Most of us believe that when we get sick, we should take time off work to recover. But how long is too long? Could we actually be doing our health favour by returning to work before our recovery from illness or injury is entirely complete?
You may be surprised to find these issues are being looked at again in the light of new research paper, Realising the Health Benefits of Work. In it, the Royal Australasian College of Physicians has pointed to evidence-based research, which concludes that “work, in general, is good for health and well-being”.
This is good news – after all, the health of our workforce is absolutely fundamental to our country’s prosperity. Smart companies are already investing in the health of their workforce through workplace health and wellness initiatives, but what about helping people return to work after long period of illness or injury?
There is growing awareness that long-term work absence, work disability and unemployment are harmful to physical and mental health and well-being.
The report points to evidence that shows unemployment is bad for you. It actually causes, contributes to or accentuates number of negative health impacts, says the report, including increased rates of cardiovascular disease, lung cancer, susceptibility to respiratory infections, poorer general health, poorer mental health and psychological well-being, increased likelihood of suicide and higher rates of medical consultation, medication consumption and hospital admission.
The health effects of work versus unemployment are generally most marked in middle-aged men, especially those with dependent families. It’s important to note that it doesn’t only affect the individual, but often their families suffer as well. For young people, unemployment can lead to range of psychological problems including depression, anxiety and low self-esteem.
Work can help to reverse the harmful effects of long-term unemployment and prolonged sickness absence, says the report, and it offers benefits such as:
• Ensuring some level of physical activity is undertaken on work days.
• Providing sense of community and social inclusion.
• Allowing people to feel they are making contribution to society and their families.
• Giving structure to working days and weeks.
• Providing financial security.
• Decreasing the likelihood they will engage in risky behaviours such as excessive drinking.
Unfortunately it appears that the message that work is good for health is not widely recognised or understood. The report identified:
• In 2007, one in eight households in New Zealand had no one in work.
• In the 10 years to March 2010, the number of people receiving sickness benefit grew by 23,663 (73 percent) to 56,000 and the invalids benefit ballooned by 31,681 (59 percent) to 85,000.
• Of those receiving sickness benefit at the end of March 2010, two in five (41 percent) had psychological or psychiatric conditions, and 15 percent had musculo-skeletal disorders.
• Nearly two in five (38 percent) had received sickness benefit continuously for between one and four years, while two percent had received sickness benefit continuously for 10 or more years.
• According to the Ministry of Social Development, very few people move from an invalid’s benefit into paid work.
• Last year, one in four workers in New Zealand was not in paid employment six months after making an ACC claim.
New Zealand has recorded an increase in requests for sickness certificates and disability support pensions driven by people with common, treatable health problems being permanently certified as unfit for work.
This is concerning, as work absence tends to perpetuate itself: that is, the longer someone is off work, the less likely they will ever return, and the greater the health implications.
In fact, if the person is off work for:
• 20 days, the chance of ever getting back to work is 70 percent.
• 45 days, the chance of ever getting back to work is 50 percent.
• 70 days, the chance of ever getting back to work is 35 percent.
The important point the report makes is that people think they need to be fully recovered before returning to work, but this is not necessarily always the case – in fact, often this delays recovery. Even work-related health problems have been shown to benefit from activity-based rehabilitation and an early return to suitable work.
Social Development Minister Paula Bennett says changing attitudes to work will be critical in helping to address welfare dependency in New Zealand. She says while some will never be able to work and must be supported, others can be living better life in work, which this research shows is mentally and physically beneficial, on top of the obvious financial benefits.
The focus must be on what people can do, not what they can’t, because research shows recovery is faster and more successful when people work towards wellness.
The Accident Compensation Corporation, recognising how critical it is to get long-term claimants back to work, has recently assigned four case management companies, including Southern Cross’ Care Advantage, to help manage 600 ACC clients with long-term claims. The aim is to help these people get back to their normal lives as far as practicable and as quickly as possible, because they recognise that the longer people receive help from ACC, the harder it is for them to get back to their normal lives, including work.
Dame Carol Black, the UK National Director for Health and Work, and author of Working for Healthier Tomorrow, has been major force in changing attitudes towards workforce health and in influencing policy in the UK. She says that range of people, including health professionals, need to try to reverse the belief that person needs to be totally fit and well to work, or that recovery from injury or illness must be complete before return.
She says restoring working life is closely allied to clinical goals. It should be embedded in health professional judgements and in the drive to better the public health.
To succeed, she says, we need everyone working together – health professionals and government agencies, but also employers, who play an important role in terms of the influence they have on workers’ health and well-being.
Recognising the many health benefits of work, employers should embrace employment practices that encourage employees to start, remain at and return to work.
Employers have responsibility to:
• Ensure workplaces are safe.
• Provide workplace culture conducive to health and well-being.
• Accommodate ill or injured workers back into the workforce as much as possible.
Workplaces can improve injury management practices through:
• Good individual case management.
• A positive workplace culture.
• Training staff, such as supervisors, in how to manage the return to work process.
• Showing senior management leadership.
• Auditing return to work systems and outcomes, and making improvements where appropriate.
• Actively seeking input and fostering collaboration between injured employees and co-workers.
• Encouraging workers to play an active role in their own rehabilitation and return to work.
• Helping employees access high-quality medical care.
• Adopting sensible policies and procedures – and visibly sticking to them.
• Opening the workplace up to workers with disabilities and helping those with long-term health conditions to manage their conditions in the workplace.
Peter Tynan is chief executive Health Insurance, Southern Cross Medical Care Society.
