- Observatory: EurWORK
- Published on: 08 October 2007
Disclaimer: This information is made available as a service to the public but has not been edited or approved by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.
All research carried out to date in the European Union indicates that musculoskeletal problems afflict a relatively large group of employees and that they result in considerable expenses associated with treatment and rehabilitation. The present elaboration could not aspire to present a complementary element of this diagnosis, and a basic problem is posed in the fact that there is no Polish institution which would study issues relating to musculoskeletal conditions in a systematic, comprehensive way. Those institutions which do analyse related questions, meanwhile, do not have representative data for the entire country, at any rate not processed data. One can reasonably assume, however, that musculoskeletal complaints in Poland constitute a problem on a scale comparable to other European countries.
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.
1.1 Please, report the official definition of WR-MSDs, if any, or the most widespread one. Please specify whether it includes backaches.
1.2 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?
The applicable Polish laws do not formulate any definition of work-related musculoskeletal disorders. The Social Insurance Institution (Zakład Ubezpieczeń Społecznych, ZUS), which handles benefit pay-outs within the general mandatory insurance system, resorts to the ICD-10 international classification of medical conditions.
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).
1.2 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?
1.3 Is there any research of analyse of causes available?
The only elaboration on musculoskeletal disorders in Poland available is drawn up by the Central Institute for Labour Protection – National Research Institute (Centralny Instytut Ochrony Pracy – Państwowy Instytut Badawczy, CIOP-PIB) and published in the periodical whose title translates as Work Safety. Theory and Practice.
Such analyses of musculoskeletal conditions as available tend to focus not so much on discussing the actual conditions or on the main reasons for their prevalence but on prevention.
The Social Insurance Institution (ZUS) does collect and process some data about musculoskeletal disorders, but it is largely incomplete. The ZUS data will be discussed in greater detail below.
On rare occasions, research gauging the prevalence of musculoskeletal disorders is carried out in Poland. In Health of the Polish Population in 2004 (actually published in 2006), the Central Statistical Office for Poland (Główny Urząd Statystyczny, GUS) concerns itself only with musculoskeletal conditions and with disorders affecting the peritoneum and similar tissues in children aged up to 14 years old. For all its merits, this detailed analysis does not as much as mention musculoskeletal disorders resulting from working conditions. This elaboration states that, of the aggregate number of 5,997,100 disabled Poles in 2004, 2,763,800 were afflicted with conditions affecting the limbs and with other diseases impeding mobility.
The most recent set of data concerning mobility problems constituting occupational illnesses dates back to 1998. In that year, as GUS reports, various mobility disorders accounted for 2.4% of all occupational illnesses. In 1996, 0.6% of vocationally active women and 0.5% of men underwent treatment for musculoskeletal disorders and connecting tissue injuries.
The World Health Organisation (WHO) relies on the DALY index as it mentions - in Highlights on Health in Poland 2005 – that, in 2002, 3.8% of men and 7.4% of women in Poland were afflicted with musculoskeletal illnesses.
The references and information set out above largely exhaust the available pool of data on musculoskeletal conditions in Poland (data from ZUS will be presented below). This, however, is not to say that research on these topics is not pursued, to mention only the work of the Nofer Institute of Occupational Medicine (Instytut Medycyny Pracy im. prof. J. Nofera) or, indeed, of a number of other medical schools, although strictly medical analyses tend to be confined to cases from individual hospitals or clinics and, even if their conclusions offer broader insights, they are not circulated very widely.
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:
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)
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);
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.
1.4 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.
1.5 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.
1.6 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:
pace of work (speed or repetitiveness, tight deadlines)
autonomy (in general and wher possible breaks opportunities , scope on pace of work, scope on methods);
use of PCs and other ICTs devices;
scope of discussion over work organization and/or organizational changes;
The only data which we have been able to secure from the Social Insurance Institution (ZUS) is set out in the table below:
Table 1. Day of sick leave and numer of medical certificates attesting to temporary inability to work
|Days of sick leave for insured persons, as certified to ZUS in 2005||No of medical certificates attesting to temporary inability to work|
|Type of condition||Total||Incl women||Total||Incl women|
|Incl persons aged >19||Incl persons aged >19||Incl persons aged >19||Incl persons aged >19|
|M19 – Other degenerative conditions||258,600||200||101,3||02||22,500||0||8,800||0|
|M23 – Internal knee joint damage||862,200||4,500||235,000||1,200||44,800||0,300||12,000||0,100|
|M40 – Ciphosis and lordosis||18,100||200||7,800||0||1,400||0||0,600||0|
|M41 – Scoliosis||106,900||1,600||59,800||800||8,100||0,100||4,300||0|
|M50 – Neck vertebrae conditions||913,800||500||476,800||100||68,200||0,100||34,800||0|
|M54 – Back pain||1,682,300||6,300||592,200||1,100||165,900||1,100||55,600||0,200|
|M70 – Trauma-related soft tissue conditions||1,519,300||9,100||568,900||2,000||145,200||1,500||50,600||0,300|
|M75– Shoulder injuries||276,600||0,300||96,200||0,100||20,800||0||7,100||0|
|M77 – Other enteosopathies||142,000||0,400||56,400||0||11,000||0||4,200||0|
|M93 - Other osteochondropathies||20,800||0,200||8,900||0,100||1,300||0||0,6||0|
Source: GUS 2006
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.
1.7 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?
1.8 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 data available in Poland on this subject.
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:
Good quality working conditions;
Possibilities of cooperation;
Organisation of work which allows to make maximum of benefit out of the workforce
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).
1.9 In general, plant-level prevention policies are “risk elimination oriented” or centered around “risk information”? What the role of social partners?
1.10 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?
1.11 Have been developed any quality indicators measuring “room to manoeuvre” preventive strategies?
Under the regulation promulgated by the Minister of the Economy and Labour on July 27, 2004, responsibility for occupational health and safety training rests with the employer. An employer is legally bound to provide its employees with health and safety training appropriate for the type of work performed by her/him and to furnish her/him with relevant instructions. Training of this sort may be carried on by the employer itself or outsourced to duly certified external contractors; training assumes the form of an introductory course for new employees and of refresher/further courses.
Unfortunately, there is no data available concerning the consequences of the binding force of he law as well as trainings.
It is impossible to find any information about social partners’ role in the context of musculoskeletal disorders.
Brenner, Fairis and Ruser, 2004, “”Flexible” work practices and occupational safety and health: exploring the relationship between cumulative trauma disorders and workplace transformations”, Industrial relations 43.
Bourgeois F. (ed.), 2000, TMS et travail: quand la santé interroge l’organisation. ANACT.
Clot Y., 2005, “Les TMS: hypersollicitation ou hyposollicitation”, communication presented at the “1.er congrés francophone sur les TMS du membre supèrieur”, Nancy, 30-21 may 2005.
Coutarel F., 2004, La prevention des troubles musculo-squelettiques en conception: quelles marges de manoeuvre pour le dèploiment de l’activitè?, Coll. Thèses et Mèmoires, Universitè Victor Segalen Bordeaux 2 – ISPED, Laboratoire d’Ergonomie des Systèmes Complexes.
Daniellou F., 2005, “TMS et modèles d’organisation du travail et de la produciont”, communication presented at the “1.er congrés francophone sur les TMS du membre supèrieur”, Nancy, 30-21 may 2005.
Hakim C. (1993), “Segregated and Integrated Occupations: A New Approach to Analysing Social Change”, European Sociological Review 4.
Oesterman P., 2002, “Organizing the US Labor Market: National Problems, Community Strategies”, in Trubek D., Zeitlin J. (eds.) Reconfiguring work and welfare in the New Economy, Oxford, Oxford University Press, 2002
Pèze M. (2002), Approche psychosomatique et psychodynamiques des TMS. Mimeo.
Putz-Anderson V. (2002), Cumulative trauma disorders – A manual for musculoskeletal diseases of the upper limbs. Taylor&Francis, London.