2Economic impact of musculoskeletal disorders (MSDs) on work in Europe
Section snippets
Context
There are four contextual factors, which frame the issue of workforce health in most European Union (EU) member states.
The first is the ‘ageing workforce’. Across the EU, the proportion of workers aged 50 years or more is 2 times that of those aged 25 years or younger. This is a disparity which is expected to worsen for several decades to come. With ageing comes a greater risk of poor health and premature withdrawal from the labour market. In some developed economies, almost half of those aged
The prevalence of MSDs and their impact on work
In an ad hoc analysis of the European Labour Force Survey commissioned by DG Employment and Social Affairs in Brussels [18], MSDs accounted for 53% of all work-related diseases in the EU-15. Work-related MSDs resulted in most lost days and permanent incapacity to work. Overall, they accounted for 50% of all absences from work lasting for more than three days, 49% of all absences lasting two weeks or more and about 60% of all reported cases of permanent incapacity. The analysis estimated that
Work-related upper limb disorders
The Global Burden of Disease data indicate that neck pain accounts for the fourth largest proportion of YLDs of all health conditions across the world. Just over 22.8% of European workers report that they have experienced muscular pain in their neck, shoulders and upper limbs [20]. Whilst no agreed classification of WRULDs exists, there is a common consensus that symptoms of WRULDs can present in the tendons, muscles, joints, blood vessels and/or the nerves and may include pain, discomfort,
Low back pain
Back pain is common, episodic, often recurrent and generally self-limiting. It ranks as the health condition with the highest impact on YLDs in the Global Burden of Disease. Recorded absence is greatest amongst the minority of sufferers whose condition is chronic – if pain lasts for more than 12 weeks – or recurrent – if there are several episodes of pain in one year lasting <6 months. Most people who are affected by back pain either remain in work or return to work promptly. About 85% of
Rheumatoid arthritis
RA is an example of a specific and progressive MSD. It is a form of inflammatory arthritis with a prevalence of between 0.3% and 1% in most industrialised countries [14]. Data on the prevalence of RA were obtained largely from studies performed in the USA and Europe. The disease affects people of any age, although peak incidence is in the mid-age range of the working-age population, between 25 and 55 years. Epidemiological studies have shown that RA can shorten life expectancy by around 6–10
The impact of the workplace on MSDs
The risk factors for MSDs are wide ranging. Whilst there is a broad consensus among experts that work may be a risk factor for MSDs, non-work activities such as sport and housework can contribute to musculoskeletal strain. Some studies, for example, have noted that a higher prevalence of musculoskeletal pain among working women may be linked to the fact that women are still mainly responsible for doing the majority of housework [38]. In addition, caring responsibilities can also increase the
The wider economic and social impact of MSDs
The effect that MSDs can have on an individual's ability to work and the time they may require to be absent from work means that MSDs have significant associated costs to individuals, families, carers, employers and the wider economy. Calculating the exact costs is not straightforward. Several factors need to be considered and obtaining accurate, reliable and consistent figures is a challenging task. For example, welfare payments (e.g., disability benefit) are transfer payments. They move
Direct costs
As mentioned above, cost-of-illness estimates require input from a number of different factors, and great variation is found across different studies. For low back pain, the most significant direct costs are related to physical therapy, inpatient services, drugs and primary care [50]. Nachemson, Waddell and Norlund [51] calculated that about 80% of health care costs are generated by 10% of those with chronic back pain and disability. For RA, although direct health care costs have been
Indirect costs
There are two main types of indirect costs most commonly measured in association with ill health in employees. These are absence from work and what is termed ‘presenteeism’, or loss of productivity in an employee while they are at work with an illness or incapacity. Presenteeism is extremely difficult to measure reliably. As a result, most estimates of indirect costs are based on absence data. However, it is worth noting some of the limitations of data collected on absence from work. The
Total costs
The cost calculations for MSDs in general provide relatively good estimations of the costs of nonspecific MSDs given that nonspecific MSDs constitute the vast majority of cases. Calculating the costs for specific MSDs is fraught with the same difficulties as for MSDs as a whole. The majority of studies estimating the economic burden of RA have provided cost estimates specific to the US population and health care system [61], Findings across countries with respect to work disability rates are
Work as a ‘clinical outcome’ for workers with MSDs?
If the clinical, societal and economic burden of musculoskeletal disorders in Europe's working-age population is not to become overwhelming as the workforce ages and works longer, then there are several areas of both policy and practice which may need to be re-focussed. In this final section, we will examine two such areas. The first is Health Technology Assessment (HTA) and the second is work-focussed early intervention. The argument is that if both had the principle that work should be a
Conclusion
MSDs among Europe's working-age population represent a considerable economic burden at a time when labour productivity is close to stagnant and health care costs are under severe scrutiny. Over the next two decades, the workforce will age, it will be required to retire later and it will – as a result – be more likely to have its productivity further undermined by a growing burden of chronic ill health and co-morbidity.
If the economic, societal, clinical and individual consequences of this
Conflict of interest declaration
The Work Foundation is a UK Charity and part of Lancaster University. Its research on Musculoskeletal Disorders (MSDs) has been funded by grants from Abbvie for the ‘Fit for Work’ initiative. The Work Foundation retains full editorial control over all outputs from this research.
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