Main points

• Work gives access to social relationships, identity, personal growth, financial security and other health-promoting factors.
• In Norway, about seven out of ten adults are active in the workforce. Employment in Norway is among the highest in OECD countries.
• Compared with other OECD countries, Norway has relatively high sickness absence rates
• Most sick leave and long-term benefits are granted for musculoskeletal disorders and mental health disorders such as anxiety and depression.
• Health- and work-related factors are important for whether an employee with health problems continues to work or not.
• The basis for effective prevention is knowledge of the specific work environment challenges in a particular occupation, industry or business.
• Interventions to avoid long-term sick leave are important in order to prevent the transition to disability benefits.

For most adults, work is a major part of life. On average, those who work have better health than those outside the workforce. Poor health can exclude people from the workforce and those with significant health problems may encounter more obstacles when trying to find work (i.e. due to “selection”).

Working life in Norway today

In Norway, there is broad consensus that participation in working life should be possible for as many people as possible (Dahl, 2014). Most adults are registered in the workforce.

The workforce consists of all employed and unemployed persons in the 15-74 year age group. They may have shorter and longer periods of unemployment, for example due to dismissal or health problems.

By the end of 2015, 70.7 per cent of the population in Norway were considered to be part of the available workforce. This was made up of 2,642,000 employed and 135,000 unemployed (Statistics Norway, 2016).

Proportion not working

People who receive disability benefits are outside the workforce. In addition, some people are absent from work due to short-term or long-term illness. Those on long-term sick leave have an increased risk of leaving the workforce and receiving disability benefits.

• Disability benefits: As of June 2016, 317 700 individuals received disability benefits, equivalent to 9.5 per cent of the population aged 18-67 (NAV, 2016).

Figure 1 shows the percentage of medically-certified sickness benefits issued for the period 2007-2016. This was 5.4 per cent in the third quarter of 2016.

Figure 1: Medically-certified sickness benefits (per cent) in the third quarter 2007-2016. Source: Based on figures from Norwegian Labour and Welfare Organisation (NAV) (Sick leave statistics, published 15.12.2016).

Causes of absence

Most medically-certified sickness benefits and long-term benefits are given for musculoskeletal disorders and mental health disorders such as anxiety and depression.

The reasons why people are not working are many and complex:

• Job tasks and working environment affect health and motivation.
• Functioning, competence and work-related demands impact whether the individual can do the job.
• Technology development and organisational structure can affect tasks and competence requirements.
• Economic cycles and other changes affect industry structure, employment and how many take sick leave and disability benefits. Updated figures can be found on www.ssb.no  and www.nav.no.

Trends over time

The proportion in employment, the number of people on sick leave and the proportion receiving disability benefits varies over time. Abrupt variations are mainly related to structural changes.

Over time, there has been an increase in the number receiving disability benefits, especially among young people.

This is partly due to the cessation of time-limited disability benefits (TU) in 2010 which resulted in more than 50,000 recipients being transferred to work assessment allowance (AAP). Those who are not employed when the AAP period ends are transferred to permanent disability benefits.

As TU was specifically targeted towards young people, there has been a period where more young people are receiving disability benefits than with the old scheme (NAV, 2016).

Differences in the population

Age

Sick leave increased with age for both men and women.

Gender

Figure 1 shows the differences in sick leave among women and men. Over time, the difference is stable. Men and women generally follow the same variations in sick leave.

There is insufficient knowledge to explain the differences between sick leave for men and women and what can be done to reduce these differences (NIPH, 2013). Relevant factors that can explain the differences are:

• In Norway and in other countries in Europe, there are major occupational differences for men and women, see Figure 2.
• More men than women are in management positions (European Commission, 2014).
• Psychosocial factors in the workplace explain more than 20 per cent of the differences in sick leave between men and women (Sterud, 2014a). However, it is unclear to what extent different occupational conditions can highlight differences in sick leave between men and women (Laaksonen, 2010; Mastekaasa, 2012).
• Men and women differ when it comes to health. Musculoskeletal disorders are more common among women than among men and are the most common diagnosis in sick leave statistics (NIPH, 2014).

Figure 2. Proportion of women employed in 30 selected occupations. 1996 and 2010. Source: NOU 2012: 15.

Socioeconomic differences

There are socioeconomic differences in sick leave and disability benefits.

• Disability benefits due to musculoskeletal disorders are more common among people with lower education than those with higher education (Bruusgaard, 2010). The difference can partly be explained by risk factors for sick leave and disability benefits being more frequent in lower-paid occupations with lower education requirements (Falkstedt, 2014). This applies to hard physical labour, heavy lifting with twisting of the back, demanding work positions, full body vibrations, monotonous tasks, little control over workload and little flexibility in working hours (Foss, 2011; Haukenes, 2011; Sterud, 2013b)
• Physical and psychosocial work environment factors explained more than 40 per cent of the difference in the long-term sick leave between high and low-skilled workers, according to a recent Norwegian study (Sterud, 2014c).
• In workplaces with lower educational requirements, it is often difficult to adapt the work situation to health problems (Johansson, 2009).
• Employees with a lower education may also have more difficulties in finding new work if health problems require a change of work assignments.

International

Employment levels in Norway are among the highest in OECD countries, for all age groups and both genders (OECD, 2014). See Figure 3.

Figure 3. Employment in Norway and OECD in three age groups for the years 2005 and 2011. Percentage. Source: Based on figures from OECD (2016).

There is a substantial variation in how different European countries organise working life. Compared with the general standard in Europe, a higher proportion are in employed in the public sector in Norway, more have permanent employment contracts, protection against dismissal and full pay during sick leave.

Unemployment

Mental health problems are more common among the unemployed than among those in employment. A series of studies shows that job loss leads to increased mental health problems, while mental health can improve when returning to work (McKee-Ryan, 2005; Murphy, 1999; Paul, 2009; Reneflot, 2014).

Problems linked to unemployment are related to how long unemployment has lasted. Good welfare programs function as a safety net that reduces the risk of unemployment impairing mental health (Ferrarini, 2014).

However, the picture is complicated: it has also been shown that the transition from unemployment to work can be associated with mental health problems, if the working environment is unfavourable. Several studies show that psychosocial and organisational factors in the workplace are linked to the mental health of employees (Finne, 2014; Johannessen, 2013; Stansfeld, 2006).

Work as a health-promoting factor

Primarily, work provides financial security. When the working environment is satisfactory, work in itself may also be beneficial to health.

• For many, work is an important source of financial security, health-promoting social relationships and personal growth (Dahl, 2014).
• Work gives structure to daily life, provides purpose and is an important part of the social identity for many (Dahl, 2014).

Several studies suggest that job loss leads to poorer mental health (Gathergood, 2013), whereas returning to work affects mental health in a positive way (van der Noordt, 2014).

However, studies that have examined whether the transition from working life to retirement if of significance for health, report diverse findings (Wang, 2011). Retirement can contribute to good health if the job is stressful (Westerlund, 2009). This example emphasises how the relationship between health and work is complex.

Work and health risks

The workplace can also be a source of injury, disease and health problems. Many of these factors are related to the risk of sick leave and disability benefits (Aagestad, 2014; Foss, 2011; Labriola, 2009; Stattin, 2005; Sterud, 2013a, 2014b; Wang, 2014). STAMI has recently reviewed the knowledge status of work environment factors that contribute to sick leave (Knardahl, 2016).

Several well-known workplace factors can increase the risk of disease and disability benefits (STAMI, 2015):

• Psychosocial working environment factors that increase risk of anxiety, depression and musculoskeletal disorders.
• Organisational factors such as shift work, lack of training and temporary employment contracts are linked to an extra risk of occupational injuries.
• Heavy physical work and demanding working positions.
• Vibrations, noise and other physical work environment factors.
• Inhalation of dust, smoke, gas and steam, chemical contact with chemicals and other chemical work environment factors.
• Injuries and accidents

Workplace accidents often affect young employees and can have major consequences for their lives.

The number of occupational accidents and deaths due to occupational injuries has been quite stable in recent years (Norwegian Labour Inspectorate, 2015; Gravseth, 2010). However, a review of incidents suggests that there is still a potential to prevent accidents in the workplace (Norwegian Labour Inspectorate, 2015).

Arena for preventive public health efforts

Since the majority of workers are in employment, the workplace is also an important arena for preventive work through social impact and the employer’s HSE work (White Paper no. 19, 2014). The Inclusive Labour Agreement (IA) 2014-2018 and the Public Health Report (White Paper no. 19, 2014) have also focused on the workplace as an arena for prevention to a greater degree than before.

Interventions to ensure high participation and low disability

There is reason to believe that low unemployment, high occupational participation and reduced risk in the working environment promote public health.

Continuous efforts are being made to identify health risks at workplaces, through both advice and supervision from the Labour Inspectorate. The Working Environment Act decrees this work and employers, employees, company health service and supervisory authorities are obliged to contribute.

There is no single relationship between health problems and labour participation. Factors linked to both health and work can influence whether an employee with health problems stops working or not.

Knowledge of the occupational health challenges faced in specific occupations, industries or businesses form the basis for effective preventive activities. There is still a need to develop more and better knowledge of what affects the workplace and sick leave (Odeen, 2013) and how we can improve the prevention of health problems developing at the workplace (van Oostrom, 2009).

In addition to the primary preventive work, good and effective measures are also needed for those who become ill and have difficulties working. For example, working life is one of the most important arenas for the prevention of harmful alcohol consumption (Ames, 2011).

For those who are unemployed, it is important to have good, effective welfare systems to reduce the burden of being outside the workforce (Ferrarini, 2014).