In this issue of Occupational Medicine
Assistant Editor
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Unfit for work? |
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Absence from work attributed to illness is inevitably a matter of concern not only for occupational physicians but also for employers and benefit providers. In the UK at least this topic is currently centre stage following the recent publication of ‘Working for a healthier tomorrow’, Dame Carol Black's review of the health of Britain's working age population [1]. Many of the papers in this issue add an international perspective and provide important insights into some of the factors which influence the likelihood of sickness absence or of a successful return to work.
Does the health of people in work correlate with their levels of sickness absence? Yes, at least in male military personnel in Finland, according to a study of more than 7000 soldiers by Kyröläinen et al. [2]. This showed that high body mass index, poor muscle fitness and poor aerobic endurance were associated with increased sickness absence. Another study, from the USA, by Soteriades et al. [3] highlights the association between obesity and job disability in male firefighters and suggests the need for preventive measures to limit the adverse impact of obesity on fitness for work. The importance of this is emphasized by a further study from the USA of call centre employees by Boyce et al. [4] which suggests that a highly sedentary work role is associated with substantial weight gain unless offset by regular vigorous exercise. Of further relevance to the topic of obesity is this issue's review of Nerys Williams’ book, Managing Obesity in the Workplace [5].
If we are to facilitate a productive and beneficial return to work in cases of prolonged sickness absence, what factors can occupational physicians and employers influence to help employees with depression? Brenninkmeijer et al. [6] confirm what we might suspect, that measures which actively facilitate the process of returning to work, such as modified duties and reduced working hours, are associated with a better outcome in terms of symptom severity. This suggests that timely resumption of work under suitable circumstances may assist recovery.
Occupational physicians are in short supply and early recognition of risk factors for prolonged sickness absence by general practitioners (GPs) might be the key to reducing the personal and economic costs of such absence. Van Dijk et al. [7] found modest improvements in Dutch GPs’ recording of risk factors in a study evaluating a protocol to help GPs identify and record the existence of two ‘red flag’ risk factors. They conclude that better cooperation between GPs and occupational physicians is needed to implement an integrated approach to incipient prolonged sickness absence. This echoes Dame Carol's proposal of a ‘Fit for work’ service to provide early intervention to prevent short-term sickness absence progressing to prolonged sickness absence and ultimately worklessness. The editorial by Thorley et al. [8] further explores the role that GPs can play in the identification, management and reporting of work-related ill-health (and resulting sickness absence) via schemes such as THOR-GP.
We know that social deprivation affects health profoundly, but does it influence sickness absence rates among people in work? A study by Wynn and Low [9] of the effect of social deprivation on sickness absence rates suggests levels of such deprivation account for a significant proportion of the variation in sickness absence rates between different UK local government employers. This is surprising, given that the workforce concerned is in relatively secure and stable employment. As the authors point out, sickness absence is a phenomenon with multiple psychosocial and medical determinants and needs to be understood in the context of employees’ social and personal circumstances. On the other hand, a study from Denmark by Tüchsen et al. [10] explores whether shift working is a risk factor for sickness absence and finds no evidence of a link after controlling for a number of confounding factors, despite concerns about the potential adverse health effects of shift work.
Once a tendency to sickness absence is established, does it persist in the longer term? Koopmans et al. [11] investigated this over a 4-year period in Dutch postal and telecommunications workers with previous frequent short-term absences or prolonged sickness absence, and the answer seems to be yes. Interestingly, frequent sickness absence was a strong prognostic indicator of future prolonged sickness absence, as well as of continuing frequent short-term absences.
The challenge for all of us is to put such evidence to good use, both in our own practice and in ensuring that it influences policy setting and intervention strategies in this important field.
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References |
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- Black C. Working for a healthier tomorrow (2008) London: TSO.
- Kyröläinen H, Häkkinen K, Kautiainen H, et al. Physical fitness, BMI and sickness absence in male military personnel. Occup Med (Lond) (2008) 58:251–256.[CrossRef]
- Soteriades E, Hauser R, Kawachi I, et al. Obesity and risk of job disability in male firefighters. Occup Med (Lond) (2008) 58:245–250.[CrossRef]
- Boyce R, Boone E, Cioci B, et al. Physical activity, weight gain and occupational health among call centre employees. Occup Med (Lond) (2008) 58:238–244.[CrossRef]
- Hobson J. Book review:Williams N. Managing Obesity in the Workplace. Occup Med (Lond) (2008) 58:309.[CrossRef]
- Brenninkmeijer V, Houtman I, Blonk R. Depressed and absent from work: predicting prolonged depressive symptomatology among employees. Occup Med (Lond) (2008) 58:295–301.[CrossRef]
- Van Dijk P, Hogervorst W, ter Riet G, et al. A protocol improves GP recording of long-term sickness absence risk factors. Occup Med (Lond) (2008) 58:257–262.[CrossRef]
- Thorley K, Hussey L, Agius R. Health, work and the general practitioner. Occup Med (Lond) (2008) 58:233–235.[CrossRef]
- Wynn P, Low A. The effect of social deprivation on local authority sickness absence rates. Occup Med (Lond) (2008) 58:263–267.[CrossRef]
- Tüchsen F, Christensen K, Lund T. Shift work and sickness absence. Occup Med (Lond) (2008) 58:302–304.[CrossRef]
- Koopmans P, Roelen C, Groothoff J. Risk of future sickness absence in frequent and long-term absentees. Occup Med (Lond) (2008) 58:268–274.[CrossRef]
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