FfW Bulgarian report (English language) - Fit for Work Europe

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Introduction 2.3 Objectives of the study 14 More specifically, this project has sought to address each of the following questions: 1. What is the impact of MSDs on employment and economic performance in Bulgaria? How is this likely to change in the context of future demographic, workforce and lifestyle changes? 2. What is the relationship between work and MSDs? What impact do biological, psychological and social factors, including workplace factors, have on MSDs? 3. How well do employers, governmental bodies and general practitioners (GPs) understand and deal with MSDs as they relate to the workplace? How well equipped is the health sector to provide early intervention, rehabilitation and other support for people with these conditions? 4. What early interventions can policy-makers and employers deliver to ensure that those with MSDs a) retain their jobs b) maximise their quality of working life and their contribution to society and c) maintain access to (and routes back into) employment? In addressing the objectives outlined above, we have used the following approaches: 1. Desk research: Here we have drawn on existing published research from the medical, occupational health and health economics literature. This has enabled us to draw together the evidence on the nature, extent, impact and costs of MSDs to the Bulgarian economy, to employers and to individuals. We have examined a range of MSDs to assess the extent to which their impact varies and where policy and practice has been both strong and weak in preventing and intervening. 2. Secondary data analysis: We have used data from domestic and European studies and surveys to examine the prevalence and costs of MSDs in the working age population in Bulgaria. 3. Expert interviews: We have conducted interviews with Bulgarian experts across a number of disciplines (including specialists in occupational health, ergonomics and rheumatic disease and government officials) to identify the main areas of policy and practice which need to be addressed by policy-makers, health professionals and by employers. In addition to the wider picture, to focus the research, we have chosen to concentrate on four categories or groups of MSDs. These are: • Back pain; • Work-related upper-limb disorders (WRULDs); • Rheumatoid arthritis (RA); • Spondyloarthropathy (SpA). Fit For Work?
2.4 A note on definition Introduction Back pain and the majority of WRULDs are categorised as non-specific and episodic conditions which may frequently be caused by, or be made worse by, work. They manifest themselves in disparate ways and may cause periods of intense discomfort and incapacity which may affect the ability of the individual worker to carry out their work. They may also abate for long periods. Many people with these conditions, such as back pain, never seek treatment and most recover on their own but the conditions can cause significant absence from work or lost productivity. Back pain and WRULDs are often included in the occupational health and safety guidelines and literature. Occupational health practitioners typically deal with these conditions. On the other hand, RA and SpA are specific and progressive rheumatic diseases which are not caused by work, but may be made worse by work and are often handled by general practitioners and specialists, not within the occupational health arena. They are clinically diagnosed conditions that progress in a broadly predictable way, if untreated. They can have a significant impact on functional capacity at work and, in the long-term, participation in the labour market. Most people with these conditions require clinical interventions over a prolonged period of time and the management of these conditions for those of working age should involve the frequent and active participation of clinicians, employers and occupational health professionals. Together, these MSDs illustrate the effects of conditions from which a third of Bulgarian workers may report at any one time. Improving our understanding of the effects of these conditions, how staying in work can be beneficial, and what might be done to alleviate their impact, can yield significant social and economic benefits. In the absence of a consensus on a clinical definition of many MSDs, navigating the literature on their prevalence, incidence, diagnoses, epidemiology, treatment and cost to Bulgarian society is a difficult task. The lack of standardisation and validation of the terminology and classification of MSDs is one of the reasons for the contradictory findings in the literature regarding the diagnosis, epidemiology, treatment and rehabilitation of these conditions (WHO, 2003). Some clinicians differentiate between ‘musculoskeletal conditions’ and ‘musculoskeletal disorders’. The former refers to all clinical conditions affecting the musculoskeletal system and the latter, to borrow a definition from the ETUI (2007), meaning ‘any affliction of the musculoskeletal system that appears at work and causes discomfort, difficulty or pain when performing work’. Until 2007 Bulgaria did not have an official definition of work-related musculoskeletal disorders (Gladicheva and Chengelova, 2007). The most commonly used definition was defined by an expert group at the University Clinic of Occupational Diseases: Fit For Work? 15
Page 1 and 2: Fit For Work? Rosemary Thomas Kseni
Page 3 and 4: Contents 1. Executive summary 5 2.
Page 5 and 6: 1. Executive summary The ‘Fit for
Page 7 and 8: What can be done? Executive summary
Page 9 and 10: Executive summary We have found imp
Page 11 and 12: Increasing work intensity is a very
Page 13: 2.2 MSDs: The European context Intr
Page 17 and 18: 2.5 Structure of the report Introdu
Page 19 and 20: Figure 3.1. Number of MSDs inpatien
Page 21 and 22: • Stamina and resilience; • Cog
Page 23 and 24: Work and MSDs in Bulgaria It is imp
Page 25 and 26: of RA and specific leukocyte antige
Page 27 and 28: injuries or back pain 15 ; Sieper,
Page 29 and 30: 2001). The study also found that fo
Page 31 and 32: • Local or whole-body exposure to
Page 33 and 34: workers of developing rheumatoid ar
Page 35 and 36: 3.4 The wider economic and social i
Page 37 and 38: Work and MSDs in Bulgaria Direct co
Page 39 and 40: presented in the Table 3.3 below. T
Page 41 and 42: 3.5 Summary Work and MSDs in Bulgar
Page 43 and 44: Job retention and return to work pr
Page 45 and 46: 4.2 The social security regime for
Page 47 and 48: Further indirect costs of disabilit
Page 49 and 50: 4.3 Conditionspecific interventions
Page 51 and 52: RA in Bulgaria who receive biologic
Page 53 and 54: Interventions Since it was first pr
Page 55 and 56: apart from norms of shift work. 43
Page 57 and 58: Box 2. Case Study - EPIQ Electronic
Page 59 and 60: the beliefs that both parties have
Page 61 and 62: 4.6 Summary 4.5.4 Improved employer
Page 63 and 64: 5.1 Recommendations for employers 5
Page 65 and 66:
5.3 Recommendations for GPs and spe
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Conclusions and recommendations •
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Breen, A., Langworthy, J. and Bagus
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der Tempel, H. and van der Linden,
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Guzman, J., Esmail, R., Karjalainen
Page 75 and 76:
References Nachemson, A., Waddell,
Page 77 and 78:
Waddell, G. and Burton, A. K., (200
Page 79 and 80:
Appendix 2: Sample ‘Fit’ Note S
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Sources: Eurostat Statistical Datab
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Sources: Parent-Thirion, Fernández
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Hourly labour costs 2007 Average ho
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% sickness absence due to health re
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Appendix 3: Benchmarking grid Refer
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The aim of the project is to stimul
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Appendix 4: Fit for Work Europe Wha
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We provide: Research Advisory Consu
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