Government and industry leaders meet Professor Sir Mansel Aylward

Work is good for our health and wellbeing

At the dinner Professor Aylward shared his experience in major health systems review in Wales. His fundamental message was clear - work is good for our health and wellbeing. He explained that long-term worklessness has the equivalent health risk of smoking ten packs of cigarettes per day. Worklessness is therefore one of the greatest known risks to public health.

Work is the most effective means to improve the wellbeing of individuals, their families and communities. This was the theme, earlier in the day, at the launch of the Australasian Faculty of Occupational & Environmental Medicine position paper Realising the Health Benefits of Work. Professor Aylward’s work sends a powerful message of the moral obligation we all have to “rigorously attack an individual's obstacles to a life at work” and minimise the impact of injury on workers and the community.

Psychosocial factors are the main determinants of health, illness and recovery 

An individual’s health status depends more on lifestyle, environmental, and socio-cultural, factors than on biological status and conventional health care. This is also true of recovery following an injury. Psychosocial factors such as an individual’s lifestyle and social circumstances are the dominant barriers to a successful return to work in 75 per cent of cases.

Many of the medical conditions we see in compensation schemes Professor Aylward would describe as “common conditions”. This means that the conditions are common in the working age population, with little evidence of disease or impairment. It is difficult to attribute a cause to general aches and pains, and work may only be one contributory factor. For most people these episodes settle and they will remain at work or return to work quite quickly. These are essentially people with manageable health problems who will recover given the right support, opportunities and encouragement. Chronicity and long-term incapacity are not inevitable.

However, for some injured workers, personal and social factors can aggravate disability and act as obstacles to recovery and return to work. An individual’s beliefs about their injury and recovery, their social circumstances and support all play a pivotal role in return to work. For those who have difficulties returning to work, focusing on the medical condition alone is therefore not enough. Non-medical interventions are important in rehabilitation and return to work.

The graph below shows the obstacles that can prevent an individual from successfully returning to work.

Management of common health problems must address obstacles to recovery

Successful outcomes in injury management are dependant on addressing an individual’s personal, social and environmental obstacles to return to work. Professor Aylward described a “condition management” approach in which the individual learns self management and independence. The key elements of this approach are:

• Cognitive and educational interventions - beliefs drive behaviours, injured workers need assistance to understand the nature of their injury and appropriate self management strategies as part of their treatment and rehabilitation program.
• Evidence based treatment - the most appropriate and effective interventions available should be offered and linked to functional improvements.
• Tailored to individual needs - the individual, their injury and the social context need to be considered in program development.
• Case management - there should be a well co-ordinated approach with a designated case worker
• Goals are “owned” by injured workers, not imposed - planning needs to explore their concerns, preferences and expectations to enable a return to work.

This approach highlights new roles for health professionals that involve recovery coaching and guidance rather than “therapy”.

The experience of injured workers matters

Building an individual’s confidence to return to work is important. The support of the workplace and the way line managers respond to an injury are critical to the injured worker’s experience. Professor Aylward emphasised that “the line manager is the prism through which the organisation is perceived”. Managers need to talk to workers who are ill or injured, seek to address barriers, and build their trust and confidence to return to work. This support is critical to prevent disability and long-term worklessness. The manager also has a key role in recognising people who may be at work but unwell. They need to increase their support for these workers when a pattern of sickness certification is emerging.

Professor Aylward described a set of positive workplace characteristics that increase the likelihood of a return to work. An individual is more likely to return to work if they:

• have a high level of respect for the employer
• feel valued
• trust their line manager
• have the support of their colleagues

These characteristics have been shown to “cancel-out” the negative effects of some other personal risks of long-term incapacity. An important message is that the line manager has the ability to significantly modify the experience of an injured worker and positively influence the return to work outcome.

For more information visit:

• The Centre of Psychosocial and Disability Research, Cardiff University 
• Working for Health

Professor Sir Mansel Aylward CB

L-R: Alan Greenfield (Taylor Fry Consulting Actuaries), Prof Sir Mansel Aylward CB, Paul O'Connor (Comcare), Graeme Innes AM (Australian Human Rights Commission)