Is Europe Fit for Work?

Fit for Work Europe

Main Findings

Stephen Bevan
The Work Foundation

Wednesday 30 September
2009
Fit for Work - Questions
 What is the Problem?
 Why Does this Matter?
 What questions have we asked?
 How did we gather our evidence?
 What answers did we find?
 What should be done and by whom?
 What Next?
What is the Problem?
The MSD Problem
• Over 100m Europeans have Chronic Musculoskeletal Pain at some time in
their lives – more than 4 in ten of whom never get diagnosed.
• Over 40m European workers have MSDs caused by their work which affect
their job performance or their labour market status.
• MSDs include over 200 complaints such as back pain, WRULDs and other
conditions of the bones, joints and connective tissue
• This costs the EU over 240 billion Euros each year in direct costs of treatment,
absence from work and lost productivity
• We know what to do about this problem but the EC, National Governments,
Employers, Healthcare systems and Social security systems are not currently
capable of coordinating their efforts to reduce the economic and social burden
of MSDs.
• What is more, in most countries the MSD problem will get worse before it gets
better – especially as the population ages and as obesity increases.
Why does this Matter?
So What?
• We need a workforce which is Fit for Work post-recession – ill-
health in the working age population is economically inefficient
and socially corrosive.
• Once a worker – especially a worker with a long-term or chronic
health condition – loses their place in the labour market, it is
very difficult for them to return.
• This is an avoidable waste of human capital and productive
capacity which affects our competitiveness, social and
community cohesion and family stability.
What questions have we asked?
Core Study Questions
• How big is the MSD problem in Europe? What are its causes, costs
and consequences?
• Are there good examples of policy and practice which might give us
hope that something positive & sustainable can be done to improve
the position of workers with MSDs?
• What kinds of interventions can make most difference and what is the
evidence for their clinical, labour market, economic and social
benefits?
• Can early intervention yield a ‘premium’ for individuals, the economy &
society?
• What should the EC, National Governments, employers, clinicians,
workers and their representatives do to ensure that the impact of
MSDs is minimised?
How did we gather our evidence?
Our Methods
• Extensive reviews of published and unpublished research in
each country
• Collation of prevalence and cost data from National sources and
cross-country clinical and labour market studies
• Interviews with economists, labour market experts, clinicians,
patient groups and policy-makers
• Econometric data analysis
• Reports in 24 Countries in Europe & beyond
What answers did we find?
Findings
• MSDs cause more days lost from work, among more European workers, that
any other health condition – including ‘stress’ or mental health.
• Despite less physical work in modern workplaces, work-related MSDs are still
the dominant cause of absence – lifestyle and other factors are key
• Many workers with MSDs develop Mental Health problems too – this means that
treating the physical causes & symptoms by themselves will only rarely be
enough
• Not all MSDs are caused by work. Rheumatic and inflammatory conditions of
the bones and joints affect millions of workers but, because their conditions are
not caused by work, they are largely ignored by EU policymakers and by many
National Governments.
• Policy & practice in most countries have several weaknesses including, poor
data, poor co-ordination between government agencies, ignorance or fear
among employers, clinicians who do not see Return To Work as a clinical
outcome,
• Early diagnosis & intervention can make a difference to labour market
participation and yield an economic ‘premium’
 Examples

• Belgium
– Direct and indirect costs of absence rose from €8.2 bn in 2006 to €10.35 bn
in 2008: 40% of absence is attributable to musculoskeletal problems
• Italy
– >23m days of work lost every year due to specific MSDs not caused by work
– 27% of workers provide care for elderly/disabled family member: costs of
MSDs should also include this loss of productivity
• UK
– 33% suffer with back pain and up to 80 per cent of the adult population will
suffer significant back pain
– Cost of MSDs per year estimated at £7bn per year

©The Work Foundation

Responses

• Health & Safety – focuses on ‘doing no harm’ and

minimising risk – regulatory bias
• Occupational Health – focuses on functional capacity, return
to work & rehabilitation – bio-medical bias
• Good Work/Decent Work – focuses on systemic approaches
to maximising workforce well-being – biopsychosocial bias
 Cognitive-behavioural Model

Injury

Disability
Disuse
Avoidance Depression Recovery

Painful Experiences

Fear of movement
or re-injury Confrontation

Catastrophising Non-catastrophising

Source: Vlaeyen et.al, 1995

Important Principles

• Well-managed workplaces have fewer days lost

through MSD-related absence – not just about
workplace ‘hazards’
• Early return to work, through transitional work
adjustments, flexible hours and creative job design can
minimise job loss & maximise job retention
• The power of Good Work as a positive influence on
health is understated in policy & practice – especially
by employers & family doctors
• Social security regimes with a stronger emphasis on
Return to Work seem to encourage employer action to
prevent MSDs
Messages (1)

• Becoming ‘detached’ from the labour market with an MSD

can be difficult and costly for all stakeholders
• Pre-existing MSDs must also be the focus of policy & practice
• Early interventions are available and are often cost-effective
• Examples of successful early interventions should be more
widely disseminated to employers & clinicians – successful
return to work should be seen as a desirable clinical outcome
• Good Work is, for the majority, good for health – workplace
management & job design matter beyond ergonomics
• Employers, clinicians and policymakers need to focus on
capacity – not incapacity
Messages (2)
• The UK ‘Fit Note’ focuses all stakeholders on what the worker can
still do – lower tolerance for prolonged absence from work
• Policy & practice which ignores the complex links between MSDs
& Mental Health will be inadequate & of limited effectiveness
• Active labour market policies which promote job retention & early
return to work should be encouraged
• Healthcare systems should support this with earlier diagnosis &
intervention
• Short-term costs to healthcare systems can bring longer-term
benefits to wider society & to the economy
What Should be Done?
Recommendations (1)
• Better Data on MSDs.
• Active Labour Market Policy Must Allow Workers with MSDs to
Stay in Work.
• Promote and Enforce Legislation Requiring Reasonable
Workplace Accommodations for Workers with MSDs.
• Promote Examples of Good Workplace Preventative Practice.
• The EU MSD Directive Should Recognise Pre-existing MSDs
& Mental Health Links
• National Governments Should Ensure that Primary Care
Physicians are Supported in Making Decisions about Work
Disability.
Recommendations (2)
• National Governments Should Consider Adopting a
Version of the UK ‘Fit Note’.
• National Governments Should Prioritise Access to
Physical and Psychological Therapies for Workers
with MSDs.
• National Governments Should Implement national
care plans for People with MSDs.
• Health Technology Assessment (HTA) Should be
Allowed to Take Account of the Wider Societal
Benefits of Treatments and Therapies for MSDs.
What Next?
Fit for Work? What Now?
• Disseminating Fit for Work messages in the Commission &
among MEPs
• Supporting further debate & promoting arguments for a EU
Council Recommendation
• Tailoring our messages to the concerns and priorities of National
Governments
• Working with partners and stakeholders to support changes to,
and enforcement of, regulation which improves labour market
opportunities for all with MSDs
• Leading the promotion of good practice in early intervention,
Good Work and vocational rehabilitation
Is Europe Fit for Work?