| BackgroundIn 1986, the "Ottawa Charter" stated that "Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities." In 1993, the World Development Report also noted that good health can improve individual's productivity, enhance national economic growth. Conversely, health problems can also be a threat to a country's economy and development. Since 1980s, lots of studies had explored the relationship between health status of employees and productivity, found presenteeism and absenteeism can bring the loss of productivity and much more cost. Considering the interventions of health risk factors are feasible and effective, most of the researcher focused on the relationship between health risk factors and presenteeism, absenteeism. However, in China we can't find the all-around similar study expect one exploring the relationship of health risk factors and presenteeism in a metropolitan symphony orchestra launched by our research team. This study is the first to explore the relationship between health risks and presenteeism, absenteeism in a hospital in China.ObjectivesThe objective of our study is to answer the question:Is health risk factors associated with health-related productivity loss in the employees of a hospital of Jinan,Shandong Province,China?The relationship between health risk factors and health-related productivity loss is analyzed by addressing several key questions:1. Which health risk factor is associated with presenteeism?2. Which health risk factor is associated with absenteeism?3. Is having more risk factors associated with more presenteeism? 4. Is having more risk factors associated with more absenteeism?MethodsOur study is a quasi-experiment study. The questionnaire is developed by our team based on analysis and modification of the Health Risk Appraisal questionnaire of University of Michigan Health Management Research Center, Health and Performance Questionnaire and Work Productivity Short Inventory. The questionnaire is sent to 839 employees in a hospital of Jinan two times during six-month's interval. We intervene the most widely distributed health risk factor of this hospital for six-month following principles of evidence-based medicine, solving the main contradiction and health promotion. At the same time we calculate the economic losses of health related presenteeism and absenteeism of this hospital's employees.Results1. The health risks which influence the employees in the hospital of Jinan include physical inactivity (56.27%), poor-sleep-quality (46.68%), drinking (43.17%), stress (32.47%) and overweight/obesity (37.82%). The number of health risks possessed by the staff ranges from 0 to 10. The average number of heath risk is 3.18. Staff with 3 health risks accounts for the highest proportion,21.22%.After 6 months'intervention for the most widely distributed health risk factor-physical inactivity, the proportion of "physical inactivity" dropped by 19.18% (p<0.0001). Furthermore, the other two health risk factors, Hyperlipidemia and unhealthy dietary, also registered decline, which has statistical meaning. The proportion of Hyperlipidemia falls by 4.13%(p=0.006), and that of unhealthy dietary drops 14.16% (p<0.0001).Comparing the data from the last phase of the research with the baseline data, the number of the health risk factors possessed by the staff drop to 2.71 from the 3.1 at the baseline, which also has statistical meaning (p<0.0001). The proportion of employees with 0 to 3 health risk factors increases, while that of employees with 3 to 9 factors drops. The decline in the employees with 7 factors has statistical meaning (p=0.0339).2. The baseline survey showed that 46.69% of the employees in the hospital reported presenteeism. More employees with university degree or above tends to report presenteeism than employees with diploma lower than university degree (p<0.0001). More doctors tend to report presenteeism than nurses and staffs of non-clinical departments (p<0.0001). Male employees registers higher degree of presenteeism than female employees (p=0.0062). Doctors post higher degree of presenteeism than nurses and staff of non-clinical departments (p<0.0001). Staffs with university degree or above registers higher degree of presenteeism than staff with diploma lower than university degree (p<0.0001).After 6 months'intervention for the most widely distributed health risk factor-physical inactivity, the proportion of employees who reported presenteeism drops 1.47%. The proportion of employees incurring no presenteeism and mild inefficiency (p=0.0001) climbs up. The proportion of employees with medium, severe and grievous presenteeism drops (p<0.0001).The 6-month intervention enabled the hospital to reduce economic losses, which resulted from employees'presenteeism, by 188,800 yuan.3. According to the baseline survey,9.78% of the employees in the hospital registered absenteeism. More doctors and nurses tend to report absenteeism than employees of non-clinical departments (p=0.0052). Male employees registered higher degree of absenteeism than female employees (p=0.0191). Nurses and doctors post higher degree of absenteeism than employees of non-clinical departments (p=0.01).4. According to the cross-sectional survey, the research found that there is association between overweight/obesity (p=0.005, OR=1.6415,95%CI:1.1570-2.3287), high blood pressure (p=0.0345, OR=1.6175,95%CI:1.0332-2.5322), Hyperlipidemia (p=0.0261, OR= 1.8472,95%CI:1.0692-3.1915), drinking (p=0.0016, OR=1.7376, 95%CI:1.2327-2.4494), self-sensed poor health (p=0.0022, OR=2.5805,95%CI:1.3841-4.8111), stress (p=0.0400, OR=1.4587,95%CI:1.0167-2.0929) and presenteeism by using singer factor analysis.Overweight/obesity (p=0.0023), Hyperlipidemia (p=0.0368), drinking (p=0.0017), self-sensed poor health (p<0.0001), and stress (p=0.0206) have relevance with the degree of presenteeism by using singer factor analysis.Overweight/obesity and self-sensed poor health have relevance with the occurence and degree of presenteeism by using multivariate analysis.The research also found that employees with more health risk factors tends to report presenteeism (p=0.0153) and more severe presenteeism (p=0.0012).Comparing the data from the last phase of the research with the baseline data, given the 5% test level, we cann't find the association between the drop of every health risk factor or the number of health risk factor and the decline in presenteeism degree. 5. According to the cross-sectional survey, given the 5% test level, the research did not find any association between health risk factors, the number of the health risk factors and the absenteeism. Under the 10% test level, more staff reporting physical inactivity and smoking reported absenteeism. And employees reporting physical inactivity registered higher degree of absenteeism.Comparing the data from the last phase of the research with the baseline data, given the 10% test level, the drop in the health risk factors-physical inactivity, has related with the decline in the degree of absenteeism.6. The employee's medical reimbursements only accounted for 48.71 percent of the toal economic losses resulted from health related presenteeism, absenteeism and medical reimbursements (719,600 yuan). Economic losses due to presenteeism accounted for 30.89% of the total economic losses (461,000 yuan). The economic losses due to absenteeism accounted for 20.9 percent (311,900 yuan).The research has taken six months of intervention on the health risk factors held by the most employees in the hospital. Comparing the data from the last phase of the research with the baseline data, the annual average economic losses due to absenteeism and presenteeism have dropped. The annual average economic losses due to presenteeism decreased by 188,800 yuan, and that resulted from absenteeism dropped 79,600 yuan.Conclusions1. The health risks which influence the employees in the hospital of Jinan include physical inactivity, poor-sleep-quality drinking, stress and overweight/obesity. The number of health risks possessed by the staff ranges from 0 to 10. The average number of heath risk is 3.18. After 6 months'intervention for the most widely distributed health risk factor-physical inactivity, the proportion of "physical inactivity" dropped by 19.18%. Furthermore, Hyperlipidemia and unhealthy dietary, also registered decline.Comparing the data from the last phase of the research with the baseline data, the number of the health risk factors possessed by the staff drop to 2.71 from the 3.1 at the baseline. The proportion of employees with 0 to 3 health risk factors increases, while that of employees with 3 to 9 factors drops.2. The baseline survey showed that 46.69% of the employees in the hospital reported presenteeism. More employees with university degree or above, doctors, male employees tend to report presenteeism. Doctors, staffs with university degree or above register higher degree of presenteeism. After 6 months'intervention for the most widely distributed health risk factor-physical inactivity, the proportion of employees who reported presenteeism drops 1.47%. The 6-month intervention enabled the hospital to reduce economic losses, which resulted from employees'presenteeism, by 188,800 yuan.3. According to the baseline survey,9.78% of the employees in the hospital registered absenteeism. More doctors and nurses tend to report absenteeism. Male employees and Nurses, doctors registered higher degree of absenteeism.4. According to the cross-sectional survey, the research found that there is association between overweight/obesity, high blood pressur, Hyperlipidemia, drinking, self-sensed poor health,stress and presenteeism.Overweight/obesity, Hyperlipidemia, drinking, self-sensed poor health, and stress have relevance with the degree of presenteeism.The research also found that employees with more health risk factors tends to report presenteeism and more severe presenteeism.Comparing the data from the last phase of the research with the baseline data, given the 10% test level, the drop in health risk factors, including physical inactivity, stress and unhealthy dietary has related with the decline in presenteeism degree.5. According to the cross-sectional survey, given the 5% test level, the research did not find any association between health risk factors, the number of the health risk factors and the absenteeism. Under the 10% test level, more staff reporting physical inactivity and smoking reported absenteeism. And employees reporting physical inactivity registered higher degree of absenteeism.Comparing the data from the last phase of the research with the baseline data, given the 5% test level, we cann't find the association between the drop of every health risk factor or the number of health risk factor and the decline in presenteeism degree.6. The employee's medical reimbursements only accounted for 48.71 percent of the toal economic losses resulted from health related presenteeism, absenteeism and medical reimbursements (719,600 yuan). Economic losses due to presenteeism accounted for 30.89% of toal economic losses resulted from health related presenteeism, absenteeism and medical reimbursements (461,000 yuan). After six months'intervention the annual average economic losses due to presenteeism decresed by 188,800 yuan, and that resulted from absenteeism dropped 79,600 yuan.
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