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Launching 'Fit for Work' in Estonia

Ksenia Zheltoukhova

07 November 2011

On Friday I was proud to launch the latest Fit for Work report at the X annual Forum of Reumaliit patient group in Estonia. The Reumafoorum heard on the importance of early intervention in reducing the impact of MSDs from a variety of renowned speakers, including Dr Tõnu Peets, Head of the Estonian Society for Rheumatology, David Magnusson from The Swedish Rheumatism Association and Ain Aaviksoo from Praxis Centre of Policy Studies, who is leading on a study of the socioeconomic costs  of rheumatic disease in Estonia.

In Estonia many individuals are reluctant to disclose their condition to their colleagues and managers, or even their doctors, out of fear of losing their jobs. That is why it is particularly significant that this year’s Reumafoorum marks the 20th anniversary of the Reumaliit patient group, which brings together patients with rheumatic conditions, health care professionals and government officials to increase awareness about the impact of MSDs on the Estonian society.

As in some other European countries, many Estonian employers and policymakers mistakenly believe that MSDs only affect people of 65 years and older. Our report has confirmed that MSDs are highly prevalent among the working age population, and the prevalence of MSDs in Estonia is one of the highest in Europe. In 2009 the work capacity of 59 per cent of employees aged 15-64 was limited due to long- term problems with hands, legs, back or neck. We have also found that:

  • Estonia ranks second among other European countries for the prevalence of long-standing illness or health problems, which affect over 40 per cent of Estonian population.  
  • Over 95,000 cases of MSDs were registered among the working age population in 2010; the prevalence is particularly high for 40-65 year-old women; On average 4 people are diagnosed with a case of MSD daily, requiring an average of 6.7 days hospital stay; 
  • In 2008 almost 6.4 million work days in Estonia were compensated due to temporary incapacity caused by illness, of which MSDs are estimated to account for 16 per cent. Different estimations suggest that sick absence costs the Estonian economy between 6 and 15 per cent of GDP; 
  • Much of the costs of MSDs in Estonia are associated with late intervention, as individuals fail to disclose their conditions early enough for efficient treatment of disease;  
  • There is a lack of joined-up action between organisations for health professionals, such as Estonian Rheumatism Association, government and employers;  
  • Employers are rarely proactive in preventing ill health of their employees. What they fail to realise is that simple interventions to manage MSDs will cost less than losing employees with key skills;  
  • There is little awareness of the existing in-country research highlighting the benefits of early intervention. Cases of early intervention for RA in Estonian hospitals are anecdotal and are a result of local rather than national initiative.

We were very pleased to hear from Hanno Pevkur, Estonian Minister of Social Affairs, and Kaia Vask from the Estonian Health Insurance Fund, who appreciate the importance of early interventions for prevention of long-term impact of MSDs. This high level of interest at the Reumafoorum gives hope that the burden of MSDs will be addressed more proactively in Estonia in the coming years.

So what can be done to reduce the burden of MSDs in Estonia?

  • Government should prioritise reducing the costs of MSDs for individuals, employers and the labour market and consider a National Plan for people with MSDs, driven forward by a dedicated representative at the Ministry of Social Affairs. 
  • Employers should give individuals a voice in making decisions about workplace organisations. Acknowledge invaluable skills of employees and support job retention through workplace and working time adjustments to hasten recovery or rehabilitation. 
  • Employees should not delay talking to their doctors about their symptoms. Carrying on with a regular workload when unwell may lead to complications in the future. If your MSD is causing you difficulty, discuss your needs for working time or environment adjustments together with your doctor and your manager. 
  • Health Care Professionals should work in partnership with the patient and their employer for early intervention and phased return to work. Identify where job retention or early return to work is good for the patient.

In her speech at the Reumafoorum Dr Oivi Aakre has called all stakeholders to campaign for action at a national level. We know that there are many experts and policymakers in Estonia who are committed to tackling the burden of MSDs at all levels and we hope that the recommendations of the report will become a foundation for a National Fit for Work Estonia Plan for MSDs.