Work ability and challenges for employers and employees on sustainable employability

Transcription

1 Work ability and challenges for employers and employees on sustainable employability Prof Alex Burdorf Department of Public Health Erasmus MC Rotterdam

2 Life is treating us very well.. Life expectancy in the Netherlands men women Life expectancy at birth in the Netherlands. Source: CBS 2008

3 higher vocational & university intermediate education lower education primary school higher vocational & university intermediate education lower education primary school.but some are much better off... life expectancy 90,0 85,0 80,0 75,0 70,0 65,0 men women Large health inequalities in society

4 higher vocational & university intermediate education lower education primary school higher vocational & university intermediate education lower education primary school.but some are much better off... life expectancy healthy life expectancy 90,0 85,0 80,0 75,0 70,0 65,0 60,0 55,0 50,0 men women Large health inequalities in society

5 Consequences of increased life expectancy: adjustment of retirement age to life expectancy? Age of retirement w ith equal life expectancy (16 years) at age of retirement 68,0 66,0 64,0 62,0 60,0 58,0 56,0 higher educ intermediate educ low -intermediate eudc low er education men

6 higher educ intermediate educ lowintermediate eudc lower education higher educ intermediate educ lowintermediate eudc lower education Consequences of increased life expectancy: adjustment of retirement age to life expectancy? Age of retirement w ith equal life expectancy (16 years) at age of retirement 72,0 70,0 68,0 66,0 64,0 62,0 60,0 58,0 56,0 54,0 men w omen

7 Cumulative Survival, % 1-Cumulative Survival The role of ill health in labour force participation Displacement from the labour market through various exit routes 1,00 1,00 0,90 0,80 0,95 0,70 0,60 economically inactive 0,50 unemployment 0,90 Disability pension 0,40 disability pension 0,85 Early retirement Unemployment Economically inactive 0,30 0,20 0,10 0,80 0, Year 0, Year Merel Schuring, Scand J Work Environ Health year follow-up study among Dutch workers

8 The role of ill health in labour force participation Leaving paid employment due to: unemployed economically disability early inactive pension retirement HR HR HR HR Poor health 1.87 ns Low income 50-25% <25% Low education

9 The role of ill health in labour force participation Van den Berg et al. Occup Environ Med 2010;67:845-52

10 Crude estimates of determinants of quitting labour force participation Average contribution early retirement unemployment Poor health 8% 12% Unhealthy lifestyle 6% 16% Hazardous working conditions 6% 10% (work demands, physical load) (20%) (38%) Source: Burdorf A, Mackenbach PJ. The influence of health on early displacement from the labour market. Zoetermeer, Council for Public Health and Care, 2006 [in Dutch]

11 Health, work, and lifestyle as risk factors for quitting paid employment SHARE-study European countries, persons aged years Theoretical gain in working life expectancy due to complete elimination of unfavourable factors: Men Women Lack of job control & 0,4 yr 0.5 yr effort-reward imbalance High physical load 0,3 yr 0.4 yr ill health 0,4 yr 0.5 yr

12 proportion participation Potential impact of elimination of ill-health on labour force participation (men) Effect of interventions on labour participation among men aged 50 and older age current participation prevention of poor health Life table analysis based on associations between self-assessed health and exit from paid employment (longitudinal analysis of SHARE)

13 Take home messages 1 * Large inequalities in health: Inequality in life expectancy by education: 6 to 7 years Inequality in healthy life expectancy by education: 16 to 19 years * Consequences for working population: Lower educated workers have a much higher probability to encounter serious health problems during working life than higher educated workers * Health (and its determinants) is important to remain in the workforce: Poor perceived health predicts quitting the labour force, especially through disability and unemployment

14 Will these workers work until older age?

15 Keeping workers vital and healthy The challenge: working longer in good health Health: Challenge: Stay healthy Work: Challenge: 1. maintain in paid employment 2. maintain productive at work 3. maintain capabilities

16 The Work Ability Index (WAI) from Finland Work ability as measure of health-related capabilities of a individual worker to meet the demands at work Consists of 7 items (score between 7 and 49) 1 Comparison of current work ability with the best during workers lifetime (1-10) 2 Current work ability in relation to the physical and mental demands of the job (1-10) 3 Number of diagnosed diseases (1-7) 4 The effect of the diseases on daily work(1-6) 5 Number of days of sickness absence (1-5) 6 Self-estimated work ability after two years (1-7) 7 Mental resources (to enjoy daily activities, etc) (1-4)

17 Distribution of work ability among Dutch construction workers (n = 26,000)

18 Prognostic value of work ability Consequences of a reduced work ability for * Permanent disability * Sick leave * Productivity loss at work * Health care use

19 Prognostic value of work ability Work-related disability among 853 construction workers (sample North-Holland, 40 yrs and older, 2.5 yrs follow-up) Workability Risk on becoming disabled n RR excellent/good 71% 1.0 moderate 24% 8.3 poor 5% 40.2

20 Prognostic value of work ability Work-related disability, 853 construction workers, 40+ yrs

21 Prognostic value of work ability Predictive power of work ability index for sickness absence (1 year follow-up study among 5,677 construction workers in the Netherlands)

22 Prognostic value of work ability Predictive power of work ability index for sickness absence (1 year follow-up study among 5,677 construction workers in the Netherlands) WAI sickleave < 2 weeks 2 weeks - 3 months > 3 months RR RR RR Excellent 1.00 reference 1.00 reference 1.00 reference Good 1.21* 1.65* 1.43* Moderate 1.39* 2.00* 2.90* Poor * 3.18* * Statistically significant, adjusted for important confounders Source: Alavinia et al Scand J Work Environ Health 2009

23 Maintain productivity

24 Prognostic value of work ability Self-reported productivity loss (0-10 scale) at work (cross-sectional survey among 2252 workers across the Netherlands) Work ability Good Moderate Poor Degree of productivity loss at work -7.1% vs excellent -16.6% vs excellent -26.4% vs excellent

25 % workers with care use in past 12 months Prognostic value of work ability Study among > 7,000 nurses in Dutch health care

26 Take home messages 2: Work ability index has predictive value for work performance: permanent work disability, sick leave, and productivity loss at work Work ability index is also associated with medical consumption The consequences of a decreased work ability differ strongly across individuals and workplaces

27 Vital and healthy Winning the league?

28 Potential solutions 1. Address the factors that determine a reduced work ability: - health - physical work demands - psychosocial work demands 2. Ensure that workers with health problems can remain active in the workforce

29 Factors that determine a reduced work ability Determinants of a reduced workability: - high mental work demands, lack of autonomy (job control) - high physical work load - age - obesity, lack of physical activity Workplace and lifestyle interventions required

30 Factors that determine a reduced work ability

31 Associations of physical and psychosocial work-related factor with WAI score, adjusted for age and job type Work related factors β SE R 2 Work related physical load Repetitive movements * Static work postures * Awkward back postures * Manual materials handling * 0.22 Work related psychosocial load Lack of support at work * High work demands * Low job control * Alavinia et al Scand J Work Environ Health 2007

32 Work- related determinants of WAI score among professional workers in banks and software companies (highly educated) WAI Multivariate model High teamwork Intermediate teamwork Low teamwork * SE High stress-handling Intermediate stress-handling Low stress-handling * -2.75* High self-development Intermediate self-development Low self-development * -2.20* Van den Berg et al. Int Arch Occup Environ Health 2008

33 Individual determinants of WAI score among professional workers in banks and software companies (highly educated) WAI Multivariate model Age Male Intermediate vs. Low life change score High vs. Low life change score Lack of vigorous physical activity Current smoker Problematic alcohol use Obesity (BMI 30) VO 2 max (ml/kg/min) Biceps strength (kg) -0.09* 2.08* -1.14* -2.01* -0.71* n.s n.s -1.21* n.s n.s SE

34 Factors that determine a reduced work ability Determinants of reduced work ability (cross-sectional survey among 5,000 nurses in the Netherlands) Reduced WAI (OR) Imbalance between work and home 4.2 High work pressure 2.6 Lack of respect from employer 2.4 Lack of job control 2.0 Lack of respect from patients and family 2.0 Heavy physical work 1.8 Negative about leadership 1.7

35 Factors that determine a reduced work ability Self-reported productivity loss at work (cross-sectional survey among 10,542 workers across the Netherlands) Good WAI and high job control 1.00 Productivity loss at work (OR) low job control 1.23 ( ) Decreased WAI and high job control 2.25 ( ) low job control 3.11 ( ) Thus, among those with a decreased WAI high job control will reduce the negative effects on productivity at work by 38% Van den Berg et al. 2010

36 Potential solutions Take home messages 3 1. Poor health, lack of vitality, and poor workability have similar determinants and, thus, similar solutions: - preventive interventions on unhealthy behaviour (obesity, lack of physical activities) - poor working conditions (physical load, work pressure, lack of control) - organisational culture (leadership, communication) and career development

37 Potential solutions 2. Effective interventions are possible: - health promotion (without dedicated effort very limited effect!) - physical load (reduce heavy lifting and awkward postures) - psychosocial load (reduce work stress, increase individual job control) 3. A sustainable workforce requires an integrated approach in companies of health management, occupational health, and human resources

38 The challenges 1. More insight into inter-relationships among different determinants: * age-dependent effects of ill health and working conditions on workability * influence of HRM on workability * workability after return to work 2. Effective interventions to increase sustainable employment: * Cost-effectiveness studies are highly needed * Monitoring of uptake and sustainability of activities * attention for interaction between individual workability and organisational characteristics (culture, leadership, HRM)

39 The challenges 1. More insight into inter-relationships among different determinants: * age-dependent effects of ill health and working conditions on workability * influence of HRM on workability * workability after return to work 2. Effective interventions to increase sustainable employment: * Cost-effectiveness studies are highly needed * Monitoring of uptake and sustainability of activities * attention for interaction between individual workability and organisational characteristics (culture, leadership, HRM)

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