Address by Alexander Rinnooy Kan, at TNO/WHO international conference
The Hague, SER Building, 29 November - 1 December 2011
Check against delivery.
Welcome to the headquarters of the Social and Economic Council, the institute that brings together the key parties in social and economic affairs in the Netherlands. This is where employers, employees and independent experts discuss how best to resolve vital social and economic issues. They then make recommendations to the Dutch government.
This conference is entitled Connecting Health and Labour. This is a crucial issue and one that the Council has addressed with some regularity for many years.
Almost fifteen years ago, in 1998, the Council presented an advisory report on Social Security and Health Care. In this report, the Council stated that the health care system “should contribute to the vigilant and satisfactory treatment of occupational and work-related diseases and disorders by means of prevention, diagnosis and cure”. The present conference demonstrates that we have yet to achieve that aim.
The connection between labour and the health care system is still far from ideal. One particular connection is the main focus of this conference: that between labour and primary care – in other words, the first and therefore a crucial contact between a sick employee and the health care system. How can that connection be improved?
Your own role in this is crucial. As a group, you are insightful about the strategies that can improve the connection. So I expect quite a lot of the next three days as you share your thoughts and ideas, and I hope that the parties involved in the labour-health care connection will make good use of your insights. That may take a while, however. After all, as any relationship counsellor will tell you, it may take a lot of time and effort to improve a relationship.
As I already mentioned, a good relationship between labour and health care is crucial. I would like to kick off this conference by outlining the social and economic significance of that relationship. I am naturally taking the situation in the Netherlands as my starting point, but I hope those of you from other countries will recognise some of what I am about to say, also when your circumstances are quite different from ours. Introduction Example: Vincent
Vincent is sitting at his desk at work with an excruciating headache. He feels nauseous and exhausted, and he is trembling. He is getting sicker by the minute. Is it a hangover? Is he coming down with the flu? No: he’s getting a migraine. Recently the migraines have come on more frequently and last longer, and that means he’s been taking more sick days.
Vincent is no exception. According to a national occupational health survey conducted last year in the Netherlands migraines are one of the three most common chronic illnesses among employees. As a result Dutch businesses lose 5.4 working days a year to migraines. Estimated costs: 1.7 billion euros a year.
As is so often the case for the chronically ill, Vincent needs the assistance and support of a whole series of health care professionals: his family practitioner, the occupational physician, a neurologist, and perhaps a physiotherapist and a psychologist. Except for the occupational physician, however, none of these professionals have much if any understanding of Vincent's work, and so they are unable to examine the role that his job plays in the occurrence of and dealing with his migraines. Faulty communication
That raises a problem that affects not only employees with a chronic illness but in fact all sick employees and their employers. Professionals working in the curative health care system are often blind to a patient’s working life. On the other hand, do employers and employees make sufficiently clear what they expect of the health care system?
The problems affecting the connection between labour and health care are the subject of considerable study. Here, for example, the Netherlands Organisation for Applied Scientific Research – better known as TNO, one of the co-organisers of this conference – is participating in a major study investigating the reasons for this suboptimal relationship and the ensuing costs. Need for a closer connection
Good health has many advantages at various different levels and for a variety of different parties.
To begin with, good health has an innate value at the micro-level, in other words for individuals. When they enjoy good health, people are more likely to live a long and productive life and to participate in society. At the level of organisations, healthy employees are an economic advantage: businesses have fewer employees on sick leave or long-term disability, their employees perform better, and their productivity rate rises. At the macro level healthy employees also means less pressure on collective resources, for example in the case of occupational disability benefits, and employees who continue working for much longer. And in Holland and in many other countries we need that: to help us bear the cost of the ageing population, to ensure that our social insurance system remains affordable, and to reduce long-term labour shortages.
In addition, improving the connection between labour and health care will allow us to optimise the benefits of our occupational health and safety system and our occupational disability and reintegration schemes.
In 2005, the Netherlands introduced a new law overhauling the entire occupational health and safety system, in part as a result of an advisory report published by the Council in 2005. In the new system, the role of government is limited to issuing target-setting provisions. This means that employers and employees have a considerable responsibility when it comes to preventing ill health and restricting absenteeism. This is also the case for legislation on occupational disability and reintegration.
However, employers and employees can only achieve outstanding results in cooperation with the health care system, which plays an equally vital role in the overall picture. Improvement initiatives
The health care system is gradually paying more attention to labour. The Dutch experts at this conference will undoubtedly be able to list them. In mid-October, for example, a toxicology outpatient clinic opened in the town of Nijmegen for people who have become sick after exposure to chemical substances on the job. The clinic was set up by a partnership made up of the University Medical Centre and a large occupational health service.
Other initiatives are those supported by Netherlands Organisation for Health Research and Development, ZonMW (present here as well). It has set up a major programme to develop guidelines for diagnosing and treating a range of disorders. The guidelines are important in that they consider the working lives and participation in society of those suffering from the disorder. And – good news for Vincent, who featured at the beginning of my speech – a guideline for migraines is currently in development. Conclusion
It is extremely important that health care cooperates with relevant parties in the world of work to avoid occupational diseases, sickness and long-term disability: for social and economic reasons. That relationship can only improve if both sides involved make an effort. There are several initiatives showing that they wish to do so. That gives me hope.
I am sure that this conference will give us many more ways to improve that connection between health and labour, in developed countries like ours, but certainly also in developing countries, where the conditions are quite different from those here in The Netherlands, my starting point. That improvement is important, because a relationship that never gets any better can be a real headache.