European League against Rheumatism (EULAR) President Professor Iain McInnes highlights the workplace challenges and opportunities highlighted by COVID-19 on World Arthritis Day (12 October). The pandemic has increased the threat of unemployment across society, but for communities already living with health-related job insecurity the impact of COVID-19 risks are much more acute. COVID has pressure tested our systems, and the fault lines it has exposed must be addressed to support Europe’s recovery, and ensure that, faced with an ageing population and workforce, we can reduce the hidden human and economic cost from workplace exclusion.
It is estimated that more than 100 million people in Europe live with Rheumatic and Musculoskeletal Diseases (RMDs), a diverse group of diseases that commonly affect the joints, but can also impair any organ of the body. There are more than 200 different RMDs and include diseases such as Osteoarthritis, Rheumatoid Arthritis, Fibromyalgia and Osteoporosis.
The cost to Europe productivity, employment and citizens
RMDs are mistakenly considered an old-person’s disease, however they commonly affect the young and working age population in large numbers. In normal times, RMDs are the main occupational disease and account for about 60% of all health problems in the workplace.They are the biggest cause of sick leave and premature retirement due to work disability in Europe. For example, up to 70% of people with Rheumatoid Arthritis become work disabled within 5–10 years of symptom onset.
The exclusion of RMD patients from the workplace affects their finances, self-esteem, and mental health. It also has a very significant economic and societal cost. The total annual cost of work-related RMDs to Europe is estimated at more than €163 billion, and with an ageing population and workforce are set to increase dramatically.
Old and new workplace challenges
Given the impact RMDs can have on workplace attendance and productivity, many people are fearful of informing their employers of their condition. In fact, one in three employees with long-term conditions have not discussed their condition with their employer. In turn this means that many people do not receive the optimum workplace support, from ergonomic seating to flexible working hours, to help them best manage their illness. This can increase stressors on the body and exacerbate the symptoms and absenteeism.
COVID has created new challenges. Some of the conditions that signify high vulnerability to COVID-19, such cancers, cardiovascular disease, gastrointestinal disease, diabetes, are common comorbidities for RMD sufferers. Also, patients with inflammatory RMDs, who take high doses of steroids and immunosuppressants are at higher risk from COVID-19 and are very concerned about whether or not they should continue with their treatments.
These people also face the extremely difficult dilemma of whether to return to work if they are employed in health care or other professions with direct human contact, or if they commute using public transport. This dilemma is exacerbated by fears of unemployment in a global downturn.
The global policy response to COVID has also reduced access to some healthcare facilities and treatments, leading to the exacerbation of some conditions. As a result of social distancing measures and lockdowns, hospitals, doctors’ surgeries, and services like physiotherapy, have been harder to access.
People with lupus and rheumatoid arthritis, medical conditions eased by hydroxychloroquine, also reported shortages in parts of Europe during an escalating international campaign to deploy it against coronavirus. This could be a precursor of medical shortages created by supply chain disruptions and the erection of more trade global barriers as a response to the pandemic.
Silver linings of the pandemic point to future solutions
The pandemic has hastened the adoption of flexible working patterns and digital workplace and healthcare solutions that have proven extremely beneficial to many people with RMDs. This live experiment has shown that technology and flexible work can meet the needs of both RMD sufferers and employers.
To capitalize on this opportunity, we need policies and programmes that create an open, positive and supportive culture between patients, colleagues, and employers; including strong protection against workplace discrimination. We also need to create ergonomic workplaces to increase comfort and reduce risk of accidents and flareups, and promote flexible work schedules and tele-working.
The EU can play an important role by ensuring its post-2020 disability strategy better responds to the employment needs of people with RMDs. It should work with the Member States to set clear targets and timelines, and ensure adequate resources are available to implement this strategy.
However, the disability strategy should be part of a broader comprehensive effort to address the challenges of RMDs, with the EU guiding and supporting the member states as they develop strategies to deliver more effective RMD-related health promotion, prevention, treatment and rehabilitation.
The pandemic has exposed the vulnerability of RMD sufferers to workplace exclusion. But it has also shown what is possible, and that we – the health authorities, government, companies, everybody – can act quickly and decisively to address the hidden human and economic cost of excluding RMD sufferers from the workplace.