KUALA LUMPUR, Dec 26 — As organisations seek to enhance the wellbeing of their employees, the ability to harness mental health data is proving to be a game-changer in creating a healthier and more productive workforce.
Azran Osman-Rani, chief executive officer and co-founder of Naluri – a company that specialises in personalising health and wellness programmes for employees – said companies can no longer simply claim to provide support without having the ability to quantify mental health data and establish a mental health baseline for their employees.
“Today, for many organisations, this is the first time that they see a (quantitative) analysis of the risk of depression, anxiety, and stress in their workforce.
“In Malaysia, for instance, 40 per cent of employees have depression, 60 per cent have anxiety, and 30 per cent experience some level of stress, but at different degrees of severity. About eight to 12 per cent are at a severe stage where they cannot function at work.
“More importantly, 30 to 40 per cent who appear healthy, are coming to work, but have early signs of depression and anxiety, which if left untreated, will progress into a costly and unproductive situation,” Azran said at the Industry Leadership Forum: “Building A Productive Workplace Culture of Health and Wellbeing” organised by the Galen Centre for Health and Social Policy last October 23.
The former AirAsia X chief executive said the first step is to help organisations establish the baseline and proactively address the 30 to 40 per cent at early risk of depression and anxiety before they worsen into a critical state.
Azran said aggregate data is also crucial for organisations, as it allows them to design more focused intervention programmes.
To do this, Azran first underlined the importance of employee confidentiality to encourage assessments and prevent stigmatisation.
Dr Mohammad Razin Kamarulzaman, head of group safety and security at the Malaysia Aviation Group, said that the airline company has an open-door policy for pilots and cabin crew that always maintains patient-doctor confidentiality.
During the pandemic, the company provided training to the management on ways business units could support their employees. This included options like reassignment to different locations or increased flexibility.
“We had teams working from home, and for those who couldn’t stay at home due to their living situations, the company provided quiet workspaces and cubicles in their workplace, so there was a lot of flexibility,” Dr Razin said.
Azran pointed out that companies typically spend between RM100 and RM200 per month per employee on insurance, which amounts to RM1,200 to RM1,400 per year. With a conservative annual medical cost inflation rate of 10 to 18 per cent, this expense can escalate significantly.
Azran said it makes sense then to invest in prevention programmes that reduce employee health claims.
However, despite the potential savings, Azran highlighted that many organisations fail to proactively collect and evaluate the data generated by these programmes to assess their effectiveness.
“You’re not merely aggregating the data; you need to integrate it with historical data to provide accurate insights.
“Let’s give an example where you conduct four straightforward physical health tests: weight, blood pressure, blood sugar, and cholesterol, in addition to a mental health assessment.
“If your HbA1c level is above 6.3 per cent, cholesterol is above 5.2, your blood pressure is above 140/90, BMI is higher than 30, and your depression, anxiety, and stress scores indicate risk.
“Looking at the past six years, a profile like this will typically result in an average annual cost to the company of RM8,000 to RM12,000 in direct medical claims, plus an additional RM12,000 to RM14,000 in sick leave.
“For four out of five employees, the cost falls between RM8,000 and RM12,000, for three out of five, it’s around RM6,000 to RM8,000, for two out of five, it’s RM2,000, and for one out of five, it’s between RM400 to RM800 per year.
“Understanding these numbers is essential. Year by year, you should ask, ‘Is my employee profile getting healthier?’ This analysis involves examining the percentage of people with multiple risk factors, those with fewer, and how this relates to medical claims.
“We need to approach this quantitatively before discussing whether this is a sound investment. Otherwise, it’s like shooting in the dark,” Azran said.
Collecting such data may seem straightforward, but Azran said it can be challenging as health care data is highly “transactional”. This means the data is episodic because patients typically only see a doctor when they are unwell or experiencing a specific ailment.
Occupational health general practitioners (GPs) also play a part in making data collection difficult. Azran said they often struggle with coding conditions using the International Statistical Classification of Diseases and Related Health Problems (ICD) 10 codes, making it difficult for companies to obtain valuable patient data.
“In Malaysia, 500,000 Malaysian employees did the dataset. Rate of obesity as tagged by an ICD 10 code was two per cent. Clearly, it is not two per cent. But people are not classifying and coding it properly, and that is why it takes a lot of effort to transport or translate the data set from incident data into longitudinal data.
“What is the pattern they (the employees) are experiencing over a 10 year period? That is where the insights become really useful. So, in a way that’s what we have to do because otherwise, that data that you get on claim rates alone is useless.”
Dr Razin said that while the ICD codes are a good way for insurers to categorise illnesses, most illnesses are an amalgamation of many things. For example, a respiratory tract infection can result in coughs, fever, headaches, muscle aches, and a sore throat.
Dr Razin is hopeful that advancements in technology, such as rapid test kits, can assist frontline clinics. He said that unless modern technology becomes more affordable, managing illnesses will remain a challenge for human resource departments in companies.
To facilitate employee health management, Dr Razin advises employers to either establish an in-house health facility that collaborates with human resources or, if the company can’t afford that, to partner with a health advisory organisation.
Many companies have approached Azran, requesting his company to quantify mental health issues and chronic diseases affecting their employees. This data aims to establish a baseline that helps determine the effectiveness of their initiatives.
The baseline also serves as a quantitative measure of the monetary value of health improvements.
“Now, once you have that data set and can analyse it, for example, we have the privilege of working with PM Care who are a very data-driven organisation. With six years of medical data, you can actually now put a dollar value to it.
“If I improve someone’s blood pressure by 23 millimetres of mercury and improve their depression by 23 per cent, what is the dollar value of that? Then you can then say, ‘Can I make proper investing decisions?’ Because it is an investment if you know how to quantify the dollar value of improving health.”
Young Employees More Prone To Depression, Anxiety, Stress
Employees under 35, particularly those in the 20 to 29 age group, exhibit higher susceptibility to depression, anxiety, and stress, Azran said.
During his work with a logistics company in 2020 or 2021, Azran observed that young individuals are more prone to experiencing mental health issues. These mental health challenges were directly linked to poor physical health conditions such as diabetes, hypertension, and high blood pressure.
“Their blood pressure was consistently above 140/90, a prevalence rate that you expect for people above 40. The displacement caused by Covid was manifesting itself into high blood sugar and high blood pressure at an accelerated rate, creating a ticking time bomb,” Azran said.
This correlation was less pronounced in individuals above 40 but considerably stronger for those under 35, suggesting a generational factor at play.
“And, more specifically, the prevalence of depression and anxiety and stress among the younger workforce is manifesting in their lifestyle choices and stressors, which we (from an older generation), are not experiencing. There is financial pressure, the breakdown of family units, the disconnection between your boss and your colleagues.
“This is a workforce that probably joined the workforce before they established meaningful social connections and relationships within the workplace.
“During the pandemic, everyone is just a picture, and you all know in your meetings, only 50 per cent will turn on the webcam.
“So, the social displacement has now manifested itself in these physical health markers, which means this is a generation that is going to have a much weaker immune system to all the inevitable communicable disease threats that are coming,” Azran said.
Dr Razin delved deeper into the impact of stress on the body, explaining that when an individual experiences stress, the body signals the adrenal glands to release a surge of hormones, including adrenaline and cortisol.
Adrenaline makes the heart pump faster, causing an increase in blood pressure, while cortisol elevates glucose levels in the bloodstream.
In the short term, this reaction can be beneficial, but if it persists, the body will continue to release glucose into the bloodstream. This prolonged response not only leads to mental health issues but also triggers physical reactions such as high blood pressure, diabetes, and even heart disorders.
Dr Razin added that Malaysians consume more calories in a day than they burn, resulting in the accumulation of fat. This means that Malaysians also need to turn their lifestyle around by engaging in more physical activities and eating healthily.
Employees’ Role In Maintaining Good Health
While employers have a significant role to play in their employees’ health, Azran and Dr Razin agree that employees must also take an active interest in their own wellbeing to achieve good health.
Azran said that for many employees, a “catalyst” to change is essential. Without it, change is unlikely to occur. Therefore, it is more beneficial for companies to focus on employees who are motivated to change and take charge of their health.
According to Azran, companies should prioritise these motivated employees through group-centred programs. Expecting employees to achieve their health goals individually typically results in a success rate of only 20 per cent. However, when individuals work together in groups, there is a 50 per cent chance of successfully achieving their health goals.
“You’re not going to get an 80, 90 per cent success rate. But moving someone from just simply expecting that one person who is self-motivated, which is one in five; two in five; or 2.5 in five, you create an ability to generate that four times return on investment.
“Let’s start by quantifying it and understanding that people will change at different paces, but you increase that probability by helping them quantify and understand what they want to change by creating programmes where they’re doing it together and a 50 per cent success rate is a substantial improvement in lowering health care costs.”
Azran said it is also important to match employees with the right peer groups. Azran said one of the more powerful peer groups the company has is mothers with young children, new managers, and employees who have fitness goals such as completing their first 5km or 10km run.
In these group programs, employees can motivate each other, while employers can provide top-down support and remain consistently present, motivating not only the individuals directly involved but also other employees throughout the organisation.
