1. Health and Safety Executive Cause and effect of sick leave Dr. Emilia Zainal Abidin Department of Environmental and Occupational Health Faculty of Medicine and Health Sciences UPM

2. Outline of this presentation The health agenda Understanding sickness absence Identifying the underlying causes Managing excessive sick leave

3. Health: the role of the workplace More than 50% of working age people in Malaysia are in employment and spend a high proportion of their waking hours in the workplace The workplace offers great scope for targeting of messages and initiatives about healthy living – with potential impact on both employees and their families Need to go beyond essential compliance with health and safety legislation and promote health and well- being more generally

4. Work and health – what we know Work offers opportunities to promote individual health and well- being Work should be recognised by all as important and beneficial, and access to, and retention of work promotes and improves the overall health of the population Long-term sick leave / sickness absence is a strong predictor of disability and mortality Work has a positive impact on health and well-being (‘good jobs’ in well managed organisations) Under some circumstances work can have adverse effects (‘bad jobs’) The key is prevention of underlying causes rather than relying just on management of outcomes (secondary & tertiary interventions)

5. Sources: WHO (2010). WHO Healthy Workplace Framework and Model: Background and Supporting Literature and Practices.

6. Sickness Absence or Sick Leave and Health Risk factors for sickness absence are not always the same as risk factors for disease An holistic approach needs to focus both on the risk factors that precede absence as well as implementation of policies & procedures for monitoring & management. Sickness absence data collection, analysis and interpretation methods need to reflect both aspects.

7. Sick leave and legislation in Malaysia The Employment Act 1955 An employee is entitled to paid sick leave only under the following circumstances: –he has obtained a certificate from a registered medical practitioner duly appointed by his employer; or –he has obtained a certificate from a dental surgeon; or

8. A national study of absence Definitions: Disease: is defined in terms of objective biological abnormalities in the structure and/or functions of bodily organs and systems Illness : is the personal subjective perception of unwellness. Therefore, if a person feels ill, they are ill Sickness: is derived from the concept of the “sick role”, a role that carries certain privileges (to stay away from work), as well as obligations (to seek medical help and to ‘get well’).

9. Ill health: A Population Study 33 23 5 8 3 2 1 Illness % Disease % Absence % >14 days None of these 25% Wikman et al (2005) 2% of the blue ‘sickness absence’ represents factors other than health-related ones. So, what are they? The short answer is we are not sure! combination of reasons including coping behaviour; withdrawing from the hazard, the so-called flight response.

10. Sickness Absence: NHS Trust

11. The Individual The biopsychosocial model: (Waddell & Burton, 2004) Biological: The physical or mental health function Psychological: Recognises that personal and psychological factors also influence functioning and the individual must take some responsibility for their behaviour Social: Recognises the importance of the social context, pressures and constraints, on behaviour and functioning

12. Drivers of sickness absence Individual factors – personality and motivation; past behaviour; sick role The ‘system’ – organizational culture and tolerability, what is legitimate; sickness certification Non-work factors – life events and family pressures Work factors – absence as ‘coping’, job satisfaction, chronic adverse features of work Commitment and involvement

13. Health and Safety Executive Findings from Whitehall II and other studies Work stressors: effects on health and sickness absence Findings from Whitehall II and other studies

14. 2  Moves to private sector practice  Job insecurity  Temporary employment Labour market stressors

15. Moves to private sector practice (transfer to an executive agency) effects on health and sickness absence (men) * adjusted for age, employment grade, marital status & health at the beginning of the follow-up period Ferrie et al. J Occup. Health Psychology 2001 3 relative increase in cardiovascular risk factors compared to men not transferred to agencies* % excess ill-health compared to men not transferred to agencies*

16. Job insecurity and health in women *adjusted for age, employment grade & health at the beginning of follow-up Ferrie et al. J. Epidemiology Community Health 2002 4

17. Ferrie et al. Am. J. Public Health 1998 Job insecurity and coronary artery disease *adjusted for age, grade and CAD before the threat of privatisation 5

18. Job insecurity and sickness absence Odds Ratios* *adjusted for age, employment grade and health status Ferrie et al 2001 J. Occup. Health Psychol 6

19. Temporary employment and sickness absence Rate Ratios* *adjusted for age, sex, income, and number of contracted days Virtanen et al 2003 Occup Environ Med 7

20. Temporary employment and early death Hazard Ratios* *adjusted for age, occupational status and income Virtanen et al 2003 Am. J. Epidemiol 8

21. Organisational Justice  Procedural component  Procedural component decision-making procedures include input from affected parties, are consistently applied, open and ethical  Relational component  Relational component respectful and considerate treatment of employees by supervisors 21 refers to the extent to which employees are treated with fairness and justice at their workplace

22. Organisational Justice (relational component) and sickness absence in women Odds Ratios* *adjusted for age, employment grade and health status Head et al 2007 J. Psychosomatic Research 23

23. Health and safety statistics 2007/08

24. Managing sickness absence

25. Introducing sickness absence management Do you have a procedure? Is your existing procedure contractual? You will require employee agreement to vary existing terms No procedure Engage employees to introduce a new policy Explain your business reasons Explain the changes/new procedure to employees

26. Introducing sickness absence management Make your attendance policy part of your induction process Make it part of your appraisal process Make line managers accountable

27. Introducing sickness absence management Keep accurate records of absence Record all absence Measure the cost of absence in all departments Employees to complete self certification forms Carry out return to work interviews Train line managers

28. Introducing sickness absence management Cautions not warnings Non contractual Develop triggers Calling in and keeping in touch Eligibility for company sick pay Consistent treatment

29. Tools for tackling short term absence Rigorous notification procedure Return to work interviews Should all short term absences be counted? Medical evidence? Withholding sick pay Employee health initiatives

30. Tools for tackling long term absence Keep in touch Early intervention 4-6 weeks Consider temporary adjustments Be proactive in asking for medical advice Preferably Occupational Health Practitioner

31. Designing ‘good’ jobs Promote ‘healthy’ workplaces Prevention and management of common health problems Job content, job context and organizational arrangements critical Move from a less desirable (‘bad jobs) to a more desirable state (‘good jobs’) HSE Management Standards can help in prevention and management

32. Summary The workplace offers the opportunity to promote and improve the health of employees and their families The drivers for ill-health are not always the same as the drivers for absence We need a better understanding of the causes of sickness absence so these can be managed in a proactive manner Current attendance management practice and policy is based on convention rather than evidence (IES, 2007)

33. Thank you