- Observatory: EurWORK
- Health and well-being at work,
- Working conditions,
- Published on: 20 July 2010
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.
Since a peak at the beginning of the millennium, absence from work in the Swedish labour market has decreased every year. This reduction is probably not due to a higher level of well-being but to changed attitudes in society and tightened national rules on sick pay. The main causes of absence from work are repetitive strain injuries, depression and cardiovascular diseases. Absence seems to increase with age, and is more frequent among women, as well as in larger companies.
Definitions and aims of study
Absence from work is frequently discussed in terms of its costs. These costs were outlined in a report published by the European Foundation for the Improvement of Living and Working Conditions (Eurofound) in 1997: Preventing absenteeism in the workplace. Since that time – as many reports of the European Working Conditions Observatory (EWCO) and of the European Industrial Relations Observatory (EIRO) note – it has become an issue in many countries; one approach has been to try to reduce the costs by tightening rules on sick pay.
In addition to a focus on costs, sickness absence has been connected to wider debates on the quality of work in two main respects. Firstly, there is growing interest in well-being and health at work. Attention has thus turned to positive ways in which well-being can be promoted, with improved attendance being a possible consequence. Secondly, the concept of ‘presenteeism’ – meaning being present at work while feeling ill or being unable to work at normal capacity – has emerged. Presenteeism may mean that measured absence levels are low but also that there are hidden stresses and pressures on employees.
The purpose of this comparative study is to provide an overview of the extent of absence from work and policies for its management, and to place this overview in the context of wider debates on well-being and presenteeism. The report assesses the current picture in terms of the level of absence and how the problem is treated – purely in terms of cost or in relation to the quality of work. It also examines the effect of the economic recession on levels of absence and how the problem is viewed.
Absence is defined as non-attendance at work when attendance was scheduled or clearly expected. The specific focus is a period of absence lasting longer than three days; the comparative analysis seeks information on this level of absence but recognises that data may not always be available.
The study has two main themes: the extent and patterns of absence, together with any trends; and the means of control and policies towards absence.
Extent and patterns of absence
1. Broad patterns
Where data are sought on the extent of absence, please use if possible the definition given in the briefing note. If available data do not distinguish between absence lasting longer than three days and all absences, please provide the closest available figure.
(a) Please describe the main data sources for absence from work at national level. How are the data collected, and how is absence defined? Are the data broken down according to the length of absence? Which spells of absence are taken into consideration (e.g. three to 19 days and 20 days or more)?
SCB conducts Labour Force Surveys (Arbetskraftsundersökningar, AKU), based on the population aged 15–74 years in the labour force. The AKU examines reference periods where total absence is charted for one week per month concerning about 22,000 employees. Absence is divided by gender and age group. AKU surveys consider employees who have been absent at some time during the reference period, employees who have been absent for the total reference period and absences lasting longer than the reference period. Categories for absence are divided into 1–2 weeks, 3–12 weeks, 13–51 weeks and 52 or more weeks.
The data from the Swedish Social Insurance Agency consist of the amount of disbursed days from the social security per person and year. This information is collected from the administrative register of the social security system, containing disbursements and decisions from the Social Insurance Agency. The data are principally divided into two categories: disbursements of up to 14 days or longer.
(b) Please state the average overall current level of absence either in terms of % of working time lost or number of working days a year. What has been the trend over the past five years?
The data show a continuous decline in the level of absence over the past five years: from 4.275% of lost working time in 2004 to 3.725% in 2006, to 3.075% in 2008.
(c) Please provide a breakdown of absence by gender. What has been the trend over the past five years?
Absence according to gender follows the general decline, and women consistently report a somewhat higher absence rate than men. The data estimate the proportion of absent employees: in 2004, the absence rate for women was 5.325% and the rate for men was 3.225%. In 2006, the absence rate was 4.725% for women and 2.8% for men; by 2008, it had decreased to 3.775% for women and 2.4% for men.
(d) Please provide a breakdown of absence by age groups (if possible, according to the following age groups: 15–29, 30–49 and 50 years). What has been the trend over the past five years?
The age groups considered in Swedish statistics are divided into the categories of 15–24 years, 25–54 years and 55 years. The distribution of total absence in 2008 among these categories is 5% for the 15–24 age group, 62% for the 25–54 age group and 33% for the 55 age group. This division has remained more or less intact over the past five years as no strong trends are visible in this regard. Looking further back to the previous five-year period, the younger age groups have increased their representativeness.
Various studies indicate that absence from work increases with age, and a probable explanation for the lower rate in the 55 age group – compared with those aged 25–54 years – could be that some people in this age group have already left the labour market due to illness, for example.
(e) Please provide any available estimates for the proportion of the total volume of absence a year due to short (3–19 days’ duration) spells and long-term absence (20 days or more). Have there been any changes in the prevalence of short-term and long-term levels of absence over the past five years?
As SCB uses a reference period for its evaluation, absence lasting only a few days is not accurately represented in the AKU surveys, which makes it difficult to estimate the actual total. The lowest category of absence, of one to two weeks, represented about 30% of the total in studies from 2008.
The Swedish Social Insurance Agency estimates that about 80%–85% of all absence from work is short-term, lasting no longer than two weeks, which is the lowest category of absence in the AKU surveys.
(f) Please give the level of absence in small and medium-sized enterprises (SMEs) with fewer than 250 employees, compared with large organisations.
In general, absence is lower in SMEs than in large organisations. A study from the Swedish Federation of Business Owners (Företagarna) shows that the average absence rate in companies with up to 50 employees is 1.95% while the proportion in companies with more than 200 employees is 3.9%. This is an interesting observation, as large organisations often have better resources to prevent absence – with preventions plans, and health and wellness training, for example.
One possible explanation for the lower absence rate in SMEs could be small-scale advantages, as in small businesses it is easier to adapt working conditions to individual competence. It is easier for employees to influence their work situation and, for instance, work from home if needed. This could create a feeling of comfort, with positive effects on the work environment and well-being of the staff. In small enterprises, employees who do not fit in are more likely to leave the company, which implies that the remaining workforce is satisfied with their work situation, which lowers the level of absence.
Another explanation is the fact that women are overrepresented in absence from work, and as many women work in the public sector this attributes to a higher absence rate in these large organisations.
It is also possible that workers in SMEs are under more pressure to come to work, as the workforce is relatively small. Thus, a higher degree of presenteeism may apply in SMEs (see below).
(g) Using the table below, please provide the latest figures on absence levels by activity sectors.
|Economic sector||Average working time lost per year (%)||Average days lost per employee per year|
|All private sector||2.7||6.08*|
|All public sector||3.56||8.0*|
|(A) Agriculture, hunting and forestry (B) Fishing||1.5||3.38*|
|(C) Mining and quarrying||2.38||5.36*|
|(E) Electricity, gas and water supply||2.4||5.4*|
|(G) Wholesale and retail trade||2.48||5.58*|
|(H) Hotels and restaurants||1.35||3.04*|
|(I) Transport, storage and communication||2.9||6.53*|
|(J) Financial intermediation||2.08||4.68*|
|(K) Real estate, renting and business activities||2.28||5.13*|
|(L) Public administration and defence||No data||No data|
|(N) Health and social work||2.8||6.3*|
|(O) Other community, social and personal activities||2.38||5.34*|
|(P) Activities of households||No data||No data|
|(Q) Extra-territorial organisations and bodies||No data||No data|
Note: Data marked with * are the author’s own estimation according to existing statistics, as official statistics are not available in all categories.
Source: Data from SCB
2. Causes of absence
(a) Please describe the main causes of absence as identified in national surveys. Are there differences according to gender, company size or sector of economic activity?
In surveys, SCB divides absence from work into categories such as illness, vacation and parental leave. Absence due to illness is not further divided according to causes but only into categories of age and gender, as SCB claims that further divisions would lead to data unreliability.
Many studies show that the main causes of absence from work are repetitive strain injuries and depression, followed by cardiovascular diseases.
The healthcare sector has the largest total number of absences; a majority of the personnel are women. In total, as noted, women have higher absence rates than men, and women are particularly overrepresented in absence for psychological and psychosocial reasons, such as stress, anxiety and depression.
As mentioned, there is a higher absence rate in large organisations than in SMEs.
Many of the common physical causes of absence relate to blue-collar workers in, for example, the manufacturing and construction sectors. Among white-collar workers, stress, depression and feelings of burnout are predominant.
(b) Please indicate the main occupational diseases and occupational injuries or accidents responsible for absence from work. Please identify and offer explanations for any changes that have occurred over the past five years.
The frequency of work-related injuries in Sweden is low in an international comparison, although every year some 30,000 accidents occur in the country. The main type of occupational accident leading to absence from work is falling accidents, followed by injuries in industrial sectors involving machinery, and psychosocial disorders due to stress, threats or robbery.
The level of accidents is about the same from year to year although, over time, it has decreased slightly. This is perhaps due to greater awareness both among management and personnel of the importance of a good working environment.
Please refer to the definition of presenteeism: ‘being present at work while feeling ill or being unable to work at normal capacity’. What data are available on its extent?
Several studies show that numerous employees go to work when they should be staying at home for health reasons. According to the survey Arbetsmiljön 2007 [The work environment 2007] from the Work Environment Authority (Arbetsmiljöverket), more than 50% of people answered yes to the question ‘during the last 12 months, did it happen that you went to work, even when you thought you should report sick?’.
Presenteeism appears to be more frequent among women than men, and is more common in the public sector than the private sector. The main reasons for presenteeism seem to be a high workload, loyalty towards colleagues, and a financial situation whereby people cannot afford to stay at home and lose some or all of their pay. Presenteeism is most common among teachers and healthcare workers, of whom more than 60% and 50%, respectively, answered yes to the question.
There are no data on presenteeism related to company size. Nonetheless, as a high amount of loyalty towards colleagues and management is common in smaller companies, this could imply a greater level of presenteeism in SMEs. Self-employed individuals have a big responsibility and are rarely absent from work.
The Swedish Association of Occupational Health (Föreningen Svensk Företagshälsovård, FSF) has published its annual national report Jobbhälsobarometern [Work health barometer]. The report is the result of interviews with a population of 5,000 individuals aged 20 to 67 years. The respondents were asked about their working life, health, working ability and capacity, and well-being at work. About 8% of those interviewed – which corresponds to 350,000 individuals among the total working population – estimate that they will not be able to continue their current job considering their health and well-being. These results are a cause of concern as they indicate that the employed population and their work capacity are under some pressure. The report also shows that young people aged less than 31 years are under high pressure at work (SE0908039I).
Costs and policies
4. Costs of absence
Are there estimates or studies on costs of absence from work? Please provide available information on:
a) Figures for costs of absence from work for employers. Please summarise how the data are collected, how costs are compiled (what is included in the costs and concrete data) and measured (e.g. costs of absence as a percentage of company production or as a percentage of GDP for the whole country).
It is almost impossible to estimate the total cost of absence from work at national level for employers; there are as yet no data or completed research in this regard, according to the Institute for Labour Market Policy Evaluation (Institutet för arbetsmarknadspolitisk utvärdering, IFAU), the Confederation of Swedish Enterprise (Svenskt Näringsliv) and the Swedish Federation of Business Owners. To provide correct data, numerous variables have to be included, many of which are inaccessible. The cost in each individual case of absence has to include sick pay, the costs of hiring and educating substitute staff, rehabilitation, a decrease in production depending on the absent employee, and many more factors. Thus, the total cost is difficult to measure. Nonetheless, it may be assumed that the cost is probably very high including all elements, and it is even probable that the cost for employers exceeds the cost for the social security system.
b) Figures for costs of absence from work for the social security system. Please summarise how the data are collected, how costs are compiled (what is included in the costs and concrete data) and measured (e.g. costs of absence as percentage of social security expenditure).
According to the annual report of the Swedish Social Insurance Agency, the total costs of absence from work for the social security system were close to SEK 108 billion in 2008 (€11.28 billion as at 3 June 2010). This figure includes sick benefits and costs of rehabilitation, and corresponds to about 4% of gross domestic product (GDP).
The total cost of absence in 2007 was about the same; a visible trend in recent years indicates lower costs in the 1990s followed by increased costs from 2000 onwards.
5. National and company measures
(a) Please outline any recent measures at national level intended to reduce the costs of absence through positive policies. An example would be changed social security rules on sick pay. Are any specific actions or measures directed at long-term absence?
According to the Companies Act, it is compulsory for companies to account for work absence in the annual financial report to create an awareness of and try to estimate its costs. There have been suggestions to eliminate this requirement, but at the moment the law is still in effect.
There are also proposals to the Swedish government (Regeringen) on how employers shall work to facilitate and rehabilitate absent employees towards reintegration to working life, for example Prop. 2006/07:59.
Considerable debate is currently taking place in Sweden about recent government changes to the national health insurance system. Before the change, there were no formal limitations on sickness pay, which resulted in very long sick leave. In 2008, a major reform was introduced which implies a limit of 180 days of sickness pay. After 180 days, the Swedish Social Insurance Agency will assess whether the employee is able to return to work; if it decides that they are, the sick payment will cease and employees have to go back to work or they might risk losing their job (SE0901019I).
Employer organisations believe that these changes will allow people to maintain their working capacity and support themselves. Trade unions, however, consider that this could create situations where people in some cases lose sick payment and have to apply for income support instead. Therefore, there is a risk that some employees may fall through the safety net between the Swedish Public Employment Service (Arbetsförmedlingen) and the Swedish Social Insurance Agency: the former organisation might consider the employee too sick to work while the latter might deem the worker too well to be on sick leave.
In 2006, the government, led by the Swedish Social Democratic Party (Sveriges socialdemokratiska arbetareparti, SAP), launched a major initiative to reduce work absence – both short and long-term – entitled ‘A billion to healthcare’ (Sjukvårdsmiljarden). It aimed to encourage the county councils to create driving forces and reduce absence with a grant of SEK 1 billion (€104 million) from the state every year over a period of three years between 2007 and 2009. Examples of programmes within this initiative are medical research projects on absence and rehabilitation, and various investments to improve cooperation.
(b) What are companies doing to reduce overall absence from work (e.g. attendance incentives or bonuses)? Are sickness prevention plans elaborated? If so, how are elected employee representatives involved in these plans (e.g. through involvement in their design and implementation, or through being informed about them)? Please illustrate with up to three examples.
As companies realise the costs and problems of absence, they take a number of measures to reduce the overall absence from work. According to the Working Environment Act, employers have to provide a good working environment and prevent illness at work.
For non-legislative initiatives, various types of occupational health services (Företagshälsovård) cover about 70% of all Swedish employees. These occupational health services aim to work both directly and indirectly by preventing future work-related problems and helping the workplace to improve working conditions technically, medically and socially.
Health and wellness training (friskvård) is practised at many Swedish workplaces, meaning that during working time employers may provide opportunities for physical exercise, massage therapy and other facilities to improve the well-being of employees. The employers can avail of tax deductions towards the costs. It is also increasingly common for companies to offer employees services such as free medical care, stress management and help in giving up smoking.
(c) Do companies have any specific policies directed at long-term absence? What is done to encourage the reintegration into work people who are long-term sick? Is work redesigned to meet the needs of employees?
Company policies to reduce absence from work are often simultaneously directed at both short and long-term absence. Employers are well aware of the fact that ill and absent employees mean having to pay sick leave, together with a fall in production. In order to avoid future long-term absence, it is important to take preventive action: providing a good working environment and health and wellness training now will have good outcomes in the future.
One example of facilitating reintegration to work after long-term absence within companies is a project of so called ‘employer-rings’ whereby participating companies can relocate employees if there are better suited working conditions in another company within the ring for the rehabilitated employee. There are also various joint initiatives among the social partners: for example, Prevent is an association with a focus on the working environment established by the Swedish Trade Union Confederation (Landsorganisationen i Sverige, LO), the Confederation of Swedish Enterprises and the Council for Negotiation and Cooperation (Privattjänstemannakartellen, PTK). Another initiative is Sunt liv, a website for employees in the public sector that provides knowledge and support to improve health and working environment conditions.
6. Well-being at work
(a) Is the concept of well-being at work a feature of debates in your country? Which are the most relevant initiatives in this area, for example in relation to redesigning work to encourage attendance or to promote the health of employees? What are the objectives of such initiatives? How far do they aim to reduce absence levels, and is there any evidence of any reductions? Please provide up to three examples.
Recent years have seen a greater awareness of the value of well-being at work, and the general debate underlines the importance of health and wellness and its consequences for the working environment. Despite this, many employers concede that in times of financial crisis matters such as a good working environment are not top priority and are easily put aside in favour of more urgent, economic issues.
Notwithstanding the increased awareness, more attention focuses not on well-being but on reactions to practical measures to solve the problem of absence from work. Increasing social inclusion and ending long-term exclusion from the labour market is one important strategy for the government.
As already mentioned, the changes to the social security insurance system in 2008 received considerable attention and were highly criticised by trade unions. A follow-up to this reform is a recent initiative from the government to facilitate the reintegration of long-term absent employees into work. Over the next three years, the government will put SEK 17 million (€1.77 million) into different measures such as introduction programmes, rehabilitation, coaching and vocational training (SE0909029I).
(b) To what extent do policies on the management of absence and on well-being engage elected employee representatives? At what stage are representatives involved?
There is no overall answer to this issue, but in most cases employees are represented in some way in the designing of policies on management of work absence. This can be both in developing the policies and also, to a large extent, in making sure that the employers follow these. Most workplaces organise this input by having a health and safety committee, where local health and safety representatives scrutinise the work and function as a link between the management and employees.
Several collective agreements at national level include regulation for good working environment conditions, for example with regard to the physical environment, individuals’ rehabilitation and action plans. In these cases, employees are represented by trade unions and local health and safety representatives.
(c) Please summarise the policy position of social partners, and if relevant other representative bodies, on the management of absence, attendance and well-being at work.
The recent debate on the change to the social security system serves as a good example of the different positions of the social partners in this area. In this discussion, it is apparent how employer organisations and trade unions protect different interests. The employers welcome tougher measures, encourage tightened rules on sick pay and claim that it will increase people’s capacity to support themselves. At the same time, trade unions are highly critical and fear that if a person has to worry about not receiving sick pay, it is almost impossible to focus on getting well, which in the end will create bigger gaps and costs for society.
These different opinions are also apparent in a new debate on a proposed change to the Work Environment Act. In the spring of 2009, the Confederation of Swedish Enterprise proposed a reform of this Act to the Swedish government, suggesting reduced power for safety representatives at workplaces in favour of increased individual responsibility (SE0907029I).
Trade unions are opposed to increased power for employers as they argue that a loss of power for safety representatives would mean a decline in workplace safety. The employer organisations, on the other hand, believe that the law needs to be modified as it has not kept pace with developments. They support increased power for employers and greater individual responsibility.
Please provide an assessment of national debates about absence. What is the balance between controlling high levels of absence, on the one hand, and promoting health and a positive work environment, on the other?
In order to reduce absence from work, strict regulations at national level need to be combined with softer initiatives promoting health and encouraging well-being at workplaces. Both company and national initiatives seem to be increasingly aware of this situation, as the issue have received more attention in recent years. They recognise the importance of preventative work in the present in order to avoid both short-term and long-term absence.
National-level measures include stricter checks on absent employees by random inspections and tighter controls to curtail social welfare cheating, reduce absence and thereby increase employment. One example of a company initiative is flexible working time, where employees can adjust working schedules to personal preferences for well-being.
In addition, since 2005, companies are legally bound to report the number of days that employees were on sick leave in their annual financial report, also called ‘health reports’ (hälsobokslut). This obligation is regulated in the Swedish Companies Act (Aktiebolagslag 2005:551). Statistics on sick leave have to be reported as a percentage of the employee’s regular working hours and must be specified by gender. This is a government measure to highlight the costs of absence and sick leave and may be regarded as another example of initiatives aiming to balance control on absence and the promotion of well-being.
The working environment is frequently discussed at many levels of society and two public inquiries (Official government report (Statens offentliga utredningar, SOU) 2006:44, SOU 2007:43) have been published regarding how the Working Environment Act should be reformed. The working environment was also expected to be one of the central themes of discussions between the social partners in the collective bargaining round for 2010 (SE0908029I).
One observation worth noting is that, despite the fact that a greater proportion of women than men are absent from work, the female absence in total implies a smaller cost for the social security system than the absence of men. This is because women in general have lower incomes as a base for sick payment.
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Ellinor Häggebrink and Karolin Lovén, Oxford Research