01.07.2014 Work-related diseases

Forum Prof. Dr. med. Brigitta Danuser. Work-related health problems are common; indeed, all surveys show that they have been growing rapidly since the 1990s. In the 2012 Swiss Health Survey, 60 percent of respondents stated that they suffered from stress, and around 20 percent claimed to experience chronic stress that affected their health. The risk of depression is five times higher among chronically stressed individuals. According to an estimate of the State Secretariat for Economic Affairs (SECO), stress generates costs of ten billion francs a year for employers. Every second respondent in the general population had experienced back pain in the previous four weeks, with 18 percent of them receiving medical treatment for the problem. In surveys of the working population, 18 percent report work-related back pain, and 13 percent (or over 50% in 2010) other work-related musculoskeletal pain. The economic costs generated by back pain amount to between 1.6 and 2.3 percent of Swiss gross domestic product.

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Work-related health problems often result in sickness absences, and about 10 percent of people affected may experience long-term unfitness for work and even disability – every sixth patient with chronic back pain applies for a disability pension.
There are many different reasons, as yet little researched, for the increase in work-related health problems. Experts agree that changes at work, in the way work is organised, in the labour market, in social medicine structures, but also in new demands made on employees at the workplace and in their private lives all play an interacting role.
Given their frequency and associated costs, work-related health problems are a priority public health problem. What is being done in Switzerland to prevent them? The 2006 ESENER (European Survey of Enterprises on New and Emerging Risks) survey shows clearly that Swiss employers are much less aware of the risk of work-related health problems than their European counterparts and they have undertaken fewer preventive measures. What is more, workplace health management in Swiss-based companies often goes no further than absence management.
There is a lack of primary prevention measures, and little has been done to develop and coordinate the medical care and rehabilitation of those affected. In Switzerland, the underdeveloped state of occupational medicine means that the identification of occupational diseases and work-related health problems has to depend on primary care providers and a number of specialists such as rheumatologists and psychiatrists who are particularly involved. 820 physicians in the French-speaking part of Switzerland (general practitioners, rheumatologists, pulmonologists, psychiatrists and dermatologists) stated in a questionnaire survey that 14.5 percent of preliminary diagnoses were work-related. This figure varies according to specialist field: general practitioners 15 percent, psychiatrists 17 percent and rheumatologists 21 percent. The most frequently cited work-related diseases are mental disorders (93 percent), back pain (70 percent) and other musculoskeletal disorders (29 percent). Of the physicians surveyed, 55 percent had never consulted a specialist in occupational medicine and 40 percent had never contacted a patient's employer, in an average of 27 years of professional practice. When asked about the need for assistance, 74 percent want help with stress-related diseases, 75 percent with getting patients "back to work" and 73 percent with the diagnosis of occupational diseases. On the basis of these findings, the Institute for Work and Health (IST) has in the last two years offered the interdisciplinary consultations on "Suffering at work", and a comparable service is being developed on "Back to work".
It is not surprising that returning to work after work-related health problems or other serious or chronic diseases that may require changes at the workplace creates problems for the physicians surveyed. They are not trained to help people back to work, and they fear that medical confidentiality is put at risk by the lack of a medical contact person within the enterprise. Moreover, the world of work is becoming increasingly competitive, which does not make it any easier to work with, or after, an illness. In addition, the OECD Report on Mental Health and Work Switzerland shows that the interface between the healthcare system and the world of work is not really functioning. Today, for instance, we can see that this interface is increasingly being handled by the insurers (daily sickness benefits and disability insurance) – and not only at the administrative level. If this is motivated solely by short-term cost-cutting considerations, a return to work ends in many cases in termination of employment.

Prof. Brigitta Danuser MD
FMH (Swiss Medical Association) specialist in occupational medicine
Institute for Work and Health, University of Lausanne

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