates of work-related ill-health

3.1 Survey evidence: ill-healthIn 1990 and 1995 questions were added onto the regular Labour Force Survey (LFS) askingadults in a representative sample of households whether they had, in the preceding 12months, suffered from any illness or disability or other physical problem either caused by ormade worse by their work. This has been termed “self-reported work-related ill-health”(SWI) – “Sick of work? SWI95”, Health and Safety Bulletin, July/August 1998, pp 9-16. A totalof 1 188 people were included in the analysis of the 1995 SWI.

Self-reporting of illnesses and of their perceived causes will not in general lead to the sameresults as when these are classified by professional medical staff. Apart from anything elsethere is a huge knowledge imbalance between medics and the general population as to diseases and their causes (Economics, Medicine and Health Care, second edition, Gavin Mooney,Harvester Wheatsheaf, Hemel Hempstead, 1992). Self-reporting will not give a precisedescription of the picture, nor of what is related in some way to work.

From the 1995 SWI results it was found that 4.8% of the sample (people who had everworked) reported having been affected by a work-related illness in the previous year. Theeffects ranged from minor to severe. Extrapolating the findings to the nation showed thataround two million people would have had a work-related illness. That two million wouldhave included 712 000 who were included in the LFS but did not work during the periodbeing referred to.

Of that 2 000 000, the survey proportions were equivalent to about 542 000 (27%, or 42% ofthose in work with SWI) who took a total of 19.5 million days off sick, and 43 000 (2%, or 3%of adults in work with SWI) who took over six months off. Note that 575 000 (29%, or 45% ofthose in work with SWI) had experienced illness perceived to be related to work but wouldhave taken no sick leave on account of their illness.

On average each employee would have lost 0.7 day off work a year because of work-related ill-ness. The 1990 SWI study had shown an average of 0.5 day lost in a year because of work-related illness, within which figure there was about 0.25 day reportedly caused by work (Self-Reported Work-Related Illness, J. T. Hodgson, J. R. Jones, R. C. Elliott & J. Osman,Research Paper 33, HSE, HSE Books, 1993).

Although the law is that employers are only responsible for work-related health risks, manyfirms do not distinguish between work and non-work risks to health when considering theiremployment practices (Health Risk Management A Practical Guide for Managers in Small andMedium-Sized Enterprises, HSE). For some companies this is because they appreciate that sickness absence, whether caused by work-related factors or happenings outside of work, maystill lead to the same outcomes: temporary or permanent absence of an employee – and nowork as a result.


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The most common SWI conditions were as shown in Table 1:–

Table 1: Self-Reported Work-Related Illness (SWI), 1995

Group of Illnesses Proportion of Total SWI (note: some people had more than one) %

Musculoskeletal disorders 57

Stress, depression and anxiety 14

Stress-ascribed conditions (other than above) 12

Lower respiratory disease 10

Occupational asthma 8

Deafness, tinnitus or other ear condition 8

Skin disease 3

Headache or “eyestrain” 2

Hand-arm vibration syndrome (caused by vibrating machinery) 1-3

Trauma (covering long-term effects of injuries) 1-2

Pneumoconiosis (including asbestosis) 0-1

Other diseases 4

Source: HSE, cited in “Sick of work? SWI95”, Health and Safety Bulletin , July/August 1998, pp 9-16.

Accidents are the most immediately obvious causes of work-related ill-health. Other factorssuch as layout of equipment and work areas may be contributory factors to ill-health thatdevelops over a longer time. Such things may lead to aches, pains, perhaps breathing, hearingor visual problems, and other discomforts. Other issues, including the effects of passive smoking and risks to mental health, also come to mind.

Despite the collection of vast amounts of health-related data through health services, information on many ailments is neither systematically recorded nor reported centrally. Hencefor many conditions less than satisfactory information has to be used in trying to draw conclusions. Self-reporting of illness is one source.

Not every case of each condition listed in Table 1 has work as a causal factor by any means. Itis almost impossible for a non medically-trained person to unequivocally link an illness thatmay develop over a long time (such as heart disease) to working practices or conditions. So inmany cases we must be seeing perceptions of causes rather than actual causes of ill-health.

Now, perceptions are important because people believe them (“Perceptions matter: whyclients commission opinion research in the City”, Roger Stubbs, Investor Relations Journal,January 1997, pp 6-7). Even so, in an area in which it is increasingly fashionable to link work-related factors to all manner of ailments – especially with litigation being encouragedthese days – it is rather important to try to be as objective as possible.


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3.2 Some specific illnessesBy category of disease, in the early 1990s coronary heart disease (CHD) and stroke accountedfor nearly 25% of total days of certified incapacity for men and 10% for women, whereas mentalillness accounted for 15% and 26% for men and women, respectively (Government consultationpaper: Our Healthier Nation A Contract for Health, Cm 3852, The Stationery Office, London,February 1998). Note that these figures cover all causes of such illnesses, not specifically work-related sickness.

Treating people who suffer from mental ill-health costs the National Health Service (NHS)and local authority social services £5 billion annually – at 17% of the total, the largest singlearea of expenditure by category of illness. For comparison, CHD, stroke and related illnessescost £3.8 billion (12% of the total), cancers £1.3 billion, and accidents and other injuries £1.2billion. Now, mental health costs cover those who are mentally handicapped and those withlearning difficulties. However, they also encompass disorders such as depression and neuroses, some of which have been linked to stress and to stress in the workplace. Stress itselfhas been linked to CHD and to illnesses caused by high blood pressure (such as stroke). TheConfederation of British Industry (CBI) found that employers generally tended to ascribestress as a cause of absence more in larger organisations than in smaller ones.

3.2.1 Stress: a pointStress can be an elusive concept. “In the minds of the public and in media coverage, stressoften seems to be a major risk marker for coronary heart disease” whereas the evidence is thatit is, but there are other more significant risk factors for CHD, like cigarette smoking (EssentialPublic Health Medicine, by R. J. Donaldson and L. J. Donaldson, Kluwer Academic Publishers,Lancaster, 1993).

Work-related stress is said to lead to increased risk of physical and mental ill-health, causingloss of productivity, absenteeism, and consequential loss to both employees and employers(Stress at Work: Does it Concern You?, European Foundation for the Improvement of Living andWorking Conditions, Dublin, date unknown). One 1997 survey of 1 176 full-time and part-time employees in 30 large firms covering several sectors showed differences in perception between employers and employees on various issues, including stress:–

Proportion AgreeingStatement Employers % Employees %

Employees have to work harder and 10 15health has deteriorated as a result

Source: Employee Welfare 1997 Survey Results, Watson Wyatt Worldwide, March 1997.

This sort of opinion gathering is of interest but is not by itself of greatest value in establishingcausative links. Nor are surveys of representatives’ views. For example, when asked about thefactors associated with stress, the most common responses from 7 268 trade union safety representatives were references to occupational stress and overwork, with a conclusionthat ill-health was the result (Stressed to Breaking Point: How Managers are Pushing People to theBrink 1996 TUC [Trades Union Congress] Survey of Safety Reps, TUC, London). In that particularsurvey 48% of representatives said that “new management techniques” were a cause of stress.Another area which has been said to be linked to stress, and to other aspects of health isworking hours (see section 3.4).


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Many organisations have studied or commented upon stress at work. These include theEuropean Foundation for the Improvement of Living and Working Conditions, the HSE, theInstitute of Occupational Safety and Health, the Institute of Personnel and Development(IPD), the Institute of Work Psychology at Sheffield University, and the TUC.

The HSE has set out some advice on the nature and causes of stress, including guidance ongood practice (Stress at Work, HSE, HSE Books, 1995). This contains brief descriptions ofphysical and behavioural effects of stress. It also mentions association of stress with some serious conditions, like anxiety, depression, heart disease, high blood pressure, thyroid disorder, and ulcers. The HSE points out that stress “is not the same as ill-health”, eventhough it may be a risk factor for some ill-health conditions.

The HSE view is that harmful levels of stress are likely to occur when pressures on people lastfor a long time or accumulate, when people feel that they are trapped or have little ability toinfluence any of the demands made on them, or when they get confused by conflictingdemands.

Stress is clearly a current topic of discussion, although the following quote may help set thingsin perspective:

“[stress] ... is no more than a mask for more traditional problems” (“Britons stressed fromoverwork”, Chris Barrie, The Guardian, 21 August 1996).

Stress in the workplace can be the combined effect of a whole range of problems, such as lowparticipation in decision making, task design, opportunities for advancement, and unpredictable hours (“Prevention of work stress: avoiding a blown fuse”, translated from“Preventie van werkstress – voorkom dat de stoppen doorslaan”, Ministry of Social Affairs andEmployment, The Netherlands, August 1993). It is interesting that the results from a recentsurvey of 5 500 readers of Management Today, undertaken by the magazine together withmanagement consultants WFD, showed that the reduction of stress as such was bottom of alist of 10 desires of the respondents (“Careers turn heat on Cool Britannia”, Nick Hopkins,The Guardian, 1 June 1998, p 5). Clearly the sample would not be representative of the general workforce.

3.3 Survey of working conditions relevant to healthThe HSE has published a study of self-reported working conditions (Self-Reported WorkingConditions in 1995 Results from a Household Survey, J. R. Jones, J. T. Hodgson & J. Osman, HSEBooks, 1997). This was based on the responses of 2 230 adults who had been employed in thepreceding ten years. The sorts of factors that showed up are summarised in Table 2:–

Table 2: Working Conditions Relevant to Health

Factors at Work Examples

Job demands, control and support Amount of work, pace, control and support

Physical conditions Fumes, harmful substances, temperature

Noise and vibration Noisy environment, vibrating machinery

Ergonomic aspects Repetitive movements, speed, force, posture

Violence Attacks by public or colleague

Source: HSE, from two Office for National Statistics (ONS) Omnibus Surveys, 1995.


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As Table 2 shows not all the factors are the ones commonly associated with, for example,workplace accidents. It may surprise some to see the inclusion of violence, however (see thebox).

3.4 Working hours, stress and health

3.4.1 IntroductionAt various times there have been assertions and discussions about the effect of working hourson health, most recently in the context of European Union legislation about working time.

The European Commission (EC) 1993 working time directive limits weekly employmenthours to 48 from October 1998, although the Directive excludes about six million employeesacross the European Union. The European Parliament recently voted for the inclusion of allemployees (“The not so 48-hour working week”, Session News, European Parliament, 3 July1998, p 13). The whole issue of legislation on working hours has concerned many IoD members. Reports published in 1997 have shown opposition to many aspects of rigid all-encompassing limits on working time (The Working Time Directive and the Social ChapterResults of an IoD Member Questionnaire, IoD, January 1997, and Fierce Opposition to Working TimeDirective, IoD, March 1997).

3.4.2 OvertimeThe EC’s Statistical Office found that the average UK working week including both paid andunpaid overtime was 43.4 hours in 1992, over an hour longer than in 1983 (“Undue diligence”,The Economist, 24 August 1996, pp 57-58).

Incomes Data Services (IDS) has reported on UK overtime in the 1990s (“Overtime”, IDSStudy, 617, January 1997). IDS mentioned that although manual workers had the highest levelof paid overtime, many professional staff worked “a considerable amount” of unpaid overtime. The Spring 1996 LFS results showed 60% of such professional employees said thatthey usually worked about 6.5 hours/week unpaid overtime, with average paid overtime coming to some 1.75 hour/week. Manual employees said that they normally worked nearly 7hours/week paid overtime but only 0.75 hour/week unpaid overtime.

The IDS Survey found, anecdotally, several employers stating that it was common for managers to work from between 4 and 12 hours/week unpaid overtime. One paper stated that70% of “British workers want to work a 40-hour week while only 30 per cent do so”, with 25%of male employees working over 48 hours/week, 20% of all manual employees working over50 hours/week, and 12.5% of managers working over 60 hours/week. It mentioned thatwomen working full-time had 14 hours less free time a week compared with full-time male


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Violence at work

According to the 1995 British Crime Survey, the incidence of work-related violence doubledover the five years 1991 to 1995, from 350 000 to 700 000 incidents (“Making work a saferplace”, Diana Lamplugh, Local Government Executive, May/June 1998, pp 30-31). Such figures are dependent on willingness to report so are probably underestimates. BritishPetroleum (BP) has commented that although deaths from industrial accidents haddeclined, those resulting from criminal violence and road traffic accidents had risen (BPHSE Facts 1997, BP, London). Now, BP operates globally, not just in the UK, and althoughthe total number of fatalities is thankfully small, they nevertheless give pause for thought.

employees (“Stress the problem of the future: how can it be recognised, managed or prevented?”, Patrick G. Keady, The Health & Safety Practitioner, January 1996, pp 24-29).

IDS has also commented on the perception that the UK has a long-hours culture (IDS Focus,81, March 1997). Yes, it seemed that overtime levels had risen over the preceding decade. Yes,managers and professionals were stating that they put in lots of unpaid overtime, but thereport’s view was that it was “stretching it a bit” to describe working through lunch and taking work home as unpaid overtime, and that it is different in character from factory workers’ overtime. Debatable. However, they did highlight other factors, such as travel timeto work, the organisation of work and management practices, which could contribute to the perception.

A 1994-1995 survey of 1 000 people by Global Futures found that although “nearly half of all employees are now expected to work extra hours, only a third of this overtime is paid for”(“Undue diligence”, The Economist, 24 August 1996, pp 57-58). We could speculate as to whoseexpectations; employers’ or employees’? Global Futures did blame long hours as a contributory factor for “growing stress” in the British workforce. What is the evidence for this?

3.4.3 Working hours and healthOne survey of 30 large firms showed that employers’ and employees’ views differed. Whenpresented with a suggestion that days off sick would increase because of longer working hours, 12% of employees agreed with that, compared with 0% of employers (EmployeeWelfare 1997 Survey Results,Watson Wyatt Worldwide, March 1997).

A recent quantitative and qualitative overview of existing studies using the statistical technique of meta-analysis has reported that there were positive even though very small correlations between increasing hours of work and symptoms of ill-health (“The effects ofhours of work on health: a meta-analytic review”, Kate Sparks, Cary Cooper, Yitzhak Fried andArie Shirom, Journal of Occupational and Organizational Pyschology, vol. 70, 1997, pp 391-408).

Their study examined work that had researched weekly working hours. Both mental andphysical health were examined. They found 31 studies and included 19 in the meta-analysis,excluding those lacking sufficient supporting information. Bearing in mind publication bias(the tendency to only publish research with positive rather than negative findings), only twostudies of the 19 reported no correlation between ill-health outcomes and working hours, andnone found a negative association, i.e. one that would have indicated improved health fromlong hours. The mean correlation coefficient between hours and ill-health measures came outat r = 0.13. A perfect positive correlation would have r = 1.00, so the value found is quite low.This indicates a small positive association linking poorer health with longer hours. The correlation for mental health was slightly stronger. An indication of how well increasing hoursexplain ill-health is given by r2, which is about 0.02. So only about 2% of the increasing illhealth is attributable to working hours increase.

Note that in their research, the authors did not investigate if this linear association (ill-health effects increasing uniformly with time worked) became non-linear at some point,for example above a certain number of hours, with possible greater ill-health effects than froma gradual increase. They did refer to two studies that people working over 48 hours a weekhad greater health problems than those working fewer hours. They thought that furtherresearch was needed.

As to physical health, heart disease had the highest correlations with hours of work of all theill-health indicators examined. Most but not all of the studies analysed used self-reportedmeasures of health status, and self-reported health status has been found to correlate more stronglywith many other factors than non-self-reported health measures. Eight of the 19 studies did have this latter type of measure. According to some theories, different personality types tend to


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perceive their situation in different ways; poor self-image tending to go along with reportingof poor perceived health.

The authors do mention the paucity of studies that have looked solely at the effect of lengthof the working week on health; many of the studies included examined other factors, some ofthem probably interlinked.

Age may well be one factor. Two studies had found increased stress in people over 40 years;they may have been more stressed by feeling more liable to redundancy. They also commenton employees’ control over their job content as an issue in relation to perceived stress. Oneinvestigation even found that presumably busy moonlighters tended to have no worse healththan others with a more conventional work pattern; the element of choice amongst at leastsome of the moonlighters in working long hours being a positive factor.

One other factor is the “healthy worker effect”; the tendency that people in work tend to behealthier than unemployed people (A Dictionary of Epidemiology, second edition, edited byJohn M. Last, Oxford University Press, New York, 1988). Thus in some cases the health status of some overworked people would probably be better than that of underoccupied individuals.

Almost certainly, stress can contribute to an outcome of ill-health, but the effects identified byKate Sparks and colleagues are more likely to affect those who already have other risk factors,such as being overweight in the case of CHD (Essentials of Preventive Medicine, J. A. Muir Grayand Godfrey Fowler). In other words, while any work-related illness linked to long hours is nota good thing – and definitely not for those with high levels of other risk factors –it is unlikely to be one of the major causes of public ill-health.

3.4.4 Work ... or working hours?Thus, it would seem that there is some evidence for effects of long hours of work contributing to ill-health, but there are likely to be other work-related factors that may wellhave larger influences (see section 3.4.3). We concur with the IDS comment that for healtheffects, “Long hours are only part of the story” (IDS Focus 81, March 1997).


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4. Costs to business of ill-health

The CBI began a series of surveys about absence in 1987. From the results of the survey conducted in January 1997, it estimated that 187 million working days were lost by industryeach year because of sickness – leading perhaps to a £12 billion cost to business (ManagingAbsence – in Sickness and in Health, CBI, London, April 1997).

Other estimates of cost have ranged between £6 billion and £12 billion a year, equal to 5%-10% of all UK industrial companies’ trading profits (Safety Culture, HSE Books). Comparethis with theft losses of £1.4 billion just in retailing (“UK stores see increase in theft and violent crime”, Reuters Business Briefing, London, 18 February 1998). The actual amountsattributable to work-related illness may be closer to 20 million days annually, according to theHSE’s 1995 survey of household residents (“Work-related illness stresses the NHS”,Healthlines Magazine, Issue 52, May 1998, p 4). Nevertheless this is still a considerable burdenon business. Accidents alone have been estimated to cost businesses about 5% of gross trading profits (“Spotting the dangers”, Frances Lee, Health in the Workplace, AFinancial TimesGuide, November 1995, pp 9-11).

For non-manual employees in full-time work the average time lost in a year was 7.9 days(3.5% of available working time), whereas for full-time manual employees it was 9.7 days(4.2% of working time). For part-time employees the figures came out at 7.3 days (3.5%) and10.6 days (5.1%), for non-manual and manual workers, respectively.


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5. Directors’ views on health at work

5.1 Survey of IoD membersThe IoD commissioned NOP Business to undertake a telephone survey of a randomly selectedquota sample of 500 IoD members in June 1998, as an add-on to one of the IoD’s quarterly business opinion surveys. Directors were asked about a range of topics, covering aspects of sickness absence, stress and general health at work.

Directors were asked not only about their views on policies and practices relevant to health atwork, but in some instances about factual matters such as whether there had been changes insickness absence (see section 5.2, for example). In these latter cases we are aware thatresponses are likely to be subject to more error because most of the directors interviewed didnot have functional responsibility for monitoring personnel information. However, taken as awhole, we think that the findings give a preliminary view of IoD members’ attitudes towardsmany topics connected with health at work. Some of these results should be useful inresponding to Government consultation exercises about health and work in due course, forinstance a public health White Paper due to be issued later in 1998.

The responses were weighted by NOP to match the distribution of IoD members by businesssector, organisation size, and region of the UK. In this report we refer to the weighted responses, and the percentages quoted in sections 5.2 to 5.11 exclude those indicating thatthey did not know, or who had no response to make. For only one of the questions asked inthe telephone survey did the total in these two categories of “non respondent” equal as muchas 4% (a question about problems caused by suspected dishonest sick leave – see figure 6 in section 5.2). For all barring one of the other questions the non-response category did notexceed 1%; a question about changes in sickness absence in the previous year (2%) – seeFigure 4 in section 5.2.

In its division by number of employees, NOP Business provided a breakdown of the resultsin four categories: 1-20, 21-100, 101-200, and over 200 employees. In sections 5.2 to 5.11 following we comment on results which showed probable differences by size of organisation,and also occasionally where there were differences by other category. Also, differences arecommented on in the main if they are likely to have been statistically significant at the 95%level of confidence or above (i.e. less than 1 in 20 likelihood of having appeared differentbecause of random chance).

Some of the NOP source data appear in tables starting on page 24.

In the following sections we also give some brief background comments to add to the moregeneral material set out in section 3.


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5.2 Sickness absenceMost respondents’ organisations (78% out of 499 responses) formally monitored sicknessabsence – see Figure 1.

Looking at the responses broken down by number of employees in the respondents’ organisation showed that this practice was statistically significantly more common in largeorganisations than in small. The range was from 54% for bodies with 1-20 employees, increasing to just over 90% for employers of more than 100 employees.

Of those monitoring sickness absence, 80% also recorded information about the nature ofthe illness, condition or accident. Note that accident reporting at work is covered by legislation, and that the figure here is for the combined category of incidents or ill-health.Recording of details ranged from just over 60% in the smallest organisations (1-20 employees),and approached 90% in larger organisations.

Similar differences showed up when it came to having a policy on the management of sickness absence. Over two thirds of responses came from directors whose organisations hadsuch a policy (see Figure 2), and once again it was the organisations with larger numbers ofemployees who were more likely to do so. The range was from 51% (1-20 employees) up to85% for those employing over 200 people. A practice frequently referred to was a requirementto give reasons for absence, including the production of a doctor’s certificate. Sixteen percent mentioned that advice, support or counselling was offered to employees, and 9% stated thatthere were disciplinary procedures, which could include termination of employment for“excessive” sick leave. Under 2% said that a bonus was offered as an inducement for fullattendance.

Sickness absence reports were received by the board, in just over a third of the organisations (see Figure 3, over page). Again, larger organisations were more likely to followthis practice (a little under half of these reportedly did so), as compared with organisationsemploying up to 20 people (15% from our survey).


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Formally Monitored Sickness Absence?

(499 responses)

Yes78%

No22%

Policy on Management of Sickness?(383 responses from those monitoring sickness absence)

Yes68%

N o32%

Figure 1

Figure 2

According to the CBI, absence rates at the beginning of 1997 were lower in firms with a policyon managing absence than in firms with no such policy (Managing Absence – in Sickness and inHealth, CBI, London, April 1997). Average absences were 20% lower where a policy was operated compared with those where it was not. From an earlier survey the CBI had found thatthe mean number of days of sickness absence (presumably standardised to correct for differences in size of organisation) was 30% higher in organisations that kept no records than inthose keeping computerised records (“Wish you were here”, Frances Lee, Health in theWorkplace, pp 14-15). Some firms ensure that information is reported to their board, not only ofaccidents at work but also other ill-health.

Four-fifths of respondents did not think that there had been changes in the amount of sickness absence in their organisation in the previous year (see Figure 4).

Where there were thought to have been increases, these seemed more likely to have been inthe largest than in the smallest organisations. A closer look at the figures revealed that in organisations where sickness absence had increased this was more likely to have been in thecombined category of Government, education, health and personal services than in the totality of all other sectors (around 20% of the former thought to have increased, comparedwith about 10% for the latter). This displays similar results to other findings about levels ofsickness absence in the public sector (for example, “Sick leave exceeds private sector levels”,George Parker, Financial Times, 11 February 1998, p 8). Note that direct comparisons betweenpublic and private sectors may be obscured by differences in collecting the information, andalso the responses analysed here do lie in the more subjective parts of the survey (see section 5.1).

Touching on even more subjective matters, the survey included a question about whethertaking days off sick for reasons other than being ill caused significant problems for theemploying organisation. Just over a quarter said that this happened, although a third said thatthey did not think that it happened in their organisation (see Figure 5 over page). Larger employers apparently were more likely to have had such problems, with a higher proportionwithin the manufacturing and distribution sectors than in most other sectors.


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Sickness Absence Reported to the Board?(493 responses)

Yes34%

No66%

Change in Sickness Absence in Last Year(488 responses)

12 8

81

0

20

40

60

80

100

Gone up Same Gone down

%

Figure 3

Figure 4

There were some differences when it came to discussing suspected dishonest sicknessabsence with employees, but over four-fifths of those who thought that they experiencedproblems reported that discussions with held with employees in those circumstances (see Figure 6).

In the 1997 CBI absence survey 98% of the responding employers thought that most sicknessabsence in their organisation was genuine. Nevertheless, it has been said by at least one surgical consultant that there is some evidence of exaggeration of illnesses when people havesued employers over claims of work-related injuries (“Patients hype pain for court cases”, IanMurray, The Times, 27 July 1998, p 7). After general illness, employers’ perception was that family responsibilities were seen as the second highest cause of absence.

5.3 StressInterviewees were asked whether they thought that stress was a big problem in the organisation. Nearly 40% said that it was, to varying degrees, but over half thought that it wasnot (see Figure 7). Those agreeing or agreeing strongly that stress was a big problem wereslightly more likely to have been in larger than in smaller organisations, although the differences were not statistically significant.


15

Significant Problems Caused by Dishonest "Sick Absence"?

(494 responses)

2633

41

0

20

40

60

80

100

Yes No Does not happen

%

Suspected Dishonest Sick Absence Discussed with Employee?

(321 responses from those where it occurred)

10

51

7

32

0

20

40

60

80

100

All cases Most cases Rarely Never

%

Stress at Work a Big Problem in Your Organisation?

(498 responses)

Agree25%

Neither agree nor disagree

8%

Disagree39%

Agree strongly13%

Disagree strongly

15%

Figure 5

Figure 6

Figure 7

Slightly higher proportions indicated that in terms of the actual time spent at work thingswere more stressful than they were a year earlier in the organisation; about 47% whoagreed or agreed strongly, compared with 42% who disagreed or disagreed strongly (see Figure 8).

When asked about stress at work and sickness absence compared with the previousyear, half the respondents thought that stress was no more important a factor, althougharound a third said that it was (see Figure 9).

Lastly, we asked for opinions on whether working practices could be a factor affecting the levels of stress that people said they were under. Over four-fifths agreed or agreed stronglythat this could be the case, with only about a tenth disagreeing or disagreeing strongly (seeFigure 10).


16

Stress at Work a Bigger Problem than a Year Ago in Your Organisation?

(495 responses)

Agree33%


10%

Disagree36%

Disagree strongly

7%Agree strongly

14%

Stress at Work More Important Factor in Sickness Absence than a Year Ago?

(494 responses)

Disagree41%

Agree26%

Agree strongly8%

Disagree strongly

9%


16%

Working Practices in an Organisation Can be a Factor Affecting People's Perceived Stress?

(498 responses)

Agree strongly35%


5 %

Disagree strongly2 %

Disagree7%

Agree52%

Figure 8

Figure 9

Figure 10

Responsibility for dealing with stress at work was overwhelmingly felt to be sharedbetween the employer and the employee (see Figure 11). Only 4% thought that it would besolely the employees’ responsibility to deal with.

The Government set up an Inter-Agency Group on Mental Health in the Workplace, and theHSE has produced a resource pack on its behalf to help in the management of mental health,including stress at work (Mental Well-Being in the Workplace A Resource Pack for Management Trainingand Development, HSE Books, 1998). This was supported by several bodies, including the CBI,Cranfield University School of Management, the Department of Health, the Health Education Authority (HEA), the IPD and the TUC. This is against a background in which employers have been held responsible for workplace stress leading to ill-health, for example the suicide of an NHS employee (in an NHS Mental Health Trust) whohad been displaying suicidal tendencies of which the employer was aware (“Suicide – payout”,Health Safety & Hygiene Newsletter, Number 49, June 1998, p 4). See also section 3.2.1.

5.4 Advice for worried workersAccording to our survey, a confidential service was offered for employees to discuss their worries about work, or even problems outside of work, by half of the organisations (seeFigure 12). This was more likely to be the situation the larger the organisation; 39% for thesmallest ranging up to 67% for the largest.


17

Whose Responsibility for Dealing with Stress at Work?

(491 responses)

1

8

1

66

19

1

4

0 20 40 60 80 100

Other

All of the above

Outside Body

Employee & Employer

Employer

Employee, Friends & Relatives

Employee

%

Confidential Service Offered for Worried Employees?

(498 responses)

Yes51%

No49%

Figure 11

Figure 12

These sorts of services were offered free of charge in most cases (see Figure 13).

5.5 General healthWe move now to views about health itself. As Figure 14 shows, over 80% of the IoD memberssurveyed agreed or agreed strongly with the idea that employers have an important role inimproving employees’ health. A total of about 8% disagreed with this notion. These findings appeared much the same by size of organisation, and by sector.

We asked whether health advice and health checks and screening were offered by theemploying organisation, and found the results shown in Figure 15. Larger organisations weremore likely to engage in these practices than were smaller.

ICI has plans to make general health screening and health education available to everyemployee worldwide by the year 2000 (Safety, Health and Environment Performance 1997, ICI,London).


18

Categories of Employee Offered Free Service for Discussing Worries

(251 responses from those with a service)

0

2

1

7

90

0 20 40 60 80 100

Qualifying period needed

Certain postholders only

All full-time employees

All permanent employees

All employees

%

Employers Have an Important Role in Improving Employees' Health?

(496 responses)

Agree strongly41%Agree

42%

Disagree6 % Disagree strongly

2%


9%

Health-Related Advice Offered by Employer?(496 responses)

42

27

0 20 40 60 80 100

Healthchecks/screening

Health advice

%

Figure 13

Figure 14

Figure 15

5.6 SmokingSmoking at work is an area that can cause problems for non-smokers, smokers and for management devising ways of coping with not only employees but also customers and visitors.

Figure 16 shows our findings concerning smoking restrictions at work for employees andfor customers or visitors. Just over half had a complete ban on smoking. The services sectorsseemed to have the highest prevalence of smoking restrictions, and manufacturing the lowest.From our responses it would seem that restrictions are more severe for employees than forpeople visiting the premises for whatever reason.

According to a survey in 1995 of people aged 16-74 years living in private households, 78% ofpeople in employment said that smoking was banned at work or allowed in certain areas only(Health in England 1995, HEA and the former Office of Population Censuses and Surveys(OPCS), now the ONS). Our results reported here seem to indicate slightly higher levels ofrestriction than was the case in 1995, although of course the survey respondents were different.

Even for an activity with such known and well-researched links with ill-health, smokersshould not necessarily give up nicotine (found in tobacco) at a stroke, if some recent findingsare verified. Analysis of HSE records of serious but non-fatal accidents at work covering theyears 1987-1996 has shown that there seem to be more such accidents coinciding with theWednesdays designated National No Smoking Day once a year in the UK1 (“Nicotine withdrawal and accident rates”, Andrew J. Waters, Martin J. Jarvis and Stephen R. Sutton,Nature, vol. 394, 9 July 1998, p 137). People quitting smoking feel irritable and restless, andlose their concentration. The researchers – from the Institute of Psychiatry and UniversityCollege London – advised that because nicotine addiction is so strong, people should try outnicotine replacement while trying to kick the habit.

Things should still be kept in perspective when considering the relative risks. Smokers ingeneral have poorer health than do non-smokers over many different measures of health, withsmoking being the biggest single cause of diseases in the UK that lead to an early death (OurHealthier Nation A Contract for Health, The Stationery Office, London, February 1998). A studyby the World Health Organisation showed that non-smokers exposed to smoke at work faceda 17% excess risk of developing lung cancer as compared with those not exposed (“Passivesmoking causes lung cancer”, Healthlines Magazine, Issue 52, May 1998, p 5).


19

Smoking at Work(497 responses)

16

37

47

8

38

55

0 20 40 60 80 100

No restrictions

Allowed in certainareas

Banned altogether

% EMPLOYEESCUSTOMERS/VISITORS

1. Incidentally, HSE records apparently show that accident rates normally tend to be highest on Mondays andfall throughout the week to Friday.

Figure 16

5.7 DrinkingRestrictions on the drinking of alcohol at work were reported to be in place in 62% oforganisations, according to our survey. Such restrictions were somewhat less common thanwere restrictions on smoking.

Alcohol and its effect on work and workers can be a controversial subject in itself. Eventhough a certain amount of alcohol is considered a good thing for many people (see for example “A drink a day keeps the doctor away”, Dr Richard Halvorsen, Director, April 1998,p 99), employers have tended to keep more of a watchful eye on alcohol in the workplace.

5.8 Diet and nutritionMore attention is being given to diet nowadays. Around a fifth of organisations with a canteenor restaurant offered advice on healthy eating (see Figure 17).

Again this is an area that can cause heated debate, although various surveys have shown theimportance of healthy eating. As with areas such as stress, diet, nutrition and health effects arenot confined to the workplace by any means.

5.9 ExerciseNine percent of respondents said that their organisation provided exercise facilities. Doublethat proportion said that they encouraged use of such facilities provided by others. Both theprovision and encouragement of exercise were most likely in organisations employing over200 people.

Physical inactivity is as big a risk factor for CHD about equal to that of cigarette smoking, having high blood pressure, and high cholesterol levels (Health in England 1995 What PeopleKnow, What People Think, What People Do Summary of Key Findings, Gill Mabon, AnnBridgwood, Deborah Lader and Jil Matheson, HEA and OPCS, London, 1996). The HEAand OPCS (now ONS) found that 67% of people in work described their job as “active” in thephysical sense, leaving a third who were either not very active, or not active at all.

Ten percent said that they encouraged cycling to work, with the same proportion encouraging walking to work. These are topics which are likely to feature in a differentcontext over coming months, as the UK Government’s White Paper on an integrated transportpolicy is debated (A New Deal for Transport: Better for Everyone, Cm 3950, The StationeryOffice, London, July 1998).


20

Employers with Restaurant or Canteen: Advice on Healthy Eating Given?

(216 responses)

No advice given81%

Healthy eating advice given

19%

Figure 17

5.10 Health insuranceSome 70% of organisations offered private health insurance to some or all employees (seeFigure 18).

In the main private health insurance was paid for by the employer (see Figure 19).

5.11 Promoting health at workThe survey included questions about involvement with joint initiatives on health atwork. That is, involvement with other bodies, such as the HSE and its “Good Health is GoodBusiness” programme (see section 6.1).

Replies indicated that about 13% of organisations said that they were involved in some waywith outside bodies, with 5% saying that they had some involvement with “Good Health isGood Business”. We did not ask about the nature or extent of that involvement.

From examination of the survey results, it seemed that organisations involved with joint healthat work initiatives were more likely than non-participants to also offer advice services for worried employees (see section 5.4), to offer health advice or health screening to employees (see section 5.5), to have a policy restricting alcohol at work (see section 5.7), and toprovide exercise facilities or encourage exercise (see section 5.9). Perhaps surprisingly, participation in such initiatives did not appear to be linked to whether smoking was banned(see section 5.6). In general, however, joint initiatives seemed to be associated with practicalactions in the realm of health at work. Whether or not that is cause and effect we cannot say, butit does indicate that an interest in health at work can result in differences in health-related practices. It is far too premature to comment on actual outcomes, i.e. changes in people’shealth.


21

Private Health Insurance Offered to Eligible Employees?

(498 responses)

Yes69%

No31%

Who Pays for the Private Health Insurance?

(340 responses)

Employer82%

Employer & Employee

13%

Employee4%

Figure 18

Figure 19

We asked about intentions to participate in joint initiatives on health at work, with theresults shown in Figure 20.

A little over a third said that they should become involved, with 17% saying that they intended to do so (see Figure 21).

5.12 An IoD viewFrom our survey of members, it can be seen that there is a willingness for many employers totake sickness absence seriously, but also be positive about employers’ responsibilities in minimising absence levels. This is so not only about matters concerning the perhaps morefamiliar health and safety area, but also when it comes to other areas like health advice andhealth promotion.

While there is a willingness to be positive about health issues at work, there are also practicalconstraints, particularly for many small firms, about being able to devote resources to a focuson “healthy workplaces” and joint initiatives with other organisations.

Health at work may be a more tenuous issue to get to grips with than matters of safety. Thelatter may lead to visible accidents, but often, exposure at work to less obvious risks may leadto illness that develops after a latent period perhaps long after the original exposure (“Healthy,wealthy .... and wise”, Robert Taylor, Health in the Workplace, pp 3-4). Our findings show thatthere is a genuine concern for many of the issues connected with health at work.


22

Should Become Involved in Joint Initiatives on Health at Work?

(409 responses: those not currently involved)

Agree29%


24%

Agree strongly6%

Disagree strongly

11%Disagree

31%

Intended to Become Involved with a Health at Work Joint Initiative?

(420 responses: those not currently involved)

Yes17%

No69%

Uncertain14%

Figure 20

Figure 21

6. What can or should business do about it?

6.1 Some current programmesThe Government Consultation Paper (Our Healthier Nation, February 1998) stated that businesses can bring its skills into play – including marketing and communications expertise,as well as more traditionally thought of health and safety considerations. In fact there is a focuson “healthy workplaces” as a setting for action.

The HSE has been running a programme called “Good Health is Good Business” for threeyears. Aimed at all employers, the campaign is intended to help managers to manage healthrisks and reduce the amount of work-related illness (“Foreword by the Chairman”, Frank J.Davies, Health and Safety Commission, Health in the Workplace, p 2). The HSE produced 200 000 information packs for small and medium-sized companies. The latest phase of the campaign was launched in May 1998.

The HEA has a health at work programme providing health advice and training to employers,and advice on health at work is given by local health promotion units in some parts of thecountry. Outwith the NHS, private organisations such as the British United ProvidentAssociation (BUPA) and Guardian Health provide healthcare schemes for employers. TheHEA has developed a computer based health risk assessment package called Health at WorkCheckpoint, which is being used by 45 organisations, including Alliance and Leicester, andHewlett Packard (“Health checkpoint”, Health at Work, No 13, May 1998, p 6). This may beused to draw up personalised and confidential health advice for individual employees.

Also, the HEA set up the Workplace Health Advisory Project, the idea of which is to get largecompanies to help smaller ones improve employee health (Working Together, HEA 1996/97Annual Report, 1997). One example is at Stansted Airport, where BAA occupational healthstaff are working with 100 small companies in the area. Whether such schemes will take offelsewhere remains to be seen.


23

Annex A: NOP Survey Results

IoD Member Survey: MethodThe questions on health at work issues asked of IoD members were treated as additional ad hoc questions to the regular IoD Business Opinion Survey

The IoD Business Opinion Survey is designed to provide an up-to-date indication of currenttrends within the UK economy. The survey is carried out on behalf of the IoD by NOPBusiness and is conducted every three months by telephone.

The results presented in this Research Paper are based on interviews with 500 members ofthe IoD carried out between 1 and 12 June 1998. The sample was randomly drawn from theIoD membership database and is structured so as to be representative in terms of companysize, industrial sector and region. A detailed breakdown of the sample structure is provided inthe data tables. For simplicity, different types of firms are referred to as follows:

Size

1 - 20 employees “Micro”21 - 100 employees “Small”101 - 200 employees “Medium”201+ employees “Large”

Sectors

ManufacturingDistributionOthers including construction/mining/transport “Others (including

Construction)”Government/educational/medical/personal services “Non-business services”Business/finance/professional services “Business services”

In order to give a simple, clear indication of the trend in any particular variable, the surveyresults shown in the following tables are sometimes summarised in terms of a positive or negative balance. The balance is computed by simply subtracting, for example the number ofrespondents replying no to a question from those replying yes, to give a single number, or thenumber who disagreed with a statement from those who agreed with the same statement.


24

health matters in business

Health & Medicine

business health

health matters

health insurance

concept of health

sicknesswhenever health

matters of employee

matters of occupational

matters of mental health