Investigative Review on the Impact of Nutrition on Business.

As the world around us is becoming more interconnected and complex, human health is increasingly perceived as the integrated outcome of its ecological, social-cultural, economic and institutional effects (Huynen et al 2005).   The development of globalisation, and changes in technology and the business environment affects our health and the life and health of future generations.

New technology and advances in medicine and nutrition science have developed our understanding of ill-health, the causes of disease and how nutrition works to prevent illness and promote health.  Changes in the business environment affect employee working conditions, lifestyle and stress which can, positively or negatively, affect individual health and the health of a business. The workplace should promote health and prevent stress through education.  Health promotion programmes may help to positively influence productivity, absenteeism and morale and ultimately impact on future development and business success.

Globalisation, Technological and Work Changes

The effect of globalisation, new technology, the internet and ecommerce is evident in the way we communicate, work, run business and understand the world.  Advancement of globalisation and technology affects many economic, political, social and cultural influences including:

  • trade – global markets e.g. international food trade
  • economic development – e.g. employment and resource control
  • human migration
  • health and health policies
  • social equity and social networks
  • knowledge
  • lifestyle
  • physical environment

Globalisation is causing profound and complex changes in the very nature of our society, bringing new opportunities as well as risks (Huynen et al 2005).  Global life expectancy is rising, the global economy is expanding, and scientific innovation and discovery proceed at seemingly exponential rates (Owen & Roberts 2005).  However, we are also becoming increasingly aware of the downside of our developing interconnectedness.  With all the advances in medicine and technology, with new wonder drugs and scanning technology, we are still seeing an increasing cost of healthcare and a decrease in health (Bland 2005).  It may seem that it is the developing countries who suffer but inequality, health and working conditions appear to be worsening worldwide.

The modern working environment leans towards dynamism and flexibility, with many organisations in a permanent state of flux (Beal 2003).  Inevitably this fluid environment leads to shrinking workforces, overwork and stressed employees (Beal 2003). Changes in equipment and technology have been identified as factors that increase stress at work and stress may contribute to long-term sickness (Beal 2003). The modern working model also has flexible working contracts, short-term contracts, job share and part time working; all of which may generate a sense of instability or lack of permanence (Beal 2003). This kind of instability coupled with increased competition, technological change and government budget restrictions may bring a sense of insecurity to organisations as well as employees.

British workers take shorter lunch breaks, less holiday and work far longer hours than other Europeans; an International Congress and Marketing (ICM) survey revealed that in the UK:

  • over half the workforce (57%) take less than thirty minutes for their lunch-break at work (the legal minimum for an average working day)
  • 62% of those surveyed said they skipped lunch or lunched at their desk at least once a week, with one in five saying they did this everyday
  • 20% never take a lunch break at all (Flynn 2003).

The ICM survey concluded that this sort of work pressure is “not healthy for the employee and not healthy for business” (Flynn 2003).

Capitalism’s expansion has depended on a massive influx of women into the workforce (Horgan 2001).  Yet, even with employment, some women continue to be responsible for looking after the children and domestic tasks such as shopping and cooking.  The burden of working inside and outside the home, plus longer working hours, have driven the market for ‘labour saving’ kitchen technologies, ready meals, fast foods and other ‘convenience’ foods which are usually high in fat, salt, sugar and calories and low in nutrients.  The nutritional focus has changes since the 1950’s, when the concern was to ensure that workers had enough food, today there is greater attention to food safety (Wanjek 2005) with progressively more food processing, preparation and cooking taking place in factories rather than at home.

Impact on Health
Opinions differ with regard to the benefit of globalisation on health and some argue that global markets facilitate economic growth which then benefits health.  However, unemployment, combined with insecure working conditions and worsening wages, are major factors in creating and perpetuating social exclusion and health inequality (Stephens 2000).  In addition, consumption of convenience and snack foods, skipping meals and stress are contributing factors to:

  • micronutrient depletion
  • a decrease in health
  • the rise of obesity
  • increased risk of diabetes, cardiovascular disease and other degenerative diseases.

One billion people in developed countries suffer with malnutrition, excess weight and obesity (Wanjek 2005). Type B malnutrition (multiple micronutrient depletion usually combined with calorific balance or excess) is widespread in the UK.  A 2003 report from the Malnutrition Advisory Group found that two million Britons (60% of hospital patients) were malnourished (Wanjek 2005).  Obesity in England has doubled in the last 10 years; not only does England have some of the worst obesity figures in Europe but it also demonstrates some of the worst trends in the acceleration of obesity (House of Commons Health Committee 2004).  Cardiovascular disease and diabetes are associated with obesity and these diseases are appearing in increasingly younger age groups, in particular middle aged men (Wanjek 2005).  Unfortunately the problem is getting worse and the World Health Organisation (WHO) has estimated that the number of deaths from diabetes will soar by 25% in the next century due to Britain’s escalating weight problem  (Diabetes UK 2004).  The rise of obesity has been blamed on a host of factors including: technological advancement, fast food, cars, TV viewing, lack of participation in sports and working women.

Technological advancement has changed the nature of work as well as the supply of food.  In agricultural and early industrial societies work was strenuous; in effect, workers were paid to exercise; in a post industrial society, work entails relatively little exercise (Proper 2004).  Agricultural innovation has also contributed to lower price and quality of food which affects type B malnutrition, obesity and disease. Research suggests that around 40% of recent growth in weight in the US may be due to agricultural innovation that has lowered food prices, while 60% may be due to demand factors such as declining physical activity from technological changes in home and market production (Proper 2004).  We may also eat more because improved technology, such as the microwave oven, flavour protecting preservatives and attractive packaging, have cut the time it takes to prepare food (Proper 2004).

Research has found that stressful jobs have a role in the illness and death caused by cardiovascular disease (Everson et al 1997).  The modern work environment may be a significant source of stress.  A 1997 study revealed that almost every job in Britain had become more stressful than it had been just over a decade previously (Cooper 1997).  Management techniques, job security, longer hours and organisational change are internal influences which may induce some form of stress (Beal 2003). Research has also shown that organisational downsizing (redundancy) may increase sickness absence and risk of cardiovascular disease in employees who keep their job (Vahtera et al 2004).  Work stress and related conditions are the second most commonly reported work-related ill health problems in Great Britain (HSE 2005).  Stress increases cellular activity and reduces the effectiveness of the digestive system which may impact on malnutrition; it also impairs immune function and increases susceptibility to infections and allergies (Golan 1995).  Research has concluded that illness and mortality are linked to prolonged stress (Golan 1995). Therefore, stress, as well as malnutrition and obesity, plays an important role in illness and premature death.

Health impact on Business
Workplace stress is now recognised as a major cost to industry in Britain. The Health & Safety Executive (HSE) have estimated:

  • about half a million people in the UK experience work-related stress at a level they believe is making them ill
  • up to 5 million people in the UK feel “very” or “extremely” stressed by their work
  • 12.8 million working days were lost to stress, depression and anxiety in 2003/4
  • the cost of stress to British industry is £370m a year, while the cost to society as a whole could be as high as £3.75bn (HSE 2005).

The National Audit Office (NAO) estimate that obesity accounted for 18 million days of sickness absence and 30,000 premature deaths in 1998 (NAO 2004).  They estimated that the direct cost of treating obesity and its consequences in 1998 was £480 million (1.5% of NHS expenditure) and that indirect costs (loss of earnings due to sickness and premature mortality) amounted to £2.1 billion, giving and overall total of £2.58 billion (NAO 2004).  A conservative total projected figure of £3.6 billion was given for 2010 (NAO 2004).

Obesity, chronic disease, stress and malnutrition are detrimental to a productive workforce.  Research by the International Labour Office (ILO) has found that:

  • inadequate nourishment can cut productivity by up to 20%
  • iron deficiency, which affects 66-80% of the world’s population, is associated with weakness, sluggishness and lack of co-ordination; it accounts for up to a 30% impairment of physical work capacity and performance
  • low blood sugar, which can occur after skipping a meal, can shorten attention span and slow the speed at which humans process information
  • obese workers are twice as likely to miss work as fit workers
  • poor nutrition is tied to absenteeism, sickness, low morale and higher rates of accidents (Wanjek 2005).

Poor nutrition therefore affects many workplace issues including: morale, safety, productivity and the long-term health of workers (Wanjek 2005).  Paying people who are not at work is costly in both finances and man hours.  Absence may also impact customer service, product quality and the workload and stress of other employees.

Nutrition in the Workplace
The work environment is one of the factors which may be inhibiting healthy eating.  Studies of trends in healthy eating found that 59% of adults surveyed cited “hard to get at work” as the most frequent barrier to eating fruits and vegetables (Rosi n.d.) and few workers are happy with their meal arrangements (Wanjek 2005).  With increased understanding of how nutrition works to promote health and prevent disease the need for the proper nutritional provision of workers, who may spend two thirds of their time at work, is essential.  The workplace should be providing meal programmes which help to prevent micronutrient deficiencies, obesity and chronic diseases.

Even modest changes, such as reducing the amount of sugar and caffeine in the work environment or introducing whole foods could help to balance blood sugar levels and increase nutrients, such as the B vitamins and vitamin C. This, from a biochemical standpoint, may help to strengthen the nervous system and immune system, raise tolerance to cope with stress, prevent inadequate nourishment and help to reduce the risk of obesity and degenerative disease.  Research has demonstrated that the workplace environment influences health related behaviours (Stokols et al 1996).   Workplace health promotion and education develops awareness of the impact lifestyle and nutrition have on health and stress; it may help to empower individuals to take responsibility for their own health.

Nutrition education and promotion also offers numerous benefits for a company, including:

  • decreased absenteeism
  • decreased staff recruitment and training costs through reduced staff turnover
  • reduction in the number of worker compensation claims
  • gains in productivity through improved health and morale (Wanjek 2005).

Investments in nutrition are repaid in a reduction of sick days and an increase in productivity and morale (Wanjek 2005).  Research using control groups found a positive correlation between reduction in health care costs and absenteeism with implementation of comprehensive health promotion programmes (Gebhardt & Crump 1990). In Canada, the cost-effectiveness of workplace health promotion programmes is estimated to be US$ 1.50 – $ 5.75 for every corporate dollar invested (Wanjek 2005). Further research is required to examine potential cost savings of a healthy diet and workplace health promotion in the UK.

The Future
With disease and sickness absence on the rise it is no wonder the Government are considering setting actions to be taken in the workplace.  In March 2005 the Department of Health published a white paper: Choosing Health, Making Healthier Choices Easier, which details the actions required from a range of organisations to improve nutrition and health in the UK.  The overall aim is to reduce the prevalence of diet related disease, and to reduce obesity, by improving the nutritional balance of the average diet.

Legislation increasingly requires employers to look after the physical and psychological wellbeing of their staff.  Occupational health should promote nutrition as an element of the healthy workplace alongside physical and mental health promotion (Wanjek 2005).  Employers should demonstrate they value their employees to stop them feeling unmotivated, going off sick or becoming less productive.  This may be achieved with:

  • health promotion programmes in the workplace
  • healthy food options in staff restaurants
  • making healthier food choices cheaper
  • availability of healthier food in vending machines
  • provision of food vouchers
  • stress auditing

The rationale for implementing changes in health policies, healthcare and the workplace are supported by advances in our understanding of disease.  Chronic diseases such as diabetes and heart disease are conditions where there is not one single explanation that causes them; they involve many factors, such as genes, environment, levels of stress and diet, which combine to present a unique disease in each individual person (Bland 2005).  So a diagnosis which represents the same symptoms in numerous unique individuals is not possible, it is the mechanism of ill health that connects people to their diseases not the name of their disease, and this will change the way medicine is practiced in the future (Bland 2005).

Health promotion programmes therefore offer opportunities to educate individuals about the many factors and mechanisms which influence their health.  Changes in knowledge, health, workplace environment, stress and eating habits may help to prevent nutrient deficiencies, obesity and disease which affects individuals as well as business.  It may increase productivity and reduce absenteeism which affects attendance, retention and performance records.  It should be seen as profitable and a good business investment.  It will not only help to look after current staff but it may be an attractive tool in recruitment.  It could help create a healthier culture and promote commitment and motivation.  Businesses offering health promotion and meal programmes also improve their competitiveness and can promote themselves industry leaders.

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