In an attempt to elucidate the relationship between community health and employee performance, we conducted a comparative case study of four manufacturing plants and communities. We found that plants located in communities with relatively poor community health profiles had higher rates of ABT. Our quantitative and qualitative findings lend support to the notion that employee performance is affected by community health.
Although we can demonstrate a link between community health and employee performance, the dollar value of lost wages associated with ABT was relatively low for three of the four plants included in this study. However, our cost estimates are likely understated. If a worker is unexpectedly absent, the company may “call in” another worker, paying time-and-a-half or double time to cover the shift. Further, in plant A we heard about absenteeism leading to a direct reduction in the production of goods. Our cost estimates do not take into account lost sales or the cost of labor variances.
The opportunity to address deficiencies in community health in manufacturing communities is substantial. Prior work suggests that manufacturing communities have higher rates of poor health behaviors, such as smoking and physical inactivity, and health outcomes, such as diabetes and cardiovascular deaths . Our findings also point to high levels of stress experienced by hourly workers due to family and community issues, which may be underlying the poor health behaviors and health outcomes. Within the plants, this stress is manifested through absences, a lack of focus, low morale, and in rare cases, accidents. This is consistent with research showing that chronic stress is associated with fatigue, an inability to concentrate, and irritability [16,17,18].
Our results may be used to bolster the case for greater business investment in community health, particularly in communities like plant A’s where the connection was most identifiable. Large employers, including manufacturers, may rightly maintain that they are already directing significant sums of corporate philanthropy toward improving the social determinants of health [19,20,21]. However, their investments in local community health are typically made without the benefit of rigorous evidence or evaluation [19, 20]. Further, the social problems affecting organizational stress, including poverty and drug use, are complex, intractable problems that are unlikely to be mitigated solely through companies acting on their own.
Nevertheless, there is an opportunity for greater business leadership in addressing the social determinants of health, in addition to simply increasing corporate philanthropy. First, employers can work more closely with public health partners, which have extensive experience monitoring the health status of communities, developing policies and partnerships to address community health, and evaluating the effectiveness of population-based interventions . Second, large employers can use their considerable collective political might to advocate for greater investment in public health [23, 24]. Despite evidence on the cost-effectiveness of public health spending [25,26,27], public health has been chronically underfunded, representing a small portion of federal health spending [28, 29]. Third, employers should also reconsider their wellness benefits, especially since previous studies have shown that they rarely yield the desired results [30, 31]. Wellness benefits could be enhanced and customized locally to include well-being components that aim to mitigate the outside stressors on employees and their families.
Employers will need assistance to make this shift a reality. First and foremost, more research is needed to identify the most effective interventions for improving community health. Our findings suggest that interventions targeting youth may be attractive to employers, as younger workers had higher rates of ABT, and were often cited as having a poor work ethic.
This study had several limitations. First, our single measure of employee performance, ABT per 1000 hours worked, was selected because similar data were available across all four plants. There may be other indicators that better represent employee performance, for example, disciplinary action, complaints received, and short- and long-term disability. Second, the timekeeping systems and disability policies differed between the two companies, making it difficult to make direct comparisons of ABT across companies. Third, the case study was designed as a first effort to test two hypotheses regarding community health and employee performance within two companies. Replication is needed to test the generalizability of the findings. Finally, the observed statistical relationships between community health and ABT were associational, and do not necessarily indicate causal mechanisms.