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

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Executive summary The Impact of MSDs on the Bulgarian workforce 6 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 Bulgarian workers. Evidence suggests that: • At least 30 per cent of Bulgarian workers experience pain in their back or limbs at any one time. • MSDs accounted for 1005.2 hospitalisation cases per 100,000 working age population (6.1 per cent) in 2004. • Direct costs of MSDs are estimated at just over 46 million euros. • MSDs are the third most common reason for absence from work amongst insured people after respiratory diseases, injuries and poisonings. • The costs of MSD-related absence amounted to almost 27 mln BGN in 2010. • Diseases of the musculoskeletal system and connective tissue accounted for 8.9 per cent of primary disabilities for people over 16 years of age in 2009. Of these, 83 per cent experienced over 50 per cent loss in their capacity to work. • Just over the nine months to September 2011 at least 31.6 mln BGN were spent on pensions for work-related disability. 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; • Agility. It is becoming clearer that people with MSDs are also likely to have depression or anxiety problems related to their conditions, and are therefore reluctant to disclose those to their employers. Delays in treatment 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 general practitioners (GPs), employers and even individuals with MSDs do not fully appreciate the long-term impact of poor health on their performance and ability to stay in work. This is partially due to poor communication and lack of coordination between GPs and employers regarding occupational health issues. Fit For Work?
What can be done? Executive summary 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. Concerned with legal compliance, GPs and employers may mistakenly believe that employees have to be 100 per cent fit to perform their jobs. However, evidence suggests that phased return to work can help ameliorate the deterioration of many conditions and help recovery from MSDs. For example, altering the psychosocial factors within the workplace, such as work hours, level of autonomy, and relationship with direct management, can have a significant impact on the employee’s productivity. 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. Looking to the future, with prospects for an ageing workforce, growth in obesity and smoking rates, reduction in exercise and physical activity and general fitness in the general population, it is likely that the incidence and effects of MSDs will intensify and worsen rather than improve in the medium-to-long term. We are concerned that this will affect the quality of working life of many Bulgarian workers, and that the productive capacity of the Bulgarian workforce will be adversely affected at a time when it needs to be on top form. There are five main principles which GPs, employers, employees and the government should focus on if we are to improve the working lives of workers with MSDs. • Early intervention is essential. The overwhelming evidence is that long periods away from work are usually bad for MSD patients – the longer they are away from work, the more difficult it is for them to return. Early action, preferably in a partnership between GPs, the patient and their employer, can help those with MSDs to keep their jobs and to achieve a balance between the individual’s need for respite and their need to work. For some MSD patients’ early access to physiotherapy or to drug therapies can reduce the severity, impact or progression of the condition – a delay in diagnosis or treatment can make recovery, job retention or rehabilitation much more difficult. Once the economic upturn arrives – which it assuredly will – the Bulgarian economy cannot afford for its recovery to be inhibited by a shortage of skilled, motivated and healthy workers. • Establish work as an outcome of treatment. Both GPs and specialist consultants should bring to bear their understanding of the biopsychosocial model and – most importantly – the limitations of the biomedical model in diagnosis and assessment of the role that a job might play in helping someone to stay active and avoid isolation. Focus Fit For Work? 7
Page 1 and 2: Fit For Work? Rosemary Thomas Kseni
Page 3 and 4: Contents 1. Executive summary 5 2.
Page 5: 1. Executive summary The ‘Fit for
Page 9 and 10: Executive summary We have found imp
Page 11 and 12: Increasing work intensity is a very
Page 13 and 14: 2.2 MSDs: The European context Intr
Page 15 and 16: 2.4 A note on definition Introducti
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
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Box 2. Case Study - EPIQ Electronic
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the beliefs that both parties have
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4.6 Summary 4.5.4 Improved employer
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5.1 Recommendations for employers 5
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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
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References Nachemson, A., Waddell,
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Waddell, G. and Burton, A. K., (200
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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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