To the Editor:
Loeppke et al1 have made another substantial contribution to our understanding of the relationship between health and work.
The health and work performance questionnaire (HPQ) has been validated. It is a good tool but an imperfect one. Its applicability to all workers has to be in question. For example, there will be many occupations when presence at work is more important than performance (eg, gate keeper). No workers can perform maximally on every occasion, and so there are occasions when not feeling able to contribute optimally would not have any meaningful impairment on the output (eg, elite athletes win gold medals without doing their best times). HPQ helps to develop understanding of the issues but it generates its own concerns.
How the conditions reported here might be associated with self-reported absenteeism and presenteeism is not always clear. For example, hypertension is insidious and often without any noticeable symptoms making it difficult to understand how a substantial presenteeism cost might be attributable to this. In contrast, obesity is high visible to all, but it is still not clear how this might result in such a great amount of presenteeism.
A great deal of further research will be needed before the impact of presenteeism across occupations and sectors is properly quantified. Although this study draws together data from a number of sectors it is not representative of US workers. More than 90% of the workers surveyed work for companies employing more than 10,000 people whereas only about 26% of all US workers are employed by such large employers.2 In contrast, no employers surveyed had less than 1000 employees, but more than half of US workers are employed in these small organisations.
This study expands knowledge but our understanding remains quite limited and mostly to large employers. In debating and investigating this important subject, we need to keep the wider workforce firmly in our minds.
Richard Preece, MB, MBA, FFOM
Mottram St Andrew
1. Loeppke R, Taitel M, Haufle V, Parry T, Kessler R, Jinnett K. Health and productivity as a business strategy: a multiemployer study. J Occup Environ Med
2. US Census Data
. Available at: http://www.census.gov/epcd/www/smallbus.html
. Accessed June 18, 2009.
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