01.07.2014 Work – a health risk

Work-related health problems. Road workers with damaged hearing, hairdressers with chemical allergies or carpenters with asbestos-impaired lungs: Suva (the Swiss Accident Insurance Fund) handles around 3000 such work-related insurance cases each year. In addition to these relatively clearly defined "occupational diseases", however, there are an infinitely larger number of dis­orders that are also – though not only – caused by work: "work-related health problems". Such physical and mental disorders, for instance stress and back pain, have increased massively in recent decades. Prevention of work-related health problems requires close cooperation between employers, prevention specialists and insurers.

Pictures Work – a health risk


While the causes of occupational diseases can be clearly attributed to the exercise of a particular type of work, in the case of work-related health problems it is extremely difficult to demonstrate a precise causal chain. It is virtually impossible to measure or even only estimate the extent to which an illness is due to the patient's work. Besides specific working conditions, a role is also played by factors such as individual predisposition or problems in private or social life. But one thing is certain: such health problems are particularly common among people who work. According to surveys of the Swiss working population, 18 percent report work-related back pain and 13 percent other work-related musculoskeletal pain. The stress study carried out by SECO (State Secretariat for Economic Affairs) has shown that the proportion of the working population who suffer frequently or very frequently from stress rose from 26 percent in 2000 to over 34 percent in 2010. Stress fosters a large number of physical and mental disorders, for instance cardiovascular diseases of all kinds, burnout or depression.

Top performance, but too little physical activity
The reasons for the rise in work-related health problems are obvious: the demands made on employees with regard to performance, flexibility and information processing have increased, as has the intertwining of work and private life. In addition, these higher demands combined with growing uncertainty at work promote the widely observed phenomenon of putting oneself voluntarily at jeopardy. This occurs when someone is prepared to sacrifice their health and wellbeing to their putative career by, for instance, turning up for work despite being ill, going without breaks, making themselves available during holidays or doing lots of unpaid overtime. Such excessive levels of performance increasingly result in recourse to medication. In the SECO study, four percent of respondents said they had used stimulants in the previous twelve months to boost their physical performance. A further four percent reported taking medicines such as Ritalin to enhance mental performance or mood. This situation calls above all for entrepreneurs and managers to adapt their working climate so as to prevent such work excesses by themselves and their employees within the framework of a caring, appreciative corporate culture.

While the demands on mental performance are growing, people in Switzerland engage in far too little physical activity because of the predominantly sedentary nature of their work, due on the one hand to the shift of jobs from industry to the service sector and on the other to growing automation in industry. The outcome is musculoskeletal pain or overweight, which itself facilitates a number of diseases such as high blood pressure or diabetes. A further consequence of physical inactivity is metabolic syndrome. As the name suggests, this is a problem of the metabolism; it is associated with high blood sugar and blood lipid levels and increases the risk of heart attack and stroke. Lack of physical activity is also associated with other problems, for instance an increased risk of colon cancer and osteoporosis. People who take little exercise also suffer from mental problems such as depression or anxiety. But studies show that even a slight increase in physical activity can greatly reduce these health risks. The risk of, say, a heart attack can be virtually halved by engaging in additional physical activity that uses up 2000 to 3000 calories a week. This corresponds, for instance, to three one-hour swimming sessions a week or jogging for a good half hour every day.

Economic cost in billions
In Switzerland, the distinction between occupational diseases and work-related health problems has immediate implications for insurance coverage: occupational diseases are subject to the Accident Insurance Act, and thus insurance funds such as Suva come into play, while work-related health problems are subject to the Health Insurance Act. This means that, in the former case, the employer's insurance takes over the health-related costs, in the latter the employee's health insurance fund. Regardless of the type of insurance cover involved, however, work-related health problems and the resulting absences from work generate enormous costs for employers. According to the SECO study, stress alone generates annual costs of around ten billion francs. Back pain costs the Swiss economy between 1.6 and 2.3 percent of gross domestic product. It is therefore all the more important not just to react to work-related health problems but also to take steps to prevent them. Effective prevention requires close networking of the numerous players active in this area.

Preventing work-related health problems: Suva in the vanguard
Suva has taken an active interest in the phenomenon of work-related health problems for many years. It has advocated the development of practice-oriented prevention measures through its "Progrès" project since 2002. Companies operating an effective in-house workplace health promotion system are still rare. The money spent on prevention is usually perceived as a cost rather than an investment. However, many managers underestimate the cost of work-related illnesses and accidents and overestimate the cost of prevention measures. But if the efficiency of prevention measures is to be documented and employers are to be persuaded of the benefits, scientific evidence is required. This is also a goal of the Suva "Progrès" project (see box). A further major Suva commitment is the annual discussion forum on the subject of work-related health problems, at which representatives of industry, medicine, prevention and the social partners meet to exchange views. Given the complex nature of work-related health problems, a joint interdisciplinary approach to the development of prevention measures is the only way of tackling the growing issue.

Suva's project on work-related health problems

– Study of intervention strategies for chronic musculoskeletal pain (ETH Zurich/University of Lausanne)
– Study of work-life balance and health (ETH Zurich/University of Zurich)
– Study of the effect of working out on somatic disorders (University of Bern/
Bern University of Applied Sciences and Arts)
– Study of cultural differences in perceptions of stress and the corresponding communication strategies vis-à-vis co-workers and employers
(University of Lugano)
– Annual discussion forums with interdisciplinary participation
– "Bewegung ist möglich" [Physical activity is possible] – Suva competition
to promote physical activity at the workplace
– stressNOstress.ch – website with a self-test and information on the subject
of stress (University of Bern)



Regula Ricka, Health Policy, regula.ricka@bag.admin.ch

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