The APS has endorsed, and is now a signatory to, the Australian Faculty of Occupational and Environmental Medicine (AFOEM) Position Statement, Realising the Health Benefits of Work.1 This important new document summarises evidence showing that work is a determinant of health in exactly the same way as lifestyle and genetic factors.

Risk factors associated with not working

For the working age population, not being at work is a progressively increasing health risk factor. Indeed, not working for six months or more has been found to be an equivalent health risk factor to smoking 10 packets of cigarettes each day. Accordingly, long-term worklessness is now considered to be one of the most significant public health risk factors. When a person is off work for 20 days, the prospects of them successfully returning to work are 70 percent; when they are off work for 45 days, the chances of getting back to work are 50 percent. However, when a person is off work for 70 days, the chances of successfully resuming work decline to 35 per cent. Thus, the overarching theme of the Position Statement is that, generally, work is good for health.2

Australian statistics

In Australia we currently have an emergent problem with increasing levels of ‘discretionary’ absenteeism (as opposed to ‘medically indicated’ absenteeism). Indeed, requests for GP sickness certification have increased by 70 per cent over the past nine years – and this is over and above industrial relations and legislative changes. Further, there are now more Australians on Disability Support Pensions (DSP) than there are on unemployment benefits. The growth in DSPs is largely attributable to conditions that are traditionally regarded as not being totally incapacitating for work such as milder mental health disorders (anxiety and depression) and chronic musculoskeletal pain.

Implications for psychologists treating those not attending work

Too many health professionals still regard extended periods of time off work as being beneficial for wellbeing, and return to work as a process that occurs subsequent to the completion of their treatment. As the AFOEM Position Statement makes clear, good practice involves: (1) minimising time off work as far as is practically possible; and (2) integrating return to work expectations and initiatives as an essential core component of all treatment regimes. To paraphrase Professor Gordon Waddell, actually returning to work is typically the most effective treatment in and of itself! n

Dr Peter Cotton FAPS
Strategy and Innovation Group, Medibank
WorkSafe and Transport Accident Commission, Victoria

  1. Downloadable from: www1.racp.edu.au/index.cfm?objectid=5E2C3448-0957-60C9-FAA30410E29589E8
  2. The one qualification to be made here is that we are referring to work that is at least of reasonable ‘psychosocial quality’. As Peter Butterworth and colleagues at ANU have recently shown, work that is of very poor psychosocial quality (i.e., low control, high demand and complexity, job insecurity and unfair pay) can be as deleterious to health as long-term worklessness (Occupational and Environmental Medicine, 2011, doi:10.1136/oem.20101.059030).