As The Work Foundation’s research has demonstrated, the health of the working age population across the EU is likely to represent a major economic and social burden over the next 20-30 years. In a context in which chronic conditions are imposing an increasingly significant burden on our healthcare systems, and where only 3 per cent of EU health spending is allocated to prevention, new approaches throughout the continuum of care (from early prevention to recovery) are urgently required.
Last week The Work Foundation, through our Fit for Work initiative, hosted a major conference to showcase innovative approaches from across the EU to maximising ‘workability’ among people with chronic illness. The conference – Healthcare Solutions to Improve Workability – was endorsed by the Latvian Presidency of the Council of the European Union and Riga Stradins University and we were delighted to welcome Dr Guntis Belēvičs, Minister of Health and Mr Uldis Augulis, Minister of Welfare who opened the event.
We heard contributions from Poland, Spain, Latvia, Germany and Austria, together with presentations from both the OECD and WHO Europe.
In addition, at a meeting of national representatives of Fit for Work Coalitions from across Europe, we had presentations from The Netherlands, Estonia, Finland, Czech Republic, Belgium and the USA. We also launched a new paper looking at the economic benefits of early healthcare interventions which help people with MSDs to stay in work. This paper shows that early, work-focused interventions can reduce sick leave and lost work productivity among workers with MSDs by more than 50 per cent, reduce healthcare costs by up to two-thirds, reduce disability benefits costs by up to 80 per cent, reduce the risk of permanent work disability and job loss by up to 50 percent, reduce the risk of developing a co-morbid mental illness and deliver societal benefits by supporting people with work-limiting chronic conditions to optimise their functional capacity and maintain economic independence.
The debate in Latvia focused very much on the practical steps we need to take to convince policymakers, clinicians and employers to re-double their efforts to prioritise early return to work for people with chronic health problems through earlier intervention and through vocational rehabilitation support.
“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.
On 1st January 2015 the Latvian Government assumes the Presidency of the EU Council. It does so at a crucial time, with economic recovery painfully slow and unevenly distributed among EU Member States, and with jobs (especially for the young) and productivity all high on the agenda. In addition, the new Commission will still be very new and only just beginning to establish its core priorities. This places the Latvian Presidency in a potentially very interesting position and, last week, I spent two days in the beautiful capital city of Riga meeting members of our Latvian Fit for Work Coalition and Health Ministers in the Latvian Health Ministry to discuss ways in which Fit for Work Europe can play an active part in shaping the priorities and content of the Latvian Presidency.
Daiga Behmane – Project Lead, Fit for Work Latvia
My visit was hosted by Daiga Behmane, Project Leader of the Latvian Fit for Work Coalition, President of the Latvian Association of Health Economics and lecturer at Riga Stradins University. Daiga brings considerable experience and insight to the work of the Coalition and is well-placed to bring the Fit for Work messages alive to stakeholder in Latvia about early intervention, the need to prioritise health as a clinical outcome and the need to regard health spending which leads to improved workability as an investment rather than a cost. These were some of the messages which Daiga and I took to the Deputy Under-Secretary of State for Health, Egita Pole, and some of her senior officials. We discussed whether some of these principles might be reflected in the priorities of the Latvian Presidency as well as our plans to run a high level event on chronic conditions and work – featuring MSDs – as part of the Presidency programme.
In other meetings I enjoyed an excellent discussion with Prof Daina Andersone of Pauls Stradins Clinical University Hospital, a very eminent Latvian rheumatologist who has strong views about the need to treat young people with inflammatory MSDs as early as possible to help them manage their conditions and successfully move from education to employment. I also met with Dr Jelena Reste. Jelena is an Occupational Physician at Riga Stradins University and a member of the Latvian FfW Coalition. She has been conducting research on MSDs in Latvia and has access to some useful data and research on the prevalence of MSDs in Latvia’s working age population. She and her colleagues have been doing some excellent research on workplace interventions as well as a project on the cost-effectiveness of self-management initiatives.
The challenge for Latvia is that state spending on healthcare has recently fallen below 3 per cent of GDP – a low figure compared with many other countries. This makes it more difficult to make persuasive arguments that investing in workforce health in the short-term will bring wider economic and social benefits in the medium-term. Despite this, the Fit for Work Coalition in Latvia is well-positioned and well-respected and we hope that the weight of evidence and good examples from both within and outside Latvia will help show that prevention – especially in the case of workforce health – is better than cure. For more details on our recommendations for the health and work officials in Latvia you might want to take a look at our evidence-based report.
Response from The Work Foundation and the Fit for Work Europe Coalition
The Work Foundation, part of Lancaster University, is an applied research and policy think tank which specialises on the health of the working age population. The Fit for Work Europe Coalition has, since 2009, been conducting research on the impact of musculoskeletal disorders (MSDs) of the health and productivity of workers across all EU Member States.
In response to the Strategic Framework, Prof Stephen Bevan, Director of the Centre for Workforce Effectiveness at The Work Foundation and Founding President of Fit for Work Europe, said:
1. We welcome the strategic framework as it recognises that workplace health and safety are critical areas to sustained economic recovery, especially as the workforce ages and as increasing labour productivity becomes a strategic priority.
2. We are concerned that the strategic framework places little emphasis on a number of workforce health issues which have a significant impact both on workers and on the businesses where they work. For example, it is clear from our own research that EU workforce health and safety cannot merely focus on the workplace causes of ill-health among workers. Pre-existing conditions which are exacerbated by work, or co-morbid health conditions where non-work factors are important and lead to workplace consequences (i.e. lost productivity, presenteeism) must also be given priority, as should the wider psychological climate of workplaces.
3. We are increasingly convinced that joined-up efforts to promote workforce health are required. We feel that the strategic framework should reflect the need for cross-silo investment in workforce health across government at national level and at EC level. We are concerned that, with austerity policies, there has been a more narrow focus on initiatives which are low cost, low risk and which do not prioritise early intervention or prevention. In addition, EU-OSH should be focusing more on coordinating efforts in national health systems to prioritise work as a clinical outcome of treatment among people of working age. Unless the expertise of OH professionals is included more prominently in the way workers with health condition receive access to health treatments which support job retention and return to work, our experience tells us that ‘work ability’ will not be given sufficient priority.
4. The strategic framework should also focus on providing more practical support for employers to make workplace adaptations & to focus on job retention among employees with long-term or chronic conditions. Dissemination of national examples of early interventions which deliver good workplace, clinical and economic results Highlighting case studies of cross-agency working at national level where employers, health systems and welfare interventions combine to promote job retention and return to work for more workers whose jobs are at risk. We would like to see existing legislation on workplace accommodations for people with MSDS, for example, focus on early intervention, and recognise the effect on work ability of pre-existing and comorbid conditions which are not caused directly by work, Specific support for small and medium-sized enterprises should also be targeted.
5. We were very disappointed that the proposed MSD Directive was abandoned after several years of development work. MSDs are the leading cause of sickness absence in Europe, accounting for half of all absences and 60% of permanent work incapacity. In addition, MSDs cost up to 2% of EU GDP, i.e. around €240bn in costs to the continent each year. Our experience is that, in matters of workforce health and safety – requiring a strategic approach – social dialogue can undermine bold, visionary and forward-looking initiatives as a result of narrow, sectional positions being taken. While seeking consensus is to be encouraged, we are concerned that measures to mitigate the negative impact of foreseeable long-term, demographic and epidemiologically important health changes in the working age population in the EU will be undermined by the occasional short-term and self-interested nature of some aspects of the social dialogue process. We would like to see the strategic framework reflect this need more explicitly.
– Ends –
Notes to editors
1. Prof Stephen Bevan, Director of the Centre for Workforce Effectiveness at The Work Foundation and Founding President of Fit for Work Europe, is available for interviews, briefings and written comment.
2. The Work Foundation transforms people’s experience of work and the labour market through high quality applied research that empowers individuals and influences public policies and organisational practices.
3. Fit for Work Europe is a multi-stakeholder Coalition, driving policy and practice change across the work and health agendas in then UK and Europe. 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.
4. Fit for Work Europe submitted a response to the EU-OSHA consultation on the new EU Occupational Safety and Health Policy Framework (2014-2020), which can be read here.
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.
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.
Late last year, Fit for Work (FfW) Estonia took part in a debate to discuss how people with musculoskeletal disorders (MSDs) can be supported by policymakers to stay in and return to work to coincide with the publication of FfW Estonia.
Over a hundred people took part in a lively debate which took place in Tallin. We were pleased to see a large number of high-level policymakers involved in the debate, such as Hanno Pevkur, the Minister of Social Affairs; Andres Tsahkna, the Head of Estonian Parliament Health Board and Peeter Ross, the Head of the Estonian Health Insurance Fund.
The debate explored recent findings which reveal that chronic diseases in Estonia cost the economy 27.2 million. Over two-thirds (68.7%) of this is due to reduced working hours and absences from work.
Despite this compelling evidence, policymakers in Estonia rarely recognise how work can contribute to improved health outcomes and economic returns. So it was welcome progress when Estonian MP, Andres Tsahkna, pledged his commitment to continue a relationship with the newly established FfW Estonia Coalition to improve work outcomes for people with MSDs.
The event featured FfW Europe Coalition member Professor Ingemar Petersson and captured the expertise of rheumatologists, rehabilitation doctors, clinicians, occupational health practitioners and e-health authority representatives. It also included powerful personal testimony from those with personal experience of MSDs demonstrating how the impact of such conditions can be reduced through the right kind of support.
The resounding conclusion was that chronic conditions are presenting a massive burden on the Estonian social and healthcare systems. Barriers preventing people with MSDs from working will only be broken down through early intervention and comprehensive national plans which improve the management of chronic diseases.
As the constructive debate drew to a close, Professor Petersson concluded, “If the FfW Estonian Coalition continues working along the lines we have seen today, within a couple of years the situation for Estonian patients will be much better.”
The increasing life expectancy in Europe can be considered an achievement, reflecting the improving quality of life. However, this development also constitutes a challenge both to the governments and individuals. While the ageing population is regarded as a burden over the state finances, individual aspects of the ageing population remains largely unspoken. Recognizing the fact that the longer life expectancy does not necessarily mean a healthier life cycle, then it is crucial to stress on healthy ageing as a continuous process across the lifecycle.
Last week I chaired the 4th Annual Fit for Work Summit in Brussels. The Fit for Work programme is a 35-country study, which has been examining the burden of musculoskeletal disorders (MSDs) on the health and productivity of working age people across Europe, Australasia, North America and parts of Asia. Over 200 delegates from across the world spent two days hearing presentations from eminent clinicians, patients, policy-makers and health economists. Their message was clear: MSDs in the workforce cost the EU over 240 billion Euros each year (up to 2% of GDP) and much more can be done to prevent the loss of productivity and the risk of social exclusion which they represent.
What is the value of living longer if we are spending more of our later years suffering from chronic illness and working much longer than we ever planned? These were some of the themes explored this week at a major event in Nicosia on ‘Active and Healthy Ageing through the Lifecourse’. The so-called High Level Conference was held as part of the Cypriot Presidency of the EU and I was invited to speak on the theme of health in an ageing EU workforce.
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.
Since 2007, the Fit for Work programme has looked at the impact of MSDs on individuals’ ability to work in 30 European and beyond. Now that we have collected data from all over Europe, we are beginning to understand why some countries perform better at tackling the impact of MSDs on the economy and the society. We see strong evidence for the connection between prevalence of long-term illness, labour market indicators and the country’s economic performance. (more…)
On Friday I was proud to launch the latest Fit for Work report at the X annual Forum of Reumaliit patient group in Estonia. The Reumafoorum heard on the importance of early intervention in reducing the impact of MSDs from a variety of renowned speakers, including Dr Tõnu Peets, Head of the Estonian Society for Rheumatology, David Magnusson from The Swedish Rheumatism Association and Ain Aaviksoo from Praxis Centre of Policy Studies, who is leading on a study of the socioeconomic costs of rheumatic disease in Estonia. (more…)
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FfW Europe Co-President, Stephen Bevan, and independent health economist, Leela Barham, discuss pros and cons of taking a wider societal perspective in healthcare decision-making, and possible reasons why work and labour market participation are rarely included in the remit of Health Technology Assessment.
Steve Bevan, Founding President, Fit for Work Europe Coalition, publishes new briefing paper – ‘Fit for Work? Maximising Employment and Social Inclusion in the EU.’ The paper examines the case of workers with MSDs.
On Thursday my colleague Ksenia Zheltoukhova and I were proud to launch the latest Fit for Work report at the Economic Forum in Krynica-Zdrój in southern Poland. We hope that the findings and recommendations of our research will increase awareness and provide a foundation for action at a national level. Now that Poland has assumed the Presidency of the European Union (EU), it has a unique opportunity to lead positive changes in the way the societal burden of chronic disease and work-related health conditions are managed. The Polish Presidency will also see the publication of a new EU Directive on Musculoskeletal Disorders (MSDs) at work, which provides another opportunity to put these issues under the spotlight.
So what is the impact of MSDs in Poland and what can be done to improve the situation? (more…)
A huge highlight of our visit to Poland this week was the opportunity to meet former President of Poland Lech Wałęsa. The President very kindly wrote a Foreword to our report and has endorsed its findings. He said of our report:
‘Fit for Work is an initiative to improve the quality of life of active workers. I am glad to learn that in times of economic crisis there are people who are willing to promote new ideas, ready to and capable of fighting for a better future.’ (more…)
This week I was in Bucharest to launch the Romanian ‘Fit for Work’ report. The setting for the launch was the incredible Parliamentary Palace, second only to the Pentagon in size. It dominates the south-western part of the city and many houses, churches and a football stadium were demolished to make way for it and surrounding government buildings. (more…)
This week, the Fit for Work Europe Coalition is hosting an EU Presidency Conference together with The Hungarian Association of Rheumatologists (MRE), The Ministry of National Resources (Government of Hungary) and The European League Against Rheumatism (EULAR). The Conference will centre on the impact of Rheumatic and Musculoskeletal Diseases (RMDs) at EU and national level, as well as ensuring the EU’s Disability Strategy gives due focus to RMDs in the workplace across the EU.
You can download the agenda below for the programme: “Burden of Rheumatic and Musculoskeletal Diseases: Challenges in Work Capacity and Prevention of Disability in the EU”.
Since 2007, the Fit for Work initiative has looked at the impact of MSDs on individuals’ ability to work in 30 countries in Europe and beyond. Now that we have collected data from all over Europe, we are beginning to understand why some countries perform better at tackling the impact of MSDs on the economy and the society. We see strong evidence for the connection between prevalence of long-term illness, labour market indicators and the country’s economic performance.
Maarten de Wit, Member of the Fit for Work Europe Coalition Steering Group, presented at the European Platform for Patients’ Organisations, Science and Industry workshop on Chronic Conditions on 10 December 2010. See his presentation below:
Yesterday I took great pleasure in launching the findings of the Fit for Work Greece research in sunny Athens. I was honoured to be a keynote speaker at the 1st Pan-Hellenic Congress on Occupational Health & Safety, presenting to an audience of 1,200 people. The event was also attended by Deputy Minister for Labour Mr Giorgos Koutroumanis, whom I had the pleasure to welcome to the ‘Fit for Work’ stand at the Congress.
Sunday (10 October 2010) was World Mental Health Day, and the theme is: ‘Mental Health and Chronic Physical Illnesses: The Need for Continued and Integrated Care.’ Along these lines, our new report, Body and Soul, examines the relationship between mental and physical health, including musculoskeletal disorders, and the impact of these conditions on productivity and work participation.
Having both a physical and mental health condition is common, and the prevalence of mental health conditions is higher among those with a chronic physical health conditions, and vice versa. The relationship between mental and physical health conditions is bi-directional – meaning the physical health impacts mental health and mental health impacts physical health. Often, when individuals have both mental and physical health conditions, their health and work outcomes are worse. For example, around 25% of people with arthritis report a co-morbid mental health condition, which can increase psychological barriers to functioning and the number of days out of role.
In addition to examining the relationship between mental and physical health conditions, Body and Soul explores interventions that seek to reduce the impact these conditions have on individuals and society. This year’s World Mental Health Day calls for continued and integrated care, which Body and Soul also recommends. More effort needs to be directed to integrating care for physical and mental health.
The report also provides recommendations for employers. We know that work, particularly good work, is good for health and can aid in recovery. Therefore, providing good quality jobs that offer flexibility, autonomy and control, can mitigate the effects of health conditions – mental and physical – on individuals, employers and society. Work provides a sense of normalcy, which is illustrated by the following quote highlighted in the report:
‘I felt that one thing that would really help was if I could keep on doing the stuff I did before as much as possible so my life wouldn’t be limited by the condition.’
Our report calls for stakeholders to improve recognition between physical and mental health and to identify, design and provide effective interventions that address both physical and mental health in the health care setting, as well as the workplace setting. In the coming years, the prevalence of mental and chronic physical health conditions is set to increase, which means that employers and health professionals will have to do more to reduce the impact of these conditions on the working age population. Already in the UK, one in six working-age individuals have a common mental health condition, and the costs of mental health conditions in England exceed £105 billion. Mental health and associated co-morbid physical health conditions remain an important issue for individuals, families, colleagues, line managers, health professionals and policy makers.
Tomorrow – for the second time – we will gather here in Brussels for the annual Fit for Work conference. I am delighted to be invited to co-host the conference this year, and will be joined by my fellow colleagues from the European Commission, the Council and partners from NGOs and the private sector.
I am an advocate for evolving societal and governmental thinking to develop effective European policies on public health, backed by evidence-based research. Fit for Work is a prime example for this! I am delighted to see the increased number of advocates for this innovative initiative, and hope many of you will join us in a few days. (more…)
This week, on 30 September, I look forward to participating in a unique meeting in Brussels. Gathered in one room will be leading politicians, patient groups and health professionals from across the EU. They are coming together to launch a unique coalition to call upon European and national policy makers to develop national plans for improving the working lives of those living with MSDs.
The annual Fit For Work Europe conference and the launch of the Fit for Work Europe Coalition promises to be an milestone development in the prioritisation of MSDs, with, we hope, implications and outcomes extending far beyond the Brussels arena, into national policymaking across the continent.
I am particularly delighted to be part of this Coalition, coming to it with the experience of our UK pilot of the national ‘Fit Note’ programme.
Creation of the Fit Note scheme in the UK, designed to help people to stay in or return to work more quickly whatever their illness, was, we believe, an innovative measure to help reduce the staggering cost of £100bn imposed on our economy by ill health – and MSDs are the second leading cause of missed work after mental health.
I am aware that my European colleagues across the EU face similar challenges and economic pressures, and I am looking forward to sharing our experiences with them at the Summit.
In the current economic climate, the challenges to health and work budgets , stretched by the growing number of people who stay out of work due to health problems represent a significant threat for national economies.
The annual Fit for Work conference will create an ideal opportunity to come together to formulate real, practical solutions to help national health systems drive changes in the policies and mobilise governments to take action. Specifically: to make more Europeans, Fit for Work.
The launch today of the Spanish Fit for Work report coincided with the announcement of the latest Spanish unemployment figures. They make grim reading, as predicted in our report, they passed the 20 per cent threshold which now means Spain has a level of joblessness exactly twice the EU average. What is worse, youth unemployment is close to 40 per cent, again the worst in Europe. On of the core Fit for Work messages has been that we need to avoid people with long-term or chronic health conditions becoming the first victims of a depressed labour, yet that is what seems to be happening both in Spain and elsewhere. (more…)
The launch today of the Spanish Fit for Work report coincided with the announcement of the latest Spanish unemployment figures. They make grim reading, as predicted in our report, they passed the 20 per cent threshold which now means Spain has a level of joblessness exactly twice the EU average. What is worse, youth unemployment is close to 40 per cent, again the worst in Europe. On of the core Fit for Work messages has been that we need to avoid people with long-term or chronic health conditions becoming the first victims of a depressed labour, yet that is what seems to be happening both in Spain and elsewhere. (more…)
Wow! What a trip. Last Wednesday, I went to Stockholm to present the pan-European Fit for Work report at the 1st Baltic & North Sea Conference on Physical and Rehabilitation Medicine. I was scheduled to return Thursday afternoon, but needless to say the volcano disrupted my return travel plans.
I presented the findings to the conference attendees before I learned about the volcano. The presentation focused on interventions available to facilitate retention and return to work, such as early identification, multidisciplinary and cognitive behavioural team-based approaches, targeted and tailored interventions, work-style interventions and reintegration approaches. The biopsychosocial and International Classification of Functioning, Disability and Health models underlined many of the approaches used in these interventions.
Britt Arrelöv (Sweden) chaired a panel discussion around the topics I presented. On the panel were Andrew Frank (United Kingdom), Jan Ekholm (Sweden), and Christoph Gutenbrunner (Germany), and I. One of the key questions to the panel was the definition of early. Early varies by condition and type of intervention but is very important to consider. For instance, most cases of back pain resolve themselves within four to six weeks, so once the case goes beyond this time period, it is time to begin implementing interventions to facilitate recovery and reduce the likelihood of prolonged absence. However, for other conditions such as rheumatoid arthritis or ankylosing spondylitis, outcomes are often better the earlier individuals receive appropriate treatment.
Other points of discussion reflected on the role of rehabilitation medicine and the role of good work, as well as the importance of individual motivation and the psychosocial factors related to recovery. All in all, the discussion was very interesting and well received.
A few hours after the presentation, I learned about the volcanic eruption delaying my flight back to the UK. I thought I might be delayed for a day at the most, but seven days later I finally returned to the UK. We now know a variety of ways to travel from Stockholm to London ranging from driving, taking a train, riding a ferry to a combination of all three! Thankfully, I was able to board one of the first flights back into London and that Stockholm is a nice place to be stuck for an unexpected visit.
Today I attended the first full meeting of the RMSD Interest Group in the European Parliament in Brussels. This group, initiated by EULAR, and chaired by Mrs Edite Estrela MEP (Portugal) was launched on World Arthritis Day in October this year. One of its aims is to raise the profile of Rheumatic conditions and MSDs in the Parliament and in the Commission and to help position EULAR as the authoritative source of clinical and patient voice.
The Group has a number of MEPs as members, including Jim Higgins (Ireland), Antoniya Parvanova (Bulgaria) and Marije Cornelissen (Netherlands). Senior figures from EULAR and EULAR-PARE represented included Professor Paul Emery, Professor Josef Smolen and Neil Betteridge.
The Group was addressed by Dr Gigorij Kogan, Scientific Officer from DG Research and a specialist in chronic disease. He described some of the research into rheumatic diseases and MSDs which the EU had funded during recent years and explained how research priorities were decided. The Group discussed whether rheumatic and musculoskeletal diseases were receiving enough priority given their prevalence and their economic and social impact.
The next meeting of the Group will be in March 2010 when the topic for discussion will be ‘Work’. The Fit for Work programme has been asked to provide input to this meeting and we will be working with EULAR to ensure that the content is both informative and provocative!
My colleague Tatiana Quadrello just attended the launch of the Working Joints and Muscles Toolkit in London. She advised on the document, which provides practical guidance in promoting musculoskeletal health in companies as part of an integrated health and wellbeing programme. Click here to follow the link to the BITC website and download the report.
I attended a lunchtime Roundtable event yesterday organised by the European Policy Centre here in Brussels. The speaker was Dr Martin Terberger, Head of Unit for Pharmaceuticals at DG Enterprise and Industry. While the focus of the discussion was the so-called ‘Pharma Package’ a set of EU proposals to deliver safe, innovative and accessible medicines, I was able to ask Dr Terberger a question about the impact which differences in Health Technology Assessment (HTA) helped or hindered accessibility, especially if one outcome was to support the labour market participation of people with long-term or chronic conditions (eg some MSDs).
He was careful to avoid using the term ‘harmonisation’ but felt that, on the science, there was more room for ‘convergence’ around the clinical evidence. He warned, however, that HTA must take care not to widen health inequalities by treating more economically ‘useful’ patients differently from, for example, elderly patients just because of differences in their productive capacity.
Fit for Work truly seems to have ‘caught a wave’. After a launch such as we just had for Fit for Work, one always wonders what the best next steps should be to keep up the momentum, and it’s fantastic when others are working towards the same goals. So I’m delighted to note that one of our patrons in the European Parliament, Mrs Edite Estrela, MEP, is helping us to do just that. She today hosted the launch of an interest group on MSDs in at the Parliament in Brussels. She notes in the invitation we saw that the “key goal of the Interest Group should be to ensure the greatest possible visibility for rheumatic (and we presume broader MSDs, since the interest group’s title covers both…) diseases on the European Parliament’s agenda and systematic consideration of the needs of professionals and patients across Europe in all relevant initiatives and legislative acts at European level.”
Equally exciting is an editorial on Fit for Work in The Lancet, available in the journal and here online.
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…)
“FIT FOR WORK” reception, 30 September 2009, speech by Jan Jařab, Member of Cabinet of Commissioner Vladimír Špidla
Honourable Members of the European Parliament, Ladies and Gentlemen,
It is my great pleasure – and honour – to forward to you the greetings of Commissioner Vladimír Špidla, and to congratulate you in his name on the valuable report which is being launched today. (more…)
Fit for Work pan-European Report Presentation and policy Workshop 30 October
Minister Milquet, Ladies and Gentlemen; Distinguished Members of the European Parliament; Mrs Estrela, Mrs Parvanova, Mr Hutton, Distinguished Guests, many thanks for inviting me to take part in this reception and briefly present to you the work of the Directorate General for Health and Consumers of the European Commission; (more…)
[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…)
Muscle and joint pain costs
European economies up to €240 billion a year
New study reveals musculoskeletal disorders (MSDs) responsible for more sick days than any other health condition
Brussels, 30 September 2009 – A new study today finds that musculoskeletal disorders (MSDs) account for nearly half (49%) of all absences from work and 60% of permanent work incapacity in the European Union. These and other socio-economic consequences of suffering from poor health due to muscle and joint pain represent an estimated cost to society in Europe of up to €240 billion. (more…)
From March through to May this year I spoke at Health, Work and Well-being’s Countrywide Events. The excellent health and well-being programmes on display at the events in the nine English regions, Scotland and Wales, really hit home to me just how far we have come with the health and work agenda in the last couple of years.
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…)
Today, as workers across Europe face uncertain futures and an ever more challenging job market it’s clear to us in Arthritis Ireland, and to the employers, Trades Unions and policymakers we speak to, that employee health has never been more important. It is important as a driver of productivity and competitiveness and a waste of money for those affected not to be in the workplace. It’s a huge mistake in the 21st century not to have these people contributing to society rather than taking.
Specifically, the Fit for Work report launched today is asking tough questions about the ways that workers with long-term and chronic conditions – especially Musculoskeletal Disorders (MSDs) – can be kept in work in a way that maximises their economic contribution and their quality of life. (more…)
Health of Ireland’s workforce is undermining our competitiveness
Musculoskeletal disorders (MSDs) cause 50% of absences from work and costs Irish economy €750 million annually yet early diagnosis and intervention could keep more Irish workers Fit For Work
DUBLIN, 7th May: Musculoskeletal disorders (MSDs), including back pain, work- related upper-limb disorder and rheumatic diseases including arthritis, are the cause of 50 percent of sick days in Ireland costing the economy an estimated €750 million each year. But early detection and intervention can reduce the burden on the Government’s health and disability budgets. The report, published by The Work Foundation based in the UK, presents evidence that work is good for your health and adopting an approach that focuses on capacity rather than incapacity is also better for the employees who suffer from any of these conditions. (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.