Fit For Work Europe: Launch By Steve Bevan

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 – illhealth 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

Avoidance

Disability Disuse Depression

Recovery

Painful Experiences Fear of movement or re-injury

Confrontation

Catastrophising

Source: Vlaeyen et.al, 1995

Non-catastrophising

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?