Posted by on January 19, 2020 10:35 am
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Sick to work? Presentism is widespread in Germany”

Courtesy of IAB


In Germany, many employees go to work despite illness. This has to do with working conditions and fear of job loss. It therefore makes sense to work more towards appropriate health behavior.


Illness-related absence from work is a not insignificant problem for the German economy – not only in the cold season. In 2017, the corresponding absences for employees insured with health insurance averaged 19.4 days. 53.4 percent of employees reported sick at least once a year, according to a contribution published by Markus Meyer, Jenny Wenzel and Antje Schenkel in the Absenteeism Report 2018 . The absence from work due to illness can therefore be accompanied by noticeable losses in productivity and cause considerable costs for employers and health insurance companies.


Conversely, it would be premature to conclude that low absenteeism per se reflects a healthy workforce and is an advantage for a company. Absence statistics naturally hide those employees who come to work despite physical and mental suffering – a phenomenon that is referred to as “presentism.”


Presentism is expensive


According to a study by Boris Hirsch, Daniel S. Lechmann and Claus Schnabel , published in 2017, 54.6 percent of those surveyed stated that they came to work sick at least once a year. Presentism is therefore hardly less prevalent quantitatively than absence due to illness. The average was 6.3 working days per employee. The number among employees who went to work at least once a year despite illness was 11.6 days.


Presentism, like absence due to illness, is accompanied by lost productivity. These losses can often be higher than the costs that arise when sick employees stay at home and recover, because if they go to work anyway, they run the risk of spreading their illness and worsening it.


In a study published in 2009, Claus D. Hansen and Johan H. Anderson found that people who appear sick at work more than six times a year compared to people who do not show up for work or only come to work once a year are 74 percent more likely to fail later than two months later due to illness. Other possible influencing factors, such as the general state of health or a long absence due to illness in the previous year, have been excluded.


In the case of communicable diseases, sick employees can also infect their colleagues – or especially their customers in the case of service occupations. Presentism can have a particularly serious impact in the nursing and health care sector, for example, when sick nurses infect patients who are already suffering from health problems.


Given these possible costs for employees, companies and the economy, the question arises as to why not a few workers go to work sick, even though they have legitimate reasons for not doing so.


Work ethic, corporate culture and business cycle can influence presentism


For the occurrence of presentism, on the one hand, the individual work ethic, i.e. the general attitude to work, can play a role. Employees may therefore go to work sick because of a pronounced sense of responsibility, because they do not want to put additional strain on their colleagues or because the work cannot be left unfinished.


Operational factors such as corporate culture or working conditions can also influence presentism. An absence due to illness in a company that considers the physical presence of employees to be very important could be viewed with particular suspicion. Social workloads that arise from working with colleagues or superiors, and psychological stresses such as high time pressure or a high workload can also play a role.


Last but not least, economic factors can favor presentism. Vincenzo Scoppa and Daniela Vuri , among others, found in a study published in 2014, at least for Italy, that the absence due to illness decreases with an increasing unemployment rate. According to this, at least some of the employees who appear sick at work are afraid of losing their jobs if the economic situation of their employer deteriorates and at the same time the chances of finding a job elsewhere are slim. This could motivate them to go to work sick, in order to put themselves in the best possible light towards their employer.

The level of presentism is still high


A survey of employees in 2017 provides information on the spread of presentism and its connection with work-related factors. Employees were asked whether they came to work at least once in the past year, even when their health status should have made them sick.


The results confirm that presentism is currently widespread in Germany. A total of 68.6 percent of those surveyed stated that they had appeared at work sick at least once in 2016. Employees came to work on average 8.7 working days per respondent despite illness. Taking into account only those people who appeared sick for work at least once a year, it is 12.6 working days.


These figures are therefore higher than the data collected in 2012 from the previously mentioned study by Boris Hirsch, Daniel S. Lehmann and Claus Schnabel. However, the results are not exactly comparable, since the 2017 employee survey was limited to companies with at least 50 employees subject to social security contributions.


Given the good economic situation in recent years, which should rather lead to a decline in presentism, the question arises as to which other factors can influence the decision to come to work sick.

Fear of job loss, tight deadlines and a lack of support from colleagues encourage presenters


The findings from the employee survey confirm the assumption that certain working conditions favor presentism. While it doesn’t seem to make a difference whether an employment contract is temporary or permanent, it does seem to make a difference whether employees fear losing their job in the near future. Because among employees who are afraid of losing their jobs, presentism is 75 percent more pronounced than among those who consider their jobs to be safe, at 66 percent.


It is also worth taking a look at the possible connections between workloads and presentism. A high deadline pressure seems to go hand in hand with a higher level of presentism. Presentism is also more common in jobs with physical environmental stress such as noise or extreme temperatures than in jobs without such stress factors.


The social environment at work also seems to play a role: If employees experience little or no support from colleagues, they are more likely to appear sick at work at least once a year. Finally, if one looks at the general job satisfaction, it shows that 80 percent of the people who are rather dissatisfied go to work sick at least once a year, while the number of those who are satisfied is only 66 percent.


The relationships shown are essentially confirmed in so-called multivariate calculations, although the differences here are somewhat smaller. Other characteristics of the employee such as individual health status, gender or professional position are taken into account.


However, the working conditions considered only explain a relatively small part of the “presentism” phenomenon. Rather, other factors, such as personality traits, are likely to play a strong role. The multivariate calculations, for example, suggest that presentism is more pronounced in some sectors such as the manufacturing sector or the information and communication sector. Employees in the retail or business-related service sector, on the other hand, have a comparatively lower level of presentism.


Since workloads can vary by industry, it should make a difference in which industry the people concerned work. For example, physical presence in the workplace could play a greater role in certain industries than in others. The employees there could therefore feel more urged to appear sick at work if necessary. Ultimately, however, not all conceivable influencing factors were queried in the employee survey, so that a not inconsiderable part of the phenomenon of presentism remains unexplained here.


It should also be noted that these are only correlations, not cause-and-effect relationships. The interdependency could sometimes be reversed: For example, company working conditions could also be perceived as particularly stressful because employees feel more or less forced to work even though they are sick. It is also possible that employees do not go to work sick because they are dissatisfied with their work, but that the presence culture that may prevail in their company causes dissatisfaction.


Companies are also challenged


The working environment therefore plays at least a certain role in the decision to come to work sick. In their own interest, companies are therefore required to reduce the extent of presentism through suitable measures, such as through appropriate representation regulations.


The high level of presentism in Germany also makes it clear that sick leave alone is not enough to make reliable statements about how healthy a workforce is. Rather, an exclusive focus on sick days – without taking into account the phenomenon of presentism – can lead to employees being perceived as healthier and more productive than they actually are.


In this context, incentives designed to reduce absenteeism, such as bonus payments for employees who have not taken sick leave within one year, should be viewed critically, because such incentives can possibly intensify presentism.


Presentism depends only partially on the work environment


Even if the working environment undoubtedly plays a role in the decision to come to work sick, its influence should not be overestimated. The proportion of people who come to work sick at least once a year is also high among those who are satisfied with their work and are not afraid of losing their jobs.


Other factors such as the basic attitude to work, personality traits, the working atmosphere or social expectations should also play a role if employees are reluctant to report sick leave.


It is therefore important to take a closer look at the various reasons why presentism is generally widespread in the German working world: Why do employees often go to work even if they are sick, despite institutional achievements such as protection against dismissal or continued payment of sickness? Is this even expected in some cases? If presentism and its negative consequences are brought to the fore in public awareness, this can help raise awareness among companies and employees about the topic itself and about appropriate health behavior.




In 2016, at least in companies with more than 50 employees subject to social security contributions, almost 70 percent of employees went to work at least once a year. Presentism is at least as widespread in Germany as absence due to illness. Poor working conditions, fear of job loss and general job dissatisfaction are more likely to be reluctant to report sick.


However, it is not only the responsibility of companies to reduce presentism. Rather, a general rethink is necessary in the public consciousness. An absence from work due to illness must not be stigmatized and equated with reduced performance, because the damage that presentism can cause to employees, customers and companies should not be underestimated.