Report 3 - Exploring the Link Between Work-Life Conflict and Demands on Canada's Health Care System

Chapter 1 - Introduction

What does a healthy workplace look like? Drawing from our own research and the work of others (i.e. Lowe, 2000; Duxbury and Higgins, 2001, 2003; Higgins and Duxbury, 2002; CCIH, 2002), we can identify a healthy workplace as one that:

• supports the psychological, physical and psychosocial health of its employees (i.e. has a supportive culture);
• has a measurement and accountability system in place that visibly supports people management practices;
• makes sound people management and workplace health a priority; and
• views employee health, work-life conflict, and well-being as strategic issues.

The basic objective of this report is to gain wider commitment, at both the public policy and organizational level, to the idea that pressures on Canada's health care system can be reduced by focusing on workplace health issues. Specifically, this report uses hard data to draw the link between work-life conflict, ill health and health care costs. It is hoped that the data contained in this report will motivate health care professionals and institutions, governments and employers to work together to improve the health of Canadians and to accept the idea that "healthier workplaces help create a healthier nation" and that "money alone neither causes problems in health care nor solves them" (CIHI, 2003).

This report advances the argument that the health of Canadians and the soundness of Canada's health care system can both be addressed through an agenda that focuses on workplace health and work-life conflict. We focus our arguments at two different levels: the level of the health care organization and the broader societal level. The need to address workplace health issues within the health care sector itself is supported by the work of the Romanow Commission which noted that:

"We simply have to make health services healthier workplaces because if we don't look after health care professionals, they can't look after us." (Roy Romanow, notes for the speech to the Canadian Medical Association in Saint John (New Brunswick), August 20, 2002)

The link between healthier work environments and societal health has been advanced by CIHI (2003), and includes improved health and quality of life within communities and a reduction in the use of the health care system with its concomitant savings to health care's bottom line. It has also been recognized by researchers such as Danielle Pratt (as cited in CCIH, 2002, p. 25) who observed that:

"Costs related to absenteeism, temporary workers, employee replacement, not to mention the opportunity cost of missed revenues and compromised quality resulting from an under-functioning workforce ... percolate throughout the organization, the health care system and society at large."

To date, relatively little attention has been paid to the potential contribution of workplace health (of which work-life conflict is a key component) to the larger issue of health care in Canada (CCIH, 2002).

1.1 Objectives of the Research

Ill health costs Canada far more in lost productivity and quality of life than what is spent to treat disease. CIHI (2003) estimated the economic burden of illness in Canada to be $159 billion in 1998. The sources of these costs include the loss of potential economic output due to absenteeism from work or school, or premature death. It should be noted that this estimate of the costs of illness is likely to be conservative, as factors such as time caring for sick friends and family, pain and suffering, and other related consequences of illness were not included in the estimates. This report seeks answers to the following research questions:

1. How do Canadian employees view their physical health?
2. To what extent are Canadian employees making use of the various facets of Canada's health care system?
3. How much do Canadian employees spend on prescription medicine?
4. What impact do gender, job type, sector of employment and dependent care status⁹ have on:
   • How healthy an individual feels?
   • The use of Canada's health care system?
   • The amount an individual spends on prescription medicine?
5. How does work-life conflict (operationalized to include role overload, work to family interference, family to work interference and caregiver strain) affect:
   •  How healthy an individual feels?
   •  The use of Canada's health care system?
   •  The amount an individual spends on prescription medicine?
6. What impact does high work-life conflict have on health care costs in Canada?

1.2 Why Do We Need a Study Like This One?

Why does Canada need to focus on workplace health and work-life conflict? It is our contention that dealing with these two inter-related issues is absolutely critical to the health of Canada's health care system, the overall health of Canadian society, and to the economic health of Canada (e.g. the organizational bottom line and the ability to recruit and retain key employees in a globally competitive labour force market). Unfortunately, little concrete Canadian evidence exists linking workplace health and work-life conflict to the bottom line (both the corporate bottom line and the bottom line of Canada's health care system). In its 2002 report, CIHI posed the following question:

"Given the presence and impact of the workplace in most Canadians' lives, where does workplace health fit into the wider Canadian healthcare landscape? Should workplace health become more or less of a priority for Canada and why?" (p. 2)

The current report seeks to supply answers to this question. By providing sound empirical data in these areas to inform the debate, it is hoped that this report will encourage both governments and employers to focus on issues associated with healthy workplaces which provide employees the ability to balance work and life.

Canada's health care system needs a cure

Canada's health care system is "under siege" and both health and health care are top priority concerns for Canadians (CCIH, 2002). Popular media and academic studies alike note that emergency departments in many parts of the country have become over-crowded in recent years and there is often a wait for hospital beds, diagnostic care and treatment (CIHI, 2002). Wait times for health care remain a key issue for Canadians. In 2001, one in five patients aged 15 or older who had received specialized services reported that waiting for care had a negative impact on his or her life. Common ways that waiting for care had impacted Canadians included pain, poorer health, trouble doing everyday tasks, worry, anxiety and stress, and loss of work or income (CIHI, 2002). For those working within the health care system (according to CIHI [2002], one in ten employed Canadians works in health and social services), a major issue continues to be health human resources (HHR) (CIHI, 2003). Key questions linked to this issue include: Do we have enough personnel in the right places to provide care? Is the health care workplace healthy? How can we improve HHR planning and capacity?¹⁰

Reflective of this concern on the part of their citizens, several provinces and territories (New Brunswick, Quebec, Saskatchewan, Alberta, British Columbia, Northwest Territories ) completed major reviews of their health care systems in 2002 (CIHI, 2002) and the federal government commissioned two major studies: the Kirby Commission (the Federal Role in Health of Canadians) and the Romanow Commission (The Future of Health Care in Canada) (CIHI, 2002).¹¹ Yet, despite all the study, there appears to be lack of consensus on what Canada can do to "fix" its health care system. Some groups doubt that internal reforms can adequately contain health care costs and suggest exploring non-tax-based sources to finance increases. Others espouse internal reforms to the system itself, a reduction in the comprehensiveness of publicly financed services or use of other non-governmental revenue sources of funding (CIHI, 2002). CIHI does, however, note the following common themes in these studies:

• there is a need for timely, accurate and reliable data on the health of Canadians and the health care system as we cannot improve what we cannot measure (CIHI, 2002),
• primary health care renewal is central to the sustainability and revitalization of Canada's health care system (CIHI, 2003), and
• any new investments in the health care system need to be used to buy lasting change (CIHI, 2003).

We need to recognize the link between work and health

For most Canadians, paid and unpaid work is a part of daily life. Good health is an important precondition for meeting these demands (CCIH, 2002). Health is, however, affected by more than just health care (CIHI, 2002). A large number of factors, many of which are beyond the formal authority of the health care system, affect Canadians' health status (Statistics Canada, 1999). Trends affecting organizations and health include an aging population, a declining birth rate, falling after-tax incomes, and increased labour force participation by women (Statistics Canada, 1999). There is also extensive literature linking health and socio-economic factors (Townson, 1999). This research notes the strong negative association between "good" health and "wellness" with poverty, unemployment, poor housing, lack of education and child poverty. Townson (1999, p. 95) typifies the view of many when she notes that:

"The mantra of globalization and the perceived need for international competitiveness are increasingly invoked to justify inaction or to explain social or economic policies that have profoundly negative consequences for population health."

Many of the health care challenges that face Canada have workplace connections (CCIH, 2002). Recent research indicates that unhealthy work environments and heavy workloads are associated with a myriad of health problems (Duxbury and Higgins, 2001, 2003; CCIH, 2002; Higgins and Duxbury, 2002). CCIH (2002, p. 22) notes that:

"Paradoxically, the workplace has become an environment that both contributes to employee ill health while simultaneously offering the most potential for improving overall employee health and well-being."

CCIH (2002), in its review of academic research on workplace health, found that in the 21st century definitions of health have broadened to include psychosocial well-being as well as physical health. As such, workplace health is critical to "good" health (CCIH, 2002). Research in this area indicates, however, that initiatives to improve workplace health which focus purely on health promotion are not sufficient to improve a multifaceted definition of health (CCIH, 2002). This contention has been supported by some recent ground-breaking studies which have focused on the link between work environment and employee well-being (Lowe, 2000; Shain, 2000; Duxbury and Higgins, 2001, 2003; Lowe and Schellenberg, 2001; Higgins and Duxbury, 2002).

Workplace health programs are likely to have little impact on employee health unless key conditions, such as supportive policies, an enabling culture and leadership from the top are in place (CCIH, 2002). In its 2002 report, CCIH reached the following conclusion:

"While public policy, employers and unions have demonstrated varying degrees of commitment to the concept of workplace health in the past, all Canadians would benefit from the creation of a new and different environment-one that recognizes the need to develop a collaborative strategy for health in the workplace as a national priority." (p. 4)

CCIH (2002) also argues that a "new mindset" with respect to workplace health is necessary for progress to be made in this area. It is hoped that this report will inform this debate by looking at the link between use of the health care system, impaired health, non-supportive work environments and work-life conflict.

Organizations that deliver healthier work environments have healthier bottom lines

In its 2002 report, CCIH put forth the argument that there is "a very real value proposition for employers who adopt a more proactive approach to workplace health (p. 4)." In other words, employers have the potential to positively affect their bottom line by creating a healthier workplace (CCIH, 2002). The costs of ill health and high work-life conflict for employers are overwhelming. In our second report in this series (Duxbury and Higgins, 2003), for example, we determined that absenteeism that could be attributed to high work-life conflict costs Canadian organizations approximately $6 to $10 billion per year. Specifically:

• The direct costs of absenteeism due to high role overload were estimated to be approximately $3 billion per year. This estimate increased to $6 billion per year when indirect costs were included in the total.
• The direct costs of absenteeism due to high levels of work to family interference were estimated to be $1 billion per year in direct costs alone (costs increased to $1.5 to $2 billion if the indirect costs of this absenteeism were also included).
• The direct costs of absenteeism due to high levels of family to work interference were estimated to be just under half a billion dollars a year (approximately $1 billion per year when indirect costs were also included in the total).
• The direct costs of absenteeism due to high levels of caregiver strain were calculated to be just over $1 billion per year (indirect costs were estimated at another $1 to $2 billion).

The costs to the employer are not, however, constrained to absenteeism. Compared to their counterparts with low levels of role overload¹², employees with high role overload were:

• 5.6 times more likely to report high levels of job stress,
• 2.3 times more likely to report high intent to turnover,
• half as likely to report high levels of job satisfaction, and
• approximately half as likely to have a positive view of their employer.

Recruitment and retention-in the health care system and beyond-can be linked to workplace health

Within the decade, Canada, along with much of the industrialized world, will need to address labour force shortages as the demand for labour exceeds the supply in many key areas. This labour force shortage can be attributed to four factors: low fertility, an aging population, the large number of baby boomers reaching retirement age and increased mortality (Bachmann, 2002). These factors are spurring organizations to focus on recruitment and retention of key workers (Bachmann, 2002). What strategies are employers using to attract the new generation of employees to their organization and to ensure that their good baby boomers do not take early retirement? Bachmann (2002) identifies the following: new compensation packages, reward and recognition programs, training and career development.

Will such strategies be effective? The data that are available suggest no, as they do not deliver what either the new generation of workers or the aging baby boomers say they want from a job-a psychosocially healthy workplace (i.e. work environments that offer challenging work, career development, work-life balance, reward and recognition, and respect) that delivers on workplace health programs (Bachmann, 2002). Furthermore, the research that is available in this area indicates that to ensure that employees are satisfied, motivated and committed, organizations need to deal with issues related to health and well-being (Bachmann, 2002).

Recent research indicates that the factor that has the strongest association with employee commitment is managers' recognition of their employees' needs for work-life balance. Work-life balance, in its turn, has been shown to be a key to employee well-being (AON Consulting, 2000; Duxbury and Higgins, 2001, 2003; Bachmann, 2002; Higgins and Duxbury, 2002). In other words, employers have to start delivering on their promises with respect to the provision of supportive work environments and work-life balance. It is hoped that the findings from this research will encourage governments and employers to do just that.

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