Health Matters in Business

Health Matters in Business – Health at Work
IoD Research Paper

Geraint Day

This research paper was written by Geraint Day, Business Research Officer. It was produced
by Charlotte Williamson and Joanne Walton.
August 1998

ISBN 1 901580 12 1
Copyright © Institute of Directors 1998
Published by the Institute of Directors
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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

HEALTH MATTERS IN BUSINESS – HEALTH AT WORK

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 a
Government 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 a
healthy workforce (see section 2.1).
• Surveys of self-reported ill-health have shown that around 2 million people in the
UK 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 to
establish cause and effect, because apart from anything else people’s state of health
depends on a wide variety of factors (see section 3.1).
• Nevertheless there has been an increasing emphasis on such areas as stress and
working 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 each
year (perhaps equivalent to 5-10% of industrial trading profits) – see section 4.
• A recent survey of IoD members has shown a positive attitude towards issues
such 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 a
few large organisations have been assisting smaller firms in this area (see section
6.1), although in practice it may be unrealistic to expect the smallest firms to be able
to devote significant resources in this way.

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2. Background – health at work

2.1 Health, safety and sickness
Whenever 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 Safety
Executive (HSE), and matters of occupational health may come to mind. People may
associate health at work issues with accidents, spillages of corrosive chemicals, leakages of
noxious fumes and even radioactive materials. Most of these are fairly noticeable and can lead
to sudden injury and incapacity.
However, when thinking of health as a topic in itself, people may more often think of sickness
and disability, perhaps. Increasingly in recent years the concept of health at work has come to
encompass not only issues like accidents but also some of the factors associated with sickness
and 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 more
obvious physical health.
When it comes to employment and business, what immediately springs to mind from the
point of view of the employer and also of colleagues is the fact of sickness absence and
absences for medical appointments. When employees are absent problems can arise for the
organisation, affecting productivity and profitability.
At one time it was believed that sickness absence from work was an indicator of the health of
the nation. This was because it may have been natural to assume that the amount of time lost
was 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 Godfrey
Fowler, Blackwell Scientific Publications, Oxford, 1984). To be sure, absences from work are
certainly very much influenced by the actual levels of disease. However, disease is only one
factor among many.
These encompass organisational factors (for example, personnel policies, industrial relations,
quality of management and working conditions). Personal factors are also important (such as
age, job satisfaction, life crises, family responsibilities and social activities – including alcohol
consumption).
Whatever the underlying reason or reasons, from the point of view of a business, an absent
employee means a deficit in one of the factors of production (see, for example, Safety Culture
A 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 when
a focus on efficiency means that there is less ability in many organisations to enable effective
cover for the work of absent employees.

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Therefore it is not surprising that governments in recent years have included health at work
as an area to be covered by health policies, not only for alleviating sickness, but also in the
fields 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 includes
some of the background, some statistics, and also the views of a sample of IoD members. As
a voice of leaders in business and other important organisations, the IoD perspective is that
progress in key areas depends on the opinions of those at the top, and that is just as true for
health at work.

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3. Estimates of work-related ill-health

3.1 Survey evidence: ill-health
In 1990 and 1995 questions were added onto the regular Labour Force Survey (LFS) asking
adults in a representative sample of households whether they had, in the preceding 12
months, suffered from any illness or disability or other physical problem either caused by or
made 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 total
of 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 same
results as when these are classified by professional medical staff. Apart from anything else
there 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 precise
description 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 ever
worked) reported having been affected by a work-related illness in the previous year. The
effects ranged from minor to severe. Extrapolating the findings to the nation showed that
around two million people would have had a work-related illness. That two million would
have included 712 000 who were included in the LFS but did not work during the period
being referred to.
Of that 2 000 000, the survey proportions were equivalent to about 542 000 (27%, or 42% of
those 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% of
those in work with SWI) had experienced illness perceived to be related to work but would
have 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, many
firms do not distinguish between work and non-work risks to health when considering their
employment practices (Health Risk Management A Practical Guide for Managers in Small and
Medium-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, may
still lead to the same outcomes: temporary or permanent absence of an employee – and no
work 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 factors
such as layout of equipment and work areas may be contributory factors to ill-health that
develops over a longer time. Such things may lead to aches, pains, perhaps breathing, hearing
or 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. Hence
for 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. It
is almost impossible for a non medically-trained person to unequivocally link an illness that
may develop over a long time (such as heart disease) to working practices or conditions. So in
many 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: why
clients 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 encouraged
these days – it is rather important to try to be as objective as possible.

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3.2 Some specific illnesses
By category of disease, in the early 1990s coronary heart disease (CHD) and stroke accounted
for nearly 25% of total days of certified incapacity for men and 10% for women, whereas mental
illness accounted for 15% and 26% for men and women, respectively (Government consultation
paper: 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 single
area of expenditure by category of illness. For comparison, CHD, stroke and related illnesses
cost £3.8 billion (12% of the total), cancers £1.3 billion, and accidents and other injuries £1.2
billion. Now, mental health costs cover those who are mentally handicapped and those with
learning 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 itself
has been linked to CHD and to illnesses caused by high blood pressure (such as stroke). The
Confederation of British Industry (CBI) found that employers generally tended to ascribe
stress as a cause of absence more in larger organisations than in smaller ones.

3.2.1 Stress: a point
Stress can be an elusive concept. “In the minds of the public and in media coverage, stress
often seems to be a major risk marker for coronary heart disease” whereas the evidence is that
it is, but there are other more significant risk factors for CHD, like cigarette smoking (Essential
Public 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, causing
loss 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 and
Working 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 Agreeing
Statement Employers % Employees %
Employees have to work harder and 10 15
health 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 establishing
causative links. Nor are surveys of representatives’ views. For example, when asked about the
factors associated with stress, the most common responses from 7 268 trade union
safety representatives were references to occupational stress and overwork, with a conclusion
that ill-health was the result (Stressed to Breaking Point: How Managers are Pushing People to the
Brink 1996 TUC [Trades Union Congress] Survey of Safety Reps, TUC, London). In that particular
survey 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 is
working hours (see section 3.4).

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Many organisations have studied or commented upon stress at work. These include the
European Foundation for the Improvement of Living and Working Conditions, the HSE, the
Institute 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 on
good practice (Stress at Work, HSE, HSE Books, 1995). This contains brief descriptions of
physical 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”, even
though 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 last
for a long time or accumulate, when people feel that they are trapped or have little ability to
influence any of the demands made on them, or when they get confused by conflicting
demands.
Stress is clearly a current topic of discussion, although the following quote may help set things
in perspective:
“[stress] ... is no more than a mask for more traditional problems” (“Britons stressed from
overwork”, Chris Barrie, The Guardian, 21 August 1996).
Stress in the workplace can be the combined effect of a whole range of problems, such as low
participation 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 and
Employment, The Netherlands, August 1993). It is interesting that the results from a recent
survey of 5 500 readers of Management Today, undertaken by the magazine together with
management consultants WFD, showed that the reduction of stress as such was bottom of a
list 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 health
The HSE has published a study of self-reported working conditions (Self-Reported Working
Conditions in 1995 Results from a Household Survey, J. R. Jones, J. T. Hodgson & J. Osman, HSE
Books, 1997). This was based on the responses of 2 230 adults who had been employed in the
preceding 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 the
box).

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

3.4 Working hours, stress and health

3.4.1 Introduction
At various times there have been assertions and discussions about the effect of working hours
on health, most recently in the context of European Union legislation about working time.
The European Commission (EC) 1993 working time directive limits weekly employment
hours to 48 from October 1998, although the Directive excludes about six million employees
across the European Union. The European Parliament recently voted for the inclusion of all
employees (“The not so 48-hour working week”, Session News, European Parliament, 3 July
1998, 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 Chapter
Results of an IoD Member Questionnaire, IoD, January 1997, and Fierce Opposition to Working Time
Directive, IoD, March 1997).

3.4.2 Overtime
The EC’s Statistical Office found that the average UK working week including both paid and
unpaid 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”, IDS
Study, 617, January 1997). IDS mentioned that although manual workers had the highest level
of paid overtime, many professional staff worked “a considerable amount” of unpaid
overtime. The Spring 1996 LFS results showed 60% of such professional employees said that
they 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 7
hours/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 that
70% 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 over
50 hours/week, and 12.5% of managers working over 60 hours/week. It mentioned that
women working full-time had 14 hours less free time a week compared with full-time male

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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 the
report’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 time
to 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 whose
expectations; 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 health
One survey of 30 large firms showed that employers’ and employees’ views differed. When
presented 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 (Employee
Welfare 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 of
hours of work on health: a meta-analytic review”, Kate Sparks, Cary Cooper, Yitzhak Fried and
Arie 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 and
physical 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 two
studies of the 19 reported no correlation between ill-health outcomes and working hours, and
none found a negative association, i.e. one that would have indicated improved health from
long hours. The mean correlation coefficient between hours and ill-health measures came out
at 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 hours
explain ill-health is given by r2, which is about 0.02. So only about 2% of the increasing ill
health 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 from
a gradual increase. They did refer to two studies that people working over 48 hours a week
had greater health problems than those working fewer hours. They thought that further
research was needed.
As to physical health, heart disease had the highest correlations with hours of work of all the
ill-health indicators examined. Most but not all of the studies analysed used self-reported
measures of health status, and self-reported health status has been found to correlate more strongly
with 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

9


perceive their situation in different ways; poor self-image tending to go along with reporting
of poor perceived health.
The authors do mention the paucity of studies that have looked solely at the effect of length
of the working week on health; many of the studies included examined other factors, some of
them 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 comment
on employees’ control over their job content as an issue in relation to perceived stress. One
investigation even found that presumably busy moonlighters tended to have no worse health
than others with a more conventional work pattern; the element of choice amongst at least
some 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 be
healthier than unemployed people (A Dictionary of Epidemiology, second edition, edited by
John 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 by
Kate 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 Gray
and Godfrey Fowler). In other words, while any work-related illness linked to long hours is not
a 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 well
have larger influences (see section 3.4.3). We concur with the IDS comment that for health
effects, “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 industry
each year because of sickness – leading perhaps to a £12 billion cost to business (Managing
Absence – 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). Compare
this 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 amounts
attributable to work-related illness may be closer to 20 million days annually, according to the
HSE’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 burden
on 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 Times
Guide, 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%) and
10.6 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 members
The IoD commissioned NOP Business to undertake a telephone survey of a randomly selected
quota 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 at
work, but in some instances about factual matters such as whether there had been changes in
sickness absence (see section 5.2, for example). In these latter cases we are aware that
responses are likely to be subject to more error because most of the directors interviewed did
not have functional responsibility for monitoring personnel information. However, taken as a
whole, we think that the findings give a preliminary view of IoD members’ attitudes towards
many topics connected with health at work. Some of these results should be useful in
responding to Government consultation exercises about health and work in due course, for
instance 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 business
sector, 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 that
they did not know, or who had no response to make. For only one of the questions asked in
the telephone survey did the total in these two categories of “non respondent” equal as much
as 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 not
exceed 1%; a question about changes in sickness absence in the previous year (2%) – see
Figure 4 in section 5.2.
In its division by number of employees, NOP Business provided a breakdown of the results
in 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 are
commented 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 different
because 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 more
general material set out in section 3.

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

Figure 1 Formally Monitored Sickness Absence?
(499 responses)

No
22%

Yes
78%

Looking at the responses broken down by number of employees in the respondents’
organisation showed that this practice was statistically significantly more common in large
organisations 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 of
the 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 had
such a policy (see Figure 2), and once again it was the organisations with larger numbers of
employees who were more likely to do so. The range was from 51% (1-20 employees) up to
85% for those employing over 200 people. A practice frequently referred to was a requirement
to 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 that
there 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 full
attendance.

Figure 2 Policy on Management of Sickness?
(383 responses from those monitoring sickness absence)

No
32%

Yes
68%

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 follow
this practice (a little under half of these reportedly did so), as compared with organisations
employing up to 20 people (15% from our survey).

13


Figure 3 Sickness Absence Reported to the Board?
(493 responses)

Yes
34%

No
66%

According to the CBI, absence rates at the beginning of 1997 were lower in firms with a policy
on managing absence than in firms with no such policy (Managing Absence – in Sickness and in
Health, 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 that
the 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 in
those keeping computerised records (“Wish you were here”, Frances Lee, Health in the
Workplace, pp 14-15). Some firms ensure that information is reported to their board, not only of
accidents 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).

Figure 4 Change in Sickness Absence in Last Year
(488 responses)

100
81
80

60
%
40

20 12 8

0
Gone up Same Gone down

Where there were thought to have been increases, these seemed more likely to have been in
the 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 the
combined 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, compared
with about 10% for the latter). This displays similar results to other findings about levels of
sickness 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 between
public and private sectors may be obscured by differences in collecting the information, and
also 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 whether
taking days off sick for reasons other than being ill caused significant problems for the
employing organisation. Just over a quarter said that this happened, although a third said that
they 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 proportion
within the manufacturing and distribution sectors than in most other sectors.

14


Figure 5 Significant Problems Caused by Dishonest "Sick
Absence"?
(494 responses)
100

80

60
% 41
40 33
26
20

0
Yes No Does not happen

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

Figure 6
Suspected Dishonest Sick Absence Discussed with
Employee?
(321 responses from those where it occurred)
100

80

60 51
%
40 32

20 10
7
0
All cases Most cases Rarely Never

In the 1997 CBI absence survey 98% of the responding employers thought that most sickness
absence 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 have
sued employers over claims of work-related injuries (“Patients hype pain for court cases”, Ian
Murray, 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 Stress
Interviewees 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 was
not (see Figure 7). Those agreeing or agreeing strongly that stress was a big problem were
slightly more likely to have been in larger than in smaller organisations, although the
differences were not statistically significant.

Figure 7 Stress at Work a Big Problem in Your Organisation?
(498 responses)

Disagree
strongly Agree strongly
15% 13%

Agree
25%

Disagree
39% Neither agree
nor disagree
8%

15


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

Figure 8 Stress at Work a Bigger Problem than a Year Ago
in Your Organisation?
(495 responses)
Disagree
strongly Agree strongly
7% 14%

Disagree
36% Agree
33%

Neither agree
nor disagree
10%

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

Figure 9 Stress at Work More Important Factor in Sickness
Absence than a Year Ago?
(494 responses)
Disagree
Agree strongly
strongly
8%
9%

Agree
26%
Disagree
41%
Neither agree
nor disagree
16%

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 strongly
that this could be the case, with only about a tenth disagreeing or disagreeing strongly (see
Figure 10).

Figure 10 Working Practices in an Organisation Can be a
Factor Affecting People's Perceived Stress?
(498 responses)

Agree
52% Neither agree nor
disagree
5%
Disagree
7%
Disagree strongly
2%
Agree strongly
35%

16


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

Figure 11 Whose Responsibility for Dealing with Stress at
Work?
(491 responses)

Employee 4
Employee, Friends & Relatives 1
Employer 19
Employee & Employer 66

Outside Body 1
All of the above 8
Other 1

0 20 40 60 80 100
%

The Government set up an Inter-Agency Group on Mental Health in the Workplace, and the
HSE 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 Training
and 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) who
had 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 workers
According 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 (see
Figure 12). This was more likely to be the situation the larger the organisation; 39% for the
smallest ranging up to 67% for the largest.

Figure 12 Confidential Service Offered for Worried
Employees?
(498 responses)

No Yes
49% 51%

17


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

Figure 13 Categories of Employee Offered Free Service for
Discussing Worries
(251 responses from those with a service)

All employees 90

All permanent employees 7

All full-time employees 1

Certain postholders only 2

Qualifying period needed 0

0 20 40 60 80 100
%

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

Figure 14 Employers Have an Important Role in Improving
Employees' Health?
(496 responses)
Neither agree nor Disagree
disagree 6% Disagree strongly
9% 2%

Agree strongly
Agree 41%
42%

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

Figure 15 Health-Related Advice Offered by Employer?
(496 responses)

Health advice 27

Health
42
checks/screening

0 20 40 60 80 100
%

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

18


5.6 Smoking
Smoking 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 and
for customers or visitors. Just over half had a complete ban on smoking. The services sectors
seemed 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 for
people visiting the premises for whatever reason.

Figure 16 Smoking at Work
(497 responses)

55
Banned altogether
47

Allowed in certain 38
areas 37

8
No restrictions
16

0 20 40 60 80 100

% EMPLOYEES
CUSTOMERS/VISITORS

According to a survey in 1995 of people aged 16-74 years living in private households, 78% of
people 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 of
restriction 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, smokers
should not necessarily give up nicotine (found in tobacco) at a stroke, if some recent findings
are verified. Analysis of HSE records of serious but non-fatal accidents at work covering the
years 1987-1996 has shown that there seem to be more such accidents coinciding with the
Wednesdays 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, and
lose their concentration. The researchers – from the Institute of Psychiatry and University
College London – advised that because nicotine addiction is so strong, people should try out
nicotine replacement while trying to kick the habit.
Things should still be kept in perspective when considering the relative risks. Smokers in
general have poorer health than do non-smokers over many different measures of health, with
smoking being the biggest single cause of diseases in the UK that lead to an early death (Our
Healthier Nation A Contract for Health, The Stationery Office, London, February 1998). A study
by the World Health Organisation showed that non-smokers exposed to smoke at work faced
a 17% excess risk of developing lung cancer as compared with those not exposed (“Passive
smoking causes lung cancer”, Healthlines Magazine, Issue 52, May 1998, p 5).

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

19


5.7 Drinking
Restrictions on the drinking of alcohol at work were reported to be in place in 62% of
organisations, according to our survey. Such restrictions were somewhat less common than
were restrictions on smoking.
Alcohol and its effect on work and workers can be a controversial subject in itself. Even
though 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 nutrition
More attention is being given to diet nowadays. Around a fifth of organisations with a canteen
or restaurant offered advice on healthy eating (see Figure 17).

Figure 17 Employers with Restaurant or Canteen: Advice on
Healthy Eating Given?
(216 responses)

Healthy eating
advice given
19%

No advice given
81%

Again this is an area that can cause heated debate, although various surveys have shown the
importance of healthy eating. As with areas such as stress, diet, nutrition and health effects are
not confined to the workplace by any means.

5.9 Exercise
Nine percent of respondents said that their organisation provided exercise facilities. Double
that proportion said that they encouraged use of such facilities provided by others. Both the
provision and encouragement of exercise were most likely in organisations employing over
200 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 People
Know, What People Think, What People Do Summary of Key Findings, Gill Mabon, Ann
Bridgwood, Deborah Lader and Jil Matheson, HEA and OPCS, London, 1996). The HEA
and OPCS (now ONS) found that 67% of people in work described their job as “active” in the
physical 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 different
context over coming months, as the UK Government’s White Paper on an integrated transport
policy is debated (A New Deal for Transport: Better for Everyone, Cm 3950, The Stationery
Office, London, July 1998).

20


5.10 Health insurance
Some 70% of organisations offered private health insurance to some or all employees (see
Figure 18).

Figure 18 Private Health Insurance Offered to Eligible
Employees?
(498 responses)

No
31%

Yes
69%

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

Figure 19 Who Pays for the Private Health Insurance?
(340 responses)

Employer &
Employee
13%

Employee
4%

Employer
82%

5.11 Promoting health at work
The survey included questions about involvement with joint initiatives on health at
work. That is, involvement with other bodies, such as the HSE and its “Good Health is Good
Business” programme (see section 6.1).
Replies indicated that about 13% of organisations said that they were involved in some way
with outside bodies, with 5% saying that they had some involvement with “Good Health is
Good 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 health
at 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 to
provide 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 practical
actions in the realm of health at work. Whether or not that is cause and effect we cannot say, but
it 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’s
health.

21


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

Figure 20 Should Become Involved in Joint Initiatives on
Health at Work?
(409 responses: those not currently involved)
Disagree
Disagree strongly
31% 11%

Agree strongly
6%

Neither agree
nor disagree Agree
24% 29%

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

Figure 21 Intended to Become Involved with a Health at
Work Joint Initiative?
(420 responses: those not currently involved)

Uncertain
14%
No
69%

Yes
17%

5.12 An IoD view
From our survey of members, it can be seen that there is a willingness for many employers to
take sickness absence seriously, but also be positive about employers’ responsibilities in
minimising absence levels. This is so not only about matters concerning the perhaps more
familiar health and safety area, but also when it comes to other areas like health advice and
health promotion.
While there is a willingness to be positive about health issues at work, there are also practical
constraints, particularly for many small firms, about being able to devote resources to a focus
on “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. The
latter may lead to visible accidents, but often, exposure at work to less obvious risks may lead
to 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 that
there is a genuine concern for many of the issues connected with health at work.

22


6. What can or should business
do about it?

6.1 Some current programmes
The 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 focus
on “healthy workplaces” as a setting for action.
The HSE has been running a programme called “Good Health is Good Business” for three
years. Aimed at all employers, the campaign is intended to help managers to manage health
risks 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 the
country. Outwith the NHS, private organisations such as the British United Provident
Association (BUPA) and Guardian Health provide healthcare schemes for employers. The
HEA has developed a computer based health risk assessment package called Health at Work
Checkpoint, which is being used by 45 organisations, including Alliance and Leicester, and
Hewlett Packard (“Health checkpoint”, Health at Work, No 13, May 1998, p 6). This may be
used 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 large
companies to help smaller ones improve employee health (Working Together, HEA 1996/97
Annual Report, 1997). One example is at Stansted Airport, where BAA occupational health
staff are working with 100 small companies in the area. Whether such schemes will take off
elsewhere remains to be seen.

23


Annex A: NOP Survey Results

IoD Member Survey: Method
The 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 current
trends within the UK economy. The survey is carried out on behalf of the IoD by NOP
Business and is conducted every three months by telephone.
The results presented in this Research Paper are based on interviews with 500 members of
the IoD carried out between 1 and 12 June 1998. The sample was randomly drawn from the
IoD membership database and is structured so as to be representative in terms of company
size, industrial sector and region. A detailed breakdown of the sample structure is provided in
the 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
Manufacturing
Distribution
Others 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 survey
results 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 of
respondents replying no to a question from those replying yes, to give a single number, or the
number who disagreed with a statement from those who agreed with the same statement.

24

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