Fit for Work

Executive Summary

A healthy workforce means a healthy economy. Yet conventional measures to improve productivity, from investment in skills, technology and innovation to labour market deregulation, fail to take account of one of the most serious barriers to growing prosperity: poor workforce health.  Despite relative prosperity in Europe, we must face up to the fact that the European workforce may not be healthy enough to drive the improvements in productivity required to ensure that Europe can compete with the USA and China. Indeed, in a post-recession Europe, poor worker well-being may represent a serious impediment to economic growth and competitiveness.

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Having a significant proportion of Europe’s working age population either temporarily or permanently unable to work through ill-health – even in a favourable economic climate – can reduce the aggregate level of labour productivity in an economy and damage the competitiveness and effectiveness of private and public sector organisations. In depressed labour markets, there is a heightened risk that those with long-term or chronic health conditions will find themselves detached from the workplace for long periods, with little prospect of returning quickly.

Fit for Work Europe – a focus on musculoskeletal disorders (MSDs)

Over 44 million (one in six) members of the European Union (EU) workforce now have a long-standing health problem or disability that affects their ability to work, and musculoskeletal disorders(MSDs) – conditions affecting bones, joints and connective tissue – account for a higher proportion of sickness absence from work than any other health condition. Indeed, over 40 million workers in Europe are affected by MSDs attributable to their work. This report is the product of a major study – Fit for Work Europe – conducted by The Work Foundation across 27 European countries and growing (www.fitforworkeurope.eu). The study has looked in some detail at:

• the impact that MSDs have on the working lives of thousands of European workers, the adequacy of the treatment and support they receive

• their experiences in and out of work

• the effect of their condition on their family and colleagues

• the human and financial costs involved.

Specifically, we have looked at the impact of low back pain and work-related upper limb disorders (WRULDs) – two groups of conditions which are usually characterised by short but intense episodes of pain and incapacity – and rheumatoid arthritis (RA) and spondyloarthropathy (SpA), two inflammatory conditions that are often progressive and increasingly incapacitating.

We undertook a review of the recent academic and practitioner research on the relationship between these MSDs and labour market participation, and conducted interviews with over 100 acknowledged experts in this field from around Europe. The report examines the causes, effects and costs of MSDs in the European workforce and assesses what more can be done by policy makers, health care systems, social welfare regimes, clinicians, employers and by workers themselves to help alleviate the often damaging economic and social consequences of this widespread, but often hidden, problem.

Extent, causes and consequences of MSDs

The quality and quantity of data on the definition, prevalence, impact and costs of MSDs vary considerably between countries. Nonetheless, we know enough to conclude that chronic musculoskeletal pain affects 100 million people in Europe and that it is widespread in Europe’s working age population – although undiagnosed in over 40 per cent of cases. Despite the growth of stress-related illness among European workers, MSDs remain the single biggest cause of absence from work. It is estimated that up to 2 per cent of European gross domestic product (GDP) is accounted for by the direct costs of MSDs each year.

Of the four categories of MSDs that the Fit for Work research concentrates on both WRULDs and low back pain affect large numbers of workers and are frequently caused by work – either through physical strain, repetitive movement or poor posture. The second two, RA and SpA, while affecting smaller numbers of workers, are not caused by work, but can be made worse by work. However, work can be both a cause, or aggravator, and a cure.  In all cases there is clear evidence that well-designed work environments and flexible working arrangements can support job retention, and phased return to work and that work – especially if it is good work – can be good for health, well-being and recovery. 

Early interventions make a difference

If the negative effects of MSDs on both quality of life and work disability are to be minimised then early diagnosis and treatment can often be critical. The Fit for Work Europe study has focused on the kinds of early interventions which can make the most difference to both health and labour market participation. 

We found a number of imaginative examples of early interventions for MSDs across Europe ranging from early access to physical therapy for workers with low back pain, through to drug treatments which put those with inflammatory conditions into remission, to cognitive behavioural therapy (CBT) with persistent wrist, neck or shoulder strain. However, we also found that – in many of the countries we studied – awareness, resources and political will are not yet at a stage where coordinated and effective early intervention is currently deliverable. The consequences of this lack of readiness may be far-reaching for workers with MSDs who want or need to retain contact with the labour market.

Successful early interventions require clinicians, employers and the health care and social welfare systems to work together. This is rarely the case, even to achieve positive clinical outcomes. It is even less common to find that job retention or return to work is the goal. And yet, through our qualitative research and our exploratory econometric analysis, the

Fit for Work Europe study has found a growing body of evidence that there may be quantifiable evidence of an economic return to early interventions aimed at keeping people with MSDs in work. Indeed, we have identified that there is likely to be an early intervention ‘premium’, which is linked both to levels of sickness absence from work and to a reduction in premature exit from the labour market due to ill-health.

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Sometimes small things can make a big difference to help workers with MSD's

Resourse: Fit for Work Europe