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The Health Benefits of Work (Part 2)

The other difficulty with WorkCover’s “health benefits of work” is conceptual: how does working actually assist a patient to recover from injury? Is all work therapeutic? Is work therapeutic for all injuries?

It is easy to imagine cases were returning to work will be, useless or even harmful to recovery. For example, a worker who suffers amputation of his or her hand as a result of a missing safety guard on a machine, is not going to regrow a hand by returning to work. If a worker acquires an occupational asthma such as Bakers Lung, returning to the workplace will only exacerbate that condition.

It seems that most of the conceptual and some evidential underpinning for the health benefits of work claim are drawn from the UK, and in particular from a study by Gordon Waddell, CBE DSc MD FRCS and A Kim Burton, PhD DO Eur Erg: “Is Work Good for your Health and Well-being?”. This review collates and evaluates the evidence on the question of the link between health and work, and was commissioned by the UK Department for Work and Pensions. “Pensions” immediately alerts the reader to the fact that the purpose of the paper was to look at the health of pensioners, that is, the long term unemployed.

The findings are underwhelming on the direct health benefits of work. For a start, it is conceded by the authors that in the case of sick and disabled people there’s no evidence of a causative relationship:

When their health condition permits, sick and disabled people should remain in or (re)-enter work as soon as possible because it variously:

  • is therapeutic;
  • helps to promote recovery and rehabilitation;
  • leads to better health outcomes;
  • minimises the harmful physical, mental and social effects of long-term sickness absence;
  • reduces the risk of long-term incapacity;
  • promotes full participation in society, independence and human rights;
  • reduces poverty;
  • improves quality of life and well-being.

This list combines two sets of evidence: clinical management is based on extensive clinical evidence and experience; disability rights are based on social justice and fairness. There may be little direct scientific evidence that work has a beneficial impact on the health of sick or disabled people, but valid consensus can be established on these other grounds.[33]

Establishing a “consensus” is not a method of scientific enquiry. In any event, what exactly is a “valid” consensus? Further, while it may be true that returning people to work reduces poverty or increases a patient’s status in the community, these are not health benefits of work, as such.

The point is made later on the same page that:

There may again be little direct evidence of the causal link between (return to) work and improved physical and mental health outcomes, but there is a clear association between better clinical and occupational outcomes. Importantly, there is no evidence that work has adverse effects on physical and mental health outcomes, except in very specific circumstances. The strongest arguments then lie in the benefits of work for general and social well-being [33].

In other words, the only health benefits of work are “general and social well-being”, and work won’t hurt you. This falls far short of the claim:

Good work is beneficial to health and therapeutic to recovery. Compelling evidence shows that supporting injured workers to return to suitable work early improves the likelihood of optimal recovery.

There is a paucity of “compelling evidence” to support this sweeping claim in the paper by Waddell & Burton, as the paper says itself. Another point worth remembering is that Waddell & Burton’s study was focused, for the most part, on the long term unemployed, the chronically sick and the disabled, and not on normally healthy workers.

The upshot is that there is no scientific evidence to support the health benefits of work  generalisation, in the context of workers compensation claims, let alone evidence that is “compelling”. Further, there is no stated concept of how work produces a direct health benefit that could be of any use to a medical practitioner treating an individual patient who is recovering from a workplace injury.

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