by Spanning the Silos in Health of Investment Decision-Making #MakeWorkCount by Spanning the Silos in Health of Investment Decision-Making Brussels 29/11/2016 Antonella Cardone, Executive Director, Fit for Work Global Alliance The Work Foundation, Lancaster University

Linking Health & Work Good Work has been shown to improve health outcomes Good Health enables people to be productive workers Lack of integration between health systems and employment and welfare policy

Contextual Factors of Workforce Health Ageing workforce – 50+ twice as 25-. employment rate of older persons is predicted to raise from 50% in 2013 to 67% in 2016 Pension crisis – gap between the number of economically active vs inactive Growing burden of chronic disease – up to 3 every 10 EU citizens suffer from a chronic disease that affects their ability to work & 50% of EU population report MSK pain. 50M have 2 or more conditions & mostly over 65

Musculoskeletal Disorders in the EU Workforce

A loss on average of over 10 working years Multiple Sclerosis in the EU Workforce 700.000 people live with MS in the EU MS affects people between the age of 20 and 40 37% of people with mild MS are in work 10 years after diagnosis 50% of people with MS will stay in work 15 years after the onset of MS, between 60% and 80% of patients will lose their jobs 35% of people with MS in Europe retire early because of the condition A loss on average of over 10 working years

Early labour market withdrawal More social exclusion & poverty Contextual Factors More Chronic Illness Later Retirement Ageing Workforce Reduced productivity Early labour market withdrawal More social exclusion & poverty Poor Workforce Health Increased burden on families & carers Increased healthcare costs Reduced tax revenue Increased welfare spending ©The Work Foundation

Good Work & Recovery “Work? For me it’s waking up in the morning. Work for me is doing something that you enjoy, because when you enjoy something, no matter how tired you are, you will get up and do it.” Working with schizophrenia, lived experience participant “My health was a lot better then, it was a lot better, because I was doing a job that I was enjoying, obviously my health had improved.” Working with schizophrenia, lived experience participant People’s aspirations are to have a girlfriend, a job, a new house. They don’t say “I want less symptoms”. Working with schizophrenia, Occupational Therapist

Work Should be a Clinical Outcome Clinicians, employers and individuals too often focus on ‘Incapacity’ rather than ‘Capacity’ Work should be regarded as a clinical outcome of care – incentives & care protocols rarely reflect this principle Good Work is Good for Health – can have therapeutic benefits (biopsychosocial model)

What is “Good Work”?

Work in Health Investment Decisions Perspective taken in Health Investment Decisions: In theory, Governments across Europe aim to take the societal perspective – which includes consideration of the impact of a healthcare intervention on the patient’s ability to work and the economic effect In reality, we see that a health care system perspective is taken – covering only those costs and benefits of immediate relevance to the health care system.

Why is this? Silo mentality Individual departments and agencies of government tend to focus on the specific areas for which they are directly responsible

Health and Work Policy Stakeholders Workforce health Government – MOH, M. of Finance, M. of social A. & welfare, M. of Labour, etc. Employers Local government Health bodies Individuals Business community (Chambers, Associations) NGOs, Voluntary and charity sector Health & social care professionals

Why spanning the silos? Investment decisions under budget and resources constraints and must demonstrate value for money and possibly cost-savings The return on the investment can be shown through productivity, job retention or RTW Work can have therapeutic benefits Early Interventions play a significant role beyond drugs and devices

Spanning the silos Mandate ‘Work as a Clinical Outcome’ of Treatment   Mandate ‘Work as a Clinical Outcome’ of Treatment Changing the Scope of Economic Evaluations of Healthcare Intervention Join up the work of Healthcare, Social Insurance & Employers – and placing patients at the centre of their care Set up “gain sharing” or “shared savings” pilots

Health at a Glance 2016   Although health and labour market policies are often formulated independently of one another, this chapter has shown the need for greater intersectoral collaboration. Both labour market and health outcomes would greatly benefit from improved policy integration.

Thank you. For more information: www.fitforworkeurope.eu www.theworkfoundation.com Antonella Cardone: acardone@theworkfoundation.com