Health and Safety Executive

Cause and effect of sick

leave

Dr. Emilia Zainal Abidin

Department of Environmental and Occupational Health

Faculty of Medicine and Health Sciences

UPM

Outline of this presentation

• The health agenda

• Understanding sickness absence

• Identifying the underlying causes

• Managing excessive sick leave

Health: the role of the workplace

• More than 50% of working age people in Malaysia are in employment and spend a high proportion of their waking hours in the workplace

• The workplace offers great scope for targeting of messages and initiatives about healthy living – with potential impact on both employees and their families

• Need to go beyond essential compliance with health and safety legislation and promote health and well-being more generally

Work and health – what we know

• Work offers opportunities to promote individual health and well-being

• Work should be recognised by all as important and beneficial, and access to, and retention of work promotes and improves the overall health of the population

• Long-term sick leave / sickness absence is a strong predictor of disability and mortality

• Work has a positive impact on health and well-being (‘good jobs’ in well managed organisations)

• Under some circumstances work can have adverse effects (‘bad jobs’)

• The key is prevention of underlying causes rather than relying just on management of outcomes (secondary & tertiary interventions)

Sources: WHO (2010). WHO Healthy Workplace Framework and Model: Background and Supporting Literature and Practices.

Sickness Absence or Sick Leave and Health

• Risk factors for sickness absence are not always the same as risk factors for disease

• An holistic approach needs to focus both on the risk factors that precede absence as well as implementation of policies & procedures for monitoring & management.

• Sickness absence data collection, analysis and interpretation methods need to reflect both aspects.

Sick leave and legislation in Malaysia

• The Employment Act 1955

• An employee is entitled to paid sick leave only under the following circumstances:– he has obtained a certificate from a registered

medical practitioner duly appointed by his employer; or

– he has obtained a certificate from a dental surgeon; or

A national study of absence

Definitions:

• Disease: is defined in terms of objective biological abnormalities in the structure and/or functions of bodily organs and systems

• Illness : is the personal subjective perception of unwellness. Therefore, if a person feels ill, they are ill

• Sickness: is derived from the concept of the “sick role”, a role that carries certain privileges (to stay away from work), as well as obligations (to seek medical help and to ‘get well’).

Ill health: A Population Study

33

235

8

3

2

1

Illness %

Disease %

Absence % >14 days

None of these 25%

Wikman et al (2005)

2% of the blue ‘sickness absence’ represents factors other than health-related ones.

So, what are they? The short answer is we are not sure! combination of reasons including coping behaviour; withdrawing from the hazard, the so-called flight response.

Sickness Absence: NHS Trust

Typical - Stress Sickness Abscence Data(n=3600, mean 27 days)

0

10

20

30

40

50

60

70

80

01-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 101-110 111-120 121-130 131-140 141-150 151+

DURATION - DAYS

No.

INC

IDEN

TS

The Individual

The biopsychosocial model: (Waddell & Burton, 2004)

Biological:

• The physical or mental health function

Psychological:

• Recognises that personal and psychological factors also influence functioning and the individual must take some responsibility for their behaviour

Social:

• Recognises the importance of the social context, pressures and constraints, on behaviour and functioning

Drivers of sickness absence

• Individual factors – personality and motivation; past behaviour; sick role

• The ‘system’ – organizational culture and tolerability, what is legitimate; sickness certification

• Non-work factors – life events and family pressures

• Work factors – absence as ‘coping’, job satisfaction, chronic adverse features of work

• Commitment and involvement

Health and Safety Executive

Work stressors: effects on

health and sickness absence

Findings from Whitehall II and other studiesFindings from Whitehall II and other studies

2

Moves to private sector practiceMoves to private sector practice

Job insecurityJob insecurity

Temporary employmentTemporary employment

Labour market stressorsLabour market stressors

Moves to private sector practice Moves to private sector practice (transfer to an executive agency)(transfer to an executive agency) effects on health and sickness absence effects on health and sickness absence (men)(men)

* adjusted for age, employment grade, marital status & health at the beginning of the follow-up period

0

0.5

1

1.5

2

2.5

systolic bp diastolic bp weight

0

10

20

30

40

50

60

physical ill-health*

longstanding illness*

sickness absence

mental ill-health

Ferrie et al. J Occup. Health Psychology 20013

rela

tive

incr

ease

in c

ardi

ovas

cula

r ri

sk f

acto

rs

com

pare

d to

men

not

tran

sfer

red

to a

genc

ies*

% e

xces

s il

l-he

alth

com

pare

d to

men

no

t tra

nsfe

rred

to a

genc

ies*

Job insecurity and health in womenJob insecurity and health in women

60

80

100

120

140

160

180

200

220

240

260

poor physical health poor mental health depression longstanding illness

Incr

ease

in il

l-hea

lth*

remained securegained job securitylost job securitychronic job insecurity

*adjusted for age, employment grade & health at the beginning of follow-up

Ferrie et al. J. Epidemiology Community Health 20024

Ferrie et al. Am. J. Public Health 1998

Job insecurity and coronary artery diseaseJob insecurity and coronary artery disease

*adjusted for age, grade and CAD before the threat of privatisation

5

Job insecurity and sickness absenceJob insecurity and sickness absence

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

1.1

Women Men

Secure (Controls) Insecure - Short spells Insecure - Long spells

Od

ds

Rat

ios*

*adjusted for age, employment grade and health status

Ferrie et al 2001 J. Occup. Health Psychol6

Temporary employment and sickness absence

0

0.5

1

Baseline Follow-up

Permanent Temp - Perm Temporary

Rat

e R

atio

s*

*adjusted for age, sex, income, and number of contracted days

Virtanen et al 2003 Occup Environ Med7

Temporary employment and early death

0

0.5

1

1.5

2

Women Men

Permanent Temp - Perm Temporary

Haz

ard

Rat

ios*

*adjusted for age, occupational status and income

Virtanen et al 2003 Am. J. Epidemiol8

Organisational JusticeOrganisational Justice

Procedural componentProcedural component decision-making procedures include input from affected parties, are consistently applied, open and ethical

Relational componentRelational component respectful and considerate treatment of employees by supervisors

21

refers to the extent to which employees are treated with refers to the extent to which employees are treated with fairness and justice at their workplacefairness and justice at their workplace

Organisational Justice Organisational Justice (relational component)(relational component) and sickness absence in womenand sickness absence in women

0.8

0.9

1

1.1

1.2

1.3

1.4

Short-spells Long spells

Low Intermediate High

Od

ds

Rat

ios*

*adjusted for age, employment grade and health status

Head et al 2007 J. Psychosomatic Research23

Estimated incidence rates of self-reported work-related illness, for people working in the last 12 months

0

500

1000

1500

2000

2500

All illnesses Musculoskeletal disorders Stress, depression or anxiety Other illnesses

Inc

ide

nc

e r

ate

(p

er

10

0 0

00

)

2001/02 2003/04 2004/05 2005/06 2006/07 2007/08 95% confidence interval

Health and safety statistics 2007/08

Managing sickness absence

Introducing sickness absence management• Do you have a procedure?

• Is your existing procedure contractual?

• You will require employee agreement to vary

existing terms

• No procedure

• Engage employees to introduce a new policy

• Explain your business reasons

• Explain the changes/new procedure to

employees

Introducing sickness absence management

• Make your attendance policy part of your

induction process

• Make it part of your appraisal process

• Make line managers accountable

Introducing sickness absence management

• Keep accurate records of absence

• Record all absence

• Measure the cost of absence in all departments

• Employees to complete self certification forms

• Carry out return to work interviews

• Train line managers

Introducing sickness absence management

• Cautions not warnings

• Non contractual

• Develop triggers

• Calling in and keeping in touch

• Eligibility for company sick pay

• Consistent treatment

Tools for tackling short term absence

• Rigorous notification procedure

• Return to work interviews

• Should all short term absences be counted?

• Medical evidence?

• Withholding sick pay

• Employee health initiatives

Tools for tackling long term absence

• Keep in touch

• Early intervention 4-6 weeks

• Consider temporary adjustments

• Be proactive in asking for medical advice

• Preferably Occupational Health Practitioner

Designing ‘good’ jobs

• Promote ‘healthy’ workplaces

• Prevention and management of common health problems

• Job content, job context and organizational arrangements critical

• Move from a less desirable (‘bad jobs) to a more desirable state (‘good jobs’)

• HSE Management Standards can help in prevention and management

Summary

• The workplace offers the opportunity to promote and improve the health of employees and their families

• The drivers for ill-health are not always the same as the drivers for absence

• We need a better understanding of the causes of sickness absence so these can be managed in a proactive manner

• Current attendance management practice and policy is based on convention rather than evidence (IES, 2007)

Thank you