Fit for Work Europe Chronic Diseases Submission

8/2/2019 Fit for Work Europe Chronic Diseases Submission

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The Fit for Work Europe Coalition is supported by an ongoing grant from Abbott--a founding partner--and a supporting grant from

GE Healthcare. For information and the opportunity to comment/blog/share your experience on making Europe Fit for Work, go to

www.fitforworkeurope.eu .

FIT FOR WORK EUROPE: EU Reflection Process on Chronic Disease

Contents

1. Fit for Work ..................................................................................................................................... 2

2. Musculoskeletal Disorders: a widespread burden to Europe's economy and society .................... 3

3. EU Reflection Process on Chronic Disease: European Commission request for input .................... 4

3.1 What is the current situation on chronic diseases in the European Union? ................................. 5

3.2 Health Promotion and Disease Prevention: what more should be done? .................................... 6

3.3 Healthcare & Healthcare Systems: what changes can be made to respond better to the

challenges of prevention, treatment and care of chronic diseases? .................................................. 7

3.4 Research priorities: meeting the challenges of chronic diseases................................................ 10

3.4 Information and Information Technology: what more can be done?......................................... 12

3.5 Roles of Member States, the EU and Stakeholders: additional activities ................................... 13

4. References ..................................................................................................................................... 15


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1. Fit for WorkTheFit for Work Europe(FfW) Coalition is a unique multi-stakeholder platform bringing together patients,

physicians, policymakers and social partners, all of whom believe in the importance of prevention, early

intervention, and management of musculoskeletal disorders (MSDs)1 in the workplace. The vision of FfW

is to shift the perception of MSDs from being disabling conditions to manageable conditions, ensuring that

more European citizens stay in work or return to work2, while helping to improve the sustainability of

Europe's health and social care systems.

The Coalition aims to highlight to stakeholders the importance of making MSDs a priority at the EU and

national levels as well as aiming to improve the individual, clinical, employer and related approaches for

managing MSDs. FfW's core principles for people of working age living with MSDs are based on the belief

that employing early intervention practices for MSDs promotes the idea that staying in work is good for

health and wellbeing. The principles are as follows:

FfW at national level

Since the 2009 publication of Fit for Work? Musculoskeletal Disorder in the European Workforceand

more than 30 national FfW reports, there has been activity at the European and national levels among

patients, physicians, policymakers and society representatives to support those living with MSDs to stay

active and working, contribute to society and maintain a high quality of life. This has lead to changes in

policy and practice in Europe and beyond, including the following highlights:

In the UK, the NHS Operating Framework for the first time has classified work as a clinicaloutcome. Wider societal costs will be considered as part of drug assessments, and higher

thresholds for medicines will be allowed where it can be demonstrated that there are broader

societal benefits within the new value based pricing mechanism.

In France, the health Chair of the influential university Sciences Po ran a national seminardevoted to chronic diseases and work, and included recommendations from national FfW

stakeholders.

In Greece, the FfW Greek research inspired public-private collaboration to develop a nationalGuide for Citizens with Rheumatic Diseases.

In Spain, the government announced a national strategy for MSDs; regional action plans weredeveloped, with the one from the Catalunya region presented by stakeholders in Brussels as best

practice to FfW national stakeholders from other European countries and regions.

In Italy, the Senate Health Commission unanimously approved a national inquiry that establishedMSDs/chronic degenerative diseases as a public health priority.

In Denmark, additional funding has been earmarked for improving the management ofMSDs/chronic diseases.

Work is healthy for patients and society.

Work makes economic sense, driving national economies, and is integral to health and social

care systems.

Healthcare professionals (HCPs) should promote work as a desirable clinical outcome for

patients.
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In Austria, a think tank was formed to discuss MSD policy targets, and agreed the need for anAustrian fit note.

The recommendations from the Belgian Fit for Work report have been included in a report on thelegal and financial aspects of bringing people with Rheumatoid Arthritis back to work in Belgium.

This report has been facilitated by the Scientific Research Body of Rheumatology in Belgium and

will be launched later this year. Their main priority focus for 2011 - 2014 is on Arthritis and Work. In Croatia, the FfW report was supported by Parliament and subsequently the National Insurance

Institute allocated a special fund for biologic therapy for treating rheumatic diseases.

Finland has developed a Back to Work programme with an employers' organisation and patientorganisations which supports people with MSDs wanting to get back to work, and for people who

struggle to stay at work.

In Germany, the Commissioner for the disabled in Rhineland Palatinate agreed to develop anational plan for improving working conditions for disabled people.

In Ireland, a National Clinical Lead for Rheumatology was appointed, and has agreed funding for24 physiotherapists to lead early intervention clinics for MSDs.

The Israeli government agreed specific improvements to manage MSDs, set up an employer-based vocational rehabilitation programme for people with MSDs, and established work

productivity as a health technology evaluation measure.

In Canada, the launch of FfW was a catalyst for the development of a National ArthritisFramework.

These national FfW endeavours underline the growing consensus for change locally which should help

inspire evolutions and best practice sharing across countries and at European level.

2. Musculoskeletal Disorders: a widespread burden to Europe's economy and societyMSDs is an umbrella term covering over 200 conditions that affect the muscles, joints, tendons, ligaments,

peripheral nerves and supporting blood vessels, causing pain and functional impairment to sufferers.3

The

impact of MSDs goes beyond the immediate physical symptoms; the conditions affect a person's self-

esteem, quality of life, professional and family life and financial situation. MSDs are a major cause of

disability and functional decline.4

They consume a large share of resources in healthcare systems and have

an enormous impact on the social costs related to disease, worklessness, lost productivity and social

exclusion. There is also a strong correlation between MSDs and other, co-morbid, long-term conditions

such as mental illnesses, obesity and cardiovascular disease. Yet health and social care systems in all

Member States remain fragmented and do not prioritise early interventions or work as a clinical outcome.

This makes national governments frequently ill-prepared as the burden of MSDs on society increases

while the labour force ages and needs to work longer.


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3. EU Reflection Process on Chronic Disease: European Commission request for inputThe FfW Europe Coalition welcomes the European Commission's request for input to the EU Reflection

process on Chronic Diseases, as an opportunity to highlight the challenges facing Europe's ageing

workforce. Moreover, the current economic crisis is an opportunity to bring forward an era of policy,

clinical practice and other value-added solutions to the challenges facing Europe in relation to public

health and national productivity.

This response to the Commission's request for input has been drafted taking into account the impact of

chronic conditions, including a special focus on MSDs, on health and social care systems and in particular,

the importance of recognising MSDs as the leading cause of disability and long-term sickness absence in

the working age population across the EU both now and for at least the next two decades.

Facts

At least 100 million people in Europe reported chronic musculoskeletal pain in 2008 although

MSDs are undiagnosed in over 40% of cases (Veale et al, 2008).

Up to 80% of the adult population will be affected by an MSD at some time in their life (WHO2003).

1 in 6 members of the EU workforce have a long-standing health problem or disability which

affects their ability to work (Eurostat, 2003).

MSDs affect more than 40 million workers in the EU and account for about half of all work-

related disorders in EU countries (ETUI, 2007), representing an estimated cost to society of

between 0.5 and 2% of gross domestic product (GDP) annually.

Up to 40 % of people with MSDs are out of work at some time in their life (Bevan et al, 2007).

The European Commission estimates that MSDs account for almost 50% of all absences from

work lasting three days or longer and for 60% of permanent work incapacity (EC, 2007).

Reported unemployment rates are three times higher among people with MSDs than in the

general population (Bevan et al, 2007).

Impacts and costs

Muscle and joint pain costs European economies up to 240 billion a year (EC, 2007). PERIOD

Direct costs of MSDs include the cost of prevention, detection, treatment, rehabilitation and

long term care.

Indirect costs of MSDs include lost work output attributable to a reduced capacity for activity,

lost productivity, lost earnings, lost opportunities for family members and lost tax revenue.

These indirect costs typically account for 80% of the total costs of MSDs.

Intangible costs include psychosocial burdens resulting in reduced quality of life, such as job

stress, economic stress, family stress and suffering (WHO, 2003).

In the UK, total costs associated with MSDs in 2007 were estimated at 7 billion (HSE, 2007).


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3.1 What is the current situation on chronic diseases in the European Union?

By 2060 the proportion of the population aged 65 and over is projected to increase to 30 % from 17.4 % in

2010,5

which means that there will be just one person of working age for every dependent person aged

under 19 or over 65 years in the EU.6

Hence, the role of work should be taken into account by national

governments and the EU regarding chronic conditions. Work plays a crucial part in the health and

wellbeing of an individual. Work is a cross-cutting issue for the reasons identified below:

FfW calls on the EU and National Governments to implement the following solutions:

Early intervention in treatment and care of MSDs can lead to improved functionality and work

ability and can serve as a case study for optimal care and management of a range of other Chronic

Conditions, especially among citizens of a working age.

Establishing European and National Directors for Health and Work can help to stimulate a more

strategic integrated approach across the EU and national health, employment, social affairs and

finance departments.

Health Technology Assessments (HTAs) and health economic evaluation targets should be

holistic and include clinical and societal impacts of regimens which support people with MSDs or

other Chronic Conditions. Such evaluations can help result in health decisions that help patients to

remain active and productive in the labour market, as opposed to decreased work ability and

potential reliance on welfare payments.

Work ability should be established as a clinical outcome of treatment and a meaningful dialogue

about a patients workability status should occur regularly between people with MSDs and

healthcare professionals. Better data generation and exchange is required at national and EU level on prevalence,

incidence and costs of MSDs and other Chronic Conditions among the current and future EU

workforce, as well as on successful solutions of improving productivity through early intervention

practices and modified working conditions.

Methods, tools and support networks to increase patient engagement and self management

practices should be developed which support positive clinical and labour market outcomes.

Cost-effective and timely physical and psychological therapies for people of working age with

MSDs improves access and return to work as well as full and fulfilling labour market

participation of people with MSDs.

More collaboration between primary care physicians and specialists (e.g., physiotherapists and

occupational therapists) is needed to ensure that healthcare professionals are supported in

making decisions about work disability, job retention or return to work, including a revision of the

medical statement so that work ability is part of clinical outcomes.

Better enforcement of existing national legislation requiring reasonable workplace

accommodations can help people to stay in work or reintegrate into the workforce.

Labour market policies should be geared towards helping employees with Chronic Conditions

and disabilities to remain in work or reintegrate into the workforce. This should include flexibility

in welfare benefits which allows workers to earn income and claim financial support while they

phase their return to work.


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3.2 Health Promotion and Disease Prevention: what more should be done?

More primary prevention measures can be taken to slow or forestall the onset of chronic conditions,

including MSDs. For example, employers and occupational health professionals can help design and adapt

workplace settings with conditions and ergonomics that are conscious of promoting workplace health and

wellbeing. Individuals can proactively manage their health and act to avoid lifestyle and other risks that

may result in acute and long-term chronic conditions.

With the rise ofco-morbidity alongside long-term conditions, health promotion including health literacy

should be coupled with management of existing long-term conditions. In the case of MSDs mobility is a

vital issue and there is a relationship between lack of physical exercise due to an MSD and increases in

depression, stress and obesity. For example, people with arthritis may also be twice as likely as the

general population to have a mood or anxiety-related disorder.7

Early detection requires a better screening and monitoring process. Genetic and hereditary factors that

cause some MSDs can be detected in the early years of life and can lead to better management of

diseases and disorders throughout life.

Action at the EU level

The EU should develop an integrated approach to early detection of chronic diseases; action at the EU

level can be possible through a combination of health, social and employment policies:

The importance of work and a healthy workforce should be part of future EU health policies andinitiatives on health promotion, health inequalities and early detection measures.

The EU's revision of the MSD Directive should take into account pre-existing MSDs which may notbe caused by the workplace but can be exacerbated by some working conditions and practices.

The EU can help disseminate good practices and tools which can foster better health andwellbeing for workers. For example, in 2011 British Telecommunications (BT) set up the 'BT

passport' concept, which is a scheme that documents the specific requirements of some

employees with special needs that can on occasion impact their working life e.g. disability and

wellbeing.

Enabling people to be in productive work is a health issue.

Work is generally good for physical and mental health.

Worklessness is a greater risk to health than many killer diseases.

Peoples social and economic circumstances effects their health throughout life, so healthpolicy must be linked to the social and economic determinants of health.

Work is a social determinant of health.

Improving the health of the working-age population is in the interest of us all.


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Action at national level

Work should be prioritised as a critical factor when evaluating the need for early detection ofchronic diseases including MSDs. Lack of early detection can have a profound effect on the ability

for the person to stay in the labour market, and delayed diagnosis can result in premature

withdrawal from the labour market, with the attendant economic and social consequences.

Human and financial resources should be targeted to support early intervention of chronicdiseases and MSDs, based on the potential socio-economic return on investment.

FfW's Contribution

FfW has conducted research in more than 30 countries across Europe and beyond. This researchhas also developed actionable recommendations for all relevant stakeholders, at the European

and national levels in relation to MSDs.

Through the FfW European Coalition, FfW has fostered dialogue and shared best practices amongall relevant stakeholders to help improve the health and wellbeing of people with MSDs. This

includes informing policies and practices that support early intervention of MSDs e.g. relating to

job retention or reintegration into the workplace.

In the UK, national FfW Coalition members, notably Dame Carol Black, have been prominent inthe advent and support of initiatives such as theFfW case studies and pilot projectsand the 'fit

note'.

In France, FfW stakeholders have access to a website (www.maladieschroniques-travail.org)which creates a platform for patients, healthcare professionals, companies and clinicians to

exchange information and ideas on chronic diseases in the workplace, with chronic inflammatory

rheumatisms as an example.

FfW Ireland launched and distributed the Fit for Work Charter, which recognises the role thatpolicy makers, employers, health providers and insurers, unions and other relevant stakeholders

must play in addressing MSDs and work.

3.3 Healthcare & Healthcare Systems: what changes can be made to respond better to the

challenges of prevention, treatment and care of chronic diseases?

In most Member States, healthcare spending will continue to need to rise as a proportion of GDP due to

an ageing population and growing prevalence of chronic diseases. To maximise effectiveness of such

expenditures and enhance sustainability, early intervention and appropriate management of chronicdiseases can help contribute. In the UK, for example, people with long-term conditions are already

disproportionately higher users of health services and account for around 70% of overall health and social

care spending, representing 50% of GP appointments, 60% of outpatient and emergency attendances and

70% of inpatient bed days. By 2030, 21 million people of working age in the UK (about two-thirds of the

workforce) will have at least one work-limiting long-term health condition. The EU and national

governments must tackle these challenges in a holistic manner taking on an integrated health,

employment and social care approach.
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Action at EU level

The EU can help exchange good practices among its Member States, such as:

The Statement of Fitness for Work ('fit note') which demonstrates the importance ofcommunication between patient, physician and employer. The fit note allows a primary care

physician to provide the employee with more information on how their condition affects their

ability to work. This helps employers understand how they might be able to help an employee

return to work sooner.8

The London 2012 Olympic and Paralympic Games Health Legacy: for the construction of theOlympic 2012 site, the organisers undertook large scale measures to ensure workers' health and

safety and were active in health promotion with the view that "a healthy workforce is a

productive workforce''.9This included the establishment of occupational health facilities on-site.

Such a strategy helped to detect the early onset of long term conditions.10

Action at national level

Recognising that national governments have full competence over health and social care systems

highlights the need for action at national level.

Policy solutions

The direct and indirect impacts of MSDs can be addressed at different political levels Europeanand national but also through different policy fields public health, employment, welfare,

economic and financial affairs. There is a need for coherent policy-making to ensure that all

aspects of MSDs are tackled in a comprehensive and coherent manner, avoiding inconsistencies

or counter-productive policies.

Many national governments across Europe have policies and/or legislation requiring reasonableworkplace accommodation for people with MSDs. This can include provisions for adjusting the

ergonomics, working time or work of an employee. However, data and information gathered

from across Europe shows there is a lack of enforcement of these regulations, especially among

smaller businesses.11

Adjusting work demands (the physical work environment, working time,

psychological support, etc.) is often inexpensive and can make a big difference to the

reintegration of people with MSDs or help people with MSDs to retain their job.

Labour market policies should be geared towards helping employees with chronic conditions anddisabilities to remain in work or reintegrate into the workforce. This should include flexibility in

providing welfare benefits, which can support a phased return to work approach. Long periodsaway from work are generally bad for MSD patients. The longer the sick leave, the more difficult

it is to get the employee to return to work and the higher the economic cost.12

Health, social and employment ministries must work together . For example, in Germanydifferent national ministries (Ministries of Health, Labour and Social Welfare, and Trade and

Industry) discussed how national programs are developed and implemented, which increased the

cross-government departmental discussions on healthy ageing. The UK government appointed a

National Director for Health and Work responsible for over-seeing national research, policies and

initiatives aimed at improving the health of the workforce. This should serve as a good practice


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example and other European countries should also appoint National Directors for Health and

Work who can actively address joint issues and better coordinate health and social care systems.

Financial Planning must take into account the need for cost-effective measures which helpgovernments save in the long-term. Having a significant proportion of the working age population

either temporarily or permanently unable to work through ill-health can reduce labour

productivity in an economy and damage the competitiveness and effectiveness of private and

public sector organisations. Data from the UK's National Audit Office (NAO) shows that

worklessness has inter-generational persistence and that in the UK, 51% of those living in

workless households have a long-term disability.13

Investing in early intervention and appropriate

management of chronic diseases can help minimize other potentially greater social

disbursements.

Health and social care systems solutions

National governments should prioritise MSDs through developing and implementing nationalplans on MSDs. These plans should be created through an integrated joint policymaker andstakeholder approach to address key issues, such as the inclusion of societal perspectives in

healthcare funding decision making and better financial planning between government

departments.

Work should also be a key element in consultations between people with MSDs andprimary/secondary care physicians. Work ability should be established as a clinical outcome of

treatment, and a meaningful dialogue about a patients workability sta tus should occur regularly

between people with MSDs and healthcare professionals.

There also needs to be an increase in primary and secondary care healthcare professionals thathave sufficient information, training and resources to tackle chronic conditions in the workplace.

Health Technology Assessments (HTAs) and health economic evaluation targets should be moreholistic and include clinical and societal impacts resulting from treatments and therapies, which

support people with MSDs or other chronic conditions to remain active and productive in the

labour market rather than relying on welfare payments.

There is a need for more cost-effective and timely physical and psychological therapies forpeople of working age with MSDs. This should include improved access to work and return to

work, as well as full and meaningful labour market participation for people with MSDs.

Pilot projects need to show medium and long term value for society from patient pathwayprograms and cross-sector coordination.

Future national plans and policies need to reflect an approach that is not limited to work thatcauses diseases, but also includes an approach which targets helping people with chronic

conditions integrate in the work place.

FfW's Contribution

In Denmark FfW stakeholders have taken a proactive approach to improve policy planning (withsupport from leading healthcare politicians) through a pilot project on patient pathway programs

providing patient coordinators for patients with inflammatory arthritis.


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In Germany three separate instruction manuals will be released by the national FfW Coalition,each of which is tailored to healthcare specialists, primary care physicians, occupational health

physicians and other healthcare professionals, as well as patients.

In Turkey the national FfW Coalition has identified the gaps in the current Turkish Healthcaresystem in relation to Rheumatology. An investment gap has been identified which could provide

better management of care and better coordination with different specialists. A report has beenprepared regarding the healthcare infrastructure and will be disseminated to policy makers in

mid 2012.

In the UK 'work' is included in the NHS Outcomes Framework as an outcome indicator. Thegovernment, following stakeholder consultation, will include wider social benefits in the new

value-based pricing (VBP) system designed to supplant the Pharmaceutical Price Regulation

Scheme (PPRS) in 2014. In addition the FfW UK Coalition will be part of a project led by Dr Debbie

Cohen that will modify the existing Royal College of General Practice s (RCGPs) National

Education Programme (NEP) for work and health for members of the rheumatology team.

In Norway patient organisations, also part of the national FfW platform, are supporting agovernment strategy Back to Work for people below the age of 30 years that are suffering from

a chronic condition and its associated disabilities: the main focus for the initiative is helping

people gain further education and encouraging labour participation.

In Denmark the new government has recently presented different reform proposals on thesickness and incapacity benefits schemes. The proposals include several changes in the existing

programs, including that people under the age of 40 shall no longer be granted incapacity

benefits, although they have a reduced working ability. Instead they will be offered a tailor-made

development course including education, training, work ability testing and social support in order

for them to stay active and in education or in employment. The reform proposals also include

increased focus on early intervention for chronic patients to improve workability.

In Ireland FfW stakeholders have devised and delivered a series of person-centred workshops forpeople with MSDs to enable them to return to the workforce a Back To Work Programme.

Currently the platform is developing a FfW services programme including a website to provide

information and support to both employers and employees, as well as compiling a database of

good practice examples with a view to developing and piloting FfW programmes in the workplace

in 2012.

3.4 Research priorities: meeting the challenges of chronic diseases

Research priorities should be focused on addressing fundamental gaps in knowledge. Data gathered

through validated research needs to be translated into tools, guidance and models for implementation of

best practice. Research priorities need to be refined both at European and national levels. This should

continue the theme of an integrated approach, which addresses the need for more research on the

impact of workers health on the employment and labour spheres.


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Actions at EU level

EU funding programmes should be targeted towards bridging existing gaps in research. The role of work in

relation to MSDs should be investigated further and should also be part of future EU health and social

care projects.

Horizon 2020

With the increasing burden of MSDs on not only health and social care systems, but also thenumber of days lost to sick-leave and long-term absence from the labour market, funding needs

to be targeted on MSDs in order to provide more effective solutions as well as effective ways

for prevention and early intervention. Therefore, MSDs including rheumatic and inflammatory

diseases must be prioritised in the next EU Research Framework Programme for 2014-2020

(Horizon 2020). Key areas for research funding should include more research on developing tools

for prevention, early detection and screening.

The next EU Research Framework Programme also needs to include specific funding for researchwhich focuses on the linkages between health and employment. The theme addressing 'Societal

Challenges' should include a special focus on health in the workplace and include funding forresearch on the impact of work on wellbeing.

Health for Growth

The Health for Growth programme should include funding for gathering more evidence and dataon the impact of MSDs on the working age population, and formulate tools and instruments for

better health and social care planning. Priority should be given to the impact of MSDs and other

chronic conditions on health and social care systems.

The EU could sponsor research into further understanding whether (i) there is an earlyintervention premium (a benefit over and above late intervention, and that this outweighs the

incremental costs of early intervention) and (ii) there are additional benefits when health, welfare

and work are aligned to support early intervention.

Actions at national level

National funding programmes should encourage further research into MSDs and work ability. Thisshould include allocation of resources in support of early intervention and treatment and care of

MSDs, as well as funding research on the epidemiology and impact of MSDs on the economy.

FfW's Contribution

FfW has developed FfW country reports and a pan-European report which assesses the impact ofMSDs on countries and provides recommendations for policymakers and stakeholders. Thesereports have provided information, data and statistics on the impact of MSDs, as well as

highlighting solutions to the issues by providing recommendations for policymakers, healthcare

professionals, employees and employers.

FfW will continue to provide evidence-based research which can be translated into models,instruments and guidance at local and national level as solutions to address the socio-economic

impact of MSDs.


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3.4 Information and Information Technology: what more can be done?

The prevalence and impact of MSDs is high and yet there are still gaps in the information and data

available. To deliver effective solutions, there needs to be a renewed approach to identifying and

addressing these gaps.

Actions at the EU level

Better data generation and exchange is required at national and EU level on the prevalence,incidence, impact and costs of MSDs and other chronic conditions among the current and future

EU workforce, as well as on successful solutions for improving productivity through prevention,

early intervention practices and modified working conditions. For example, in the UK, the NHS of

England is moving towards an outcomes-based system; therefore outcomes improvement data

(including 'patient reported outcome measures') are becoming increasingly important. Data that

robustly quantifies the benefits of early diagnosis and intervention in terms of patient health and

functional outcomes, cost effectiveness and cash saving abilities are critical in an outcomes-

focused but cost-constrained NHS.

There needs to be more data and information available on the socio-economic impact of MSDson the community and society. This should include an analysis of the impact on the individual, on

the local health and social care system and on the government.


There should be more analysis and information gathered on the discussion between the patientand healthcare professional, in particular taking into account the impact of the condition on the

person's working life, wellbeing, productivity and ability to work.

There is a need for more robust and in-depth information and data on work productivity inclinical databases, and more systematic health economic evaluations and analyses on pilot

projects with patient pathway programs and patient coordinators. In some countries, this lack of

data is due to stringent privacy laws which have led to gaps that must be addressed.

In many countries there is a need for epidemiological information and data that providesevidence on the burden of MSDs and can lead to better policymaking and implementation of

national plans.

FfW's Contribution

FfW has launched interactive tools which provide information and data and demonstrate theimpact of MSDs across Europe. The FfW Health Mapshows the disparities in levels of sicknessabsence, presenteeism and work-related health in the EU. Data is sourced from a range of public

databases and academic papers. The FfW Health and Economic Indicator chart shows the

dynamics of various economic and health indicators across a range of European countries.

FfW continues to encourage good practice sharing between countries in Europe and beyondthrough various events including theAnnual FfW Summit, as well as issue-specific meetings such

as theConference on the Burden of Rheumatic and Musculoskeletal Diseases: Challenges in the

Work Capacity and Prevention of Disability in the EU, co-organised with the European League
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Against Rheumatism (EULAR) and the Hungarian Association of Rheumatologists in April 2011,

under the auspices of the Hungarian Presidency of the EU.

In France the national FfW initiative identified a strong need for data collection and is working inpartnership with healthcare professionals, medical labour groups and patient representations in

order to implement a national survey (HERACLES). This study will assess if workability is

considered by physicians in the management of patients with Rheumatoid Arthritis (RA). Results

of the HERACLES survey are expected in early 2013.

3.5 Roles of Member States, the EU and Stakeholders: additional activities

Separate to the areas outlined above, the place of work in healthcare decision-making should be

considered in addition to the areas mentioned above. Employment and social affairs policies should also

be considered as one of the key factors affecting the EU and national approaches to chronic conditions.

Health Technology Appraisals (HTAs) and health economic evaluations play an important role in the

allocation of resources, particularly at a time when there are severe austerity measures. Two key factors

need to be included in these assessments and evaluations:

(a) the societal perspective (which includes the person's ability to work and the impact of the

technology on carers), and

(b) the healthcare system's perspective (which includes costs and benefits relevant to the

healthcare system). Moreover, it may be important to include the benefit of the technology to

other systems outside of healthcare, such as the social system.14

Actions at the EU level

The EU institutions can serve as a model for an integrated approach to addressing these issues:

The EU can work with bodies EUnetHTA to help disseminate information and best practicesamong national HTA and health economic evaluation agencies.

An EU representative responsible for EU health and employment and social affairs policies couldserve as an ambassador for integrated decision making.

The EU can set up a system of good practice sharing between health and social care systems,supporting stakeholders in various countries disseminate information on tools and guidance

which can be transferred and adapted across borders. There are many examples of good

practices, models and tools which should be shared between Member States. Examples of where

outcomes are improved and costs are saved in practice, not just in theory will be hugely valuablegiven many European governments are wrestling with large budget deficits and cutting public

expenditure


National governments need to work together and identify models, tools and solutions which can be

shared across borders and between stakeholders.

National plans on MSDs and other chronic conditions should incorporate HTAs and healtheconomic evaluations which include both the societal perspective (including work ability) and


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cross-government department cost-effective savings requirements. This can have a positive

impact on people with MSDs, employees and employers, the community and national health and

social care systems.

A national ministry representative for health and work can help bridge the gap between the twoareas and increase cross-governmental discussions.


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4. References1The definition of 'Musculoskeletal Disorders' (MSDs) varies considerably; the terminology used in this

paper encapsulates all varied forms including musculoskeletal pain, diseases, conditions, disorders and

work-related MSDs

2 The definition of 'work' used in this document includes paid and unemployed employment3

Punnett, L. and Wegman, D. (2004). Work-related musculoskeletal disorders: The epidemiologic

evidence and the debate. Journal of Electromyography and Kinesiology, 14(1), 13234Fit for Work Europe (2009)http://www.fitforworkeurope.eu/Downloads/Website-

Documents/Fit%20for%20Work%20pan-European%20report.pdf5

Fit For Work? Musculoskeletal Disorders in the European Workforce' (2009)6

European Commission (2012). Demography report 2010. Older, more numerous and diverse Europeans7

Mental and Physical Health Charter:

http://ec.europa.eu/health/mental_health/eu_compass/policy_recommendations_declarations/mh_char

ter_en.pdf

8 Statement of Fitness for Work

http://www.direct.gov.uk/en/Employment/Employees/Sicknessabsence/DG_1871619

London 2012:http://www.london2012.com/about-us/the-people-delivering-the-games/the-olympic-

delivery-authority/oda-priority-themes/health-safety-and-security.php10

Louise Brearey, Head of London 2012 Games UK Health and Safety Executive (2012)11

Fit for Work Europe (2009)http://www.fitforworkeurope.eu/Downloads/Website-

Documents/Fit%20for%20Work%20pan-European%20report.pdf12

Frank et al., 1998; Meijer, Sluiter, Heyma, Sadiraj and Frings-Dresen, 200613

Fit for Work Europe (2009)http://www.fitforworkeurope.eu/Downloads/Website-

Documents/Fit%20for%20Work%20pan-European%20report.pdf

14 The Place of Work in Healthcare Decision-making, A Fit for Work Coalition Provocation Paper, LeelaBarham and Stephen Bevan (2011)
http://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://ec.europa.eu/health/mental_health/eu_compass/policy_recommendations_declarations/mh_charter_en.pdfhttp://ec.europa.eu/health/mental_health/eu_compass/policy_recommendations_declarations/mh_charter_en.pdfhttp://ec.europa.eu/health/mental_health/eu_compass/policy_recommendations_declarations/mh_charter_en.pdfhttp://www.direct.gov.uk/en/Employment/Employees/Sicknessabsence/DG_187161http://www.direct.gov.uk/en/Employment/Employees/Sicknessabsence/DG_187161http://www.london2012.com/about-us/the-people-delivering-the-games/the-olympic-delivery-authority/oda-priority-themes/health-safety-and-security.phphttp://www.london2012.com/about-us/the-people-delivering-the-games/the-olympic-delivery-authority/oda-priority-themes/health-safety-and-security.phphttp://www.london2012.com/about-us/the-people-delivering-the-games/the-olympic-delivery-authority/oda-priority-themes/health-safety-and-security.phphttp://www.london2012.com/about-us/the-people-delivering-the-games/the-olympic-delivery-authority/oda-priority-themes/health-safety-and-security.phphttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.london2012.com/about-us/the-people-delivering-the-games/the-olympic-delivery-authority/oda-priority-themes/health-safety-and-security.phphttp://www.london2012.com/about-us/the-people-delivering-the-games/the-olympic-delivery-authority/oda-priority-themes/health-safety-and-security.phphttp://www.direct.gov.uk/en/Employment/Employees/Sicknessabsence/DG_187161http://ec.europa.eu/health/mental_health/eu_compass/policy_recommendations_declarations/mh_charter_en.pdfhttp://ec.europa.eu/health/mental_health/eu_compass/policy_recommendations_declarations/mh_charter_en.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdfhttp://www.fitforworkeurope.eu/Downloads/Website-Documents/Fit%20for%20Work%20pan-European%20report.pdf

Fit for Work Europe Chronic Diseases Submission

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Transcript of Fit for Work Europe Chronic Diseases Submission