A picture of health: MetLife's database has spawned an illustrated guide to understanding and managing the health issues behind employee absenteeism.

As a disability insurer, MetLife has compiled an extensive database of short- and long-term disability claims information over the years. This wealth of data inspired MetLife's national medical director to create a visual reference guide to the injuries, illnesses and chronic health conditions affecting American workers. Dr. Ronald Leopold's book, A Year in the Life of a Million American Workers, relies on data culled from more than 8,000 employers from 2001 through 2003.The 1 million workers profiled are drawn from a sample of more than 4 million covered lives and fire representative of the American work force as a whole, Leopold said.

The book is aimed at business and insurance professionals, but it also is layman friendly. Its 200-plus pages are brimming with appealing graphics, making it a visual almanac of key data, information and references on absence management and nonoccupational disabilities. It covers a wide range of topics, including acute and chronic conditions, types of jobs and how they affect the incidence and duration of disabilities, and the driving forces behind rising costs of health care.

In his introduction, Leopold points out that the U.S. economy depends on the health and welfare of its workers. And the greater the number of people who miss work for health reasons, the greater the toll on productivity. "Understanding what health conditions, illnesses and injuries keep people away from work--and identifying where the best interventions may lie--are very valuable to any business that depends on the productivity of its employees," he said.

Recently, Leopold spoke with Best's Review about his goals for the book project, the need for disability protection and what he expects on the disability front in coming years.

Q: What prompted you to publish this book now?

We saw that there was a void in the marketplace. We were unaware of anybody putting together a comprehensive manual or almanac that addressed the issues of work, absence and health. And we think that's an area in which we at MetLife have sizable expertise, data and experience. We also wanted to give back to the industry and the marketplace something that would be of high value to a wide group of people.

A lot of the statistics quoted in this book I call "the usual suspects. "These are the same stats that you hear over and over again--you read them in articles, you hear them at trade shows, you hear them when other people speak; they're always being quoted. We wanted to collect those usual suspects from the Department of Labor, the American Heart Association, the Social Security Administration, the Centers for Disease Control, the National Health Interview Survey, and put them fill in one place. We also knew that MetLife had a very large database and that we had wonderful tools that allowed us to really drill down in our data. So we were able to crack open the coconut, if you will, and display it for the world to see in one package.

Q: Who is the audience for this book?

Employers, brokers, consultants, industry and trade people specifically for the intersection of work and health, and then, on a wider scale, CEOs, CFOs and other executives. We're seeing increasing numbers of top executives interested in the impact that work and health has on their bottom line and a lot of interest in health-care professionals for this information.

What we're trying to accomplish with the book is to help people understand the complexities out there. When people think about work-related injuries, they think it's predominantly a musculoskeletal story. But if you start thinking about all the reasons that people have to be out of work as a result of health reasons, short- and long-term disability experience is a better gauge of that activity. We want to help people understand that it's a story of musculoskeletal as well as pregnancy, cardiac, neurological, respiratory and psychiatric conditions.

We're also hoping to help employers understand the landscape, understand how they fare relative to the landscape, help them benchmark their own experience against what they should expect and, based on that understanding, begin to craft individual solutions for their own populations. So the solution for a blue-collar manufacturing environment is going to be very different than, say, for a call center.

Q: In your book, you say that "employers tend to think of disability costs as only those expenses for disability insurance, but there are many direct and indirect costs." Can you elaborate on that?

I'll give you a good illustration: If a company relies on assembly line workers, and one of its best assembly line workers is not able to come to work because he's out with gall bladder disease or whatever the reason, the company is paying him his wage replacement and that's the direct cost. The indirect cost is do I have to pay someone else to fill in for him for overtime? If he is out for a long period of time, do I have to hire someone else and train him? And most importantly, what are the day-to-day lost productivity costs that I'm incurring because the product that this worker normally would have produced is not being produced. So all of that contributes to the indirect costs.

Q: What do you characterize as the major injuries and illnesses impacting U.S. business today?

We identify five conditions that are both prevalent in the population and responsible for extended absence from work. Those five are low back disorders, depression, coronary heart disease, arthritis and pulmonary disease. From a perspective of costing a lot with regard to medical services, but also costing a lot with regard to lost productivity, those are the five biggest.

Q: We've been hearing so much about the national problem of obesity. How much should obesity concern employers in regard to short-term and long-term disability?

The obesity epidemic being described in the media and coming from a number of reliable sources is very real, and it's an absolute concern that we all need to address. There are things that employers can do to offset some of the prevalence of obesity in their population--and that is everything from revisiting what food choices are available in cafeterias and vending machines to whether or not they want to subsidize health and fitness clubs for their workers.

We believe that the attention to obesity given by the media will, in part, serve to offset some of the trend, and we think the trend is going to curve over time. In other words, we think American society does get smart about things eventually and changes its behavior.

Q: Return-to-work programs began surfacing about 10 years ago. How much is this managed disability approach being embraced by employers?

Many employers are embracing managed disability, managed return to work. For some employers, it is a business imperative; for others, it's simply nice to have. But I would say that those employers who have larger numbers of medium and heavy task-type work rather than sedentary positions certainly would benefit from more proactivity in managed disability. The process of managing disability is two-fold: The carrier processing disability claims needs to be proactive in its approach to getting people back to work, and employers, themselves, have to implement a return-to-work program that really works. What that usually means is having dedicated people at large plant sites who are responsible for making that return to work happen, having commitment from upper management to the return-to-work process and, if possible, aligning incentives to support line supervisors to get people back to work because, when it comes to a dollars and-cents approach, it's in their best interests.

Q: In the book, you argue that the U.S. working population is insufficiently covered by disability protection. For example, you list professionals and union workers as having the highest disability protection but show how other groups lag far behind. Why this discrepancy?

As a general rule, the value of disability coverage is under recognized. There are a lot of statistics in the book that speak to the likelihood of someone becoming disabled. By contrast, life insurance is coveted so much more than disability insurance. However, younger people need disability insurance, too. At age 30, an employee is three times more likely to become disabled than to die.

The message here is that the market still has under invested in disability coverage and that it is important to individual employees as well as to employers. A 2003 MetLife Study of Employee Benefits Trends found that people were astonishingly unaware of what sort of disability coverage they had and clearly tinder recognized how important it is to protect one's own income, which is the primary asset for most of us.

Q: You also look at the graying of America--specifically, the aging work force. What are the implications for employers regarding this group of employees and disability coverage?

There are three conditions--cancer, coronary heart disease and arthritis--that we think are going to become very major players in the near future for employers as a result of the graying of the workplace. Our predictions are that the aging work force is going to drive a doubling of the rate of arthritis in the next 15 years and that would be prevalence of arthritis in a working population. We also think that the aging work force is going to drive a doubling of the rate of cancer in the work force as soon as in the next 10 years. And we believe that the aging work force will drive a tripling of the rate of heart disease of the work force with in the next 10 years--that would be high blood pressure as well as discrete incidents like heart attacks, congestive heart failure and stroke.

Q: If you were producing the same book five years from now, what key changes do you think you might see in the most frequently recorded disabilities and chronic diseases?

The overwhelming difference that we would see five years from now is that the work population would be a little older--about five years older--because not only are we going to have more old people, but older people are going to be more apt to stay in the work force. So we have two trends that are really going to transform the workplace.

Five years from now, the three conditions I named--arthritis, heart disease and cancer--are going to bc bigger players. Depression will become more prevalent across a wider group of workers and specifically will increase for blue-collar workers. I think that employers will continue to struggle with how they fund benefits for the population. And hopefully, we'll have solved the problem of rapidly escalating healthcare costs.

Q: As national medical director for MetLife, what have you learned from compiling the information in this book?

You can derive an awful lot from looking at a very large population, but the rubber really hits the road on an employer-specific basis. And the fact is that employer by employer, the story is always so different. It's a story of demographics, benefits structure, industry, corporate culture. So the solutions, down to an individual employer side, really need to be so very customized. I would say that was my biggest take-away from this and related efforts.

Long-Term Disability Incidence and Prevalence
Major Diagnostic Categories

The chart illustrates MetLife's estimation of the
number of LTD claims expected for a general
working population of 1 million people's claim
incidence in a given year.

Telling a Story: MetLife's A Year in the Life of a Million American
Workers is filled with colorful graphics illustrating key data
pertaining to short- and long-term disability.

Black Height = LTD Claims Per Million

Ear Disorders:                   16

Skin Disorders:                  22

Eye Disorders:                   38

Kidney/Genitourinary System:     66

Normal Pregnancy & Delivery:     69

Self-Reported Conditions:        74

Endocrine/Hematologic:           74

Digestive System:                81

Respiratory System:              83

Ill Defined Conditions:         126

Complications of Pregnancy:     134

Infectious Diseases:            142

Neurologic Diseases:            257

Circulatory System:             361

Psychiatric Disorders:          425

Neoplasms/Cancer:               435

Musculoskeletal System:       1,278

Note: Table made from bar graph.

A Year in the Life of a Million American Workers, by Dr. Ronald S. Leopold, MetLife's national medical director and vice president of MetLife Disability, is published by MetLife. For more information, go to www.metlifeiseasier.com/disability almanac.