On a trip to Tokyo in 1992, President George H. W. Bush went to work — in the form of a state dinner — hosted by Japanese leadership, and promptly threw up on the prime minister. “The President is human,” a White House spokesperson said at the time. “He gets sick.” That scene was echoed last weekend at a 9/11 memorial service, when Hillary Clinton had to dip out and crash for a minute at her daughter’s Manhattan apartment. Weirdly, her team first said she was “overheated,” then followed up and revealed that seasonal allergies were getting to her and she’d come down with pneumonia. “While at this morning’s event, she became overheated and dehydrated,” her personal physician said in a statement. “I have just examined her and she is now re-hydrated and recovering nicely.”
Being president and becoming president are demanding jobs. And though she didn’t regurgitate on a head of state, Clinton’s overheating speaks to the same cultural norm that Bush exhibited on that fateful day — showing up for work at all costs, a habit that management scholars call presenteeism. (If you’ve ever trudged into the office with a cold that really should keep you in bed, you may have partaken yourself, and gotten your colleagues sick in the process). As Oliver Staley reports at Quartz, getting hard numbers on how much value is lost to people working when they should be recovering is hard to do, though one estimate says it’s over $250 billion a year. With presenteeism comes depression, fatigue, anxiety and disordered sleep, the research says. As well, working while you’re sick leads to depersonalization — where you no longer have your heart in your work — and burnout. In a Swedish study, workers who committed more presenteeism also had lower self-reported health, which makes a ton of sense since working while you’re sick probably isn’t the surest method of recovery.
Some jobs are more prone to presenteeism than others: Teachers, nurses, and nursing home aides are three to four times more likely to work while sick than managers, one review notes. There are lots of push-and-pull factors that lead to a culture of presenteeism in workplaces, from a sense of loyalty to vulnerable clients, like patients and students, and job insecurity — if you feel like you’re going to lose your job, you’re probably going to show up lots. From my perspective, presenteeism seems to share lots of the same causes with why Americans are worse at vacations than Europeans. Jobs in the U.S. are less secure and there’s less of a safety net; in the U.K., there’s “redundancy pay” to keep you paid if you get fired. Across Europe, labor unions are way stronger than in the U.S., as signaled by France’s increased vacation and limited overtime. As well, a survey of U.S. corporate managers found that they equated working longer hours with being “more dedicated, more hardworking, and more responsible.” You can thank the industrial era, argues MIT management scholar Robert Pozen, since that era’s clocking-in and clocking-out culture is still present in the billable hours of prestigious professions like law and consultancy, thereby ballooning time on the job. Add all that up and you get candidates looking like they’re going to faint and presidents throwing up on other heads of state. America: land of the free, home of the working-while-sick.