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-being What 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 ( ) Employment is nature’s physician and is essential to human happiness. Theodore Roosevelt ( ) The best prize that life offers is the chance to work hard at work worth doing. William Osler ( ) To the young it brings hope, to the middle- aged confidence, to the aged repose: work. Voltaire ( ) 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.Fatigue 2.Depression 3.Back / neck pain 4.Sleeping problem 5.Other chronic pain 6.Arthritis 7.Hypertension 8.Obesity 9.High cholesterol 10.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 Coalition Launched 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 led 2005 HWWB Strategy – a cross-government strategy agreed 2006 – appointment of independent National Director for Health and Work 2008 – 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 “ ”