What are the impacts of invisible disability on business and the economy?

If you manage more than a handful of employees, chances are that some of them are challenged by a chronic disease or invisible disability. In fact, we know that one in three workers have at least one chronic health condition.

 A recent study in Great Britain indicated that most employees with invisible disabilities do not properly maintain their health at work. This may be due to a number of factors, ranging from the stigma attached to illness to a lack of flexibility in their jobs.  As chronic health conditions become more prevalent in our society, it is crucial that the workplace provides a supportive atmosphere that allows employees to both maintain their health and take advantage of resources such as wellness programs and flexible work arrangements.

A flexible, understanding culture, which allows employees to perform at their best, will ultimately reduce costs such as absenteeism and presenteeism (employees who show up to work but are not fully functional). As you will soon see, these costs are a lot higher than you may think.

How widespread are invisible disabilities?

57.3 million working-aged Americans, 33 percent of the working-aged population, have at least one invisible disability.

Center for Studying Health System Change 2009

Chronic health conditions cost the U.S. economy more than $1 trillion a year, a figure that could jump to nearly $6 trillion by 2050.  

Milken Institute. An Unhealthy America: The Economic Burden of Chronic Disease

More than half of Canadians live with an invisible disability. 

Canadian Coalition for Public Health in the 21st Century

Worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability. In Ontario, chronic diseases account for 55% of direct and indirect health costs.

Ontario (Canada) Ministry of Health and Long-Term Care May 2007 

The economic burden of chronic diseases has been estimated at over $150 billion in direct and indirect costs annually. The cost of lost productivity due to short-term and long-term disability alone represents close to 30% of total costs. ($50 billion)

Centre for Chronic Disease Prevention and Control.  Public Health Agency of Canada 

96% of people with chronic illness show no visible symptoms. These people do not use a cane or any assistive device and may look perfectly healthy.
United States Census Bureau 2002 

Depression is 15-20% higher for the chronically ill than for the average person
Rifkin, A. “Depression in Physically Ill Patients,” 1992

In 1999, the Employers Health Coalition in Florida analyzed seventeen diseases and found that lost productivity from presenteeism was 7.5 times greater than productivity loss from absenteeism. For specific problems, like allergies, arthritis, heart disease, hypertension, migraines, and neck or back pain, the ratio was more than 15 to 1.

The Changing Face of U.S. Health Care: Employers Health Coalition Inc; 1999. 

Chronic Illness and The Lifestyle Myth

We are living in an age where lifestyle is finally being recognized as one of the cornerstones of health. There are good reasons to be concerned about our lifestyle these days. As our population gets older, our bodies become more difficult to maintain and the consequences of poor lifestyle choices can become more evident. 

The concept that we should be actively involved in our own health makes a lot of sense. For too long our health system has concentrated on fixing problems to the detriment of promoting wellness and I believe it is important that we address this imbalance.

The difficulty occurs when we pursue lifestyle solutions with a religious zeal, believing that lifestyle is the cause and cure of every ailment and every disease.  It is true that many chronic illnesses such as type 2 diabetes, lung cancer, heart disease and hypertension often have roots related to diet, exercise or smoking. These are significant health issues that impact a large number of people and should not be ignored.

Unfortunately, we have a tendency, as human beings, to generalize ideas and concepts. As a result, the term chronic illness has become shorthand for lifestyle illness, which is fundamentally incorrect.

To put this in context, The World Health Organization identifies more than 70 different types of chronic illnesses and most of them are not directly related to obesity, lack of exercise or smoking. In fact, many of these diseases occur in people with relatively healthy lifestyles.

Healthy Habits Alone Can’t Cure Most Chronic Illnesses

One of the most difficult things for healthy people to understand is that people with certain illnesses sometimes have little control over their disease. Many conditions (particularly autoimmune disorders) can flare up for no obvious reason. This is an uncomfortable truth that most people do not like to hear. As human beings we like to think we have total control over our health, but the sad fact is that sometimes we do not.

Regrettably, people with chronic illness often get blamed for things they have no control over. I have had more than one coaching client phone me in tears after getting a reprimand from her boss for not taking care of herself. The employee’s disease had flared up and the manager made the assumption that something the employee did or did not do was likely the cause.

The Stress of Managing Chronic Illness and Invisible Disability

This idea that every person with a chronic illness is somehow responsible for their poor health is not only incorrect, but puts additional strain on someone who is already managing a great deal of stress in their lives. The resulting level of guilt and frustration can be indescribable.       

To add to the stress, the complex and individual nature of many chronic diseases often makes it difficult to distinguish “healthy behavior” from “non-healthy” behavior.

I remember an incident involving a friend of mine who had Crohn’s disease and, like me, could no longer eat high fiber foods due scar tissue build-up on his intestines. I listened as a co-worker started criticizing my friend’s diet to another person in the office; “No wonder he’s always sick! Look at the crap he eats – meat, dairy and white bread.”

As I overheard this unjust criticism, I couldn’t help but realize that this was exactly the same diet I was limited to. I wondered how many people were thinking the same thing about me – and criticizing me behind my back. 

Please keep this in mind the next time you feel compelled to give health advice to co-workers or employees. Every illness is different and what you think may be healthy for someone could be just the opposite.

Making judgments about others is an unfortunate, but common aspect of our human nature. However, judging the lifestyle of someone with a chronic illness without knowing the facts is not only hurtful to the employee but could also cause damage to the organization in the long run.

Invisible Disability – The Trillion Dollar Problem.

More than a trillion dollars. That’s how much chronic illnesses and invisible disabilities cost organizations in the United States in 2007. These numbers are expected to quadruple by 2030. 

 A trillion dollars makes the mind boggle. That’s a million million.  With that amount of money, you could pay all of the rent cheques in the United States for three years!

You would think with so much at stake that our business and political leaders would take more of an interest in better engaging people with chronic illness. Not all of this money needs to be lost.

 A significant amount of this trillion-dollar productivity loss is due to presenteeism, where people show up for work but are not productive during their time on the job.  While many companies track absenteeism quite closely, the quality and quantity of the work and the engagement of the employee are not always measured.

To illustrate why this is a problem, let us look at a 2010 survey of workers with invisible disabilities in Canada. The study was called Patient’s Voice and it was published through Benefits Canada Magazine.  In it, 80 percent of chronically ill workers that were surveyed said they went into work even when they were not feeling well. 

This shocked a doctor on the expert panel that analyzed the data, but I don’t think this surprises anyone who has had a serious chronic illness. The fact is that many of us come into work sick because it is expected of us and taking too many days off can quickly kill a promising career. 

In our North American culture, there is often skepticism about workers who call in sick more than a few days a year. The assumption is that these workers are uncommitted or lazy. 

While there are some people who may take sick days when they are not truly sick, we know that the opposite is also true.  Many employees come into work beset by issues such as pain, fatigue and nausea that may significantly affect their productivity on the job.

Here are some of the challenges related to invisible disability:

  • The invisible nature of the problem makes it challenging to deal with.
  • Employees generally do not tell their employers about their illness because they worry about being stigmatized or losing their jobs.
  • Many of these same people do not monitor or attend to their illness (i.e. take their proper medications etc.) while at work.
  • Many organizations are still slow to offer flexible, results-oriented work arrangements that will allow employees to work more efficiently.

We know that chronic illness currently keeps many employees from being fully engaged and productive.  However, by finding ways to better engage these employees, organizations can realize significant savings going forward.


Want to better engage your employees with invisible disabilities? Click here to contact Jason today.