“Our new analyses of national survey data indicate that, despite the Mandate commitment, just 12% of people with a musculoskeletal condition currently have a care plan. There is an opportunity for many more people to benefit.” Read more on The Work Foundation blog.
Prof Stephen Bevan, Founding President of Fit for Work Europe
This week I had the pleasure of attending the first Uppsala Health Summit in the beautiful University City of Uppsala in Sweden. The theme of the conference was ageing and health and I was invited to speak on behalf of the Fit for Work Europe Coalition.
The event, hosted by the University of Uppsala, was first addressed by Mr Ulf Kristersson, Sweden’s Minister for Social Security who presented some compelling data about demographics in Sweden. Among other things, he explained that the data on ageing among the Swedish population also masked a significant reduction in inequality in life expectancy. While an inequality gap still exists Sweden has succeeded in reducing some of the negative impact of the main social determinants of ill-health.
Later in the day I presented as part of a panel session on the use of technology, diagnostics and screening to improve health outcomes for older people. My focus was on the need to regard early diagnosis and early intervention for musculoskeletal disorders (MSDs) as an investment rather than a cost, especially if the outcomes had a wider societal value (such as the ability to remain in work). I used the example of narrow policy and financial silos which, in the case of rheumatoid arthritis in the UK, the economic case for NHS investment in early treatment was made very forcibly by the National Audit Office (NAO) back in 2009. Despite this, the NHS has not prioritised early intervention, thereby forgoing the threefold return on investment in labour productivity which the NAO economic model predicted. One participant at the conference likened this example to the annual debate in Sweden about the cost of gritting roads and pavements. Local authorities are under pressure to minimise the cost of gritting, but the health system then has to bear the cost of older Swedes suffering injuries, fractures and trauma from slips and falls on icy surfaces. As the delegate concluded, the evidence that gritting is cost-effective is clear, but politicians choose to pursue short-term savings instead of doing ‘the right thing’.
I argued that the judicious use of diagnostic technologies and medical interventions which can help older workers with chronic conditions to remain active and at work – especially if this was good quality work – would enhance the health of individuals and improve workforce productivity. In addition, I reminded delegates that a high proportion (up to 65%) of working age people with MSDs are the main income earner in their household and that having to leave the labour market prematurely as a result of poor health can have dire financial consequences for individuals and their families. My plea to the conference was to ensure that healthcare decision-makers routinely consider that remaining in work might be a clinically and socially desirable outcome for older patients and that, as we all have to work longer and retire later, this consideration will become a necessity rather than an optional extra.
In many ways, the resolution to this dilemma lies in being clear about both who pays for these interventions and who stands to benefit. As we heard at our Fit for Work Summit in October 2013, it is possible for different parts of the system (eg Health & Social Security) to share both the costs and the benefits of joined-up interventions rather than just opting for the cheapest, short-term option. As one delegate suggested, our politicians have a democratic mandate to make common-sense decisions where spending leads to savings. It is a shame, he reflected, that so few have the political bravery to put these principles into practice – especially as so many stand to benefit.
Last month I spoke at the 1st Macedonian and 4th Adriatic Congress on Pharmacoeconomics and Outcomes Research in the beautiful resort of Ohrid in Macedonia. The Congress examined a range of topics relating to healthcare decision-making in the lower-income countries of the Adriatic and Balkans region. These included the contribution of health insurance to the cost-effective use of medicines, the health economics of personalised medicines and case studies of health technology assessment practices (HTA) in Serbia, Croatia and Bosnia and Herzegovina (Fit for Work has also conducted a series of case studies on the Societal Perspective in HTA).
Days lost to MSDs in Slovenia
My presentation focused on the issue of early healthcare interventions which promote workability and labour market participation. I used Musculoskeletal Disorders (MSDs) as an example and also focused on the Fit for Work research we have conducted in Slovenia to illustrate my conclusions.
In Slovenia, as illustrated by the graph below, MSDs account for a very large proportion of days lost to sickness absence – 2.5 million each year.
Almost 49 per cent of Slovenian workers report work-related back pain, and over 38 per cent of Slovenian workers report that they have experienced muscular pain in their neck, shoulders and upper limbs. There are over 13,000 people with RA – with an annual cost of treatment of €126m. Unlike some countries, the social insurance system in Slovenia extends support to people with MSDs which are not caused by work or workplace injuries (unlike some Worker Compensation schemes around the world). This means that vocational rehabilitation is an important priority. However, there can be delays in accessing treatment which supports return to work (eg physiotherapy, spa therapy, drug treatments) because referral rates to secondary care – especially Orthopaedic specialists in the case of people with MSDs – by GPs are very high, causing long waiting times. As yet GPs in Slovenia – as in most countries – do not have any incentive to regard work as a clinical outcome of care or as a commissioning priority. In addition, there are few incentives in the welfare system for people to remain in work as the disability replacement wage rate id quite high.
My presentation, however, indicated that earlier intervention for Slovenian workers with MSDs could result in an additional 2,800 being available for work each day. This estimate was derived from data produced by Dr Juan Angel Jover and his colleagues in Madrid where an early intervention clinic for people with MSDs reduced temporary work disability by 39 per cent. With the potential for such significant increases in productive capacity and human capital utilisation, I argued that the economic and social benefits of early clinical interventions should be disseminated widely to clinicians and healthcare decision-makers.
The Health Minister, Vytenis Povilas Andriukaitis, called for the implementation of the Early Intervention care model in the Republic of Lithuania at an event organised by the Lithuanian Fit for Work Coalition in the Parliament, on the 17th of March. The Minister’s call to action is a major milestone for the Fit for Work mission, as the pan-European Coalition advocates for EU mobilisation against the burden of musculoskeletal disorders (MSDs) both at central and member state levels.
Minister Vytenis Povilas Andriukaitis calls for Early Intervention
The Fit for Work Coalition in Lithuania has been advocating for quite some time for the implementation of a cost-effective solution to reduce the harmful societal and economic impact of musculoskeletal disorders (MSDs). According to a Fit for Work report analysing the impact of MSDs to the labour market in Lithuania, which is part of a pan-European study conducted by the Coalition through The Work Foundation, MSDs account for about half of all occupational conditions in the country. Fit for Work also found that more than half of those with serious forms of MSDs, such as rheumatoid arthritis, were more likely to become disable than the general EU population living with the same condition, costing the economy around €101 million a year.
On the 17th of March, at the “Musculoskeletal diseases and workability” conference, the fifth event organised by the Fit for Work Coalition at the Lithuanian Parliament and chaired by the Health Care Committee and the Lithuanian Rheumatologists Society, the Minister himself called for setting up an “Early Intervention” pilot., The audience, consisting of members of the government, directors of health organisations and experts from various governmental institutions, heard from the Minister Andriukaitis that the innovative care model can significantly reduce both the sickness absence and the permanent job loss attributed to MSDs, promoting a greater participation to the labour market and, thus, saving costs to the Lithuanian economy on the longer term.
The Musculoskeletal Diseases and Workability conference at the Lithuanian Parliament
Minister Andriukaitis’s demonstration was backed by Professor Irena Butrimiene from the University of Vilnius. Prof Butrimiene presented some operational scenarios for the set-up of the Early Intervention pilot. These are going to be discussed with experts from the Ministry of Health in the coming weeks.
The Early Intervention model was founded by Dr Juan Jover, Head of Rheumatology at hospital clinico San Carlos in Madrid, Spain. The programme ran for two year and assessed 3,300 workers with MSDs, resulting in a reduction by 39% of the sickness absence and by 50% of the permanent work disability related to MSDs. The cost-benefit analysis also revealed that there was recouped around €11 for each €1 invested in the pilot. Since then, 25 new Early Intervention programmes have open across Spain, retrieving similar results. With support from the Fit for Work Europe Coalition, EU countries such as the UK, Portugal and Latvia are now testing the programme, too.
Early Intervention consists of a rapid diagnosis and assessment, expert clinical management, restraint from bed rest, early mobilization, stretching exercises, ergonomic training, recommendations for physical activity, self-management and support for remaining in, or returning to work. The approach reduces the time of diagnosis, treatment and recovery improving patient outcomes and labour market participation, as well as savings to the health care and welfare systems.
Minister Andriukaitis expressed his interest in Early Intervention at the Fit for Work Europe 2013 Summit in Brussels, where he had delivered a keynote presentation on behalf of the Lithuanian Presidency of the EU Council
The “Musculoskeletal diseases and workability” conference organised by the Lithuanian Fit for Work Coalition has also been covered by some local media outlets, such as Delfi.lt and Lzinios.lt.
What costs EU countries upwards of €240bn annually? Musculoskeletal Disorders (MSDs) affect 100 million Europeans and member states could see up to 50 per cent of their working-age populations diagnosed with a chronic MSD by 2030. The 2010 Report on The Global Burden of Disease published by The Institute for Health Metrics and Evaluation states that “MSDs are the primary cause of disability in Europe.” MSDs are not just a health issue, they are a social and economic one, too — one that we simply cannot afford to ignore.
There is hope, however. We founded MSD Early Intervention trial clinics in Madrid… click to read Dr Jover’s piece on Early Intervention in the Parliament Magazine, issue 387 | 31 March 2014.
The tentative and delicate green shoots of economic recovery are just about visible across some EU Member States. But a major driver of sustainable economic growth and recovery across the EU will be the speed with which these Member States can mobilise and deploy highly skilled, resilient and healthy workforces and rely on them to help deliver productivity growth and increased competitiveness. One challenge is that ageing workforces across the EU are also more likely to be constrained by a growing burden of chronic conditions which threatens work ability, productivity, social inclusion and labour market participation. Chief among these chronic conditions are musculoskeletal disorders (MSDs)… continue reading on the Hanover Blog
DG SANCO announced that it is going to host a summit in Brusselsthis April to debate innovative solutions to the growing burden of chronic diseases on the health care systems and the economy. Surprisingly enough, musculoskeletal disorders are not on their agenda. A door slammed in the face of 100 million European citizens suffering from musculoskeletal pain – one might say. To give you an idea of the dimensions of the problem, this figure is comparable with the aggregated population of Belgium, Germany and Austria. Actually, in excess of 40 million people are of working-age and have an MSD cause by their work. To make things worse, evidence-based studies conducted within Fit for Work Europe, through The Work Foundation, and elsewhere by organisations such as Eumusc.netand even the European Commission, show that the EU economy loses €240bn to MSD annually. MSD is also the leading cause of sickness absence in the EU, accounting for half of all absences from work lasting three days or longer and 60% of permanent job loss.
Yet the European institutions seem to have turned a blind eye to MSDs. Neither the European Commission, nor the World Health Organisation classifies MSDs as serious non-communicable diseases. Why is that? One can speculate that MSDs, unlike cancer, diabetes or cardiovascular diseases, are not considered to be a major cause of death. It is a fact, though, that MSDs can seriously contribute to the increase of mortality rates. People living with an MSD incur the risk of developing other conditions such as mental health problems – 30% of people with MSDs also have depression – obesity and cardiovascular diseases.
Allegedly, policy-makers have given little priority to MSDs because of insufficient cross-country data. One might argue that most people with MSDs are treated in outpatient settings and that most health information systems are rather designed to provide data about inpatient care. It could also be claimed that MSD diagnoses are recorded differently in various member states, which makes it difficult to draw comparable conclusions. However, in recent years considerable progress has been made in capturing and processing comprehensive data related to MSDs. To name just a few sources, the Global Burden of Diseases and Eumusc.nethave released hefty reports on the societal and economic impact of MSDs.
In addition, Fit for Work Europe has been working for five years now to promote the prioritisation of MSDs amongst the most harmful non-communicable diseases and the implementation of healthcare and workplace interventions that support job retention and return to work for people living with MSDs. With an evidence base of over 30 studies conducted in Europe, Fit for Work is currently testing practical solutions to MSDs in several members states (Spain, the UK, Latvia, Portugal, Lithuania).
The first results of the Early Intervention pilot that ran in Spain clearly indicates that an earlier, more sustained recovery for working age citizens suffering from MSDs can highly contribute towards increased cost savings for the economy, easing the strain on the health care systems and increasing the labour market participation. As featured in the Parliament Magazine(p. 27), the Spanish pilot showed a 50% reduction in permanent work disability (people leaving work completely), a 39% decrease in temporary work disability (people having sick days from work as a result of their condition) and a 40% reduction in sanitary costs. In addition, it highly increased patient satisfaction, whilst the cost-benefit analysis revealed a two-year return of more than €10 for each €1 invested in the programme.
Fit for Work summons DG SANCO not to be oblivious to an innovative solution like Early Intervention, which could benefit not only the Europeans living with MSDs, but also people with other chronic conditions such as cancer, diabetes, cardiovascular and mental health disorders.
>>> Check independent expert opinions about MSDs and Early Intervention featured in a video from the Fit for Work 2013 Summit
The Fit for Work Coalition report, produced by The Work Foundation has found that Germany and UK have the worst sickness absence rates in Europe when it comes to muscular skeleton disorders (MSD). MSDs (including back pain, neck, shoulder and arm pains) are the leading cause of sickness absence across the EU, with 44m workers suffering, costing up to 240bn Euros in terms of lost productivity and sickness absence, representing 2% of GDP across the EU. MSDs are also linked to the next leading cause of absence, stress. There is a great deal of research that MSDs can trigger stress and stress can be the underlying cause of back pain, etc.
It is urgent that we need to prevent and intervene early so that the predictions that 50% of the working population in the EU does not have these problems by the year 2030. There have been some really good examples of early interventions, particularly in Spain. The Madrid Clinic did a two year study of intervening with people suffering from MSDs after 5 days of sickness among 13,000 workers and reduced temporary work absence by 39%. The report suggests that if there was only a 25% reduction in absence from an early intervention, 640,000 workers throughout the EU would be available for work.
This work is very important in both understanding, preventing and treating MSDs as well as workplace stress, where the number of workers suffering are growing rapidly and is now the leading cause of incapacity benefit in the UK. The Fit for Work Coalition and The Work Foundation should be congratulated for an outstanding report and a way forward.
After trying to get answers for about twelve years and losing my job over a diagnosis that.. (does not exist).. I found a way.
Watch the full story from Ann Christin on fighting her condition and work disability:
An extra one million employees could be at work each day if early interventions were more widely accessible for people with musculoskeletal disorders (MSDs) such as back pain. This is according to a new report from the Fit for Work Europe Coalition, written by The Work Foundation and published today (16 October) at a summit in the European Parliament, Brussels, endorsed by the Lithuanian Presidency of the EU Council.
With many EU member states on track to see 50% of their population diagnosed with an MSD by 2030, the report warns that early treatment for MSDs must be prioritised in order to tackle this growing problem. But it also shows how permanent work disability could fall by 50% if a tried and tested model were to be followed across different countries.
The leading cause of sickness absence across the EU, 44 million workers now have MSDs – including back pain and strains of the neck, shoulder and arms. This costs up to €240bn annually in lost productivity and sickness absence, representing up to 2% of GDP across the EU. The report calls on EU member states to coordinate action between government departments, employers and clinicians to tackle this problem and save billions while transforming the lives of those affected by such devastating conditions.
“As our analysis shows, access to early healthcare interventions for workers with MSDs are not being prioritised,” said Professor Stephen Bevan, Founding President of the Coalition – a group representing physicians, patient organisations, economists and researchers promoting policies to improve workforce health. “Thousands are taking unnecessarily long periods away from work or even leaving work permanently when tried and tested tactics could be helping to speed up their recovery and return to work,” he added.
Using data from a two-year trial of a successful early intervention clinic for people with MSDs in Madrid, Spain, the Fit for Work Europe Coalition has developed estimates of the effect of repeating its results across 12 EU member states where comparable data exists.
By assessing and treating 13,000 workers with MSDs after five days of sickness, the Madrid clinic succeeded in reducing temporary work absence by 39% and permanent work disability by 50%. The report explores the implications of these findings on 12 EU member states and estimates how they would affect all 28 EU member states.
Professor Steve Bevan, who is also a director at The Work Foundation continued, “If these results were repeated across the whole of the EU, we estimate that up to one million workers would be available to work each day. This would be a considerable boost to productivity and significantly reduce sick pay bills at a time when member states are under pressure to make savings and increase economic growth. Even if the reduction in absence achieved were 25% rather than 39%, we estimate that in excess of 640,000 extra workers would be available for work each day.”
The analysis, led by Professor Juan Jover, shows that if the Madrid results were repeated across Spain, where 26m working days are lost to MSDs each year, over 46,000 Spanish workers would be available for work each day instead of on sick leave. As the table below indicates, the numbers for 11 other EU member states are equally striking. For example, in Germany, the 217 million working days lost each year to MSDs could be reduced by around 480,000 (39%) if the Madrid clinic results were replicated – or by over 300,000 (if a more conservative estimate of 25% were achieved).
Purification Tejeda, a patient suffering from extreme pain from carpal tunnel syndrome, described how she benefited from the support of an early intervention clinic: “I was so scared about the impact it would have on my personal working life. I was given the right diagnosis, treatment and care very quickly and this helped to take away my unbearable pain. Thanks to this clinic, I can go back to work again. Work is so important to me. It makes me feel useful and responsible. I feel alive again.”
The full findings of the research is being presented at a summit hosted by the Fit for Work Europe Coalition taking place at the European Parliament today (16 October). It will be attended by the Lithuanian Minister for Health of the EU and international delegates from welfare and health government departments, businesses and healthcare organisations.
Table showing data from12 member states (70% of the EU workforce)
As the way patients are referred to early intervention services varies considerably between countries, this data is based on a more cautious estimate scenario of 25% instead of the 39% improvement rate achieved in the Madrid clinic. Nonetheless, the number of lost working days avoided even in this conservative estimate would still be substantial and show the significant impact that wider access to early intervention could have across the EU.
Days lost to MSDs each year
Number available to work if Madrid results replicated
Number available to work with just a 25% reduction
Notes to editors
An infographic (attached) is being launched at the 5th Fit for work Europe Summit, Investing in Healthcare: Breaking down the silos in the European Parliament, Brussels on 16 October 2013. This will be available from 14.00hrs CET on 16 October 2013 or from The Work Foundation media team in advance.
Professor Stephen Bevan, Founding President of Fit for Work Europe and a director at The Work Foundation along with Fit for Work Co-presidents, Antonyia Parvanova MEP, Dame Carol Black and Professor Paul Emery are available for interviews, comments and briefings.
Fit for Work Europe is a multi-stakeholder Coalition, driving policy and practice change across the work and health agendas. We aim to deliver more investment in sustainable healthcare by promoting and implementing early intervention practices. Research shows this approach is the most effective way of ensuring people with MSDs (musculoskeletal disorders) can enter and remain in work across the EU and globally.
Fit for Work Europe is a project led by The Work Foundation, supported by AbbVie and GE Healthcare. For more information, please visit, www.fitforworkeurope.eu
The Work Foundation aims to be the leading independent, international authority on work and its future, influencing policy and practice for the benefit of society. The Work Foundation is part of Lancaster University – an alliance that enables both organisations to further enhance their impact.
AbbVie is a global, research-based biopharmaceutical company formed in 2013 following separation from Abbott. The company’s mission is to use its expertise, dedicated people and unique approach to innovation to develop and market advanced therapies that address some of the world’s most complex and serious diseases. In 2013, AbbVie employs approximately 21,000 people worldwide and markets medicines in more than 170 countries. For further information on the company and its people, portfolio and commitments, please visit www.abbvie.co.uk.
GE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (traded as NYSE: GE) works on things that matter – great people and technologies taking on tough challenges. From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients. Please visit www3.gehealthcare.com.
On 20th of December 2012, the Latvian government approved the National Development plan for 2014-2020, featuring all the Fit for Work key recommendations on prevention and management of MSDs. As the most important medium-term planning document in Latvia, the plan will now include management of MSDs as one of its key priorities. This is the major step forward in the Fit for Work initiative and in improving the standard of care of MSD patients in Latvia.
Creating and developing the Coalition
FFW Latvia initiative was launched on 28th March 2012 with a key aim of creating a National MSD’s Management Program. The National Coalition includes Project Patron, Karlis Sadurskis – MEP; Project Leader Daiga Behmane – Health Economic Association; Project official partners – LV Rheum Association and Rheum Patient Organization; politicians, representatives of Healthcare Ministry, Welfare Ministry, National Health Department, LV Confederation of Employment, and other stakeholders.
At the first National Coalition Meeting on 18th of May 2012, three Task Force Groups – led by prominent Latvian opinion leaders – were established with the aims of including workability as a priority in the Latvian policy, and setting new standards of care for MSDs to reduce the extent of temporary and permanent incapacity.
Key Project Achievements:
– Latvian National Development Plan (NDP) 2014 – 2020 features early intervention and diagnosis, workability, medical and social rehabilitation.
– Model for diagnosing and treatment of arthritis within 16 weeks from first disease symptoms.
– Collecting data on occupational and rehabilitation programmes for MSDs across different authorities and stakeholders.
FFW Latvia plans for 2013 include development and implementation of a National Arthritis programme to tackle specifically autoimmune MSDs; programme for management of occupational diseases; development of HTA tool for MSDs via patient case study approach, and final submission of National MSD’s management program to the Ministry of Health.
Work is good for your health. Whilst this is now widely documented and accepted, it is not a concept that most workers appreciate until they are unfortunate enough to experience a period of absence from the work environment due to a musculoskeletal disease (MSD).
Sadly, in Ireland as well as mainland Europe too, a significant number of workers will face this experience. In Ireland, MSD’s are the single biggest contributor to workplace absenteeism accounting for over 7m lost days per annum and a staggering cost to the exchequer of over €750m, not to mention the lost productivity and socio-economic impact on the family. Most people want to work and these days most people need to work. Yet most are not prepared to ensure a speedy return, and sadly their employers are not equipped to facilitate their prompt and healthy return to work.
On 21 April Fit for Work Europe, the European League Against Rheumatism (EULAR) and the Hungarian Association of Rheumatologists (HAR) came together under the Hungarian Presidency of the EU and Hungarian Ministry of National Resources to hold an EU High-Level Conference the Burden of Rheumatic and Musculoskeletal Diseases (RMDs): Challenges in Work Capacity and Prevention of Disability in the EU. Representatives from 25 countries and over 50 organisations across Europe came together to discuss the impact of RMDs on the European workforce and how stakeholders work together to address the issue. (more…)
Today was a busy day for those of us keen to spread the word about MSDs at work. In London the Work Charter was launched by the Arthritis and Musculoskeletal Alliance. The Work Foundation is happy to support it as it strongly echoes messages from our own Fit for Work? Research which has looked at the factors which help or hinder full participation at work among the 6.5 million UK citizens who have MSDs. There was good coverage of the report on the BBC website.
Meanwhile, in Brussels, I was presenting the results of our EU research to a ‘special interest group’ of MEPs in the European Parliament. Also presenting was Mr. Armindo Silva Head of Unit Social Protection and Inclusion Policies, Employment and Social Affairs Directorate. He explained how the new Directive of MSDs was being drafted and consulted on. I presented some of the key findings of the Fit for Work Europe report, highlighting in particular the need to focus on early intervention. Several MEPs spoke in favour of our findings on the links between MSDs and Mental Health and expressed interest in hearing more on this topic. Finally, Mr Marios Kouloumas, Chairman of Eular-PARE – speaking on behalf of people with Rheumatic diseases – explained the importance of taking into account the patient perspective in policy-making, emphasizing that Rheumatic and inflammatory conditions are not caused by work, but can make staying at work difficult if insufficient support is available. This was a very important point because the forthcoming MSD Directive only covers MSDs which are caused by work and not, by definition, Rheumatic conditions. I find this troubling, and it remains to be seen how this serious omission is dealt with by the European Commission.
I recently spotted coverage of this research, published in The Lancet. It suggests that ‘talking therapies’ such as Cognitive Behavioural Therapy (CBT), especially in group settings, can have a positive impact on recovery from chronic low back pain.
This chimes with the findings of our Fit for Work research which has sought to emphasise the importance of understanding the mental health issues frequently faced by people with MSDs. We found that, for some people, being diagnosed with a chronic condition can increase the risk of depression and anxiety. As a result, people at work might fear disclosing their condition to their employer. In addition, there is evidence that poor mental health can be a bigger barrier to rapid and successful return to work than the physical symptoms of an MSD.
At the launch of our European report in September 2009, Professor Jover from Spain presented data which illustrated that an early intervention for MSDs patients which included a CBT component made a significant difference to return to work rates and yielded a notable economic return. In the autumn of 2010 The Work Foundation will be publishing the results of a further study which is examining the links between chronic conditions and mental health in more detail. Watch this space!
The guidance issued by NICE on mental health in the workplace is very timely and helpful. Among other things, the material highlights the significant cost to business of condtions such as depression and anxiety, and advocates early intervention as a crucial step towards keeping people in work.
One area is, perhaps, under-emphasised and that is the relationship between mental health and chronic musculoskeletal pain CMP). Over 100m people in Europe have CMP, with over 40 percent of these remaining undiagnosed. A significant number of people with MSDs also develop mental health problems – indeed this can inhibit return to work long after physical pain has abated.
On Tuesday, Dame Carol Black and I participated in a Roundtable event in the House of Commons – the seat of the British Government. This was a well attended, lively event and I was given the opportunity to make the following speech about the Fit for Work programme:
“For last 18 months The Work Foundation has been conducting research across 23 countries examining the impact of MSDs – including Inflammatory Diseases – on labour market participation. Rheumatoid Arthritis (RA) was one of the conditions we examined in detail because we know that levels of work disability and withdrawal from the labour market are high among people with RA – up to 40% within 5 years of diagnosis.
We’ve been looking at the direct and indirect costs of sickness absence from work and of permanent work incapacity attributable to RA. We have also looked at the interventions which Governments, clinicians and employers can take which can keep people with RA attached to the labour market and help them lead fulfilling working lives and make their contribution to a productive economy.
We launched our report in Brussels two weeks ago and we are trying to influence both National Governments and the European Commission to support steps which maximise the Labour Market participation of people with RA. We are doing some of this Advocacy work in collaboration with EULAR.
A key issue (one of many) is that current employment legislation in EU does not recognise MSDs which are not caused by work. Manual handling (CLBP) and Display screen equipment (WRULDs) are in scope – but the duty of care to support those with pre-existing conditions – such as RA – where poor working conditions can make these conditions worse, is currently out of scope.
Good Work is good for health: this includes control over tasks, control over pace & time; manageable physical work demands & an ergonomically suitable working environment; flexibility of working time.
We must reverse the focus of policy & practice from Incapacity to Capacity – the UK ‘fit note’ idea is intended to reinforce this message.
People with MSDs – including RA – can also experience periods of depression or anxiety which can complicate the process of returning to work. Policy-makers, clinicians & employers need to build this into the way they manage job retention & return to work (RTW).
Up to 30% of people with RA avoid disclosing their condition to their employer or colleagues – part of the self-stigma experienced by many.
Early Interventions can be critical, for example:
Accurate & early diagnosis
Early access to treatments and therapies – especially if early symptoms can be arrested and remission achieved
NAO data shows that early treatment brings economic & productivity benefits
TWF shows that early intervention can prolong careers and delay premature withdrawal from the labour market and that there is an economic ‘premium’ to early intervention.
There is considerable political focus on incapacity in the UK at the moment, especially as we are seeking to reduce public expenditure. However, as long as the debate has a punitive tone and is dominated by speeches and newspaper articles which focus on getting the feckless & ‘workshy’ off benefits and back into work, we are going to struggle to address the far more serious issue of how we avoid people with long-term and chronic health conditions becoming detached from the labour market until way after this recession is over.
During the Fit for Work study I’ve met hundreds of people with RA and other inflammatory conditions. None have been feckless or ‘workshy’. Most have been energetic, passionate, proud, determined, analytical, resourceful and dignified. I have been privileged & humbled to work with them & I am all too aware of the talent that goes to waste if people like this are lost to the world of work.”
Minister Milquet, Ladies and Gentlemen; Distinguished Members of the European Parliament; Mrs Parvanova, Mrs. de la Mata, Mr Hutton, Distinguished Guests, welcome to this reception, which marks the launch of the Fit for Work pan-European report – a remarkable analysis of the social and economic impact of musculoskeletal disorders (or MSD’s) in Europe. (more…)
Policymakers, employers, health professionals, and patients must act collectively to ensure
continued active participation in work and society and a high quality of (working) life. These are
the preconditions for both physical and mental health, fulfilment, prosperity and social cohesion.
[18.30 Tom Ling] An excellent final session that demonstrated, once and for all, the case for action on MSDs at a European and National level. Now our task is to work together to find those concrete actions that will move this debate along and change the way we keep people Fit for Work! (more…)
Musculoskeletal Disorders and the European Workforce: The Facts
• Over 100 million European citizens suffer from Chronic Musculoskeletal Pain (CMP) though it remains undiagnosed in up to 40 per cent of cases.
• Musculoskeletal Disorders (MSDs) account for a higher proportion of sickness absence from work than any other health condition – roughly half of all work-related disorders in EU member states. (more…)
The Fit for Work project is examining the labour market status of people with musculoskeletal disorders (MSDs) from across many countries. Last week I had the pleasure of visiting Turkey to conduct a series of interviews with eminent Turkish academics and clinicians in both Istanbul and Ankara. (more…)
I am pleased to say that the first of the Fit for Work national reports has been successfully launched in Ireland on 7th May; we had a fantastic response from all that attended the event as well as getting interest from a number of media outlets on the cost of sick days caused by musculoskeletal disorders. Denmark also launched on the 12th and it was great to see some excellent national television coverage there and a high level of engagement from key opinion leaders. (more…)
At the annual meeting of the European League Against Rheumatism (EULAR), The Work Foundation are hosting a satellite symposium at which we will be discussing the importance of early intervention and appropriate treatment for those with musculoskeletal disorders, focusing on the importance of work when treating rheumatoid arthritis patients. This meeting is being chaired by Professor Ronald van Vollenhoven… a copy of the programme, detailing our distinguished panel can be found here.
The session takes place on Friday, 12 June, 17.30 – 19.00 in Auditorium 1, Bella Centre, Copenhagen. We look forward to seeing you there!
The Fit for Work initiative is a terrific way to influence labour and social welfare policies in the studied countries as the initiative will begin to present evidence for the benefits of early intervention in the workplace. Staff, employers and policy makers can easily identify the real benefits these improvements could make.
I know from even a quick review of the emerging evidence that there is a powerful case to be made for seeing the workplace as a site for activities and interventions to support healthy working lives. For both staff and employers we can see how these opportunities for such benefits will lead to health gains outside of work and productivity gains within it. (more…)
The Fit for Work Europe Coalition works to promote a multi-stakeholder dialogue on musculoskeletal disorders to drive clinical practice and health and work policy that will improve the quality of working life for people with MSDs. Fit for Work is a partnership of organizations and individuals, and enjoys the patronage of The Work Foundation, the Bone and Joint Decade, EULAR and RAND Europe, and a broad range of stakeholders. The Fit for Work Europe Coalition is supported by an ongoing grant from Abbott--a founding partner--and a supporting grant from GE Healthcare. Secretariat support is provided by Weber Shandwick.