One key indicator that is frequently used to assess employees’ health status is the number of sick days: the days that employees stay off work because of illness called absenteeism. However, employees often continue to work, despite feeling unwell – either from home or on-site. This phenomenon of working while sick is called sickness presenteeism.

Sickness presenteeism affects about half of all employees and can be associated with long-term negative impacts on employee health and high costs for businesses. Healthy work design and leadership cultures that value recuperation can help reduce sickness presenteeism and its negative impacts for employees and organisations. These are the results of an analysis in the baua: Report brief "Presenteeism and Absenteeism - Prevalence and Correlations with Selected Working Conditions" (In German).

Sickness presenteeism is a health indicator, but it is not yet systematically recorded, unlike sick notes from a doctor.  Although various attempts have been made to define the term and to develop action plans, a uniform, broadly established approach to dealing with the phenomenon does not yet exist.

The COVID-19 pandemic brought increased attention to sickness presenteeism and the reasons why people choose to keep working despite being unwell. On the one hand, the pandemic increased awareness of health behaviours at work because of the risk of infection. On the other, the prevalence and extent of remote work increased dramatically during the pandemic. This also has impacts on whether people continue working when they are unwell. Studies by BAuA show that employees who frequently work from home are more likely to work when they are sick. This comparatively new phenomenon is also known as tele- or virtual presenteeism. BAuA is currently intensifying its research into sickness presenteeism in digital work environments.

Employees who continue working, whether from home or on-site, despite having a cold, experiencing pain or feeling otherwise unwell, do so for a number of different reasons. To provide an evidence-based overview of this phenomenon, BAuA commissioned a review of the current state of knowledge.

Research focus: employee behavior and productivity losses

There are two lines of research in the study of sickness presenteeism: studies from Europe tend to focus on employee behaviour and the reasons why individuals work despite feeling unwell. In this area, researchers primarily investigate the underlying reasons for sickness presenteeism behaviour and the factors that influence it, as well as potential health consequences. In some cases, working while sick can be considered functional, for instance if symptoms are mild and non-contagious, or when individuals are able to remain in employment despite a chronic health condition.

However, in terms of long-term health, continuing to work while feeling unwell can increase the risk of cardiovascular disease. Studies also suggest a connection between sickness presenteeism and long-term incapacity for work. At the same time, there is also evidence that sickness presenteeism can have positive impacts, particularly in the case of certain chronic musculoskeletal disorders.

By contrast, North American studies tend to focus on the productivity loss associated with health problems at work. Given the longer research tradition in this area, especially in the U.S., there is a well-established body of knowledge regarding the validity and reliability of measurement methods. From an economic perspective, the costs associated with presenteeism are comparable to the costs associated with sickness absence.