Fit for Work?

Maximising Employment & Social Inclusion in the EU

The Case of Workers with Musculoskeletal Disorders (MSDs)

Stephen Bevan The Work Foundation & Lancaster University Founding President, Fit for Work Europe Coalition

A Fit for Work Coalition Briefing Paper October 2011

Musculoskeletal Disorders: A Barrier to Employment & Social Inclusion?

For almost five years, the Fit for Work initiative has focused on the steps needed to ensure that EU citizens of working age are supported in playing a full part in the labour market even if they have a long-term or chronic health condition or disability. We have concentrated on the very significant burden of Musculoskeletal Disorders (MSDs) because they have such an overwhelming impact on the employment and social inclusion of millions of EU workers and on the productivity of EU Member States. Our 2009 research1 highlighted, for example, that:

1. Musculoskeletal Disorders (MSDs) are the leading cause of disability and inactivity among Europes working-age population; 2. 100 million European citizens suffer from chronic musculoskeletal pain; 3. MSDs caused by work affect over 40 million EU workers; 4. MSDs account for 49 per cent of workplace absence and 60 per cent of permanent incapacity to work; 5. MSDs result in more sickness absence than any other condition even mental health, though perhaps 1 in 5 workers with an MSD also suffer from a mental health condition2; 6. MSDs represent a huge cost to European countries: the European Commission estimates at least 240 billion Euros per year; 7. MSDs have a significant effect on the quality of life and economic well-being of workers; 8. The impact of work-related incapacity caused by MSDs is felt by governments and society through increased spending on health and social security and increased risk of long-term unemployment and social exclusion.

The burden of MSDs represents a significant under-utilisation of the productive capacity of Member States and increases the risk that, during a period of high unemployment, a high proportion of these citizens will be excluded from the labour market as a result of their health. As the European Commissions Health Strategy argues:
1

Bevan, S Quadrello, T, McGee, R, Mahdon, M, Vavrovsky, A and Barham, L Fit for Work? Musculoskeletal Disorders in the European Workforce, The Work Foundation, London (September 2009)

See Ashby K and McGee R, Body and Soul: Exploring the connection between physical and mental health conditions, The Work Foundation, 2010. http://www.theworkfoundation.com/research/publications/publicationdetail.aspx?oItemId=260&parentPageI D=102&PubType= (Accessed 14 October, 2011).

Health is important for the wellbeing of individuals and society, but a healthy population is also a prerequisite for economic productivity and prosperity3. Fit for Work research4 has demonstrated that if the economic activity of that proportion of the EUs working age population which has a long-term health condition is to be maximised, it will be important that national healthcare systems, welfare systems and employment policy support early interventions, job retention and return to work initiatives. Yet, in most member states, it is rare to find social policy, active labour market policy and health policy working coherently to support and maximise labour market participation among people with health conditions or disabilities. A growing body of evidence suggests that targeted investment in policies to promote job retention and return to work can be both cost effective and contribute to wider social inclusion goals.5

MSDs in the EU Is the Picture Improving?

The Third Annual Fit for Work Summit, held in Brussels in October 2011, is a timely landmark as it allows us to assess the latest data on MSDs in Member States and to determine how national governments might respond during a period of high unemployment.

MSDs are still having a significant impact of quality of life and labour market participation:

MSDs account for 3.2 per cent of Disability Adjusted Life Years (DALYs) lost among men across the EU-27 and 5.5 percent of DALYs lost among women; Rheumatoid Arthritis accounts for 0.84 per cent of DALYs lost across the EU; Over 25 per cent of the EU working population report work-related backache.

MSD Prevalence and Costs in EU Member States

Our national reports have highlighted the significant and continuing burden of MSDs across the whole of the European Union. For full details and for all of the completed National Reports, visit the Fit for Work Europe website.

Together for Health: A Strategic Approach for the EU 2008-2013, Brussels, 23.10.2007, COM(2007), http://ec.europa.eu/health-eu/doc/whitepaper_en.pdf (accessed 8 October 2011) 4 Bevan, S Quadrello, T, McGee, R, Mahdon, M, Vavrovsky, A and Barham, L Fit for Work? Musculoskeletal Disorders in the European Workforce, The Work Foundation, London (September 2009) http://www.fitforworkeurope.eu/Default.aspx.LocID-0afnew009.RefLocID-0af002.Lang-EN.htm 5 Bevan S, The Business Case for Employee Health and Well-being, Investors in People UK, 2010

Some National examples of the prevalence and costs of MSDs in the working age population are set out in Table 1, below. Table 1 Prevalence & Costs of MSDs in the Workforce: Selected Examples

Netherlands The estimated cost of work-related repetitive strain injury (RSI) is 2.1billion each year. Of this, 808 million is attributed to productivity losses Sweden The total cost of back and neck disorders to health services (including costs for the relatively few who receive surgery) is about 7 per cent of the total cost of health services. Estonia In 2008 almost 6.4 million work days in Estonia were compensated due to temporary incapacity caused by illness, of which MSDs are estimated to account for 16 per cent. Different estimations suggest that sickness absence costs the Estonian economy between 6 and 15 per cent of GDP Belgium The direct and indirect costs of absence in Belgium rose from 8.2 billion Euros in 2006 to 10.35 billion Euros in 2008. Over 40 per cent of days lost to sickness absence are attributable to musculoskeletal problems Denmark Musculoskeletal disorders (MSDs) constitute 25 per cent of the long-term sick-listed people in Denmark. Over 700,000 adults in Denmark report having a long-standing musculoskeletal disorder and almost 18 per cent of all family doctor consultations for men aged 18-39 relate to MSDs. The direct costs of MSDs to Danish society have been estimated to be DKK 25bn. Finland MSDs are the most commonly reported cause of work-related ill health in Finland. accounting for 33 per cent of all episodes of sickness absence from work. As many as 67 per cent of all Finnish workers were affected by an MSD in 2006. The direct cost of work related MSDs in Finland is estimated to be at least 222 million euros. France Nearly a fifth of French workers experience muscular pain in their neck, shoulders and upper limbs. These Work-related Upper Limb Disorders (WRULDs) are the first cause of occupational illness in France, and their prevalence increases with the increasing age of the workforce, and among blue collar workers. More than 7 million days of work in France are lost annually through MSDs, causing a cost to society of more than 736 million euros. Greece MSDs are the biggest single cause of absence from work, accounting for over 22 per cent of total sick leave and 24 per cent of total work days lost in Greece each year. Back pain affects up to 33 per cent of the Greek population with 19 per cent of the workforce experiencing absence from work of over 4 days as a result. Over 45 per cent of Greek workers also report muscular pain in their neck, shoulders and upper limbs.

Spain Nearly 2 million Spanish workers experience some work-related diseases or illness, the most common being musculoskeletal and mental diseases. Over 10 million primary care consultations a year are due to MSDs. In 2007, over 39 million days of work were lost due to MSDs. MSDs cost Spanish society nearly 1.7 billions or 83 euros a year for each employed person. Ireland 14 million working days are lost each year due to ill health in the Irish workforce. Total cost is at least 1.5 billion. Half of these lost days are attributable to MSDs twice the number caused by mental health or stress Germany On an individual-level, diseases of the musculoskeletal system cost 320 euros per inhabitant per year. The costs included in the estimate are for the prevention, treatment, rehabilitation and care of the diseases

These headlines tell us that there is a consistent message: Across the EU, MSDs continue to represent a major factor influencing quality of life, labour market participation, productivity, health status and social inclusion.

Latest EU Data on Working Conditions, Health and Absence from Work

The European Working Conditions Survey6 (EWCS) is a major source of pan-EU data on the workforce in each member state. The latest data are now available and they provide a useful picture of the working conditions and health of workers across the EU. Here are some of the headlines: MSDs: Exposure to Workplace Risks Compared to the results of the EWCS 2000 survey, EU workers in 2010 are more likely to be working in jobs involving repetitive hand or arm movements (33 per cent in 2010 compared with 30 per cent in 2000); This increase was larger among lowskilled manual workers (49.7 per cent in 2010 compared with 46 per cent in 2000); Across the EU, 22.5 per cent of workers are exposed to vibrations from tools and machinery in their jobs. The percentage of highly-skilled manual workers exposed has increased from 59.9 per cent in 2000 to 62.1 per cent in 2010; Over 33 per cent of EU workers carry out work which involves carrying or moving heavy loads; Almost 16 per cent of EU workers conduct work which involve tiring or painful positions.
6

http://www.eurofound.europa.eu/surveys/ewcs/2010/index.htm (Accessed, 14 October, 2010)

Work, Health and Absence Among EU workers 25 per cent report that their work affects their health negatively; The proportion of EU workers who have between 1 and 15 days of through sickness each year has risen from 16.4 per cent in 2005 to 35.6 per cent in 2010; Long-term absence from work seems to be increasing. The proportion who have over 15 days of absence each year has also risen from per cent 5.9 in 2000 to 7.5 per cent in 2010; Conversely, almost 57 per cent of EU workers took no absence at all in the year prior to the survey, suggesting that 100 per cent of all sickness absence from the EU is accounted for by just over 40 per cent of the workforce; Presenteeism, or coming to work when ill, is common across the EU. Almost 40 per cent of workers report that they have worked when sick during the last year; When correlated with unemployment data across the EU (see Figure 1) there is a relationship with high unemployment and high attendance, suggesting that fear of job loss is playing at least some part in suppressing levels of sickness absence and encouraging presenteeism. Figure 1 Unemployment & Attendance at Work EU 27, 2010

Over 41 per cent of EU workers report that they are unlikely to be able to form their current job when they reach 60 years old; Among the EUs self-employed workforce, fewer than 40 per cent reported that they would be financially secure if they developed a long-term illness.

Remaining Challenges
The economic crisis that has gripped the European Union has focused the attention of both the European Commission and National Governments on a recovery which prioritises jobs and inclusion. The EU Growth Strategy Europe 2020 highlights these priorities:

We need a strategy to help us come out stronger from the crisis and turn the EU into a smart, sustainable and inclusive economy delivering high levels of employment, productivity and social cohesion7.

Indeed, two of the five targets set out as part of the strategy emphasise the need to grow the employment rate of 20-64 year olds to 75 per cent by 2020 and to have 20 million fewer people in or at risk of poverty and social exclusion, also by 2020. However, several demographic factors will determine how successfully these goals can be achieved. The ageing of the EU population, the need to work longer in order to afford a pension, and the growing burden of chronic ill-health in the working age population represent challenges both to higher employment rates and higher social inclusion.

Musculoskeletal Disorders (MSDs) will continue to account for a very high proportion of work-related incapacity for the foreseeable future. EU-wide initiatives such as the forthcoming MSD Directive, the Disability Strategy and the European Year of Active Ageing set a strategic context for action at National level. The success of Fit for Work Europe reports and national Fit for Work initiatives has highlighted that, with coordinated effort from healthcare systems, welfare systems and employment policy, progress can and is being made to fashion early interventions which maximise job retention for workers with MSDs and support those who are with without work to return to meaningful, good quality work as soon as possible.

EU Growth Strategy Europe 2020; http://ec.europa.eu/europe2020/index_en.htm (accessed 8 October 2011).