This lack of testing is likely to have dire public health consequences. But it could also deepen the toll on businesses at a time when political officials and business leaders are working to limit the economic impact of the virus.
Recent research from Andrew Dillonclinical associate professor of economic development at Kellogg’s Public-Private Interface Initiative (KPPI), suggests that screening workers for an infectious disease can have a surprising impact on their productivity.
Dillon, along with the authors Ashesh Prasanna and Jed Friedman of the World Bank, Pieter Serneels at the University of East Anglia and Oladele Akogun at Modibbo Adama University of Technology, investigated how medical testing and treatment affect work performance when people are particularly concerned about infectious disease.
They focused on malaria. The team started a malaria testing and treatment program for agricultural workers in Nigeria and then tracked these workers’ earnings, productivity and physical activity in the weeks after people were informed of their test results and received the necessary treatment.
The researchers found that access to malaria testing and treatment led to significant increases in both earnings and days worked, but not only among workers who tested positive. Interestingly, earnings and productivity also increased for employees who tested negative for malaria. After learning that they were disease-free, these workers became more physically active at work and devoted more of their work hours to higher-effort, higher-paying tasks.
The finding offers an important lesson for any business facing the threat of infectious disease, whether malaria or COVID-19. “When people don’t know their condition, they can’t take appropriate treatment or protective measures for themselves,” says Dillon. “This potentially has productivity implications for businesses, workers and the global economy.”
Can you improve productivity just by testing for malaria?
Dillon and his colleagues undertook a series of experiments on a large Nigerian sugarcane farm to observe the small-scale economic impact of easily accessible malaria tests.
The economic benefits of treating terminal diseases were clear: Previous research had found that countries such as Greece, Spain, Italy and Jamaica experienced rapid economic growth after the eradication of malaria, for example. Another study concluded that in economies where malaria was widespread, income in 1995 was only 33 percent of that of otherwise similar countries where malaria was absent.
But the researchers suspected that simply testing for a disease could also provide an economic boost, not only by helping those who were sick to recover, but also by improving productivity for those who refused the test.
Malaria, which is transmitted through mosquito bites, is widespread in Nigeria. The World Health Organization calculates that 100 percent of the country’s population is at significant risk of infection and the disease kills about 100,000 Nigerians annually (a full 25 percent of the global death toll from the disease).
The early symptoms of malaria resemble a strong flu, with fever, chills, headaches and nausea being the most common. However, it can take more than a week for symptoms to appear, and people who are frequently exposed to the disease sometimes develop “partial immunity,” which can lessen the severity of symptoms. Therefore, people may continue to work even after infection. And, unlike many other infectious diseases, malaria cannot be spread from person to person, meaning that workers who choose to continue working do not put others at risk.
About 800 cane cutters (all men) were working on the farm at the time of the studies. Each morning, workers chose one of two possible tasks for the day: cutting cane or “scraping”—that is, collecting cut cane canes and preparing them for processing by rolling them into bundles.
Workers who cut sugarcane were paid per cane cut, with the average worker earning about 1,008 Naira per day. Scrambling is the less physically demanding of the two options and also pays less, offering a flat rate of 500 Naira per day, about half of what sugarcane cutters earn.
All farm workers had access to the malaria control and treatment program. Over the course of six weeks, the researchers invited the workers to take a blood sample and analyze it. They received their results about three days later. The 36 percent who tested positive for malaria were given Artemisinin-based Combination Therapy (ACT), which kills the parasite that causes the disease within seven days (although it can take several weeks for those infected to fully regain their strength in the past).
The researchers offered the six-week treatment program twice in two subsequent harvest seasons, using two slightly different approaches to answer their central question.
In the first season, they pulled from records of how many days each employee worked, what job they chose, their total earnings, and how much work they could do in a day. However, the researchers realized that such measurements were not always available (for example, when the work is done collaboratively among many people). Without such data, it would be difficult for other researchers to test whether their results could be generalized to other contexts.
So they decided to test whether their results held up when they used an alternative measure of productivity: physical activity. So, in the second harvest season, they conducted a second study on the same farm, this time giving a random subset of 83 workers FitBits to wear.
The impact of health on employee behavior
The researchers found that testing for malaria and treating those infected benefited all workers, boosting overall earnings and days worked by about 10%. The reason was twofold.
First, workers who tested positive and received treatment increased their earnings simply by feeling healthier and coming to work more often. Among this group, the number of days worked per week after treatment increased by 7 percent.
Second, those who tested negative for malaria also had higher productivity. After learning they were healthy, these employees took on more strenuous, higher-paying work and generally increased their physical activity at work.
In summary, the results show a direct relationship between a negative malaria diagnosis and the physical effort exerted by a worker. “This is something we could only detect by measuring the physical activity of workers,” says Dillon.
The researchers’ analysis also showed that, beyond the public health benefits, the medical program’s economic benefits outweighed the costs. During the three weeks after screening (or after treatment, for those who tested positive), the program increased profits by more than $13 per employee, while the cost of implementing the program was just $10 per employee.
Less easily quantifiable, Dillon adds, is the employee goodwill that accrues to a company when it provides access to an important health intervention—not to mention the many other positives that result for individuals, families and communities when hundreds of people receive treatment. for malaria.
The experiments also did not capture the long-term benefits for the farm. But Dillon says the results suggest that testing and treating could help a company cut costs. Because, for example, sick employees could recover, the farm would likely have to spend less on training replacements in the future. Additionally, they may be able to cut back on worker supervision, since a clean bill of health alone motivated people to work harder.
Who should pay for disease control?
One critical takeaway from the study: business leaders overseeing workers in environments where an infectious disease is rampant—almost every part of the world today—would benefit from ensuring their employees are clear about their health status.
“When workers are in endemic situations or face high risks as part of their job,” says Dillon, “resolving informational uncertainty can help them become more productive and devote more of their effort to work.”
Given the multiple benefits of test-and-treat programs—for individuals themselves, for businesses, for society at large—who should pay for them? Dillon argues that, in the absence of robust public health programs, companies should consider the cost a sound investment.
“Certainly the public health system should be the first port of call for workers when it comes to managing their health,” says Dillon. “But especially for very physical workers, we know there’s this relationship between being healthy and being more productive at work. It’s certainly in a company’s best interest to make these kinds of investments because it can reduce oversight and turnover in its workforce.”
At the same time, workers also have a lot to gain from implementing these programs—probably more than the businesses themselves. Does this mean they should be prepared to cover the cost of testing? Dillon believes the best answer may be a combination of both, perhaps resembling typical employer-sponsored health insurance plans in the US, where employers and employees jointly contribute to the overall cost of employee health care.
“I think it’s all about coordination,” he says. “Can companies that provide workplace-based health services reduce costs and better motivate workers to have health information and access to treatment? And can these costs be shared between businesses and workers?’