One-third of the respondents in a study undertaken by the Swedish National Institute for Working Life and published in October 1998 stated that they frequently attended work before they had fully recovered from sickness. Such "sick-presence" is most common in the caring occupations and in jobs where employees feel that they must make up for most, or all, of the time and work lost.
The traditional Swedish "full employment" model is coming under increasing threat from a number of sources. Higher levels of unemployment, structural changes in both the public and private sector, "downsizing" and a decrease in the numbers employed in the public sector have all had an influence on employee attitudes to their work. So too has the increasing number of employees who have the insecurity of working on temporary contracts.
Other changes which face employees are stricter rules for claiming health insurance payments, such as the one day's qualifying period for sick pay, which was introduced in 1993, and similar limitations on claiming work-related injuries insurance. Following these changes, there has been a clear tendency for fewer sick leave claims and fewer reports of work-related injuries. Another trend is the increase in instances of overtime work without payment.
Sick-presence instead of sick leave
On a regular basis, Statistics Sweden (Statistiska Centralbyrån, SCB) reports on changes on the labour market. In a supplement to the normal questionnaire, Professor Gunnar Aronsson and his colleagues Klas Gustafsson and Margareta Dallner, at the National Institute for Working Life (Arbetslivsinstitutet, ALI) recently investigated whether people went to work even though they considered themselves to be sick - in other words "sick-presence" (sjuknärvaro) instead of sick leave. Approximately 3,800 respondents were interviewed about their working conditions. One hypothesis was that people working in the caring occupations, such as healthcare and education, had a higher "sick-presence" than those whose work did not involve a responsibility towards other people. The basis for this hypothesis is that work in such occupations is built on interpersonal relations between the employee and the patient, client or schoolchild, which affects the employee's feeling of responsibility towards those in their care. The second hypothesis concerned the possibility of providing cover during any absence due to sickness. If employees consider that their work is accumulating during sick leave, this might encourage them to return to work before they have fully recuperated, especially if it is difficult to find a suitable person to cover for their absence.
One-third of all respondents stated that they had gone to work a number of times even though they considered themselves not to have fully recuperated. This tendency is particularly prevalent among carers. It is especially frequent among specially trained nurses such as midwives and emergency-treatment nurses (54%), followed by other nurses (52%) and doctors (47%). The study showed that a high level of employees returning to work early after a period of sick leave was also prevalent among certain categories in the educational sector: 52% of elementary school teachers and 46% of pre-school teachers reported that they often returned to work before they had fully recuperated. University and upper secondary school teachers were below average but 33% of executives stated that they often returned to work early after a period of sick leave.
Among groups where employees stated that they often return to work before they have fully recuperated, women are strongly over-represented. Some 89% of specially trained nurses are women, as well as 94% of other nurses and 93% of assistant nurses. However, neither gender, age nor education in themselves are important factors in influencing employee attitudes. It is the nature of the caring occupations and the fact that women feature strongly in such occupations which are found to be important in explaining the high prevalence of "sick-presence" among women.
The link between difficulties in providing adequate cover for sickness and the trend for certain occupational groups to return to work early is confirmed by the results of the study. The relationship between the early returners and accumulated work where employees have to make up for almost all the time and work lost is particularly strong. In this category, "sick-presence" is twice as common as for those whose work can be adequately covered by other employees.
Many symptoms
According to the study, those categories where employees return to work before they have fully recuperated experience other symptoms to a greater extent than those who take up their full period of recuperation.
Half of those who declared that they frequently returned to work before they had fully recovered had back and/or neck problems, compared with 27% of those who returned to work when they were back to normal health. Of the early returners, 44% experienced listlessness (compared with 21% of the others), 35% had stomach-aches (compared with 15% of the others), and 25% complained of sleeping problems (compared with 10% of the others).
Finally, the researchers believe that their results are likely to be part of a wider connection between many overlapping negative patterns. Sickness which is not cured by an adequate period of recuperation and recreation may lead to other problems and a greater likelihood of absence through sickness in the future.
Commentary
The study conceptualises the effects of adverse labour market conditions that increasingly face employees at present. However, since this kind of study has not been carried out before, it faces the same problem as many others: the lack of relevant reference points in order to extrapolate trends statistically. Thus, more knowledge is needed for management, policy-makers and practitioners on the long-term health effects of employees returning to work when they have not fully recuperated. If employees continue to return to work early after a period of sick leave and this pattern becomes permanent, the long-term health effects, particularly on an ageing work force, may become serious and costly. (Lena Järpsten, Arbetslivsinstitutet)