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Fit For Work EuropeThe Work Foundation

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Archive for the ‘Health Economics’ Category

Fit for Work Europe Preparing for the Latvian Presidency of the EU Council

Tuesday, July 22nd, 2014

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

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.

>> Take a look at our Position Paper for the Latvian Presidency of the EU Council.

>> Daiga Behmane spoke at the Fit for Work 2013 Summit in October. You may check her presentation here.

>> Follow us on Twitter @FfWEurope  @StephenBevan

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Posted in Europe, Health Economics, Health Policy, Labour policy, Musculoskeletal Disorders, Policy | 1 Comment »
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Ageing, Health and Work: The Need for True Grit

Wednesday, June 4th, 2014


Prof Stephen Bevan, Founding President of Fit for Work Europe

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.

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Posted in Early Intervention, Europe, Health Economics, Health Policy, Musculoskeletal Disorders | Comments Off on Ageing, Health and Work: The Need for True Grit
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Making the economic case for Early Intervention with MSDs

Tuesday, May 20th, 2014

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

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.

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Posted in Early Intervention, Europe, Health Economics, Musculoskeletal Disorders | Comments Off on Making the economic case for Early Intervention with MSDs
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Early Intervention is a cost-effective solution to reduce the burden of MSDs

Wednesday, April 23rd, 2014

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.

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New study reveals intervention that could significantly reduce impact of one million EU workers needlessly off sick each day

Wednesday, October 16th, 2013

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 from 12 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.   


Country Days lost to MSDs each year Number available to work if Madrid results replicated Number available to work with just a 25% reduction
Germany 217m 479,973 307,675
UK 35m 62,045 39,773
Spain 26m 46,091 29,545
Poland 21.7m 38,538 24,704
France 13.4m 23,724 15,208
Austria 7.7m 13,650   8,750
Ireland 7m 12,409   7,955
Finland 5.15m  9,142   5,860
Romania 3.15m  5,594   3,586
Slovenia 2.47m  4,379   2,807
Greece 1.2m  2,472   1,584
Estonia 1.02m  1,815   1,164
TOTAL 340.79m  699,832 448,610

Notes to editors

  1. 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.
  2. 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.
  3. 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.
  4. 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
  5. 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.
  6. 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.
  7. 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.


Media enquiries:

Ioana Piscociu +44 20 7976 3526  ipiscociu@theworkfoundation.com


Angelo Evangelou +44 207 976 3597  aevangelou@theworkfoundation.com

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Work as a Clinical Outcome: Fit for Work Presentation at Seoul HTA Conference

Tuesday, June 18th, 2013

Today (18 June) in Seoul, South Korea, I presented some of our Fit for Work research at the annual conference of Health Technology Assessment International (HTAi) – one of the largest gatherings of health economists in the world; the presentations of which are available to download. Our session had the title:

How Health Technology Assessments can consider Labour Market Participation and Work Productivity as a Clinical Outcome: Comparative case studies of international practice.

Dr Marieke Krol

The number of individuals of working age living with at least one chronic condition is increasing due to the effects of population ageing, poor lifestyle choices and later retirement. Most individuals with long-term conditions want to work, but many are denied this opportunity because some employers and healthcare professionals fail to recognise that being in good quality work can aid condition management and rehabilitation, ultimately reducing the economic burden on the state, employers and households. Yet, in many countries the HTA regimes do not take into account labour market outcomes when assessing the cost-effectiveness of interventions.

During the last year, the Fit for Work Europe Coalition has brought together experts from across the globe to explore evidence for the inclusion of a wider societal perspective in healthcare decision-making. Despite methodological issues, evidence suggests that macro cross-governmental decisions between healthcare, labour, and welfare departments could apply HTA as a way of counteracting the effects of ageing and rise in disability on labour market participation and work productivity. Our eight case studies found that the scope of HTA agencies, and the incentives to adopt the results of HTA differ between countries, which limits the ability of HTA to consider a wide range of investments (such as new treatments and devices), as well as the implementation of  recommendations informed by HTA. The panel compared the use of societal and payer perspectives in health decision-making internationally, and provided practical recommendations for health economists and policymakers.

Dr Rupendra ShresthaThe session was chaired by Dr Chris Henshall an associate professor of the health economics research group at Brunel University and visiting fellow at the centre for health economics at the University of York. As well as myself, we were joined by Dr Marieke Krol of the institute for medical technology assessment at the Erasmus University in the Netherlands and Dr Rupendra Shrestra who is a research fellow of the NHMRC clinical trials centre at the Sydney Medical School at The University of Sydney in Australia.

The consensus of the presentations and the panel discussion was that work productivity data could enhance healthcare decision-making in many cases, especially where people of working age ran a high risk of leaving the labour market as a result of their health. Dr Shrestra presented data from Australia which showed that 58% of men between the ages of 45-64 years who leave the labour market, do so because of a health condition. Dr Krol suggested that, from her analysis, if work productivity were included routinely in health economic assessments of medical interventions, approximately 30% of decisions to deny access on cost-utility grounds would be overturned.

The panel agreed that, while more work was needed to reach consensus on the methods used to calculate productivity costs, the demographic shifts in the workforce and the need to extend healthy working lives provided compelling impetus for more proactive use of healthcare interventions to help more people with chronic conditions to remain in, or return to, work.

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Is chasing GDP growth the only way to prosperity?

Friday, April 12th, 2013

Like it or not, Gross Domestic Product – GDP – has become one of the most important statistics of the modern age, the data of which is regularly argued over by politicians and economists. The anxious wait each quarter for the latest estimate of GDP from the Office of National Statistics (ONS) reminds me of the way the Faithful waited to see the white smoke emerge from the Vatican chimney during the election of Pope Francis last month.

Economists like Jonathan Portes of the National Institute for Social and Economic Research (NIESR) must be getting weary of warning us all not to read much into one set of figures and to take a longer view. But we all know that the next set of figures will tell us if we are in a ‘triple dip’ recession or not, so most journalists will probably ignore Mr Portes’ sage advice and will use the data to either hail recovery, or condemn further decline…

Beyond this GDP frenzy, however, a growing number of thoughtful people are asking whether this singular focus on GDP is getting us anywhere. Indeed, some are arguing that it can be doing real, long-term damage. Yesterday, I was among speakers at a seminar organised by the ALDE political grouping in the European Parliament debating this issue, and how we navigate the tension between ‘Qualitative development and Quantitative growth’. Organised and chaired by Sir Graham Watson, MEP and Dr Antonya Parvanova MEP, (Co-President of The Work Foundation’s Fit for Work Europe Coalition, by the way), the event attracted speakers from the European Commission, WHO Europe, academia and prominent NGOs.

The debate went beyond the ‘happiness’ or subjective wellbeing movement which has been a feature of recent initiatives in the USA, UK and France (not forgetting the redoubtable in Bhutan, which has gone further than any of them). Instead, we discussed how citizens, policy makers and opinion leaders might better use the emerging evidence base to improve quality of life and inequality, move away from silo-budgeting and explore social return on investment models. Speakers pointed out the dangers of a dash to increase consumption as a way of kick-starting growth, especially if this consumption led to negative consequences for public health, inequality or social cohesion which – in the long-run –is more expensive to society.

My own presentation focused on three challenges in the EU labour market:
•    The often non-economic scarring effect of youth unemployment, drawing on the work of colleagues at The Work Foundation who have looked at international experiences of managing youth unemployment.
•    The decline in job quality or ‘Good Work’ in recent years and how this may affect employee engagement, productivity and wellbeing.
•    The growing burden of chronic illness in the EU’s working age population and how, if ignored, it could be a major impediment to competitiveness, social inclusion and the reduction of social inequality.

Overall, the event concluded that chasing GDP growth alone was a fool’s errand and that more cutting-edge thinking was needed to find practical alternatives which can act as a ‘corrective’ to some of the perverse incentives inherent in the current system.

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Complex calculations: How can work be included in health care investment decisions?

Friday, June 22nd, 2012

Over the last few years the Fit for Work Europe Coalition has been advocating the inclusion of ‘work’ of Health Technology Assessment (HTA) and other health economic evaluations – you may remember our discussion paper from 2011, authored by Steve Bevan and Leela Barham. But when it comes to ‘work’, what do we actually mean? Helping people return to the labour market, and contributing to measures of productivity, has always been a few focus of ours. It is important to remember, however, that work can include formal and paid, as well as informal and unpaid. Plus, we know from our research that work can also contribute to positive health outcomes.

Given that helping people return to work is not only good for health, but can also contribute positively to economic wellbeing, how can we include it in health investment decisions? This is a complex area. Currently, we need to address the ‘unreality of economic theory’ – helping develop practical guidance on how to operationalise including work, as well as a wider societal perspective, in HTA and other health economic evaluations. There is broad agreement that a wider societal perspective should be included when making investment decisions, from the macro (financial allocations to different Government departments) to micro level (financial allocations to individual services, drugs and devices), but exactly how is another matter…

Another complicated challenge for including work in those decisions, which we need to better understand, is the ‘operational costs’. If a service, drug or device is deemed to be cost effective, partly because of its wider societal benefits, then it is worth investing in, right? But, where in the budget does the money come from to pay for this? What resources may fall out of the budget to accommodate for the new intervention? And how much money will that loss cost?

Needless to say, answers to these questions, and many more, will not be found quickly. But in 2012 we are working to move this debate forward, and inform decision-makers about inclusion of work and a wider societal perspective in their investment decisions. Later this year we will be releasing our latest insights and position on the matter, utilising some of our expert supporters to help ensure work & health together are moving towards to the top of the decision-maker’s agenda.

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Fit for Work – Timing is Everything!

Thursday, April 19th, 2012

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.


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Fit for Work Europe Annual Conference – don’t miss out!

Thursday, October 13th, 2011

FfW Conference 2011 Reminder

Posted in Europe, Health Economics, Health Policy, Labour policy, Musculoskeletal Disorders, Policy | Comments Off on Fit for Work Europe Annual Conference – don’t miss out!
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FfW Conference 2011 Agenda

Monday, September 19th, 2011

Fit for Work Europe – Annual Conference – 19 October 2011 Event Agenda

Posted in Europe, Health Economics, Health Policy, Labour policy, Musculoskeletal Disorders, Policy | Comments Off on FfW Conference 2011 Agenda
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