Describe sickness absenteeism with its measurement and significance.

Sickness Absenteeism

• The indices used to measure it, which should be given with their formulae:
• Sickness absence rate — the number of days lost per worker per year, or the percentage of scheduled working time lost
• Frequency rate — the number of spells of absence per worker per year
• Severity rate — the average duration of each spell (days lost divided by number of spells)
• Inception rate — the number of new spells per 1000 workers in a period
• The distinction between frequency and severity is the analytically useful one, and interpreting the two together is what turns a number into a diagnosis:
• High frequency with short spells suggests minor self-limiting illness, but also and more importantly low morale, poor job satisfaction, boredom, poor supervision, or domestic and social problems
• Low frequency with long spells suggests genuine serious illness, chronic disease, or major injury
• A rise in short absences among a particular department is therefore a management signal rather than a medical one, and investigating it medically will find nothing
• The determinants of sickness absence, which extend well beyond disease:
• Medical — the actual burden of acute and chronic illness, injury and occupational disease
• Personal — age, with older workers having fewer but longer spells; sex, women having higher recorded absence, largely reflecting domestic and caring responsibilities and maternity rather than greater illness; marital status and family size; and habits such as alcohol and tobacco
• The age pattern is worth explaining — younger workers take more frequent short absences and older workers fewer but longer ones, so the total days lost may be similar while the meaning is entirely different
• Occupational — the nature of the work; physical working conditions; shift work and night work; long hours; exposure to hazards; and monotony
• Psychosocial and organisational, which are frequently the largest contributors — job satisfaction; relations with supervisors and colleagues; lack of control over the work; morale; stress and harassment; and the presence of grievances
• Social and economic — the availability and generosity of sick pay, distance and transport to work, housing, and domestic responsibilities
• The sick pay point should be handled carefully — generous sick pay increases recorded absence, but absence of sick pay causes presenteeism, in which ill workers attend and spread infection, work unsafely and recover more slowly
• Presenteeism is now recognised as costing more than absenteeism in many settings, which is a genuinely counter-intuitive finding and worth stating
• The uses of sickness absence data — as an index of the health of the working population; to identify departments or processes with excess absence, which may indicate an unrecognised hazard; to evaluate occupational health interventions; for planning of services and manpower; and for estimating the economic cost of ill health
• The departmental comparison is the most useful application, since an unexplained excess in one section of a factory is a signal to conduct a walk-through survey there
• The limitations must be stated, because the indicator is easily over-interpreted — it measures absence, not sickness; it is strongly influenced by non-medical factors; it misses illness among those who continue to attend; it excludes the self-employed and the unorganised sector entirely, since they simply lose income rather than being recorded absent; and certification practices vary
• The measures to reduce it — improving working conditions and eliminating hazards; ergonomic improvement; pre-placement matching of worker to job; periodic examination and early treatment; health promotion, including immunisation, tobacco cessation and lifestyle; attention to job satisfaction, supervision and morale; welfare measures including canteen, transport and creche; active management of long-term absence with early contact and a graded return-to-work plan; and counselling and employee assistance
• Early contact with a long-term absent worker is among the most effective measures, since the longer a person is away, the less likely they are ever to return, and the barrier becomes social rather than medical
• Read frequency and severity together, or the number of days lost tells you nothing about its cause
• Many short spells signal morale and supervision, which is a management problem rather than a medical one
• Few long spells indicate genuine serious illness, which is the opposite interpretation from the same total
• Presenteeism now costs more than absence in many settings, which is counter-intuitive and worth stating
• Older workers have fewer but longer spells, so identical totals can mean entirely different things
• Excess absence in one department is a signal to walk through it, and may reveal an unrecognised hazard
• It measures absence, not sickness, and is strongly influenced by non-medical organisational factors
• The unorganised sector never appears in it, since those workers simply lose income rather than being recorded absent
• Contact a long-term absent worker early, since the longer they are away the less likely they are to return
• Women record higher absence for domestic reasons, which reflects caring responsibilities rather than greater illness