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Monitor
e-mail: monitor{at}som.org.uk
Work for most is a key determinant of self-worth, family esteem, identity, community standing, material gain, social participation and fulfilment [1].
Many factors influence health and well-being. Individuals have aspirations, burdens, skills and vulnerabilities to work. The working environment can influence well-being. Prevention of disability is an important public health issue. Identification and quantification of risk factors for labour market exclusion are necessary to target interventions to reduce disability pension (DP) rates. In order to evaluate policy, data are needed on changes in labour markets, disability benefit claimants, policy interventions and aspects of health over time.
An editorial by Allebeck [2] outlines potential contradictions between population-based and vulnerable population’s approaches. Public health practitioners observe that public health interventions can disproportionately benefit those at lower risk, potentially increasing health inequality.
Those with moderately increased risk may contribute more cases than small numbers with extreme risk factors. Thus, interventions targeting the general population are more effective than interventions targeting high-risk groups. This is called the ‘prevention paradox’ [3].
This approach is now questioned for failing to address mechanisms that lead to different distribution of risk in different social groups [4]. Targeting vulnerable populations for health interventions seems complementary to the population-based approach. ‘Vulnerable groups’ denote societal subgroups characterized by ‘shared social characteristics’ putting them at higher risk of risks’ but are distinguished from high-risk groups.
Brown et al. [5] provide descriptive epidemiology on the DP population in Glasgow and Scotland from 2000 to 2005. They analysed disability rolls data providing insights into dynamics within the DP population. In all, 16.4% of Glasgow’s working age population was receiving DP compared to 10% for Scotland and 8% for UK as a whole. This is now falling due to a decrease in on flow. Claimants tend to be older with poor work history and mental health. The rate of decline is greater in Glasgow than Scotland, although the rate of on flow remains higher.
Karlsson et al. [6] in a prospective Swedish population cohort (n = 19 379) assessed the importance of absence diagnosis and sociodemographic risk factors for DP in those on long-term sickness absence (LTSA) comparing these factors by gender and over time. Besides sociodemographic factors, absence diagnoses were significant medium and long-term predictors of DP in men and women on LTSA. The risk of DP associated with LTSA varied between men and women and over time, as well as in relation to age, income, previous absence, diagnoses and employment status. The effect of the most common absence diagnosis; musculoskeletal disorders varied between women and men. The relationship between income and DP risk also varied over time. Initial protective effect of higher income reversed after 6–10 years follow-up. In the latter period, higher income became a significant predictor for DP suggesting that DP maybe postponed among high earners who have more options for adaptation to work demands [7].
Christensen et al. [8] quantified the impact of psychosocial work factors on likelihood of DP in Danish employees followed for 118 117 person-years. After control for smoking, BMI and ergonomic work environment, low decision authority and work variation were predictive of DP. Adverse psychosocial work factors predicted 10–15% of DP cases, 13.1% were attributable to decision authority and 15.3% to work variation. In men, 9.9% of DP cases were attributable to low levels of decision authority and 14.4% to low task variation.
Kopp et al. [9] in a large Hungarian survey (n = 5863) found consistent associations between work stress and self-rated mental and physical health. A cluster of stressful work-related psychosocial factors predicted significant variation in the mental and physical health of workers. They cite the need for occupational mental health services to prevent job stress-related mental and physical ill health in the working population.
Are population-based and vulnerable population approaches required? This may depend on circumstances, population types, risk factor, etc. LTSA of 8 weeks seems to be a good predictor of DP risk. Sociodemographic and disease characteristics add some predictivity. There is clear need for monitoring and follow-up of interventions in different socio-economic groups.
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 Top References |
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- Black C. Working for a Healthier Tomorrow, Review of the Health of Britain's Working Age Population (2008).
- Allebeck P. The prevention paradox or the inequality paradox? Eur J Public Health. 18:215.
- Rose G, Khaw K-T, Marmot M. Rose’s Strategy of Preventive Medicine (2008) Oxford: Oxford University Press.
- Frolich KL, Potvin L. The inequality paradox: the population approach and vulnerable populations. Am J Public Health (2008) 98:216–221.
[Abstract/Free Full Text] - Brown J, Hanlon P, Turok I, Webster D. Establishing the potential for using routine data on Incapacity Benefit to assess the local impact of policy initiatives. J Public Health (2007) 30:54–59.
- Karlsson N, Carstensen JM, Gjesdal, et al. Risk factors for disability pension in a population-based cohort of men and women on long-term sick leave in Sweden. Eur J Public Health (2008) 18:224–231.
[Abstract/Free Full Text] - Johansson G. The Illness Flexibility Model and Sickness Absence (2007) Stockholm, Sweden: Karolinska Institutet. MD thesis.
- Christensen B, Feveile H, Labriola M, et al. The impact of psychosocial work environment factors on the risk of disability pension in Denmark. Eur J Public Health (2008) 18:235–237.
[Abstract/Free Full Text] - Kopp MS, Stauder A, Purebl G, et al. Work stress and mental health in a changing society. Eur J Public Health (2008) 18:238–244.
[Abstract/Free Full Text]
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