Anxiety About Restructuring Behind Illness-related Absence

By Staffan Marklund

According to a survey of 40 municipalities published by the Swedish National Institute for Working Life, anxiety about operational changes is the single factor most clearly linked to the high level of long-term sick leave among municipal staff.

"The greater the anxiety at a workplace, the higher the incidence of illness-related absence," says professor Staffan Marklund of the Swedish National Institute for Working Life.

Working with Stefan Szücs of Göteborg University and Örjan Hemström of Stockholm University and the Karolinska Institute, he studied the factors in municipal work which lie behind ill-health among the staff of 40 municipalities.

With staff resources falling, operational changes during the 1990s such as outsourcing and internal market systems have resulted in municipalities having the highest proportion of staff on long-term sick leave in the public sector. However, there are major variations in the sick leave figures from municipality to municipality, as was shown in the research report which the Swedish National Institute for Working Life submitted in the government's "Handlingsplan för ökad hälsa i arbetslivet", SOU 2002:5 (Action plan for increased health in working life).

"We found that anxiety about restructuring and the consequences for the work of the individual are the best explanation for the high incidence of illness-related absence," says Marklund. "The changes need not even actually be implemented, the damage is already done."

However, he fears that some municipalities are constantly carrying out restructuring, with a new organisation not having time to bed in before it is time for yet another change.

"But if the staff have some influence over an operational change, this can lessen the anxiety, according to our survey," explains Marklund.

The researchers were unable to establish a clear correlation between the financial situation of the municipalities and the number of people on long-term sick leave. Nor did the political majority (Social Democrat/Left or non-Socialist) have any significant impact on ill-health.

"You might think that municipalities under Socialist control would be less inclined to take on contractors and introduce internal market systems into municipal administration, for example."

However, a municipality's past figures for ill-health are significant in this context. Municipalities with a large proportion of sick leave in 1995 also have a high number of people on long-term sick leave now.

"It is a vicious circle where those still at work burn out and also risk requiring sick leave," concludes Marklund.