Changing Mindsets About Chronic Conditions

As the working population ages, more workers are likely to have a chronic health condition and too often these conditions lead to an early exit from work

An ideal workplace

The ultimate goal is to create a workplace that:

• recognises the importance of work-related MSDs and reduces risks, in particular for workers who may already have a musculoskeletal problem 
• takes preventive action — assessing and reducing risks to make sure the workplace is safe and designed to promote good musculoskeletal health 
• takes action to reduce stress at work 
• encourages early intervention for any musculoskeletal problem 
• makes reasonable adjustments and supports individuals to manage their own health so that people can continue to work despite their condition 
• supports a worker who is absent because of a chronic condition to get back to work through effective planning 
• promotes musculoskeletal health, for example encourages back care and physical activity, tackles prolonged sedentary work and enables workers to take short breaks, and supports workers to lead healthier lifestyles.

To achieve this, a workplace should:

• minimise risks and recognise that employees with RMDs may be more susceptible 
• avoid tasks involving prolonged static postures, sedentary behaviour or repetitive movements 
• ensure that workers avoid risks by following safe techniques and safe practices, using the right equipment and not taking shortcuts 
• plan workplace accommodations by focusing on an individual’s work ability (an individual’s capabilities not their disabilities) 
• take a joined-up approach that involves the employee, their healthcare team and their line manager, with the common goal of helping them to stay at work and work within their abilities 
• promote a culture of open conversation 
• train managers and workers to understand musculoskeletal health, RMDs and ways of supporting colleagues to remain in work. With the right employer, attitudes and workplace adjustments, combined with support from the public-health system, many people with chronic conditions can continue working.

The latest report from the European Agency for Safety & Health At Work says rheumatic and occupational safety and health has a role in supporting those with chronic conditions to remain at work.

Many adjustments are easy and cheap to implement. Health and safety measures that make work safer and easier for the entire workforce can enable an individual with reduced work capacity to remain in employment.

Simple measures to help an individual remain in work can often benefit the whole workforce.

What are rheumatic and musculoskeletal disorders

Rheumatic and musculoskeletal disorders (RMDs) are chronic problems that affect the muscles, bones,

joints and soft tissues, such measures to make work as rheumatism, arthritis, safer and healthier for all Simple adjustments osteoporosis and fibromyalgia. workers. This is important, as meain the workplace

They can affect work, or sures to make work easier be aggravated by work, but for all workers could enable Workers need to be given opportunities to find ways are not directly caused by someone with a chronic of working around their problems and to try things work. health condition to continue out on a trial-and-error basis, with enough time being

Their causes include working. allowed for this. HEALTH inflammatory diseases, ageing, injuries, and congenital and developmental conditions. If the precise cause of musculoskeletal pain is unclear, it is described as shoulder pain, back pain, etc. Conditions caused or aggravated by work are referred to as work-related musculoskeletal disorders (MSDs). Workers with rheumatic and musculoskeletal Particularly sensitive groups, such as workers with chronic conditions, must be protected against hazards that specifically affect them. However, making workplaces more inclusive for all workers, for example when buying equipment, planning tasks or altering buildings, reduces the need to make adjustments for individuals. 

Regulations setting minimum health and safety standards for Changing duties and tasks: • finding alternative ways of doing tasks • swapping or rotating tasks with colleagues • taking regular short breaks • reducing or avoiding activities that are difficult or that worsen symptoms (use of stairs, prolonged standing or sitting, and repetitive activities) • pacing work to prevent fatigue, avoiding last minute deadlines Equipment and workplace adaptations: • adapting computer equipment, for example using an ergonomic mouse, an ergonomic keyboard or voice-activated software • providing a portable perching stool to avoid the need for prolonged standing Working with musculoskeletal disorders Healthy Workplaces LIGHTEN THE LOAD How can people who develop an MSD be helped Working with musculoskeletal disorders Healthy Workplaces LIGHTEN THE LOAD disorders As the average age of the workplaces include requirements to make workplaces • improving workplace accessibility, for example with handrails, door handles, automatic doors How can people who workforce and retirement ages increase, the number of workers with a chronic Assess and reduce risks accessible for workers with disabilities. • repositioning workplace equipment and furniture to reduce strain • using adaptive controls for driving develop an MSD be helpedA positive attitude and good communication Early access to advice health condition will also Cause and effect • wearing comfortable footwear increase, which increases The impact of RMDs the need for employers to retain workers. 

However, too many people exit work early because of a chronic health condition when a few simple adaptation and support measures cause pain affecting the arms, legs, neck or back — the pain is not always severe but is often persistent, nagging and wearing. It may vary, often unpredictably. The pain can Early intervention Altering working hours: • flexible or reduced hours, for example starting and finishing later to avoid rush-hour travel or if symptoms are worse in the morning • working from home, at least on some days • flexible working and teleworking arrangements for all workers Assess and reduce risks Early Simple adjustments in the workplace A positive attitude and good communication could allow them to continue working. Equality legislation in Europe requires employmake repetitive movements difficult. 

RMDs often cause stiffness, with those sufferProviding support: • occasional time off for medical appointments (having a flexible working policy facilitates this) • opportunities for training and to change roles intervention Adjustments in the workplace ers to provide reasonable accommodation to employees with disabilities, such Changes to job duties and tasks ing taking a while to get moving. Sleep can be disturbed, • somewhere to move and stretch • a car parking space close to the work entrance • a change in office location to avoid stairs or walking Adjustments in the workplace Equipment and workplace adaptation as providing equipment, which can make it more adapting hours of work, difficult to ignore the pain. changing tasks or providing training. People can become tired and fatigued particularly Working patterns e.g. exible working hours Changes to job duties and tasks Support workplace adaptation

Some countries have more with an inflammatory disdetailed requirements, in- ease or if sleep is disturbed. cluding regarding return to Being stressed, anxious or work following sick leave. depressed because of the Working patterns

Eliminate risks at source pain or for other reasons e.g. exible working hours

Health and safety regula- also makes it harder to tions require employers to ignore the pain. prevent risks, based on risk People with an RMD often assessments. The priori- worry about the future, in ty is to eliminate risks at relation to whether their source and take collective limitations will worsen, or they will lose their job.

Some conditions are characterised by flareups, so the worker will have good and bad days. However, people do not have to be 100 percent fit to work, and those with chronic RMDs can learn to work around their problems. With the right adjustments, they can usually continue to work.

What employers can do

Most workers with an RMD are able to continue working in some form, provided some allowance is made for their symptoms and there is flexibility so that ways of overcoming the challenges posed can be found.

Continuing to work within their ability will not worsen their condition. In general, being in work is good for mental and physical health.

Such workers often are productive and try to avoid missing work. The gain for the employer is the retention of experienced, skilled workers.

Early intervention and access to advice

The earlier a problem is reported, the easier it is to deal with. An employer cannot take action if they are not aware of the problem.

This means encouraging and enabling employees to disclose health problems as soon as they arise, assuring them that they will be listened to and supported.

If someone has a persistent musculoskeletal problem that affects their work, they should be encouraged to seek medical advice as soon as possible.

Medical advice, if shared with permission, should help the employer to understand what support the worker needs.

Why we need to sit less and move more

Sedentary behaviour is increasing both at work and outside work, and there is mounting evidence for the ill health effects of sedentary lifestyles.

Health risks include diabetes and heart and vascular diseases, as well as musculoskeletal problems. Sedentary lifestyles have also been linked to depression and some cancers.

The health effects occur because our bodies need movement to get our blood pumping and oxygen circulating around our bodies.

Maintaining the same posture places higher loads on the muscles and tendons than changing postures.

Anyone with a chronic musculoskeletal condition should not sit for too long and avoiding static postures is part of making work sustainable.

When sitting, an upright posture places less strain on the spinal discs, but it is not good to maintain this posture for an extended period.

Dynamic sitting, where sitting postures are continuously altered, is preferable.

Being more active while working may also improve job performance and enhance job satisfaction.

While prolonged sitting is not specifically covered by any safety and health regulations, employers have general duties to assess risks and adapt work to the individual.

Recommendations:

• Do not exceed five hours of sitting at work each day
• Take microbreaks at least every 20-30 minutes
• Always get up for at least 10 minutes after two hours of sitting
• Work in an active manner and alternate between sitting, standing and walking come clearer through good communication. 

A conversation between an individual and their manager about a health condition could cover the following: 

• the condition 
• the symptoms experienced 
• if the symptoms vary, how they feel on a good/bad day 
• the effects of medication 
• what tasks they find challenging and need help with 
• what support they need or might need to do their job now and in the future

Getting advice and support

Advice available from public services and health disability organisations can be helpful in finding solutions. Some countries have return-to-work support schemes and work accident insurance services that offer advice, support with return-to-work plans and grants for workplace adaptations. The worker’s healthcare team should give advice on what tasks are appropriate and what should be avoided.

Temporary adjustments

Some adjustments may be needed only temporarily. After adjustments are made, they should be reviewed with the worker and whether any further adjustments are needed, discussed.

Needs should be reassessed if conditions change, which make new aspects of work difficult.

Support following MSD-related absence should include a return-towork plan.

A gradual return to work and a temporary reduction in hours can be helpful, following long-term sickness absence.

Assess and reduce risks

Work has been fantastic Early Simple adjustments A positive attitude and good communication Early access to advice intervention in the workplace A worker with degenerative osteoarthritis of the spine resulting in two knee replacements now has her own workstation, adapted to her needs. Early Simple adjustments Working flexi-hours means not having to drive in intervention in the workplace rush hour traffic. She is fully supported by all her colleagues. Adjustments in the workplace All info sheets and other campaign materials are Changes to job duties and tasks available to download from EU-OSHA’s Healthy Workplaces Campaign website Equipment and workplace adaptation Adjustments in the workplace Changes to job duties and tasks Working patterns Equipment and workplace adaptation e.g. exible working hours Working patterns e.g. exible working hours

Workers don’t have to be 100% to work

With the right support and adjustments many workers with chronic conditions can continue to work Workers don’t have to be 100% t to work

With the right support and adjustments many workers with chronic conditions can continue to work The 2020-22 campaign, Healthy Workplaces Lighten the Load, aims to raise awareness of work-related MSDs and the need to manage them and to promote a culture of risk prevention. The 2020-22 campaign, Healthy Workplaces Lighten the Load, aims to raise awareness of work-related MSDs and the need to manage them and to promote a culture of risk prevention.

Safety industry pioneer Safety Nets NZ Safety and health is everyone´s concern. has developed national standards in It´s good for you. It´s good for business. association with WorkSafe NZ, ensuring risk from falls is minimised for your construction workforce. Safety and health is everyone´s concern. It´s good for you. It´s good for business. © European Agency for Safety and Health at Work, 2020. Reproduction is authorised provided the source is acknowledged.

© European Agency for Safety and Health at Work, 2020. Reproduction is authorised provided the source is acknowledged.

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