Work accidents decline while incapacity claims for occupational diseases rise

Fewer people worked in the Italian health and social care sector in 2008 than in 2004; the hospital workforce fell slightly but more people worked in non-hospital services (especially providing care to the elderly). Work accident rates declined in hospitals but increased in non-hospital services (though accurate data are hard to obtain). Incapacity claims by hospital workers for skin and respiratory diseases declined but those for musculoskeletal diseases increased.

Employee numbers

According to the March 2010 newsletter (in Italian, 60Kb PDF) of the Italian Workers’ Compensation Authority (Inail), the average number of insured workers in the health and social care sector in Italy increased by 4% between 2004 and 2008 (from over 845,000 in 2004 to over 873,000 in 2008) (Table 1).

During this period, employment in the health services showed a moderate decline (50,000 or 2.2%), especially in hospitals as a result of severe budget constraints (leading to shorter periods of patient hospitalisation) and shortages in qualified non-medical personnel. However, social services – especially caregivers (mainly migrant women) – showed considerable growth ( 23.8%), though the reported figures underestimate the increase in the number of carers since they can also be registered as domestic workers with lower pay or be undeclared (IT1001049I).

Table 1: Average number of employees in the health and social care sector, 2004–2008
  2004 2005 2006 2007 2008 % variation 2004–2008
Health care 663,734 654,387 675,155 636,945 648,828 -2.2
Social care 179,851 187,152 196,282 204,954 222,589 23.8
Veterinary care 2,021 1,961 2,033 2,075 2,206 9.2
Total 845,606 843,500 873,470 843,974 873,623 4.0

Source: Inail, 2010

Work accidents

In the health and social care sector as a whole, the average annual number of work accidents increased by 1.2% between 2004 and 2008, peaking in 2006. This compares with a decrease in total work accidents in Italy over the same period of 9.5% (Table 2).

While the number of work accidents declined on average in hospitals (-14.1%) at a faster rate than the number of workers (-6.2%) over this period, the average number of work accidents increased by over 20% in other areas of the sector (non-hospital structures, caregivers and social services) – almost in line with the increase in employee numbers (23.8%).

Although some decline was seen in the rate of incidence of accidents in hospitals, ambiguous recording and the extent of undeclared work raise doubts over the reliability of these figures. This makes it difficult to describe trends fully, particularly as data for different occupations focus on different classes of risk.

Table 2: Average number of work accidents in the health and social care sector, 2004–2008
  2004 2005 2006 2007 2008 % variation 2004–2008
Entire sector 34,036 35,096 35,302 34,867 34,457 1.2
Hospital services 18,969 18,905 18,165 16,811 16,296 -14.1
Other services 15,067 16,191 17,137 18,056 18,161 20.5
Total work accidents 966,729 940,021 928,158 912,410 874,940 -9.5

Source: Inail, 2010

Incapacity claims

In contrast, incapacity claims due to occupational diseases in the health and social care sector increased from 332 in 2000 to 722 in 2008, showing considerable change during the 2000s (Table 3). Such claims are available only to those working in hospitals.

Incapacity claims for musculoskeletal disorders (MSDs, first four rows of Table 3) increased almost tenfold between 2000 and 2008 (from 50 to 492), primarily due to a considerable increase in the number of eligible diseases in 2007 (especially for tendonitis and rheumatic diseases). Their share of total incapacity claims for occupational diseases in the sector increased from 15% in 2000 to around 70% in 2008. The increase in MSD incapacity claims among health personnel is also linked to the low turnover of staff, which implies an increase in the average age of health personnel and thus a decline in their partial mobility and the need to adapt correspondingly to workplace activities.

With the introduction of better prevention measures, skin and respiratory diseases showed a considerable decline during the period. However, cancers showed an increase both in absolute values ( 190.9%) and share of total claims in the sector (from 3.3% in 2000 to 4.4% in 2008) according to Inail figures. The increase in MSDs incapacity claims amongst health personnel is also due to low turnover, which implies an increase in the average age of health personnel and their partial incapacity and need to workplace adaptation.

Table 3: Most reported incapacity claims due to occupational diseases, 2000–2008
  Average number % variation
2000 2004 2008 2004–2008 2000–2008
Health care Total Health care Total Health care Total
Intervertebral disc complaints 34 102 117 225 255 353 117.9 650.0
Tendonitis 6 18 49 94 123 170 151.0 1950.0
Arthritis and related disorders 3 09 25 48 73 101 192.0 2333.3
Carpal tunnel syndrome 7 21 33 64 41 57 24.2 485.7
Cancers 11 33 35 67 32 44 -8.6% 190.9
Dermatitis and other skin diseases 91 274 58 52 30 29 -48.3% -76.9
Respiratory diseases 39 117 27 52 21 29 -22.2% -46.2
Total 332 575 519 603 722 784 39.1% 117.5

Source: Inail, 2010

Compliance with health and safety regulations

For the first time, Inail sectoral figures include the findings of inspection activities in 2007. Almost half (49%) of inspected workplaces in the health and social care sector did not comply with at least one aspect of health and safety provisions. Non-compliance rates were much lower in northern regions of Italy (19%) than in central (52%) and southern (75%) ones. The most reported violations, sometimes leading to closure of non-compliant units, were:

  • non-compliance with structural requirements (25.2%);
  • lack of hygiene, dust and violation of ban on smoking in workplaces (25%);
  • non-compliance with preventive measures against work accidents and fire (23.3%)

Commentary

The health and social care sector illustrates the shift in the 2000s from collective towards individual services, and an impressive increase in caregiving to the elderly. But the data indicate divergent attention to health and safety at work between different parts of the sector. In the health and social care sector (especially hospitals), risk factors affecting working conditions are well monitored and preventive measures have led to a decline in work accidents and traditional factors leading to occupational diseases (with the exception of MSDs which increased dramatically due to the workforce ageing). However, the figures suggest that different health and social care services did not show comparable attention to health and safety between 2000 and 2008, as trends in work accidents match changes in occupational numbers. To better monitor such divergent trends, further improvements are needed in disaggregating administrative sources to provide more data.

References

Italian Workers’ Compensation Authority (INAIL), ‘Andamento degli infortuni sul lavoro (in Italian, 60Kb PDF)’, Dati Inail, No. 5, Rome, March 2010.

Verdolin, D. and Paon, F., La gestione del giudizio di idoneità e la difficoltà di gestione del personale sanitario (in Italian, 1.62Mb PDF), Istituto Assistenza Anziani Verona, Verona, 2007.

Mario Giaccone, Ires

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