Chronic diseases and related behavioural risk factors also lead to lower productivity, hours worked and wages

Labour productivity can be measured in several ways, including rates of absenteeism from work or “presenteeism” at work (that is, being at work while sick, resulting in reduced performance), reduced work hours, and lower levels of wages. This section examines productivity losses due to chronic diseases and their risk factors.

People with chronic conditions work and earn less

Figure 1.9 shows that people with chronic diseases have more sick days than people without any chronic diseases in all countries but Spain. Among people aged 50-59 who were employed in 2013 and who reported absence from work in the past 12 months, the median number of sick days is 7 in people without chronic disease, 10 in people with one chronic disease, and 20 in people with two or

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Figure 1.9. Number (median) of sick days in the last 12 months among employed people aged 50-59, by chronic diseases, 14 European countries, 2013

Note: N = 12 228 in the 14 countries studied. See the Statlink for further details on the methodology.

Source: OECD estimates based on SHARE data (wave 5).

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Chronic diseases reduce hours worked and wages. For instance, in the United States, men and women with chronic diseases worked about 6% and 4% fewer hours than healthy men and women, respectively, and earned about 6% and 9% less (Pelkowski and Berger, 2004).

Looking at the impact of specific chronic diseases, diabetes may affect the number of hours worked and the choice of full- or part-time work (Saliba et al., 2007). Evidence on US data shows that diabetes increases the number of work-loss days by two days per year in women (Tunceli et al., 2005). Diabetic people also generally earn less than nondiabetic workers (Minor, 2013).

The effect of cancer on hours worked is also significant, with a difference of three to seven hours less per week for people with cancer compared to cancer-free people (Moran et al., 2011). Cancer increases work absence. In Canada, 85% of women diagnosed with breast cancer were absent from work for a four-week or longer period compared to 18% for healthy women (Drolet et al., 2005).

Musculoskeletal diseases are associated with lower productivity. In the United Kingdom, musculoskeletal problems accounted for 30.6 million days lost, which represented almost a quarter of the total days lost due to sickness absences in 2013 (Office for National Statistics, 2014).

Mental illness is responsible for a high incidence of sickness absence and reduced productivity at work (OECD, 2015a). Poor mental health reduces workers’ marginal productivity when they are at work (presenteeism) and increases the rate of absence or reduces the numbers of hours worked (sickness absence). US workers lose an average of 1 hour per week owing to depression-related absenteeism and four hours per week due to depression-related presenteeism (Stewart et al., 2003).

Mental health problems are a predictor of both short- and long-term sickness absence, increasing the probability of short-term leave by 10% and of long-term leave by 13% for severe disorders and by 6% for mild-to-moderate disorders (OECD, 2012). Also, depression symptoms have a significant and large effect on sick-leave duration, since they account for an additional seven days of annual sick leave, more so than having two or more chronic diseases, as shown in Figure 1.10 (Knebelmann and Prinz, forthcoming).

Figure 1.10. Additional days in annual sickness absence among workers aged 50-59 due to depression symptoms, European countries, 2013

Note: N = 13 096.

* 0.1% significance level. See the Statlink for further details on the methodology.

Source: Knebelmann and Prinz (forthcoming). Authors’ estimates based on SHARE data.

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The negative labour market outcomes of chronic diseases amplify social inequalities on the labour market. Women and people with a low education level and blue-collar workers are more affected by the negative outcomes of chronic diseases on employment (Saliba et al., 2007). Lower autonomy and higher job demands increase the association of several chronic health problems (mental illness, circulatory diseases, musculoskeletal diseases, diabetes) with sickness absence.

The total costs of mental illness for society at large are estimated at 3-4% of GDP in the European Union (Gustavsson et al., 2011). Most of these costs are caused by people with mild-to-moderate mental illness, the majority of whom are employed. The large bulk of these costs are not direct costs borne by the health sector and related to medical treatments, but indirect costs due to loss of productivity and potential output, sick pay, and long-term inactivity - costs borne by employers and social benefits systems.

Obese people are more frequently absent from work and earn less than non-obese people

Obesity increases the likelihood of worker absence, especially for women (Cawley et al., 2007; Coudin and Souletie, 2016). Figure 1.11 shows that among people aged 50-59 who were in employment in 2013, more than half of obese people reported taking 12 sick days or more in the last 12 months, compared to eight days for non-obese people. Moderately and severely obese manufacturing workers have lower labour productivity because they experience greater difficulties with job-related physical tasks and with completing tasks on time compared to normal-weight workers. In the United States, obese workers’ productivity was estimated to be about 12% lower compared to that of normal-weight workers (Goetzel et al., 2010).

Figure 1.11. Number (median) of sick days in the last 12 months among employed people aged 50-59, by obesity status, 14 European countries, 2013

Note: N = 12 091 in the 14 countries studied. See the Statlink for further details on the methodology.

Source: OECD estimates based on SHARE data (wave 5).

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The cost of productivity potentially lost due to obesity is high. Obese US workers cost an estimated USD 42.3 billion in lost productive time, an excess of USD 11.7 billion compared with normal-weight workers (Ricci and Chee, 2005). The loss of productivity associated with presenteeism is even larger than that associated with absenteeism, accounting for up to two-thirds of the monetary value of total productivity losses (Ricci and Chee, 2005).

A review of the evidence covering 18 international studies highlighted that obese people earn about 10% less than normal-weight people (Sassi, 2010). This result was also found in a recent analysis of the 2012 German Socio-Economic Panel survey: among white-collar workers in Germany, obese women earn about 10% less on an hourly basis than non-obese women (Devaux and Sassi, 2015). In Sweden, a study of450 000 men found an exceptionally large 18% wage penalty associated with obesity (Lundborg et al., 2010). More recently, in Finland, research concluded that a one-unit increase in BMI is associated with 6.6% lower wages and 1.7% fewer years employed (Bockerman et al., 2016).

Smokers are less productive and earn less than non-smokers

Smoking increases both the risk and duration of work absenteeism. For example, in Sweden, a 2007 study found that smokers were absent from work up to 8-10 days more per year compared to never-smokers (Lundborg, 2007). In a meta-analysis of 29 studies including OECD countries in Europe and outside Europe, current smokers were found to be 33% more likely to be absent from work than non-smokers (Weng et al., 2012). High costs of lost productivity are associated with smoking, in particular due to illness and smoking breaks, higher insurance premiums, increased accidents during work time, negative effects on non-smoking colleagues, and early retirement. Figure 1.12 shows that among people aged 50-59 who were employed in 2013, smokers reported ten days of absence due to sickness compared to eight days for non-smokers.

A comparison between current smokers and ex-smokers showed that quitting smoking can substantially reduce the risk of work absence (Weng et al., 2012). Smoking cessation can increase workers’ productivity through reduced absenteeism and enhanced performance at work, and it has positive impacts on wages (Brune, 2007).

Figure 1.12. Number (median) of sick days in the last 12 months among employed people aged 50-59, by smoking status, 14 European countries, 2013

Note: N = 12 157 in the 14 countries studied. See the Statlink for further details on the methodology.

Source: OECD estimates based on SHARE data (wave 5).

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Several studies have found that smokers suffer from wage penalties (e.g. van Ours, 2004, for the Netherlands). Cumulative lifetime cigarette consumption is also associated with lower long-term earnings. For instance, in Finland, reducing tobacco consumption by five pack-years could be associated with a 5-7% increase in wages (Bockerman et al., 2014). The relationship between tobacco use and wage gaps among workers is often explained by smokers’ lower labour productivity, including frequent smoking breaks, absences due to sickness, and poorer health, resulting in lower wages (Berman et al., 2013).

Smoking imposes a significant burden on the economy and society through such productivity loss. In France, the lost production related to tobacco smoking was estimated at around EUR 8.6 billion in 2010, about the same as for alcohol consumption (Kopp, 2015).

Heavy drinkers are less productive at work and earn less than light-moderate drinkers

Light-moderate drinkers have less absences from work compared to former and heavy drinkers as well as lifetime abstainers, partly because they are generally in better health. For instance, in Finland, medically certified absences from work were 20% higher among lifetime abstainers, former drinkers, and heavy drinkers compared with light drinkers (Vahtera et al., 2002). Similarly, in Sweden, absences from work were 10% higher among long-term heavy drinkers compared to long-term light drinkers (Jarl and Gerdtham, 2012). Figure 1.13 shows that among people aged 50-59 who took sick leave in the past 12 months, light-moderate drinkers reported eight sick days versus ten days for heavy drinkers, with variations across countries.

Moderate drinkers have higher wages than heavy drinkers and abstainers. The wage gap between moderate drinkers on one hand, and former and heavy drinkers on the other hand, is estimated at around 20% in Finland (Bockerman et al., 2015). Moderate drinkers spend more time with their colleagues out of work and they tend to be in good health, which positively influences their wages. They have a higher degree of life satisfaction than abstainers and have stronger social networks. Social and networking skills are important factors in the labour market and can have a big impact on wages.

Figure 1.13. Number (median) of sick days in the last 12 months among employed people aged 50-59, by alcohol-drinking status, 14 European countries, 2013

Note: N = 9 927 in the 14 countries studied. See the Statlink for further details on the methodology.

Source: OECD estimates based on SHARE data (wave 5).

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In France, production losses related to alcohol were estimated at around EUR 9 billion in 2010 (Kopp, 2015). In the European Union, alcohol accounted for an estimated EUR 59 billion worth of potential lost production through absenteeism, unemployment, and lost working years through premature death in 2003 (Anderson and Baumberg, 2006).

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