Improving employee health in the Middle East

(13 pages)

Previous McKinsey research has shown that for the past century or more, improvements in health have not only delivered immense social benefits¹Adding years to life and life to years, McKinsey, March 29, 2022. but also served as a powerful catalyst for economic growth by expanding the labor force and boosting productivity.² Prioritizing health: A prescription for prosperity,” McKinsey Global Institute, July 8, 2020. When employers invest in the health and well-being of their workforce, they have often made gains in productivity and reduced attrition.³

Countries in the Middle East and around the globe are increasingly embracing a modern definition of health that encompasses not just the absence of physical illness but an all-encompassing state of equilibrium between a person’s internal and external environments. This broader definition includes four dimensions: physical, mental, social, and spiritual health.⁴Adding years to life and life to years, March 29, 2022.

About the survey and what we measured

The McKinsey Health Institute conducted a survey in four GCC countries in August and September 2022. This survey involved more than four thousand employees in the Kingdom of Saudi Arabia, Kuwait, the United Arab Emirates, and Qatar.

We assessed a range of health outcomes (mental, physical, social, and spiritual), business outcomes (with a focus on intent to leave), and workplace factors (with a strong focus on toxic workplace behaviors) in our survey.

Health outcomes assessed in our survey included:

Mental health: An employee’s cognitive, behavioral, and emotional state of being. Mental health is needed for an individual to understand and interact with the world through memory and language. Mental health allows us to experience joy, direct anger, limit harmful, impulsive behavior, and avoid serious depressive episodes. Mentally healthy individuals have the resilience to cope with normal stresses and adverse events while maintaining a positive and realistic sense of self.¹

Within this survey, we looked at four subfacets:

Burnout symptoms: An employee’s experience of extreme tiredness, reduced ability to regulate cognitive and emotional processes, and mental distancing (Burnout Assessment Tool).²
Distress: An employee experiencing a negative stress response, often involving negative affect and physiological reactivity (4DSQ Distress Screener).³
Depression symptoms: An employee having little interest or pleasure in doing things, and feeling down, depressed, or hopeless (PHQ-2 Screener).⁴
Anxiety symptoms: An employee’s feelings of nervousness, anxiousness, or being on edge, and not being able to stop or control worrying (GAD-2 Screener).⁵

Physical health: The extent to which an employee can competently perform physical tasks and activities without substantial discomfort. It includes the capacity to move through the environment in which one lives with confidence and independence and to control one’s interactions with the physical world via fine-motor control. Employees with good physical health have sharp sensory capacities with keen senses of touch, vision, hearing, taste, and smell. Physically healthy employees are full of energy and vitality, free from the twin scourges of debilitating pain or fatigue, as per the World Health Organization (WHO).⁶

In this survey, we used a self-developed tool modifying questions from the WHO’s 2012 quality of life assessment, looking at:⁷

if the stress from respondents’ jobs cause them to engage in unhealthy behaviors (for example, inadequate nutrition, lack of physical activity, lack of sleep)
if respondents are self-reporting physical symptoms (experiencing physical pain that is preventing them from doing what they need to do at work)

Social health: Represents an employee’s ability to build healthy, nurturing, genuine, and supportive relationships. Employees in good social health have the capacity to form meaningful connections with others, to both receive and provide social support. Social health gives employees a strong sense of belonging to a community.⁸

In this survey, we used a self-developed tool modifying questions from the WHO’s 2012 quality of life assessment, looking at a range of social factors (including personal relationships, participating in group activities, time spent on nonwork activities and important people in their life).⁹

Spiritual health: Enables people to integrate meaning in their lives. Spiritually healthy people have a strong sense of purpose, belonging, or identity, which can correlate to better health.¹⁰Eric S. Kim et al., “Purpose in life and reduced stroke in older adults: The health and retirement study,” Journal of Psychosomatic Research, January 22, 2013, Volume 74, Issue 5; Patrick L. Hill, Grant W. Edmonds, and Sarah E. Hampson, “A purposeful lifestyle is a healthful lifestyle: Linking sense of purpose to self-rated health through multiple health behaviors,” Journal of Healthy Psychology, 2019, Volume 24, Issue 10.They feel a broad sense of connection to something larger than themselves, whether to a community, a calling, or a form of divinity. Spiritual health helps people feel rooted and mindful in the present moment.¹¹

In this survey, we used a self-developed tool modifying questions from Spiritual Health and Life Orientation Measure, 2010, and the Work and Meaning Inventory, 2012, looking at a range of spiritual factors (including sense of fulfilling a greater purpose, living in harmony, and feeling energized by work).¹²

Work-related outcomes and factors assessed in our survey included:

Intent to leave: In this survey, we used a self-developed tool to assess an employee’s desire to leave the organization in which they are currently employed in the next three to six months.

Toxic workplace behavior: In this survey, we used a self-developed tool to assess an employees’ experience of interpersonal behavior that leads them to feel unvalued, belittled, or unsafe, such as unfair or demeaning treatment, noninclusive behavior, sabotaging, cutthroat competition, abusive management, and unethical behavior from leaders or coworkers.

The analysis of share of respondents reporting at least one mental-health challenge was determined by aggregating respondents reporting having a mental-health diagnosis, now or in the past; reporting to have sought or considered treatment for a mental-health condition; or having listed at least one of the following: symptoms of anxiety, burnout, depression, or distress.

Consideration of cross-country surveys

As cited in previous global pieces about health, such as “In sickness and in health: How health is perceived around the world,” a range of cultural and methodological factors can influence respondents’ answers to survey questions. These factors include, but are not limited to, language and word association, number ranges, comprehension issues, and attitudes toward taking surveys. It is important to note that comparisons between respondents in different countries are not only due to differences in attitudes and/or behaviors between respondents but also reflect response styles that are specific to cultural and geographic locations. Any insights drawn from cross-country comparisons should be interpreted with consideration of these multiple influences to survey responses.

In early fall 2022, the McKinsey Health Institute surveyed more than four thousand employees in four Middle Eastern countries that are part of the Gulf Cooperation Council (GCC)—Kuwait, United Arab Emirates (UAE), Kingdom of Saudi Arabia, and Qatar—to understand the state of employee health in the region (see sidebar “About the survey and what we measured”).

This article summarizes what our respondents told us about the state of their health as they saw it, namely, that:

Two-thirds of GCC respondents reported symptoms of poor mental health and well-being, or had a mental-health condition diagnosis.⁵
One in three GCC respondents reported burnout symptoms. Many also reported struggles with physical health conditions, but better social and spiritual health, with different patterns among demographic groups.
Three-quarters of GCC respondents reported being happy at work, which appeared to be correlated with employees listing a sense of purpose in their work and in their relationships at work.

Some targeted actions by GCC countries point to growing recognition of the importance of promoting employee health and well-being. For example, the UAE has been an early adopter in integrating employee health and well-being into its governmental agenda by setting up the National Program for Happiness and Wellbeing.⁶

However, further opportunities exist, on a systematic basis, for employers and governments across the region. This article explores the status of employee health and well-being, and includes data and insights that GCC leaders could consider using to inform strategies and actions to address the causes of ill health among employees.

Two-thirds of survey respondents, from countries in the Gulf Cooperation Council, reported symptoms of poor mental health and well-being.

Insight 1: More than 60 percent of GCC respondents say they have experienced mental- and physical-health challenges at some point in their lives

Physical and mental health are intimately entwined. Mental health, like physical health, exists along a continuum from optimal health to poor health. As we described in our article “Present company included, prioritizing mental health and well-being for all,” most employees are likely to experience some symptoms of poor mental health and well-being at some point during their working years.¹ Sixty-six percent of GCC respondents said they have experienced at least one mental-health challenge at some point in their lives—a figure slightly higher compared with other global research.² Present company included: Prioritizing mental health and well-being for all,” McKinsey, October 10, 2022; “It’s a new era for mental health at work,” October 4, 2021. This is proportional to physical-health challenges, where more than two-thirds also report at least one symptom of poor physical health.

The majority of Gulf Cooperation Council survey respondents said that they had experienced mental- and physical-health challenges.

Insight 2: Anxiety, depression, and distress symptoms are all high among GCC respondents, reflecting a global trend

Globally, one in four respondents are reporting burnout symptoms, which is correlated with poor mental health. That figure is closer to one in three among GCC employees surveyed, a finding that is consistent with other studies.¹ Additionally, GCC respondents also reported higher levels of distress at the time of the survey, which may be a precursor to burnout symptoms (55 percent, compared with 32 percent).²

More than twice the percentage of GCC respondents report an intent to leave their jobs, compared with employees globally (36 percent, compared with 16 percent). Although the great attrition³ ‘Great Attrition’ or ‘Great Attraction’? The choice is yours,” McKinsey, September 8, 2021. is a global phenomenon, with factors that include employees not feeling valued, some GCC-specific factors could be exacerbating intent to leave.⁴ Specific to the region, variable factors can include sponsorship requirements for expatriates, or competition for local talent.

Symptoms of depression, anxiety, and distress were all higher than the global average among Gulf Cooperation Council survey respondents.

Insight 3: Symptoms of burnout and intent to leave are often driven by toxic behavior at work

Globally, employees reporting high levels of toxic behavior at work are more likely to experience burnout, leading to an increased intention to quit.

In our survey, GCC employees who report experiencing high levels of toxic behavior at work are seven times more likely to experience burnout symptoms, compared with a global average of eight times more likely (see sidebar “What is toxic workplace behavior?”). In turn, respondents experiencing burnout symptoms are four times more likely to report that they intend to leave their employers in the next three to six months (compared with a global average of six times). While GCC respondents show a similar overall pattern to the global findings, they are less likely to show signs of burnout in response to toxic behavior and are less likely to leave.¹ Addressing employee burnout: Are you solving the right problem?,” McKinsey, May 27, 2022. Recent data has indicated that toxic culture is the single largest predictor of resignation during the Great Attrition and ten times more predictive than compensation alone.²

Employees reporting high levels of toxic behavior at work are more likely to experience burnout, leading to an increased intention to quit.

Insight 4: Poor physical health affects some respondents’ ability to work

Overall, an average of about 42 percent of respondents report experiencing physical pain that prevents them from doing some work-related activities.

Almost half of respondents say the time they dedicate to their jobs curbs the time they have to care for physical health. Some respondents say that underlying behaviors, such as inadequate sleep or unhealthy eating, affects their physical health.

Along with work-related challenges, rapid socioeconomic development is one of several factors in the region that has contributed to a more sedentary lifestyle (among the highest in the world) and a concurrent rise in obesity and diabetes.¹ Chronic diseases are now the leading causes of morbidity and mortality.²

About 42 percent of survey respondents reported experiencing physical pain that prevents them from doing some work-related activities.

Insight 5: Locally born respondents report higher rates of poor mental and physical health than expatriate employees

Expatriate employees surveyed¹ report symptoms of depression, anxiety, and burnout at rates that are at or close to global averages, whereas locally born respondents report higher rates of depression, anxiety, distress, and burnout. Furthermore, almost 40 percent of locally born workers say they expect to leave their current organization within the next six months. Some research has suggested that anonymity in the survey may allow locally born workers to acknowledge their mental-health challenges without concerns about deep-rooted stigma.²

Physical health is also stronger for expatriates, with 27 percent reporting symptoms of physical pain (compared with 47 percent for locally born respondents). This may be linked to expatriate workers being younger than locally born workers and/or having to pass health-screening tests from host countries.

Locally born employees report significantly higher rates in both mental- and physical-health domains.

Targeted actions that could improve outcomes

What is toxic workplace behavior?

Toxic workplace behavior is interpersonal behavior that leads to employees feeling unvalued, belittled, or unsafe, such as unfair or demeaning treatment, noninclusive behavior, sabotaging, cutthroat competition, abusive management, and unethical behavior from leaders or coworkers. Selected questions from this dimension include agreement with the statements “My manager ridicules me,” “I work with people who belittle my ideas,” and “My manager puts me down in front of others.”

Actions, both preventive and reactive, taken by employers at three levels—organizational, team, and individual—could help to improve employee health and well-being in the GCC region.

Governments also play an important role in fostering health and well-being and in creating an environment for society to flourish and organizations to act. They could consider measures to prevent overall damage to individuals and the system, while having the infrastructure to react if symptoms have already materialized, such as:

ensure health and well-being is on their agendas at every level, clarify their aspirations, and craft action plans to drive innovation and impact (for example, by following the WHO’s guidelines for mental health at work⁷)
boost awareness with an inspirational narrative (for example, a campaign reinforcing the importance of employee health) and foster dialogue to reduce stigma
define regulatory standards for psychological health and safety in the workplace (for example, possible penalties for organizations that fail to comply)

The role of happiness

Among respondents in this survey, the most reported complaint affecting social and spiritual health is a lack of happiness with amount of time spent on nonwork-related activities (9 percent of respondents).

“Happiness” refers to agreement or strong agreement with the statement, “I feel happy at work most of the time.” Employees who rate themselves as happy at work are also significantly more likely to indicate they have strong relationships with others at work or feel an overall sense of purpose (correlates with happiness scores of 0.29 and 0.24, respectively).

Yet what is behind who feels happiness and why? While we found no immediate association between physical health and happiness, social and spiritual health seem to be associated with higher levels of happiness. It also appears correlated to having an especially strong sense of work purpose and satisfaction with coworker relationships.¹ Interest in and examination of happiness in the region is steady: a 2015 report found that UAE, Qatar, and Saudi Arabia were the three happiest countries to work in the Middle East region,² while one ongoing research project looks at the effects of the UAE Happiness and Wellbeing policy implementation.³

For example, UAE has developed clear positioning and ambitions regarding 90 initiatives supporting its National Wellbeing Strategy.⁸ Among those are a Happiness and Wellbeing Policy Bundle, which sets guidelines and requirements for all groups in society; the Network of Happiness and Wellbeing chief officers working on developing programs promoting health and well-being at the workplace, where participants must achieve a Happiness and Wellbeing diploma; and the Global Dialogue for Happiness and Wellbeing raising overall awareness and fostering alignment among governments and organizations.⁹ (For more on happiness, see sidebar “The role of happiness.”)

Digitally generated image of a tree inside glass containers on a blue background

The secret to great health? Escaping the healthcare matrix

Read the article

Successful approaches maintain a few focus areas over time and encourage role modeling and sustained ownership by leaders

Organizations can examine actions that drive employee health and well-being (see sidebar “Organizations could take a systemic approach to improving employee mental health and well-being”). Additionally, each employee can individually drive mental health and well-being. As illustrated by the examples above, this involves three common themes:

Organizations could take a systemic approach to improving employee mental health and well-being

We suggest eight actions (exhibit) that will drive improvement in employee health and well-being.

For example, as part of its company-wide sustainability strategy, “Dare today, change tomorrow,” Majid al Futtaim has the ambition of creating healthy workplaces, underpinned by a new Healthy Workplaces Policy. This policy sets new standards for the design and amenities of physical workplaces, as well as corporate well-being programs and a “WELL” certification.¹

As individuals, managers could be encouraged to take ownership of health and well-being with personalized and bite-sized interventions. As a result, they not only take care of their own health and well-being but also act as role models for people they lead. Interventions may include:

encouraging assessment of health across the four health dimensions via the latest real-time health measurements, set aspirations, and take steps to achieve them for themselves and their teams
offering education related to individual health status (for example, via an integrated health platform) and highlighting that external support is offered
starting small and staying focused, embedding one habit at a time to improve physical health (dedicate time for exercise, improve sleep hygiene), mental health (meditate, engage in meaningful activities), spiritual health (practice yoga, connect with a faith community), and social health (interact with peers, join local teams or interest groups)

In addition to its top-down policies and precautionary measures implementing the highest health and safety standards for each individual, Aldar Properties fosters employee-driven initiatives leveraging advanced systems and technology. With a focus on providing remote working options, health offerings are highly digitized; employees have access to an online well-being platform and the ability to sign up for live sessions with health authority professionals.²

Eight key actions drive improvement in employee mental health and well-being.

First, start with a diagnosis. Understanding the baseline can help choose how to prioritize which issues are the most pressing, and where to start in addressing them.
Second, choose one or two health dimensions of focus and target goals and priorities based on the diagnostic. What are the most impactful opportunities for change? What is the realistic vision for the well-being strategy, accounting for the constraints faced by an organization? For example, Majid al Futtaim’s focus on workplace involves expanding into different health arenas (for example, a “biggest loser” challenge to promote physical health).¹⁰ Similarly, individuals could consider ways to incorporate habits such as a daily active break or meditation. The goal is to experience fast successes before getting intimidated by time constraints or limited resources.
Third, leaders should role-model interventions, change ways of working from the ground up, and make a sustained commitment over time. Early adopters on all levels help accelerate uptake intervention programs and can serve as ambassadors to raise awareness of health agendas and programs. For example, the UAE hosts the “Global Dialogue for Happiness and Wellbeing” to bring together experts from around the world to share best practices and expertise. Majid Al Futtaim’s “WeCare” representatives are based in each store and discuss professional and individual needs with their colleagues. The goal is not only to establish new standards of what good looks like but also to act as a multiplier for a shared overall benefit.

On a societal and organizational level, leadership commitment plays a crucial role not only in terms of clear positioning but also in the actual doing. One example is a driver awareness campaign started by Ibrahim Al-Zu’bi, chief sustainability officer at Majid al Futtaim. The goal is to show a genuine purpose-driven change that rallies the society, the organization, and all employees behind a shared goal.
Finally, well-being metrics need to be linked to employee performance and organizational outcomes, and relentlessly tracked. At a governmental level, societal impact of initiatives also needs to be measured and tracked.

Making the investment to improve employee health and well-being is not easy—and often means committing to a journey over time. This can lead to an upward trajectory in sustained individual and organizational performance with an employer, and in the communities and societies in which they operate.

Explore a career with us

Search Openings

Better health among Middle Eastern employees can start with awareness