While most American adults may not be patently sick, a vast majority of them still lack full health and vitality. This state of "incomplete" health has resulted in a loss of productivity in the workforce, and potentially increases health care costs in the long term, according to a new Emory University study published in the May issue of the Journal of Environmental and Occupational Health.
Using national survey data, Emory sociologist Corey Keyes examined the prevalence of mental and physical health issues among adults between the ages of 25 and 74, and how varying levels of health correlated to healthcare use and work productivity. Keyes found striking differences in productivity and healthcare visits among the healthiest and unhealthiest of those surveyed, and less than optimum levels of productivity among the incompletely healthy (those who reported some physical or mental health problems).
Overall, nearly 38 percent of completely unhealthy adults reported that they missed an entire day of work in the past 30 days, compared with 14 percent of those categorized as incompletely healthy, and just 8 percent of adults with complete mental and physical health. Also, completely unhealthy adults averaged 11 outpatient medical visits a year, compared with four visits among incompletely healthy adults and only two outpatient medical visits a year for completely healthy adults.
The results of the study demonstrate that health care providers and public health officials need to focus on the promotion of wellness to improve quality of life and increase productivity, and not just on the prevention and treatment of illness and injury, says Keyes, an associate professor of sociology and public health.
"We need to look at health as more than just the absence of illness and recognize that there are varying levels of health. Ultimately, we have it backwards -- we focus first on disease and illness instead of good health," Keyes says. "Rather than providing treatment only when the patient is broken, we need to promote physical and mental health at the same time we prevent the onset and course of disease."
Keyes' study found that 19 percent of those surveyed were "completely healthy" with high levels of both physical and mental health and low levels of physical and mental illness. This group reported the highest level of work productivity and the fewest number of lost work days. The 8 percent within the completely healthy group that reported any lost days averaged four a month. This group also reported the lowest level of healthcare use in terms of hospitalization and injuries, outpatient medical visits and prescription medications.
However, a nearly equal number (18.8 percent) were "completely unhealthy," defined as having low levels of health with elevated levels of illness, both mental and physical. Of the 38 percent within the unhealthy group that reported lost days, the average number of missed workdays was nine a month. The unhealthiest group also reported cutbacks in their work efforts an average of eight days a month.
The remaining adults, 62.2 percent, fell in to the "incompletely healthy" category, since they were healthy in one domain (either mental or physical health) and unhealthy in one of the other domains (either mental or physical illness). Though this group's productivity levels and healthcare use did not come close to the unhealthiest group, it had markedly lower levels of productivity and much more use of healthcare in terms of hospitalization, medical visits and prescription medications than the completely healthy adults.
"By promoting overall physical and mental wellness, I believe we could reduce the demand for health care as well as increase workplace productivity. The reduction of demand by focusing on true health should be a central part of this nation's debate about fixing the healthcare system and insurance coverage. To date, we have focused on the supply-side of the healthcare problems," Keyes says.
Keyes conducted the study with Wake Forest University School of Medicine professor Joseph Gryzwacz. Keyes' study used data from a representative sample of American adults collected in 1995 from the MacArthur Foundation's "Midlife in the United States" survey.
Keyes is lead editor of the forthcoming "Women and Depression: A Handbook for the Biomedical, Behavioral, and Social Sciences," to be published by Cambridge University Press, and "Flourishing: Positive Psychology and the Life Well-Lived," published in 2003 by the American Psychological Association. He is co-editor of "Well-Being: Positive Development Throughout the Life Course," published in 2003 by Lawrence Erlbaum Associates Inc.