Many workers continue to work when sick. This is called presenteeism and in a time of infection pandemic, is a major problem. Many countries have addressed the COVID19 risks of presenteeism by requiring people to work from home if they can. In Australia, the message is not totally working with people ignoring the rules for various reasons.
However, presenteeism also has a deeper cultural and institutional origin that has been exploited by some and downplayed or ignored by others.
Some decades ago, a cold and flu product manufacturer built a hugely successful advertising campaign urging Australian workers to “soldier on”. The company promoted their product that provided symptomatic relief for Cold and Influenza so that one would feel well enough to continue to work. This whole campaign ignored the fact that symptomatic relief still meant that workers were infectious. The product masked the signs of illness and, effectively, encouraged presenteeism.
All of this was occurring regardless of the obligation on workers under the occupational health and safety (OHS) legislation to not put others at risk of harm. It was also regardless of the sick leave entitlements in employment law that were designed expressly to negate presenteeism acknowledging that there will be some days where, in support of OHS duties, it is safer for the worker to remain at home, especially if verified by a certificate from a medical practitioner.
Here is a description of sick leave from a legal standpoint in 2004:
“Sick leave is leave which employees can take when they are sick and unable to work (but are not entitled to workers compensation benefits). Full-time and part-time employees generally have an entitlement to paid sick leave arising from their award or employment contract. Casual employees are usually not entitled to sick leave, but are paid a loading that is partially in compensation for sick leave. Contractors are not entitled to sick leave. Sick leave after the entitlement has been exhausted is unpaid leave.”page 613 – Australian Master Human Resources Guide 2004/05, 3rd edition, 2004
Another take on sick leave is provided by Professor Andrew Stewart:
“During the 20th century, it became common for awards to grant non-casual employees an entitlement to paid sick leave, in the event that they were unable to work due to illness or injury. By the end of the century, most States had legislation extending sick leave entitlements to non-award workers. Unlike the position with annual leave, untaken sick leave did not generally have to be paid out on termination, though some agreements provided for this as a special benefit.”Page 203, Stewart’s Guide to Employment Law, 2nd edition, 2009
Significantly in both of these quotes, and when considering the spread of COVID19 in Victoria, casual employees are not entitled to sick leave. Under OHS obligations all workers are expected to not present a hazard to the workplace, such as influenza or a coronavirus, by staying home or at least not coming to work. But for casual workers to fulfil this obligation they must choose to lose a whole shift’s wages, even though their rate of pay is supposed to compensate them for their ineligibility for sick leave. Contractors are not entitled to leave from their customers.
The Federal Government has accepted the imposition of Pandemic Leave lobbied for by Trade Unions predominantly, however how this operates in reality for casual workers remains unclear. The Victorian Government has acknowledged that not all workers are entitled to sick leave so has provided a $1500 hardship payment for those workers, expected to be primarily casual workers. Premier Andrews accepts that the current employment arrangements for casual workers encourages presenteeism.
The consequences of presenteeism pre-COVID19 were not so serious or life-threatening so the “soldier on” message was accepted widely. In this pandemic the established acceptance of presenteeism has disappeared from government strategies but it continues to be an element embedded in the Australian culture. This is partly the result of advertising, but advertising only exploited an existing belief, a cultural belief that is evident in the advertising – taking a day off due to illness is a sign of personal weakness. It may also be seen as a sign of laziness or a lack of commitment to one’s employer and/or career.
Although the context of this article is OHS, similar cultural beliefs, or rather professional beliefs, have led to the acceptance and reliance on unpaid overtime in many occupations. Excessive workloads and working hours, and the expectation that workers will be available for work purposes on their weekends and days off are presenting their own OHS-related illnesses.
Presenteeism has now become deadly and this should result in more substantial changes to employment law and conditions. Ideally, the use and promotion of casual employment should diminish. A more secure part- or full-time employment provides employers with a more reliable workforce and one that is able to be largely controlled under existing employment laws. The provision of JobKeeper supplements in the current COVID19 pandemic is one indication of how a government can assist businesses and workers when there is a clear employment relationship, not based on the contracting of services. Such supplements have not been readily available to casual worker.
Providing support to casual workers is more problematic as there is no primary income source or employer or customer through which a government can provide financial support. It may be possible to achieve this through the social security system, but that system is administered by the Commonwealth government and usually applies nationally. State variations, as are now happening in Victoria but not elsewhere, are more difficult to address.
There is also a fear or wariness by many to engage with government services except when it is absolutely avoidable.
Presenteeism should not exist in Australia. For decades entitlements for leave due to illness have existed. In many workplaces, there is a number of sick days that can be taken without a medical certificate. Colloquially these are referred to as “doona days” or “mental health days” and are an entitlement that workers in other countries and jurisdictions could only dream of. These uncertificated days are becoming more important in occupations where an “always on” availability is expected, although if one is always able to be contacted by the business, are these really days of leave or just days away from a workplace?
There will be a reluctance from many businesses, their associations and lobby groups to keep casual employment as an option that allows for flexibility. It does allow flexibility for seasonal demands or production peaks, but many forget that this flexibility was built on a base of secure employment. It was an additional option, not the primary employment model. The option was quickly exploited, especially by the gig economy, and the negative OHS impacts of casual and precarious work (most reliably exposed by Quinlan, Underhill, Bohle and other Australian researchers) were, conveniently, overlooked. COVID19 has amplified those OHS impacts into the public health context. Now going to work while feeling sick does not just present the temporary inconvenience of a cough or a cold but a life-threatening illness. It is difficult to see a return to the minor disruption from presenteeism. It is more likely that presenteeism will become illegal and that this will be enforced, instead of being tolerated.
Presenteeism, like it should always have been, should now no longer be “soldier on” but “f### off home and don’t come back until the doctor says you are fit for work”. Medical certificates will be more than an allowance of an estimated number of days off but more a certificate for returning to work. It may be time to revisit Dame Carol Black’s 2008 concept of the “fit note”. Dame Black sees the existing system as outdated:
“The current sick note asks a GP to state briefly what a person’s health condition is and for how long they should be absent from work as a result of this. In short, it focuses on what a person cannot do. The sick note includes a ‘remarks’ section which can, for example, be used by the GP to suggest amended duties as an aid to rehabilitation. However, it does not readily encourage GPs to explore with patients and employers the options for prompt return to work and the workplace adjustments which would facilitate this. Dating in its current form from 1922, it reflects an age when an employer expected an employee to do a specific job rather than today’s more flexible workplace.”Page 66
There is a strong need for reviewing the way Australians work and the expectations on workers. It is not just a matter of productivity but of safe and sustainable productivity; a productivity that has the resilience to prevent, or operate within, a more infectious world, a world without presenteeism.