Dame Carol Black UK National Director for Health and Work

Fit for Work Coalition

EU Presidency Conference

The Burden of Rheumatic and Musculoskeletal Diseases (RMDs):

Challenges in Work Capacity and Prevention of Disability in the EU

Budapest 21 April 2011

Calls for national plans on RMD:

Best practice examples on implementation at the national level

Work, health and well-beingWhat should be our EU goal?

Healthy, engaged workforces

• High-performing, resilient workforces

• Enhanced productivity

Contributing to:

• Well-functioning societies

• Better economic performance in all member states

Well-managed organisations

Work is generally good for Health

Waddell and Burton (2006) Work is generally good for physical and mental health and well-being

Galen (129-200)Employment is nature’s physician and is essential to human happiness.

Theodore Roosevelt (1858-1919)The best prize that life offers is the chance to work hard at work worth doing.

William Osler (1849-1919)To the young it brings hope, to the middle-aged confidence, to the aged repose: work.

Voltaire (1694-1778)Work banishes those three great evils: boredom, vice and poverty.

And yet for too long, people with chronic diseases or disabilities have been kept from work by discrimination, lack of access to appropriate therapy, lack of reasonable adjustments and other peoples’ low expectations.

The Top 10 Health Problems impacting Productivity

1. Fatigue2. Depression3. Back / neck pain4. Sleeping problem5. Other chronic pain6. Arthritis7. Hypertension8. Obesity9. High cholesterol10. Anxiety

Source: World Economic Forum ‘Working towards wellness’ in cooperation with PricewaterhouseCoopers

RMD/MSDs: Action needed in member states

Five principles which healthcare professionals, employers, employees and governments should focus upon to improve working lives of those with a MSD:

• Focus on capacity not incapacity• Early intervention is essential• Imaginative job design is key to rehabilitation• Think beyond the physical symptoms of MSDs (they

are often associated with depression)• Assess the direct and indirect costs of RMD/MSDs

Musculoskeletal Disorders and Labour Market Participation, The Work Foundation 2009

“Body & Soul” report produced by The Work Foundation (UK) 2010

Explores the connection between physical and mental health conditions, and the impact these conditions have on productivity and work participation.

Findings include:• The rate of mental health conditions is

higher among those with a chronic physical health condition.

• Researchers understand that physical health influences mental health and mental health influences physical health

– For example, about 25% of people with arthritis report a co-morbid mental health condition.

Fit for Work Europe CoalitionLaunched 2010

• Fit for Work ambassadors identified across nearly all of 29 countries to drive ‘national RMD/MSD plans’ (Carol Black & Paul Emery in UK)

• Each country’s Fit For Work group needs to

• Understand its local context

• Develop its strategy

• Develop an action plan

• Define desirable outcomes

• Evaluate

Fit for Work in Finland

Context

• ‘Vocal’ patients and increasing role of nurses• Too few musculoskeletal specialists and

gastroenterologists• Public discussion about medical care and treatments

mostly based on costs rather than a holistic healthcare perspective

Strategy• Shift debate towards the health and socio-economic

outcomes of investing in health with a focus on workability • Unique cooperation with patient organisations to develop

the “Back to Work” program

Fit for Work in Finland

Actions• September 2009 Launch of the Fit for Work Finland Report and National

Coalition designed for patients with chronic conditions

• Development of web-based Back to Work programme:– Provides peer support in the form of workability success stories, most frequently

asked questions with answers (from HCPs and officials), documents needed for securing state benefits, top tips for writing a CV and preparing for a job interview after a long sick-leave

• Local events with patient organisations providing education and support in getting people back to work

• Meetings with physicians and nurses to increase their knowledge of work as a determinant of health, and work as an outcome of clinical encounter

• Meetings with politicians to lobby and make the business case for funding and resources for early intervention and active treatment for patients suffering from chronic diseases, so that they can be retained in work

Fit for Work in Finland

Outcomes

• Ministry of Labour support to enable patients with chronic conditions, including musculoskeletal diseases, to work

• A commitment from the vice-chairman of the Parliament’s Social Affairs and Health Committee and a prominent MP from the ruling party to influence the upcoming government programme to include objectives in line with key national recommendations on workability and chronic diseases

• The chairman of the leading opposition party introduced maintenance in work or returning to work for people with chronic conditions as an election issue in 2011

Fit for Work in the UK

Context: the situation in 2006:

• Health and work not acknowledged as related and inter-dependent• Work not considered as a determinant of health • Topic of little importance to politicians, civil servants, health

professionals, employers etc. • Little if any cross-government working on this agenda – lots of very-

well-intentioned silo working• Little connection made, in much of UK, between Health, Well-being,

Engagement and Productivity• Workplace potential for prevention and promotion not recognised

Strategy – at first Government-initiated and led2005 HWWB Strategy – a cross-government strategy agreed 2006 – appointment of independent National Director for Health and Work2008 – publication of the Black Review; Working for a Healthier Tomorrow

Fit for Work in the UK

Actions • Cross-Government Executive: Health, DWP, HSE, plus BIS• National Stakeholder Council• Black Review accepted by the then Government• Sounding Boards: OH, General Practitioners, General• Regional co-ordinators of Health Work and Well-being• 2010 New Coalition Government commitment• 2011 Sickness Absence Review announced

Outcomes Rollout of Black Recommendations: – Fit Note - 11 Fit For Work service trials– Council for Health and Work – New standards for Occupational Health– Challenge Fund for Small and Medium Enterprises– New Government, Responsibility Deal

Fit for Work in the UK

• Health of public-sector workers e.g. National Health Service, with 1.3 million employees

– all NHS organisations to provide staff health and well-being services centred on prevention

– all NHS leaders and managers to be trained to recognise the link between staff health and well-being and organisational performance

– all NHS organisations to develop and implement strategies for actively improving the health and well-being of their workforce,

• Responsibility Deal – an initiative by the Secretary of State for Health

– Health at Work pledges for businesses to adopt– Chronic conditions guide, to be embedded within HR procedures – National standards for Occupational Health – only accredited OH

providers to be hired– Health and Well-being to be reported to each institution’s Board

and included in their Annual Report

Fit for Work Coalition in UK

• A coalition (professional bodies, Work Foundation, NGOs, academics etc) to drive forward policy on health and work - building on previous Reviews and initiatives including Black, Boorman, BUPA with links to the new Coalition Government’s initiatives including the Responsibility Deal and Sickness Absence Review

• First meeting March 2011• Plans:

– 2011/2012 campaign in development– Website– Projects– “Fringe” meetings– Ad hoc reactive statements / media– Speaking events– Provocation papers

The vision

We want to create a society where the positive links between work and health are recognised by all, where everyone aspires to a healthy and fulfilling working life, and where health conditions and disabilities are not a bar to enjoying the benefits of work.

Improving health and work: changing lives

UK Government Response to the Black review, 2008

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