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1. Executive summary 6 The ‘Fit for Work?’ project The Impact of MSDs on the Japanese workforce Japan is already facing the challenge of an older – and less healthy – working age population. The growing number of those out of work due to old age or disability is placing additional physical and emotional strain on working individuals. It is estimated that by 2035 over 30 per cent of the population will be consuming 70 per cent of total medical expenses. It is clear that the growing investment in the health care system cannot match the growing rate of dependency of the Japanese population. This is why Japan must prioritise prolonging individuals’ ability to remain in work and contribute to the society. While much is done to react to the impact of cardiovascular conditions and cancer, as well as to tackle the rapid rise in the prevalence of mental health issues, a vast burden of chronic diseases with low mortality rates remains unseen. The long-term impact of Musculoskeletal disorders (MSDs) receives little attention in Japan. This project has looked in some detail at the impact that MSDs have had on the working lives of millions of Japanese individuals. It has examined the adequacy of the treatment and support workers receive, their experiences at work, the effect of their condition on their family and colleagues, and the human and financial costs involved. Specifically, we have looked at back pain, work-related upper limb disorders (WRULDs) – two groups of conditions which are usually characterised by non-specific and short episodes of pain and incapacity – and rheumatoid arthritis (RA) and spondyloarthropathy (SpA), specific conditions that are often progressive and increasingly incapacitating. We conducted a review of the recent academic and practitioner research on the relationship between these MSDs and labour market participation, and conducted interviews with acknowledged experts in this field. MSDs have a significant impact on people’s ability to work; not only on an individual but an aggregate basis. Together, they affect the productivity and labour market participation of thousands of Japanese workers. Evidence suggests that: • Among a total of 87.9 million Japanese people aged 30 years or older in 2005, 21.4 million (24.3 per cent), 3.2 million (3.7 per cent), and 9.1 million (10.4 per cent) were estimated to have low back, hip, and knee pains, respectively. The prevalence rates of low back, hip, and knee pains will gradually increase in subsequent years, reaching 26.5 per cent, 4.4 per cent, and 12.9 per cent, respectively by 2055; • MSDs present the Japanese economy and society with a burden of up to JPY 2 trillion a year (7.5 per cent of national medical expenditure) just in the direct medical costs; • About JPY 231.2 billion each year are lost due to work incapacity resulting from pain. Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market
What can be done? Executive summary The effects of incapacity and pain from these and other MSDs can impact on several aspects of an individual’s performance at work, including stamina, cognitive capacity or concentration, rationality/mood, mobility and agility. It is becoming clearer that people with MSDs are also likely to have depression or anxiety problems related to their conditions. This can affect the severity of the condition, the ability of the individual to remain in work, the length of time they spend away from work and the ease with which they can be rehabilitated. Research suggests that a significant proportion of clinicians, employers and even individuals with MSDs do not fully appreciate the impact of ‘stress’ on the severity of physical incapacity. The biopsychosocial model of health emphasises the interplay between the biological (eg disease, strain, joint damage), the psychological (eg disposition, anxiety) and the social (eg work demands, family support) and represents a helpful way of assessing the causes of some MSDs, of planning treatment and management and of approaching rehabilitation into the workplace. It is not being adopted as widely as it should, however, because many clinicians and employers find it difficult to look beyond the immediate physical symptoms. Work can be both cause and cure. Whilst the physical conditions of work may cause or aggravate musculoskeletal symptoms, the impact or outcome on individuals (absence from work and disability) is strongly associated with psychosocial factors. Evidence suggests that work can help ameliorate the deterioration of many conditions and help recovery from MSDs. However, many health care professionals and employers mistakenly believe that workers with MSD must be 100 per cent well before any return to work can be contemplated. Looking to the future, with prospects for an ageing workforce, a growth in obesity, a reduction in exercise and physical activity and fitness in the general population, it is likely that the growing incidence and effects of MSDs will affect the quality of working life of many Japanese workers, and that the productive capacity of the Japanese workforce will be adversely affected at a time when we need it to be in top form. There are three main principles which Japanese clinicians, occupational physicians, employers, employees and the government should focus on if the working lives of people with MSDs are to be improved: • Collect reliable data on the prevalence of MSDs in Japan. The data on the incidence of occupational disease collected by employers, and the data on inpatients collected via the health care system are inconsistent because of the variability in methods of data collection. Furthermore, evidence and expert views gathered in his report suggest that Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market 7
Page 1: Fit For Work? Musculoskeletal Disor
Page 4 and 5: Contents 4 1. Executive summary 6 2
Page 8 and 9: Executive summary 8 the data that i
Page 10 and 11: 2. Introduction 10 2.1 The global b
Page 12 and 13: Introduction 12 2.3 International c
Page 14 and 15: Introduction 14 2.5 Structure of th
Page 16 and 17: Work and MSDs in Japan 16 Figure 3.
Page 18 and 19: Work and MSDs in Japan 18 3.2 Defin
Page 20 and 21: Work and MSDs in Japan 20 3.3 The i
Page 22 and 23: Work and MSDs in Japan 22 average t
Page 24 and 25: Work and MSDs in Japan 24 RA affect
Page 26 and 27: Work and MSDs in Japan 26 3.3.4 Spo
Page 28 and 29: Work and MSDs in Japan 28 3.4 Summa
Page 30 and 31: MSDs and government 30 4.2 MSDs: Po
Page 32 and 33: MSDs and government 32 of good heal
Page 34 and 35: MSDs and government 34 Figure 4.1.
Page 36 and 37: MSDs and government 36 deliver bett
Page 38 and 39: 5. MSDs and health care professiona
Page 40 and 41: MSDs and health care professionals
Page 50 and 51: 6. MSDs and employers 50 6.1 Costs
Page 52 and 53: MSDs and employers 52 6.2 The role
Page 54 and 55: MSDs and employers 54 Occupational
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MSDs and employers 56 The most freq
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MSDs and employers 58 levels of pai
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MSDs and employers 60 • Modified
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MSDs and employers 62 Box 2. Case s
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MSDs and employers 64 lower the mor
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7. MSDs and individuals 66 7.1 Impa
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MSDs and individuals 68 Figure 7.1.
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MSDs and individuals 70 7.2 MSDs: I
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MSDs and individuals 72 and other h
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MSDs and individuals 74 Figure 7.4.
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MSDs and individuals 76 Cont. Kaize
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MSDs and individuals 78 reported wo
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Conclusions and recommendations 80
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References 82 American Chamber of C
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References 84 Dagfinrud, H., Mengsh
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References 86 Hori, Y., Hoshino, J.
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References 88 Matsudaira, K., Hara,
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References 90 Rudwaleit, M., Gooch,
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References 92 Young, A., Dixey, J.,
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Appendix 2: Fit Note Sample 94 Sour
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Appendix 3: Benchmarking grid 96 So
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Appendix 3: Benchmarking grid 98 So
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Appendix 3: Benchmarking grid 100 O
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Appendix 3: Benchmarking grid Refer
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We provide: Research Advisory Consu
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