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Too many people are working while sick. The Great Resignation could help change that

‘Sickness culture’ is a huge problem—for employees, and for businesses’ bottom line.

Too many people are working while sick. The Great Resignation could help change that
[Source Photo: Edward Jenner/Pexels]

An estimated 47 million Americans quit their jobs in 2021, up from 42 million in 2019, before the pandemic. In the months since, there have been dozens of explanations proffered for this Great Resignation. These include low pay, a lack of respect in the workplace, inflexible hours, and childcare issues, according to Pew Research Center. It’s an issue of burnout or depression or moral injury. It’s the end of civilization as we know it, or the start of something new. But one concept—presenteeism—and a mounting backlash against it, ties many of these data points together. 

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Presenteeism is the technical term for being on the job, but not fully able to work. It’s usually the result of a physical illness, like working even when you’ve got the flu. But the zombie-like state can be tied to a range of mental health issues, caregiving conflicts, and more, says Debra Lerner, a Tufts University School of Medicine professor and associate director for organizational impact at Tufts Clinical and Translational Science Institute. The problem of presenteeism “has only gotten bigger with COVID-19, and it’s here to stay.” 

Under lockdown, some remote workers felt like there was more pressure to perform despite feeling unwell. But others found a new sense of liberation, whether it was time taken back from their commute or more flexibility in taking breaks during the workday. Most importantly, the pandemic has made it more clear than ever that communicable diseases, even when mild, can put coworkers and clients at risk in ways that no longer feel so easily dismissed. “The age of presenteeism is over,” Kevin Ellis, chairman of PricewaterhouseCoopers, announced in summer 2020. While his pronouncement was perhaps premature, something is shifting—and the results for the workplace could be profound.

The problem with presenteeism begins with societal archetypes, says Gail Kinman, an occupational health psychologist and visiting professor at Birkbeck University of London. In many countries, the ideal employee is seen as someone who sacrifices themselves as an act of loyalty to their company. (Over a Zoom call from England, Kinman told me about a former colleague who broke her leg—and still made it to her next meeting.) It’s then reinforced through what Kinman calls “the sickness culture” of a given organization. Even if policies are in place to encourage self-care or sick leave, when managers model unhealthy behavior, employees take notice. 

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While some might think the “martyr approach,” as Kinman calls it, will get them ahead in their careers, it often has negative effects for employees and employers. Longitudinal research has shown that when people avoid taking sick leave when it’s needed, they will often end up needing more sick leave overall. Working while sick, in pain, or depressed can also lead to more errors, accidents, and injuries. In the long run, a dysfunctional sickness culture creates problems for morale. Taken together, presenteeism costs the American economy billions of dollars a year in lost productivity, the Harvard Business Review once estimated—a problem that almost rivals absenteeism (or not showing up to work at all). 

Presenteeism has likely always been a problem, but it appears to have been on the rise over the last decade. In the U.K., for example, the Chartered Institute of Personnel and Development has found that the number of people who report seeing presenteeism in their institutions has tripled since 2010—a finding in keeping with high levels of stress among workers and a decade dominated by the #girlboss. In the U.S., for those who have no, or limited, paid sick leave, presenteeism is an economic necessity. If they don’t work, they don’t get paid. 

The pandemic posed new challenges, but also offered millions of employees the opportunity to reimagine the notion of the “ideal worker.” In the aftermath, millions quit; the subsequent labor shortage caused some industries to reevaluate how they do business, including raising pay, improving hours, providing more opportunities, and simply affording employees more respect. “The Great Resignation isn’t a mad dash away from the office. It’s the culmination of a long march toward freedom,” Adam Grant, an organizational psychologist at the Wharton School of Business, wrote in the Wall Street Journal last fall. But employees will need support in putting these best practices into effect; companies must be clear that they not only do they not encourage working around the clock, they actively discourage it.

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What comes next is anyone’s guess. But sickness cultures can be changed, and a post-presenteeism world is one worth building. Right now, researchers are learning more about what drives presenteeism and what could ward against it. “The focus is on the potential for a win-win situation with employers and employees,” Lerner says. Short-staffing, unstable jobs, and a more general sense of FOMO all seem to be at play—and responsive to a range of policy changes, from enabling people to be truly absent when they’re really sick to devising programs for staged return-to-work after an illness. And top-down behavior modeling matters, too, Kinman says. Managers: Do not normalize working through COVID-19—or with a freshly broken leg.

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