US employees lose an estimated 63.4 productive days a year to physical and mental health problems, with almost 54 days lost while still working rather than through sickness absence, according to new research.
Poor physical and mental health is costing US workers the equivalent of more than 12 working weeks of productive time each year, with most of that loss occurring while employees are still at work, according to research from Vitality and RAND Europe. The Vitality Global Health and Productivity Index 2026 estimates that US workers lose an average of 63.4 productive days annually because of health-related absence and reduced performance. Just 9.5 days are attributed to absence.
The remaining 53.9 days – 85% of the total – are lost through presenteeism, when employees remain at work despite physical or mental health problems that prevent them from performing at their best. The findings suggest traditional sickness absence figures capture only a fraction of the productivity impact poor health is having on organisations. Vitality estimates that poor workforce health costs the US economy $2.33 trillion in lost productivity annually, the highest total among the five markets studied.
PRESENTEEISM IS THE BIGGER PRODUCTIVITY PROBLEM
US employees lose an estimated 9.5 productive days through absence, compared with almost 54 days through presenteeism. Combined, the US total of 63.4 days is well above the five-market average of 54.8 days and second only to Germany, at 69.3 days. Some 32% of US workers say their health has a medium or high impact on their productivity while working, while 14% reported missing more than four hours of work during the previous week because of health problems.
The findings suggest employers focusing primarily on sickness absence may be concentrating on the most visible part of the problem while overlooking a much larger productivity loss among employees who continue working while unwell. “We consistently see evidence pointing to the impact of health and wellbeing on productivity. While absence often attracts the most attention from employers, it is presenteeism, when left unaddressed, that has the far greater impact on productivity,” said Christian van Stolk, Deputy Chief Executive at RAND Europe. “Recognising this has the potential to give businesses a significant opportunity, allowing them to take a more proactive and preventive approach to work, benefiting both employees and business.”
WORKING WHILE UNWELL IS OFTEN INVISIBLE
Presenteeism can be harder for employers to identify than absence. An employee may still log on, attend meetings and complete tasks while experiencing pain, fatigue, anxiety, depression, treatment side-effects or other health problems. But being present does not necessarily mean they can work at their usual level.
The problem is not new. Previous research highlighted by Fair Play Talks found that three in four UK employees had worked while physically or mentally unwell. More than one in five (22%) also reported feeling pressure from managers to continue working despite illness. This matters because workplace health strategies have traditionally relied heavily on absence rates as a measure of employee health.
The Vitality findings suggest employers also need to understand how well people are functioning while at work, particularly as more employees continue working with long-term health conditions. Fair Play Talks recently highlighted the growing workplace impact of cancer, with more than one million working-age people in the UK living with or beyond a diagnosis and employers facing an estimated £3.7 billion annual cost.
The wider lesson is similar: keeping people economically active matters, but employees also need the conditions, flexibility and adjustments that allow them to work sustainably.
HEALTH SUPPORT IS STILL WEIGHTED TOWARDS TREATMENT
US employers offer relatively extensive health and medical support compared with the other countries studied. But Vitality argues that much of that support remains focused on treating or managing illness rather than prevention and early intervention. Some 49% of US workers report having access to medical or health insurance through work, while 51% say they do not.
Yet only 18% report access to employer-organised health screenings, which could identify some health problems earlier. The research also highlights a substantial health burden across the US workforce.
Almost 29% of US workers are classified as obese, compared with a five-market average of 18%, while 65% report moderate or serious psychological distress. The findings point to an opportunity for employers to shift more attention towards prevention, early intervention and health support that is easier to access before problems worsen.
MENTAL HEALTH IS PART OF THE PRODUCTIVITY PICTURE
Vitality identifies mental wellbeing risk as one of five areas independently associated with productivity loss. The others are physical-health burden, AI-related concern, work strain and lifestyle risk.
These pressures can overlap and compound. An employee facing poor mental health, physical health problems and high work strain may experience a much greater productivity impact than someone facing only one of those risks. That aligns with wider evidence that workplace mental health cannot be separated from workload, leadership and working conditions.
Fair Play Talks’ World Mental Health Day 2026 coverage highlighted mounting workplace mental-health pressures and growing calls for employers to move beyond awareness towards prevention, manager capability and meaningful support.
AI MAY BOOST PRODUCTIVITY AND CREATE NEW HEALTH PRESSURES
The Index also identifies an important tension around artificial intelligence. More than half of US workers (56%) say AI or digital tools help them to be more productive. Yet across the five markets studied, workers reporting high levels of AI-related concern experienced an estimated 27.6 additional productive days lost annually compared with employees reporting no identified AI concern.
That is equivalent to more than five additional working weeks. Around 12.9% of workers across the study fall into the high AI-concern group, with concern concentrated among younger, less senior and already-distressed employees. The finding reinforces a pattern emerging across workplace research: AI can increase productivity while simultaneously increasing pressure on the people expected to use it.
As Fair Play Talks recently reported, seven in 10 workers say AI makes them feel more productive, yet workloads are not falling.
Separate research also found that six in 10 workers worry AI is weakening their skills. The productivity promise of AI may therefore depend partly on how well organisations manage the human consequences of adoption.
AI PRODUCTIVITY GAINS CAN BE LOST THROUGH ANXIETY
If AI saves employees time but uncertainty around jobs, skills or performance expectations increases stress, some of the technology’s productivity benefits could be offset elsewhere. Employers therefore need to consider not only whether workers have access to AI, but whether employees understand:
- Why the technology is being introduced.
- How their roles may change.
- What skills they will need.
- What AI will and will not be used for.
- How performance will be assessed.
- What support exists for employees struggling with the transition.
That echoes recent research showing four in 10 employees believe CEOs are not transparent enough about how AI will affect their careers. The challenge is to ensure technology transformation does not generate avoidable anxiety that undermines the productivity it is intended to improve.
FIVE HEALTH AND WORKPLACE RISKS CAN COMPOUND
Vitality identifies five risk areas independently associated with productivity loss: mental wellbeing, physical health, AI concern, work strain and lifestyle risk. The impact becomes particularly severe when several occur together. According to the Index, an employee considered high-risk across all five areas loses an estimated 119 productive days a year.
That is close to half a working year. The finding illustrates why isolated wellbeing initiatives may struggle to make a meaningful difference. An employee experiencing chronic illness, heavy workloads, poor mental health and anxiety about AI is unlikely to be helped sufficiently by a single wellbeing app or occasional awareness campaign. Employers need to understand how these risks interact and design support accordingly.
MANAGERS CAN MAKE A MEASURABLE DIFFERENCE
One of the most actionable findings concerns managers. Across the study, employees who believe their manager genuinely cares about their wellbeing lose nine fewer productive days each year than workers who do not. That is a substantial difference.
Supportive managers can help employees raise concerns earlier, access adjustments, manage workloads, take appropriate time away from work and navigate sensitive health-related conversations. But managers need support too.
Fair Play Talks recently reported that one in four UK managers regularly think about quitting, highlighting the risk of expecting managers to carry ever-growing responsibilities for employee wellbeing without giving them sufficient capacity or support. The findings suggest organisations should invest in both employee wellbeing and the training, resources and working conditions managers need to support their teams effectively.
PRESENTEEISM SHOULD NOT BECOME ANOTHER PERFORMANCE METRIC
There is also an important caution for employers. Measuring presenteeism should not mean monitoring sick employees more aggressively or pressuring them to demonstrate productivity. If badly implemented, that could make the problem worse. Employees need to feel able to say when they are struggling without fearing that doing so will damage their careers.
Psychological safety can be especially important for disabled and neurodivergent employees when asking for workplace support or adjustments, as Fair Play Talks recently highlighted. The objective should therefore be to identify the conditions preventing people from working sustainably – not to police people who are unwell.
WORKING WHILE SICK IS NOT ALWAYS A SIGN OF RESILIENCE
Workplace cultures sometimes reward employees who continue working despite illness. But presenteeism can have consequences. Employees may recover more slowly, make more errors or experience worsening mental-health problems. Long-term conditions can become harder to manage, while managers may underestimate the extent of someone’s difficulties because they technically remain at work.
Financial pressures can also leave employees feeling they have little choice but to continue working while unwell. Recent research found that 68% of UK employees considered paid sick leave an important benefit, compared with 60% who prioritised inflation-matching pay rises.
Yet only 56% of employers surveyed offered company or contractual sick pay, raising questions about whether inadequate financial protection may contribute to presenteeism. A healthier workplace culture may sometimes mean enabling employees to work differently, temporarily reduce their workloads or take appropriate time away, rather than celebrating attendance at all costs.
Flexible working can also be especially valuable for employees managing treatment, disability, long-term health conditions or caring responsibilities. The goal should be sustainable work and appropriate recovery, not simply maximising attendance.
PREVENTION NEEDS TO MOVE UP THE AGENDA
Maia Surmava, CEO of Vitality US, said the scale of health-related productivity loss should prompt employers to think beyond sickness absence and reconsider how health benefits are used. She argued that US employers already invest heavily in health support, but have an opportunity to place greater emphasis on identifying risks earlier, engaging employees with their health and making support more relevant. That is arguably one of the most important messages in the research.
Employers often spend heavily once an employee becomes unwell. The challenge is to invest more effectively before health problems escalate to the point where they affect both quality of life and ability to work. A more preventive approach would also recognise that employee health is shaped by working conditions, workload, management practices and organisational culture, not simply individual lifestyle choices.
WHAT EMPLOYERS SHOULD DO NEXT
The findings suggest organisations need to move beyond measuring sickness absence and develop a broader view of workforce health. Employers should:
- Look beyond sickness absence: Assess health-related productivity and employee wellbeing without turning measurement into employee surveillance.
- Prioritise prevention: Invest in early intervention, appropriate health screenings and accessible support before problems escalate.
- Support managers: Train managers to recognise and respond sensitively to health concerns, manage workloads and facilitate adjustments, while protecting their own wellbeing.
- Create psychologically safe workplaces: Ensure employees can discuss health difficulties without fearing stigma or career consequences.
- Make work more flexible: Provide reasonable adjustments, adaptable working arrangements and temporary workload changes where appropriate.
- Address underlying working conditions: Examine excessive workloads, long hours, job design and organisational pressures as part of wellbeing strategies.
- Connect physical and mental health: Recognise that different health risks can interact rather than treating them as separate issues.
- Consider the human impact of AI: Monitor how technological change affects employee anxiety, skills, expectations and workloads.
- Improve access to benefits: Ensure health and wellbeing support is relevant, inclusive and accessible to those who need it most.
- Measure outcomes, not just activities: Evaluate whether wellbeing initiatives improve health, retention and sustainable performance, rather than simply counting participation.
The aim should not simply be reducing absence. It should be helping employees remain healthy enough to work sustainably and effectively, while ensuring those who need time away can take it.
POOR HEALTH CARRIES A HUGE ECONOMIC COST
Across the five economies studied, Vitality estimates poor workforce health costs $3.34 trillion in lost productivity annually. The US accounts for an estimated $2.33 trillion, compared with:
- $579 billion in Germany.
- $326 billion in the UK.
- $91 billion in Japan.
- $26 billion in Singapore.
These are modelled economic estimates rather than direct accounting losses, but their scale illustrates the potential economic consequences associated with poor workforce health. For employers, the bigger lesson may be simpler. The largest health-related productivity problem may not be people staying home. It may be the much larger number who keep turning up while they are physically or mentally unable to perform at their best.
FROM ABSENCE MANAGEMENT TO WORKFORCE HEALTH
For decades, employers have closely monitored sickness absence. The Vitality Index suggests that measure alone is no longer sufficient. An employee does not need to be absent for poor health to affect performance. And a worker remaining online or at their desk should not automatically be taken as evidence that everything is fine.
The strongest workplace-health strategies therefore need to shift the question from: “How many days were employees absent?”, to: “Are employees healthy and supported enough to work well?”
That requires greater emphasis on prevention, earlier intervention, supportive management and working conditions that enable people to remain productive without sacrificing their health. If the Vitality estimates are right, the potential benefit is substantial – for employees, employers and the wider economy.
RELATED ARTICLES
A UK study has revealed that three in four employees have worked while physically or mentally unable to perform their duties due to ill health.
From rising anxiety and burnout to gaps in employee support, research across the globe exposes mounting workplace mental health pressures – and why experts say employers must move beyond awareness to meaningful action.
Cancer is costing UK employers an estimated £3.7 billion a year through absence and reduced productivity, as more than one million working-age people now live with or beyond a diagnosis, new research reveals.
One in four UK managers regularly thinks about leaving their job because of the pressure and stress of managing people, despite the vast majority saying they enjoy being a manager, research reveals.
Paid sick leave has emerged as the UK’s most valued workplace benefit, ranking above inflation-matching pay rises and flexible working, according to new research.
Why psychological safety can determine whether disabled and neurodivergent employees feel able to ask for support, request workplace adjustments and contribute with confidence.
Nearly nine in 10 CEOs believe employees trust their leadership, but just 46% of workers agree, as new research exposes a widening trust gap around AI-driven change.
Six in 10 employees worry AI is weakening their skills, while 43% say they get the blame when AI goes wrong, new global research reveals.
Seven in 10 employees say AI is making them more productive, yet workloads remain virtually unchanged, reveals research.
