“In many countries, job cuts have left fewer people in work. Those who remain are having to cope with almost unmanageable workloads, increased job insecurity, and longer hours. Their managers are often under increasing pressure, too, leading to more abrasive and aggressive management styles.”

If that sounds like workplace life in 2022, think again. The quote is from a World Economic Forum article, written in 2012 in the aftermath of the 2008 financial crisis, and entitled Why presenteeism doesn’t work. The decade-old article says: “There has been an increase in stress-related absenteeism but an even bigger increase in ‘presenteeism’ – people turning up to work ill because they are afraid of losing their jobs if they take time off. This presenteeism actually costs twice as much as sickness absence because people are in work but they are unproductive.”

Presenteeism was a problem in 2012, and it still is. But it is generally less discussed than its close cousin, absenteeism, which is the practice of regularly staying away from work (or school) without good reason.

Ask Alto unpacks the practice of presenteeism, and suggests some ways to prevent it.

What is presenteeism?

South African medical aid Discovery says people who come to work while ill, slightly under the weather, feeling blue or simply mentally disengaged are engaging in presenteeism.

The term can also refer the practice of being present at one’s place of work for more hours than required, says Investopedia, which adds that the term also encompasses the lost productivity that occurs when employees don’t fully contribute in their workplaces because of an illness, injury, or other condition.

Why does it matter?

Investopedia notes that presenteeism is not tracked like absenteeism, perhaps because it is harder to detect. But the costs of presenteeism have been estimated to be larger in real terms: employees who suffer from longer-term (but invisible) conditions see persistent drops in their productivity.

Enhasa, which works in the environmental health and safety field, quotes 2015 figures which suggested that while absenteeism costs companies about 4 days a year per employee, presenteeism accounts for 57.5 days lost per person.

An American Productivity Audit estimates that decreased productivity due to presenteeism costs the United States economy more than $150 billion per year. In Japan, that estimate totals about $3,055 per employee per year.

And in the era of Covid-19, the issue of going to work while carrying a contagious disease has made presenteeism a major health and safety issue. Previously it might (just) have been acceptable to go to work with a cold. The coronavirus made that a potentially deadly act.

How widespread is presenteeism?

Presenteeism is pervasive in the global workforce:

• Enhasa cites a 2019 Health and Wellbeing at Work study by the Chartered Institute of Personnel Development, which suggested that over 8 in 10 UK employees see issues of presenteeism in their workplace.

• A study published in the Journal of Nursing Management looked at 28 studies from 14 countries and found that the overall estimate of presenteeism prevalence among the nursing workforce was 49.2%.

• Presenteeism is a worldwide-observed behavior with prevalence rates over a year varying between 30% and over 90% of questioned employees, according to a Frontiers in Psychology paper.

Why do people do it?

Why do people drag themselves to work when they aren’t up to it? Motives will vary from person to person, but there are three main themes, according to a paper in BMC Public Health: organisational, the nature of the job and personal reasons. In human terms those translate to concerns like these: * People come to work no matter what if they fear losing their job or missing out on opportunities for career advancement.

• People may be driven by a fear of being labelled “unreliable” or “unable to handle the pressure” if they don’t come to work.

• People might feel that their work cannot be covered by someone else, or that they will miss a deadline if they don’t come to work.

• People fear what their co-workers might think if they don’t come to work – or they don’t want to place an extra burden on their colleagues.

• People may have used up all their sick leave, and be financially unable to take unpaid leave (and parents may be “saving” their sick leave so that they can use it when children are ill).

What companies can do

The starting point, says Investopedia, is to recognise that that employees contributing to presenteeism are still trying to do their best – they’re just physically or mentally unable to do so. That means the issue needs to be approached with care rather than punishment. Here are some steps that can help:

Offer a wider and more flexible range of leave and more of it. This works in management favour: if a company has a true sense of how much time off is being taken, that can be a tool for knowing when an employee is struggling and needs support.

Invest in wellness programmes – encourage employees to exercise and adopt habits shown to improve overall well being, Make sure that programme takes into account the stresses that employees face inside and outside of work. Think beyond exercise and diet: counselling or financial management support can help prevent illnesses and reduce the impact of long-term conditions. And access to consultations for common conditions like sleep disorders and allergies can be a huge help to employees.

No management presenteeism - managers need to encourage their employees to stay home when they feel unwell; they must follow that advice themselves.

Be aware of causes – high workload demands can cause employees to avoid taking time off when they need it because they’re worried about deadlines or overburdening co-workers in their absence. Rethink workflows if possible, to make work easily transferable.

Recognise the symptoms - employees with health problems, especially mental-health related ones, often feel unable to disclose them at work. That might be because managers are rarely trained to support them effectively if or when they do. Management training needs to include education that looks at the signals associated with high levels of stress or mental health problems, and the support that might be needed by employees in those circumstances.

Rethink company values – workplace wellness company Robertson Cooper points out that employees who come to work when sick are viewed as dedicated in some organisations. “It’s held as the norm that team leaders soldier through illness to get the job done… Make it clear that your company expects sick employees to stay home and recover.”