Under scrutiny

The average working adult is clocking in longer hours at work, and we all know that a highly stressed and unfit worker is often more of a liability than an asset. But are you caring for your employees the right way? By Lee Xieli.

These days, it’s rare to see friends and family working in strictly eight-hour jobs. Ever since the economy took a turn for the worse, it’s hardly an exaggeration to say we now work at least ten hours a day sitting behind a desk. There are some days when one could even clock in 14 or more hours at work.

As we spend more and more time in the office, we get stressed, get insufficient rest, neglect our daily nutrition and lack the energy to exercise. Even socialising outside of work gets pushed down the list of things-to-do. Eventually, our systems break down, and that can lead to the rise of chronic diseases and other modern health risks that impact our work productivity.

Speaking to doctors from public and private sectors, the key word HR should bear in mind when it comes to employee healthcare is “preventive”. That’s right, caring for your employees should no longer occur after they develop medical conditions. It should be taking a proactive role in caring for their health before they fall sick and have their ability to work or sometimes, even their lives cut short.

Fortunately, employers are sitting up and garnering as much information as they can to develop a more holistic health and wellness programme for their human assets. After all, prevention is better than cure. So what are the modern health risks HR should take note of?

The chronic struggle

The number of Singaporeans with chronic diseases is on the rise. Common ailments include high blood pressure, heart diseases, stroke, diabetes, hypertension, high cholesterol, chronic lung disease and cancer. The fact is any HR practitioner reading this right now may well have employees who are already suffering from any of these conditions.

Dr Lee Kheng Hock, senior consultant (head) for Singapore General Hospital’s (SGH) department of family medicine and continuing care, for one, isn’t surprised that these diseases are on the rise. No doubt, aided by the “default unhealthy lifestyles” most working adults are guilty of, he says. In fact, he believes these modern conditions will “expand in proportion unless we make a concerted effort to find balance in our lives”.

And the stats are backing him up. The National Health Survey 2004 revealed out of the total working population in Singapore, 6.6% have diabetes, 18.7% have hypertension and 18.6% have high total cholesterol. Stroke is also the fourth most common cause of death and the fourth leading cause of disability due to neurological problems in Singapore, says the National Neurological Institute. That’s not all.

According to Health Promotion Board’s (HPB) chief executive officer Lam Pin Woon, there is evidence showing that the risk of developing a chronic disease increases with age. This means employees who are 40 and above are at the highest risk of developing one or more of these conditions.

Which is why Kevin Choong, general manager of human resource for Jurong Shipyard, a subsidiary of Sembcorp Marine, believes the prevention of chronic diseases starts from providing early detection and intervention treatment for at-risk employees. “It’s important to identify individuals with high-risk factors of contracting chronic diseases early and provide targeted intervention to stem and keep such ailments under control so they do not become life-threatening.”

For employees who are diagnosed with a chronic disease or are at risk of developing one, Lam says they can refer to HPB’s Nurse Educator Programme to learn more about managing their conditions and preventing complications. For example, HPB offers individuals, who are diagnosed with pre-diabetes, a targeted intervention programme which runs over a period of one year. The programme teaches individuals how to modify their lifestyle habits – eating healthy, exercising regularly and managing one’s weight – to prevent or delay the onset of diabetes. Counselling sessions for behaviour change and referrals to community physical activity and nutrition programmes are included as well.

Dr Lee also says it’s important for employers to remember that even people with healthy lifestyles can sti ll develop chronic diseases. There shouldn’t be a stigma for employees diagnosed with chronic diseases because they are “just as effective and productive” as their healthy counterparts.

The ageing asset

Just last year, a research report published by Swiss bank UBS found that Singapore will soon be the world’s third fastest ageing nation. It said the proportion of people aged 65 and above will double to 20% in 2020. This means HR has to be on their toes if they wish to keep their ageing work population and the company’s bank account in the pink of health against inflating healthcare costs.

With the new legislation on re-employment of older workers from 2012 onwards, health will be an important determinant for both companies and workers, predicts HPB’s Lam. “No employer is keen to re-employ a sickly employee,” he says. “New skills and continual retraining will help make older workers more employable but their health remains a crucial factor that may determine employability.”

Since ageing is inevitable, it’s up to HR to help older employees lengthen their employability. Especially those who hold leadership positions and would be valuable knowledge assets to the companies that employ them, says Dr Lee. As Choong reiterates, prevention of chronic ailments and ill health now will definitely allow the ageing workforce to “remain healthy and perform well in their work” in the long run.

The mental breakdown

The combination of globalisation and technology has tellingly rendered the standard office hours obsolete. According to Dr Lee, 24/7 is the new 9-to-5 with many employees no longer getting off work once the clock strikes six. Thanks to information technology, “Wireless internet and mobile phones blurred the line between office and home. You don’t have to bring your work home anymore. It follows you everywhere.”

Hence, the increased workload and stress levels. All of which that can trigger a mental breakdown. Studies from the National Mental Health Survey 2004 showed three out of every 20 people in Singapore may suffer from minor mental health problems such as anxiety and depression. The numbers are predicted to be rising as the fallout of the current economic downturn exacerbates the Average Joe’s fears of job loss and an unstable financial future.

Employers shouldn’t underestimate this “severe stressor”. Lam of HPB says extreme stress can cause depression, “which has a direct economic impact on a company’s bottom line due to issues such as absenteeism and failure to perform”. If left unmanaged, stress may even induce or aggravate existing physical illnesses.

This is why long work hours should never be confused with high productivity as it’s scientifically proven that stress can only improve performance up to a point before it drops. “Many employees are actually at the point where stress has reached the zone where it drastically hinders performance,” says Dr Lee. “Further improvement in performance can only be achieved by improving focus, quality of life and decreasing stress.”

The big issue

We, as a nation, are getting fatter even though we know the importance of healthy living and regular exercise. Studies shown obesity in Singaporean adults had risen from 26% to 30% in a six-year period from 1992 to 1998. It didn’t stop there. The proportion of obese working adults rose again from 5.2% in 1998 to 6.6% in 2004.

Lam of HPB says obesity and overweight concerns are definitely becoming key modern health risks in Singapore. Dr Lee of SGH agrees. “There is a global epidemic of obesity and Singapore is not spared. The rise is probably more significant if we trace it further back by a few decades.”

Citing anecdotal accounts of how our students and national service men aren’t as fit as they used to be, Dr Lee says, “Generally, there is a sense that most of us eat too much and exercise too little.”

It also doesn’t help that most food we eat are highly processed which results in loss of nutrients and fibres, he adds. “Their taste is often enhanced by increasing the fat and carbohydrate content. We are all enticed to eat beyond what we need.”

Modern workplace hazards

As the levels of our physical activity dips with the longer hours we spend at work, the possibility of developing health risks from sedentary habits in the workplace becomes very real. One condition which could arise is deep vein thrombosis (DVT).

While this health risk is better-known as a result of inactivity in long-haul flights, sitting behind a desk in front of a computer for long hours can do the same to employees, which was exactly what happened to a British computer programmer who collapsed and died from pulmonary embolism after a 12-hour stint of not moving from his seat. The prolonged inactivity caused the blood in his leg veins to clot and dislodge which then travelled to his lungs and caused his death.

“Thankfully, this is very rare and most people do not spend such extreme hours behind a desk,” says Dr Lee. Nevertheless, there are still risk factors even with shorter periods of prolonged immobility. They include obesity, oral contraceptive use, varicose veins, major medical illnesses and recent major surgery.

Lee’s advice? Take a quick break away from the desk every half an hour to stretch and relax the muscles. Besides preventing DVT, it helps to reduce the risks of musculoskeletal disorders from poor posture and repetitive stress injury (RSI).

Now RSI is another modern condition which, unfortunately, is also caused by bad work habits. While it isn’t as deadly as other modern health risks, it can still hinder work productivity by causing disability and pain. Common conditions include carpal tunnel syndrome, wrist tendinitis, trigger finger and rotator cuff syndrome.

Dr Chong Yeang Chern, wellness physician for Asia HealthPartners, says these conditions are a result of overusing the muscles in whole arm and shoulder area, as well as, frequent repeated movements. This means employees who carry heavy objects, do assembly work, or sit, type and work in confined spaces for prolonged periods are at high risk. Other than striking “a work-rest balance”, employees should also be educated on the appropriate ways to execute their work tasks.

For example, heavy loads should be lifted with both hands, close to the body with an upright trunk. Body postures should be readjusted regularly to prevent static muscles. HR should also consider taking a look at the ergonomics in the office, adds Dr Chong. Providing adjustable office equipment such as tables and chairs, wrist and arm support and even proper lighting can often prevent the occurrence of RSI.

Rules of engagement

There are three criteria, unanimously agreed by doctors, employers and HR, when it comes to designing an appropriate, if not successful, workplace health programme which appeals to all employee demographics. The three rules are holistic, structured and deliberate.

Dr Lee of SGH says holistic because the programme should “advocate stress management, exercise, proper nutrition, work-life balance and a healthy work environment”. Structure, according to Lam, CEO of HPB, means it has health education and promotion activities which addresses these key pillars plus, smoking cessation.

Besides providing employees health knowledge, Choong says effective workplace health programmes should help them “translate health awareness into actual behavioural and lifestyle changes”. To deliberately encourage an active lifestyle among its employees, Jurong Shipyard organises weekly after-work exercise classes, which include engaging a certified fitness trainer to coach them yoga, aerobics and belly dancing at subsidised rates. Since then, obesity is one condition that is declining among the shipyard’s employees.

This is precisely why none of them recommends companies to adopt ad-hoc health and wellness activities. Lam says companies which do so may not see significant improvements in the health status of employees or other organisational indicators such as productivity and absenteeism. Dr Lee calls ad-hoc and perfunctory programmes “counter productive”.

“Inertia and tyranny of the urgent are the greatest enemies of health advocacy,” says Dr Lee. “It reinforces the misconception that health can be achieved by occasional improvement efforts.”

Lam says there’s also a need for employers to adopt organisational policies which are health-related and health-linked to encourage healthy lifestyles in the workplace. And HPB does practices what it preaches. The organisation has implemented policies on smoking, healthy food options, protected time for exercise, flexi-benefits schemes and workload management.

The health detector

Dr Chong Yeang Chern of Asia HealthPartners considers health screening a vital component of healthcare for everyone, not just employees. Yet, a small percentage of her clients have cut back on the health screening packages as a result of the economic crisis. “They work around with what they can afford because you [a healthcare provider] can customise most things to their needs and budgets.”

In a lot of companies however, senior-ranking staff, and sometimes depending on the organisation, long-serving or older employees, are still getting a better health screening package than the rest. While it’s obvious why senior executives are well-protected by companies, Dr Chong says older employees are often similarly well-covered because the risks of them developing medical problems are higher.

Average health screening entitlement for each employee currently ranges from S$200 to S$500 per year, depending on how comprehensive the company wants its health screening packages to be. And despite the downturn, Dr Chong is still fielding calls from HR practitioners “who are new to providing healthcare packages for their employees”. Around five out of ten of her clients are also looking to increase 10% of their current health packages.

At National Parks Board, health comes before price with its entire staff undergoing health screening exercises once every two years. The company would pay for the cost of basic screening and even partially subsidise selected optional health tests. Its acting deputy director for resourcement management Yong Fook Chyi says, “Health screenings help us determine the health profile of our staff, evaluate the effectiveness of our health promotion programmes and plan for future initiatives.”

Nevertheless, if employees want to take additional tests which are not covered under the company’s health screening plan, corporate healthcare providers would usually offer them special rates. But Dr Chong says, “Of course, there are people who depend on the company for everything. If the company doesn’t pay, they will never do the tests.”

Other than testing for chronic diseases, older employees should check themselves for symptoms of osteoporosis. Younger workers, on the other hand, should test themselves for sexually-transmitted diseases such as syphilis and HIV. Other common medical concerns Dr Chong sees rising in the younger generation include liver and kidney problems and sports-related injuries.

Female employees should also check for any breast tissue, ovaries or womb problems and even take a Pap smear for cervical cancer while male workers should get tested for prostrate cancer.

The overall view

Yet, with so much information on workplace health programmes, there are still stubborn employers out there who have yet provided any WHP programmes for their staff. When asked if legislation would give employers an incentive to do so, Jurong Shipyard’s Choong thinks “there’s no necessity”. Likewise, Dr Lee says, “Enlightened employers will realise it is in their interest to protect and support their high-performing employees.”

However, Lam understands that unlike the bigger companies, smaller scale set-ups may face challenges such as “resource constraints or critical mass” when implementing in-house health programmes. To overcome these difficulties, he says, “We recommend smaller set-ups share resources or tap on community-based programmes when designing their health programmes.”

There are also some companies that choose to only take care of their employees’ acute medical problems. That means HR would only reimburse employees for any outpatient treatment costs arising from minor illnesses such as colds or diarrhoea. But this one-sided concern is no longer enough when it comes to employee retention and engagement.

Companies need to take it upon themselves to provide both preventive care and management of medical problems, says Dr Chong. From a long-term perspective, targeting the “root of the problem” will improve employees’ health and lower healthcare costs for both parties. “If you wait till you get admitted to the hospital for a heart attack or bypass, the cost is so much higher compared to if you detect and treat it earlier.”

Ultimately, caring for employees is a two-way street. Dr Chong says, “If the health of the employees is well taken care of, and employees feel the company is truly concerned about them, the chance of [them] job-hopping is reduced.”