Managing musculoskeletal disorder— Germany
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This is the German contribution to the Study on the existing situation regarding the impact of work changes on the resurgence of work-related musculoskeletal disorders
Definitions
The various terms listed above in describing MSDs all put the accent on repetitive and cumulative motions.
The Eurostat description of EODS methodology provides some useful comparative insight about disease statistics and the general functioning of national work-insurance systems, e.g. who compensate occupational diseases, in particular MSDs included and at what degree of seriousness are listed: only some of the MSDs are recognized as such by National Insurance Agencies (NIAs) and other agencies entitled by government and/or social partners in playing such a role. There are two main obstacles to their recognition: certain activities outside work expose people to similar risks, especially women (see question 3 below); and the nature of the contract does not help to point to the occupational origin of the disease.
1. Please, report the official definition of WR-MSDs, if any, or the most widespread one. Please specify whether it includes backaches.
The Hauptverband der gewerblichen Berufsgenossenschaften (HVBG) is the national statutory insurance organisation for compensation of occupational diseases and accidents. Occupational diseases are laid down in the Occupational Diseases Ordinance (Berufskrankheiten-Verordnung). In the attachment of this Order recognised MSDs are listed under '2 Diseases caused by physical effects'.
2101: diseases of tendosynovitis of the tendosynovitis glide tissue as well as of tendon and muscle base (Recognition: 1.8.1952); Note: … that have forced the omission of all activities, that are responsible for the occurrence, the worsening or cause respectively can cause the reappearance of the disease.
2102: meniscus injuries after several years of continuous or frequent repeating activities causing more than average strain for the knee joint (Recognition: 1.8.1952)
2103: diseases caused by vibrations due to work with compressed air tools or tools or machines with similar effects (Recognition: 1.1.1920)
2104: blood circulation disorders at hands related to vibration (Recognition: 1.1.1977); Note: … that have forced to omission of all activities, that are responsible for the occurrence, the worsening or cause respectively can cause the reappearance of the disease.
2105: chronic disorders of the synovial bursa caused by constant pressure (Recognition: 1.8.1952)
2106: pressure strain on nerves (pressure paralysis) (Recognition: 1.8.1952)
2107: demolition fracture of the vertebra furtherance (Abrißbrüche der Wirbelfortsätze) (Recognition: 1.8.1952)
2108: intervertebral disc related disorders of the lower back (lumbar vertebra) after many years of lifting or carrying of heavy weights or of activities in extreme bend of the body (Recognition: 1.1.1993); Note: … that have forced the omission of all activities, that are responsible for the occurrence, the worsening or cause respectively can cause the reappearance of the disease.
2109: intervertebral disc related disorders of the cervical vertebra after many years of carrying heavy weights on the shoulder (Recognition: 1.1.1993); Note: … that have forced the omission of all activities, that are responsible for the occurrence, the worsening or cause respectively can cause the reappearance of the disease.
2110: intervertebral disc related disorders of the lower back (lumbar vertebra) after many years of predominant vertical strain of body vibration while seated (Recognition: 1.1.1993); Note: … that have forced the omission of all activities, that are responsible for the occurrence, the worsening or cause respectively can cause the reappearance of the disease.
In a brochure of the New Quality of Work Initiative (INQA) ' Guidelines for successful implementation of occupational health promotion in companies: Muscolu-skeletal disorders' an encompassing definition is given:
Musculoskeletal disorders includes a wide range of health harms: disease of joints with and without components of arthritis, diseases of connective tissue, diseases of vertebral column, diseases of the back, diseases of the soft parts tissue as well as of the bones and cartilage. Dominant are diseases of the back, ahead of diseases of joints and of soft parts tissues.
2. Please check whether criteria illustrated in the above EODS paper have been updated in the meantime. Are recognition criteria by NIAs taking into account gender differences? Have there been any changes in last years both in general and wrt to gender issues in particular?
No, there had not been any updates of criteria illustrated in th EODS paper. Regarding the dates of recognition of MSDs see Q. 1.1. Gender difference are not addressed.
Reporting
Reporting is another key preliminary issue. Two orders of problems can be identified.
Clinical reporting, statistical sources (mainly based on self-reporting), working conditions surveys and administrative sources from NIAs and Health Systems tend to differ. The latter heavily depend on the institutional definitions (both legal and administrative settings) both about their causes and their nature. Figures are often collected and classified according non-homogeneous criteria, and at different analytical level in terms of part of the body affected and causes. For instance, the LFS 1999 additional module reported MSDs in an aggregated way (Q217), while the 2007 LFS ad hoc module questionnaire distinguish (Q215/216) MSDs according three regions affected: neck, shoulder, arms and hands (WR-ULD); hips, legs, feet; back.
According to Eurostat, this make difficulties to collect comprehensive European level data on recognized MSDs. Also in the EU-15, it is not granted that the European standards (EODS in our case) are employed. This causes a further problem of comparability.
Working conditions survey are probably the least dependent on institutional (legal) framework, but cultural/social habits could can affect reporting work related MSDs. However, an UK study shows significant consistencies amongst self-reported and clinical results (see the Foundation report “Quality of work and employment in Europe. Issues and challenges”.)
This very short overview, far from being complete, outlines some of the main questions related to reporting
1.1 Please list the main sources of information about WR-MSDs (NIAs and other insurance agencies empowered by government and/or social partners, WCS, public health, statistical bureaux). Please describe the way WR-MSDs are categorized by public authorities and NIAs according to the part of the body affected (upper/lower limb, bone, joint or muscle problem, hips, legs, feet, knees, back, neck, shoulders, arms, etc. ..), causes (repetitive work, vibrations, heavy loads, postures, PCs, etc…..) and occupational and demographic characteristics (labour contracts, occupation, age, gender).
Sources of information are:
Data by the Hauptverband der gewerblichen Berufsgenossenschaften (HVBG), the national statutory insurance agency for compensation of occupational diseases and accidents and the sectoral Berufsgenossenschaften provide administrative data on MSDs.
BIBB/IAB survey 1998/99
The BIBB/IAB surveys are representative surveys of 34,000 people employed. The surveys have been conducted jointly be the Federal Institute for Vocation Education and Training (BIBB) and the Institute for Employment Research (IAB) operating as the Federal Employment Services' research institution. The surveys have been funded by the Federal Ministry for Education and Research. The first BIBB/IAB survey took place in 1979. Further surveys were conducted in 19985/86 and 1991/92. Each of the four survey had a specific topic.
The fourth and last survey took place in 1998/1999. In the survey, the Federal Institute for Occupational Safety and Health (FIOSH,German acronym BAuA) participated also.
The aim of the survey was to shed light on the structural change in the working world and the impact on working conditions and the individual mobility behaviour of employed people. In the survey detailed information on the qualification profiles and the occupational developments as well as the organisational, technological and qualification frame condition of their working place had been gathered.
German Socio-Economic Panel (GSOEP), specific module on working conditions in 2001
The GSOEP is a wide-ranging representative longitudinal study of private households in Germany. It provides information on all household members, consisting of Germans living in the Old and New German States, Foreigners, and recent Immigrants to Germany. The Panel was started in 1984 and is conducted annually. In 2003, there were more than 12,000 households, and nearly 24,000 persons sampled.
The GSOEP provides a broad information on diverse aspects of household composition, occupational biographies, employment, earnings, health and satisfaction indicators.
Subjects covered in topical modules of the survey are personal values, preferences and expectations, social security, education and training, and allocation of time.
The GSOEP is located at the German Institute for Economic Research (DIW).
Ad-hoc survey 'Was is Gute Arbeit?' (What is good work?) conducted by INIFES within the New Quality of Work Initiative (INQA).
Within the Initiative New Quality of Work (INQA) INIFES conducted an adhoc survey on the issue 'What is good work? Requirements from the perspective of employed people'. The population of the representative survey conducted end of 2004 are gainfully employed people. The sample consist of 5,200 persons. The Questionnaire focuses on quality of work-related issues.
Reports by the government on OSH (latest available data: 2004)
The data provided is primarily related to the Occupational diseases ordinance. The reports also present data on absenteeism related to MSDs (cases / days).
The 2004 report presents data on influence on work organisation etc. and on suffering from pain in the lower back, neck, shoulder, arms, hands, legs, feet based on the ad-hoc survey 'Was ist gute Arbeit'.
The reports also provide data on economic costs of MSDs.
3. Please describe the number, type and variety of questions advanced in MSDs. Please report the exact formulation of questions advanced in working conditions surveys. What is the evolution over time of question formulation?
BIBB/IAB survey 1998/99:
Question: F227
On this list health problems are listed. Please tell me by which of these you are often concerned during or immediately after work?
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pain in the lower back
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pain the neck or shoulder
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pain in arms and hands
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pain in the knees
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pain in legs, feet, swollen legs
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is not a direct link in the questions to potential causes or demographic characteristics but most of the variables given as examples are available and would allow cross-tabulation.
German Socio-Economic Panel (GSOEP), specific module on working conditions in 2001
One question that includes MSDs is:
Do you work with a computer screen to an extent which is unhealthy?
Ad-hoc survey 'Was is Gute Arbeit?' (What is good work?)
Within the New Quality of Work Initiative (INQA) INIFES conducted an adhoc survey on the issue (What is good work? Requirements from the perspective of employed people').
The questionnaire of this representative survey included a number of questions on MSDs.
Question G2: In the following a number of health problems and symptoms are listed. Please tell us all problems and symptoms, that frequently appear on working days!
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pain in the lower back
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pain in the neck, shoulder
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feelings of paralysis or pain in arms / hands
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feelings of paralysis or pain in legs / feet
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is not a direct link in the questions to potential causes or demographic characteristics but most of the variables given as examples are available and would allow cross-tabulation.
4. Is there any research of analyse of causes available?
A number of studies and reports deal with the analysis of causes of MSDs:
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A report on 'Spinal Column Diseases' by the HBVG deals with the causes (exposure) in relation to recognised MSDs. The report includes practical recommendation and information to assist interpretation that is required in the context of the newly introduced recognised occupational diseases. It deals with exposure relationships and specifies recognised medicinal assessment criteria.
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Behaviour of functional spinal units under dynamic loading (2005) is an experimental study attempting to estimate acceptable loads. It looks at the effects of mechanical loads, whole body vibration as well as repetitive impact loads.
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Characteristic and assessment of individual patterns of movement of the lumbar vertebra column (2000) is an experimental study including 107 male test persons in the age of 25 to 60 years. The key result of the study is that the combination of individual muscular and coordinative capabilities in terms of stabilising the lumbar vertebra when lifting weights is a central factor for preventing troubles caused by mechanic influences. The study points to the relevance of according training as preventive measure.
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Further development of a model for the calculation of forces effecting on the lumbar vertebra column (2000) is an experimental study investigating the impact of vertical strain of body vibration while seated in particular of driver seats and attempts to improve models for the examination.
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The study Combined programme of practicable methods aimed at the investigation of stress and strain at work and their relations to musculoskeletal disorders (1999) presents a multi-step inventory considering the requirements of legislation. Additionally, it provides data on the relationship between work-related stress, strain and musculoskeletal problems (complaints, disorders). The basic programme is a screening method. It allows a check-up of working conditions and health impairments of the musculoskeletal system within a few minutes. The advanced programme includes recommendations on specific investigations concerning task analysis, force measurement, posture and movement analysis, investigation of physiological parameters.
Trends of MSDs and their social impact
MSDs complaints show a growth across the editions of the EWCS, supporting the argument of “work densification” and that actual prevention instruments are not fully adequate in order to cope with them. As discussed above, organizational changes, which reflect both changes in competition and HRM practices (see for all Oesterman, 2000), play a key role in such a trend. Such trends can differ significantly across sectors, occupations, firm size and gender.
The increasing participation of women to labour market make the need of engendered prevention policies for the following reasons:
a. According to Pèze (2002), “women are massively hit by MSD not only because of their morphology and hormonal factors, but because work organisation keep them out massively from conception and decision-making”: therefore, workplace design is based on the prevailing occupational group, i.e. men;
b. horizontal and vertical segregation literature show that some industries are significantly engendered (for all Hakim, 1992)
c. women still cope with more domestic tasks than men, facing thus larger risk exposure outside work.
The report “Work organisation and health at work in the European Union” investigates the relationship between health according three broad classes of organizational factors, an engendered approach from the 3rd EWCS:
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temporal framework, according to the two sub-dimensions of internal flexibility (shifts, long hours, night work, sundays working, no fixed times) and industrial type of the pace of work (depending on the automatic speed of the machine, depending on quantitative standards)
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scope of manoevre, according to the two sub-dimensions of autonomy (no possibility to choose or modify the pace of work; no possibility to choose or modify the methods of work, no possibility to choose or modify the sequence of tasks, not allowed to take a break) and of control (respect of precise quality standards, personal evaluation of the quality of their work);
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social relationships, according to the three sub-dimensions of the commercial constraints (the pace depends on the current demands from customers etc.) discussions (no possibility of discussing work organization when changes occur, no possibility of discussing your working conditions in general) and continuing training.
5. Please report figures on absence days caused by MSDs (from NIAs and other Agencies, or WCS where the former are not available) according to parts of the body affected and causal agent, and their trends over last 10 years, disaggregated by labour contracts, occupation, age, if it were possible in a engendered way, accordingly to the sources available described in Q2. Please report these trends for the following sectors (with the same caveat): manufacturing and mining, health and education, transport and communication.
Table 1 gives an overview on absenteeism due to MSDs in the year 2004 according to gender and age groups based on the government report on health and safety at work. It provides data on the days of absenteeism, the days per 100 insured persons and days per diagnosis. The data is based on information for the statutory health insurances. The data demonstrate that older workers are more concerned than younger workers, and men more women.
| Diagnosis | Days of absenteeism | Per 100 insured persons | Days per diagnosis | |
|---|---|---|---|---|
| % | % | |||
| All age groups | ||||
| Women | 14.9 | 22.8 | 20.3 | 17.6 |
| Men | 20.4 | 27.1 | 25.7 | 16.6 |
| Total | 18.0 | 25.3 | 23.5 | 17.0 |
| Younger than 45 years | ||||
| Women | 11.7 | 17.7 | 15.3 | 13.7 |
| Men | 17.8 | 24.0 | 21.7 | 13.1 |
| Total | 15.2 | 21.4 | 19.1 | 13.3 |
| 45 years and older | ||||
| Women | 21.2 | 28.3 | 31.1 | 21.8 |
| Men | 25.3 | 30.2 | 34.4 | 21.5 |
| Total | 23.5 | 29.5 | 33.0 | 21.6 |
Source: Deutscher Bundestag, Drucksache 16/319
Tables 2 and 3 give an overview on the number of suspected respectively recognised MSDs from 1970 till 2004. The tables are based on data from the Umbrella federation of the Occupational health and safety agencies and is provided according the occupational diseases classification for the period 1970-2004. The data provides the number of cases of reported suspicions of a MSD to the occupational health and safety agencies of those MSD that are statutorily recognised.
| Occupational disease | 1970 | 1980 | 1990 | 2000 | 2004 |
|---|---|---|---|---|---|
| 2101 | 1515 | 1342 | 1698 | 1176 | 757 |
| 2102 | 1774 | 1169 | 1738 | 2244 | 1669 |
| 2103 | 812 | 795 | 594 | 588 | 434 |
| 2104 | - | 19 | 53 | 81 | 63 |
| 2105 | 543 | 387 | 572 | 735 | 532 |
| 2106 | 26 | 45 | 55 | 119 | 92 |
| 2107 | 26 | 18 | 37 | 5 | 7 |
| 2108 | - | - | - | 11065 | 5643 |
| 2109 | - | - | - | 1435 | 984 |
| 2110 | - | - | - | 614 | 316 |
Source: HVBG, BG-Statistiken 2004
| Occupational disease | 1970 | 1980 | 1990 | 2000 | 2004 |
|---|---|---|---|---|---|
| 2101 | 19 | 22 | 32 | 23 | 15 |
| 2102 | 457 | 345 | 432 | 327 | 300 |
| 2103 | 307 | 146 | 247 | 135 | 120 |
| 2104 | 2 | 9 | 19 | 14 | 15 |
| 2105 | 77 | 199 | 204 | 199 | 181 |
| 2106 | 7 | 11 | 8 | 9 | 15 |
| 2107 | 2 | 1 | - | 1 | - |
| 2108 | - | - | 308 | 207 | 186 |
| 2109 | 6 | 8 | 4 | ||
| 2110 | 21 | 10 | 5 |
Source: HVBG, BG-Statistiken 2004
6. Please report figures from WCSs on MSDs suffered according to parts of the body affected and causal agent, and their trends over last 10 years, disaggregated by labour contracts, occupation, and age in an engendered way by gender, accordingly to the sources available described in Q2. Please report these trends for the following sectors (with the same caveat): manufacturing and mining, health and education, transport and communication.
Tables 4 and 5 provide data on pain in parts of the body according to gender and to contract status based on data from the BIBB/IAB survey 1998/99. According to data in Table 4 women are more concerned by pain in neck and shoulder and in the legs while men show higher percentage regarding the other parts of the body.
Table 5 demonstrate that temporary agency workers are more concerned by in any part of the body analysed that workers on permanent and on fixed-term contracts.
| Pain in … | Women | Men | Total |
|---|---|---|---|
| Lower back | 52.9 | 56.7 | 55.0 |
| Neck and shoulder | 50.7 | 38.8 | 44.2 |
| Arms and hands | 17.7 | 18.2 | 17.9 |
| Hip | 7.1 | 8.6 | 7.9 |
| Knees | 11.7 | 20.0 | 16.3 |
| Legs | 27.2 | 18.4 | 22.3 |
Source: BIBB/IAB survey 1998/99
| Pain in … | Permanent | Fixed-term | Temporary agency |
|---|---|---|---|
| Lower back | 56.7 | 55.7 | 67.0 |
| Neck and shoulder | 45.0 | 41.6 | 49.4 |
| Arms and hands | 19.1 | 20.2 | 38.6 |
| Hip | 8.3 | 7.4 | 13.1 |
| Knees | 17.0 | 15.0 | 24.4 |
| Legs | 23.2 | 24.9 | 21.6 |
Source: BIBB/IAB survey 1998/99
The previous BIBB/IAB survey 1991/92 does not include the according questions/variables.
The Ad-hoc survey 'What is good work' also reveals higher percentages of women suffering pain in neck and shoulder than men. Data for other parts of the body appear to quite similar for bother genders.
| Disorder | Women | Men | Total |
|---|---|---|---|
| Back pain | 56.1 | 57.5 | 56.8 |
| Neck / shoulder pain | 64.2 | 52.9 | 58.8 |
| Feeling of paralysis in arms / hands | 14.7 | 14.1 | 14.4 |
| Feeling of paralysis in legs / feet | 12.2 | 12.6 | 12.4 |
Source: Deutscher Bundestag, Drucksache 16/319, based on: Survey Was ist gute Arbeit?
7. Please provide some crosstables of MSDs according to part of the body affected and, if possible, causal agent, with the following organizational factors in an engendered way, showing trends from the 90s and taking into account the questions included in WCS for each country:
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pace of work (speed or repetitiveness, tight deadlines)
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autonomy (in general and wher possible breaks opportunities , scope on pace of work, scope on methods);
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use of PCs and other ICTs devices;
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scope of discussion over work organization and/or organizational changes;
Tables 7 data on pain in parts of the body fro work under time pressure. For all parts of the body more than half of the workers report to suffer pain practically always or frequently.
| Pain in … | Practically always | Frequently | Again and again | Rarely | Practically never |
|---|---|---|---|---|---|
| Lower back | 23.7 | 33.2 | 23.2 | 12.0 | 8.0 |
| Neck and shoulder | 24.7 | 34.8 | 22.8 | 10.6 | 7.1 |
| Arms and hands | 26.7 | 32.3 | 21.5 | 11.0 | 8.5 |
| Hip | 27.9 | 31.7 | 20,7 | 10.8 | 8.9 |
| Knees | 25.9 | 33.6 | 21.3 | 11.1 | 8.0 |
| Legs | 22.1 | 30.9 | 22.5 | 14.1 | 10.4 |
Source: BIBB/IAB survey 1998/99
Table 8 reveals that for more for the majority of workers concerned by stress and work pressure pain in all parts of the body increased.
| Pain in … | Increased | Equal | Decreased | Does not apply |
|---|---|---|---|---|
| Lower back | 54.9 | 40.0 | 3.4 | 1.7 |
| Neck and shoulder | 58.2 | 36.7 | 3.5 | 1.6 |
| Arms and hands | 57.1 | 37.4 | 3.6 | 1.9 |
| Hip | 59.3 | 35.8 | 3.3 | 1.7 |
| Knees | 58.5 | 36.7 | 3.5 | 1.3 |
| Legs | 54.2 | 39.7 | 3.9 | 2.1 |
Source: BIBB/IAB survey 1998/99
Tables 9 and 10 provide data on the interrelations between pain in the parts of the body and the degree of determination of the work procedure and of a restrictive regulation of time and performance of the work.
| Pain in … | Practically always | Frequently | Again and again | Rarely | Practically never |
|---|---|---|---|---|---|
| Lower back | 16.3 | 18.3 | 15.9 | 23.2 | 26.3 |
| Neck and shoulder | 15.0 | 17.5 | 15.2 | 25.0 | 27.3 |
| Arms and hands | 22.3 | 20.1 | 15.3 | 19.2 | 23.0 |
| Hip | 20.3 | 20.4 | 15.2 | 20.1 | 24.0 |
| Knees | 18.3 | 20.2 | 16.0 | 21.3 | 24.1 |
| Legs | 19.2 | 19.4 | 14.9 | 20.7 | 25.9 |
Source: BIBB/IAB survey 1998/99
| Pain in … | Practically always | Frequently | Again and again | Rarely | Practically never |
|---|---|---|---|---|---|
| Lower back | 15.9 | 15.0 | 12.6 | 15.3 | 41.1 |
| Neck and shoulder | 15.4 | 14.6 | 12.2 | 15.4 | 42.4 |
| Arms and hands | 21.3 | 16.6 | 12.8 | 13.6 | 35.8 |
| Hip | 18.3 | 15.1 | 11.9 | 14.8 | 39.9 |
| Knees | 18.3 | 15.8 | 12.8 | 16.1 | 36.9 |
| Legs | 18.1 | 13.9 | 11.3 | 13.7 | 43.0 |
Source: BIBB/IAB survey 1998/99
Table 11 reveals that the majority of workers working with ICT suffer from pain in neck and shoulder and 42 % from pain in the lower back.
| Pain in … | ICT |
|---|---|
| Lower back | 42.0 |
| Neck and shoulder | 51.7 |
| Arms and hands | 29.3 |
| Hip | 30.1 |
| Knees | 29.7 |
| Legs | 32.7 |
Source: BIBB/IAB survey 1998/99
The previous BIBB/IAB survey 1991/92 does not include the according questions/variables.
2. Trends of MSDs and their economic impact
MSD has consequences both on health and work efficiency. This latter can be accounted in lower productivity of both the affected worker and his/her substitute.
Lower work efficiency is just part of the costs. They are both direct (compensation, treatment, medical care) and indirect (production lost, loss of quality in production, errors/mistakes in production, absenteism, replacement). As we have seen in the introduction, estimates produced by some countries differ in included costs.
Just from these few cases, their amount is undoubtedly huge and calls for prevention policies and a careful evaluation of their impact in terms of costs and benefits.
2.1 Are there estimates of MSDs costs? If any, which direct and indirect costs are included? Who carry them? If not, what indicators are monitored by policy makers and Agencies in order to propose/draw new policies, esp. in prevention?
The INQA brochure ' Guidelines for successful implementation of occupational health promotion in companies: Muscolu-skeletal disorders' describes that work-related disorders cause cost of 15 billion EURO. About two third are direct and indirect costs caused by MSDs. According to statistics by the health insurances almost 30% of all days of absenteeism are related to MSDs.
Table 12 provides detailed data on the macroeconomic losses due to work-related diseases. MSDs causes the largest proportion.
| ICD 10 | Diagnosis group | Days of absenteeism | Loss of production in billion EURO | Loss of gross national product in billion EURO | |||
|---|---|---|---|---|---|---|---|
| In mill. | In % | Bill. € | % of gross national income | Bill. € | % of gross national income | ||
| V | Mental disorders | 46.3 | 10.5 | 4.2 | 0.2 | 7.4 | 0.3 |
| IX | Diseases of circulation system | 28.6 | 6.5 | 2.6 | 0.1 | 4.6 | 0.2 |
| X | Diseases of respiratory organ | 55.2 | 12.5 | 5.0 | 0.2 | 8.8 | 0.4 |
| XI | Diseases of digestive system | 28.8 | 6.6 | 2.6 | 0.1 | 4.6 | 0.2 |
| XIII | Musculoskeletal disorders | 107.2 | 24.3 | 9.7 | 0.4 | 17.0 | 0.8 |
| XIX | Injuries and poisoning | 56.9 | 12.9 | 5.2 | 0.2 | 9.1 | 0.4 |
| Other | Other diseases | 117.0 | 26.6 | 10.6 | 0.5 | 18.5 | 0.8 |
| I-XXI | All diagnosis groups | 440.1 | 100 | 40.0 | 1.8 | 770.0 | 3.1 |
Source: Deutscher Bundestag, Drucksache 16/319
2.2 Are there “return to work policies” (by whom/ on what level/ whose initiative/ involvement of the actors) developed and implemented (in general and specifically for MSDs)?
Such information are collected just in order to have a flavour of the shared awareness of their social and economic impact, and as such we deal with them. Please do not devote more than 300 words.
No example could be found.
Prevention policies and room to manoeuvre
The figures/data so far available seem to suggest that we are not sure the EU is already the downward part of the slope of the reported graph form Brenner et al. (2002). The 2002 Scoreboard on implementing the Social Policy Agenda statement about the “insufficiency of current occupational health and safety practices and hence the cost of non-social policy to businesses and workers” could be applied to MSDs. As the Community strategy on health and safety at work (2002 – 06) points out, “the preventive approach set out in Community directives has not yet been fully understood”.
According to various studies, such as those summarized in Bourgeois et al. (2000) both MSDs and stress-related disorders arises out of work situations which limit workers’ discretion. Along these lines Coutarel (2003) suggests preventive strategies based on the notion of room to manoeuvre (“marge de manoeuvre”). i.e. the means and opportunities of action an employee has in a given production situation to influence and correct the work process. This gives the possibility for the individual to have control over the work situation and to use personal capacities.
According to Douillet, Schweitzer, 2002, “expanding workers’ discretion (…) becomes a key prevention priority: not just to reduce the physical and psychological stressors, but also as a way of recognizing the individual’s creativity at work”. The organizational changes in order to prevent MSDs must therefore include all the concerned stakeholders (Daniellou, 2005).
Therefore, the room to manoeuvre approach calls for prevention strategies based on interventions at an early stage at the design of the workplace according a participative method, which can be different labelled and stylized across countries. This calls for the opportunity in developing some quality indictors in order to set benchmarking policies, such as:
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Good quality working conditions;
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Possibilities of cooperation;
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Mobility;
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Rotation;
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Organisation of work which allows to make maximum of benefit out of the workforce
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Training
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Stability in the workforce/low staff turnover
Limits of such a prevention approach are economic constraints (productivity/overall performance maintainance, further investments) and social constraints (population characteristics, level of experience, training, levels of exposure).
8. In general, plant-level prevention policies are “risk elimination oriented” or centered around “risk information”? What the role of social partners?
In a brochure of the New Quality of Work Initiative (INQA) ' Guidelines for successful implementation of occupational health promotion in companies: Muscolu-skeletal disorders a number of risk factors are given.
Physical factors:
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constant repetitive movements
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heavy manual activities
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loads
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incorrect body posture
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direct mechanic pressure of parts of the body
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body vibrations
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environment and work organisation
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monotonous repetitive activities
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work rhythm
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working time targets
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remuneration system
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monotonous work
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tiredness work in cold environment
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work dissatisfaction
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psychosocial work factors.
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a limited room to manoeuvre is described to cause muscle strain.
The brochures recommends the following measures regarding working conditions for the prevention of MSDs at company level:
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ergonomic measures, for example adaptation of tables, chairs, tools etc., arrangements of materials and tools
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work organisation measures, for example regulations on breaks, avoidance of rigid bodily strain
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increase of room to manoeuvre
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removal of authoritarian style of leadership
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improvement of communication structures in the company
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personnel development
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employee participation.
Both umbrella federations of the social partners do not deal specifically with MSDs. In the German context these questions are primarily seen in the scope of the Health and safety agencies (Berufsgenossenschaften). In the Berufsgenossenschaften the social partners are involved in the advisory committees.
2.3 Please illustrate some plant-level good practices (at least one in manufacturing and one in services) following (or showing significant similarities with) the “room to manoeuvre” approach above skecthed, showing in particular the adopted approaches and the impact both in working conditions and firm performance. Is there any specific strategy of the kind towards small and medium enterprises?
One good practice example in manufacturing is the Adam Opel AG. In the development of new productions processes for cars occupational health and safety issues are considered. The instrument used is a New Production Worksheet (http://www.uni-essen.de/ied/gfa/struktur/pdf/session3/AOAG_gfah2004.pdf). This is a detailed analysis of potential strain. The aim is to avoid any harmful body posture etc. in the car production. For example, it is no longer required to assemble the cars in a bending forward posture from the outside of the coachwork. The assembly takes place in an upright position in an ergonomic way.
The Gesellschaft für technische Zusammenarbeit (GTZ) tried to optimise working conditions for the employees in the administration following the PRÄMUSK guidelines aimed at the prevention of MSDs. The application of the guidelines included
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an analysis of the existing internal data on health and environment
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survey of employees
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concept and implementation of external measures of prevention ('back school', spinal column physical exercises.
Have been developed any quality indicators measuring “room to manoeuvre” preventive strategies?
No quality indicators measuring 'room to manoeuvre' preventive indicators have been developed.
The analysis of Fröhner, Boothby and Schulze (2002) Comparative Review of Processes for Improved Operational Efficiency in an Applied Business Environment looks at instruments to appraise and calculate a company's effort towards establishing a strategy to ensure the individual's health and safety at work, towards establishing workplace layouts etc.. The study does not focus specifically on MSDs.
Another more general study by Langhoff (2002) Result-orientated occupational health-safety – Evaluation and perspectives of an innovative approach to occupational safety and health economy does not deal specifically with MSDs.
References
Bundesanstaltung für Arbeitsschutz and Arbeitsmedizin (BAUA), Volkswirtschaftliche Kosten durch Arbeitsunfähigkeit 2003, http://www.baua.de/ (pdf)
Caffier, G., Steinberg, U. and F. Liebers, Praxisorientiertes Methodeninventar zur Belastungs- und Beanspruchungsbeurteilung im Zusammenhang mit arbeitsbedingten Muskel-Skelett-Erkrankungen, , Schriftenreihe der Bundesanstalt für Arbeitsschutz und Arbeitsmedizin: Forschungsbericht, Fb 850, Bremerhaven. 1999. http://www.baua.de (pdf)
Deutscher Bundestag, Bericht der Bundesregierung über den Stand von Sicherheit und Gesundheit bei der Arbeit und über das Unfall- und Berufskrankheitengeschehen in der Bundesrepublik Deutschland im Jahre 2004, Drucksache 16/319, 21.12.2005. http://dip.bundestag.de/btd/16/003/1600319.pdf
Fröhner, K-D., Boothby, S. and T. Schulze, Bilanzierung von Verfahrend der Erweiterten Wirtschaftlichkeit für die betriebliche Praxis, Schriftenreihe der Bundesanstalt für Arbeitsschutz and Arbeitsmedizin, Forschungsbericht 962, Dortmund/Berlin 2002. http://www.baua.de/ (pdf)
Gröben, F., Freigang-Bauer, I. and K. Bös, Leitfaden zur erfolgreichen Durchführung von Gesundheitsförderungsmaßnahmen im Betrieb, Schwerpunkt: Muskel-Skelett-Erkrankungen, Initiative Neue Qualität der Arbeit, Belin/Dortmund/Dresden 2005, http://www.inqa.de/ (pdf)
Hauptverband der gewerblichen Berufsgenossenschaften (HVBG), BG-Statistiken für die Praxis, St. Augustin 2004.
Hauptverband der Berufsgenossenschaften, BK-Report 2/03 Wirbelsäulenerkrankungen (BK-Nrn. 2108 bis 2110, 2003. http://www.hvbg.de/ (pdf)
Huber, G., Paetzold, H., Püschel, K.M. and M. Morlock, Verhalten von Wirbelsäulensegmenten bei dynamischer Belastung, Schriftenreihe der Bundesanstalt für Arbeitsschutz und Arbeitsmedizin: Forschungsbericht, Forschungsbericht 1062, Bremerhaven, http://www.baua.de/ (pdf)
Langhoff, T., Ergebnisorientierter Arbeitsschutz, Bilanzierung und Perspektiven eines innovativen Ansatzes zur betrieblichen Arbeitsschutzökonomie, Schriftenreihe der Bundesanstalt für Arbeitsschutz und Arbeitsmedizin: Forschungsbericht, Forschungsbericht 955, Dortmund/Berlin 2002, http://www.baua.de/ (pdf)
Liebers, F.; Caffier, G.; Steinberg, U.; Behrendt, S.; Lau, H.; Langen, W.:Charakteristik und Bewertung des individuellen Bewegungsmusters der Lendenwirbelsäule beim Heben von Lasten1. Auflage. Bremerhaven: Wirtschaftsverlag NW Verlag für neue Wissenschaft GmbH 2000. (Schriftenreihe der Bundesanstalt für Arbeitsschutz und Arbeitsmedizin: Forschungsbericht, Fb 890), http://www.baua.de/ (pdf)
Pankoke, St.; Hofmann, J.; Wölfel, H. P.:Weiterentwicklung eines Modells zur Berechnung von Kräften, die in der Lendenwirbelsäule wirksam werden, Schriftenreihe der Bundesanstalt für Arbeitsschutz und Arbeitsmedizin: Forschungsbericht, Fb 885, Bremerhaven 2000. http://www.baua.de/ (pdf)