Sickness absence in Denmark – political context, media debate and risk factors for long term absence. Results from the ASUSI- study

Abstract

Sickness absence has been the subject of growing political interest for the last 10 to 15 years, despite evidence for a relatively stable development of sickness absence with only minor fluctuations for ordinary employees the last 30 years. This has been driven mainly by legislative changes. The focus on sickness absence has grown alongside the inclusion of greater numbers of employees in compensation schemes for sickness absence. In the same period, the media debate on sickness absence and other transfer payments has increased, mainly driven by the right-wing media. The debate has been centred mostly on individual factors and not on health aspects of the population. A large nation-wide study of 20,000 working Danes showed that proximal health-related factors such as self-rated general health, were strongly related to long-term sickness absence in the following 18 months. The study also revealed a strong and consistent association between low socioeconomic status and long-term sickness absence which did not disappear when a series of other work-related and individual characteristics were included in the analysis. Sickness absence is an extremely complex phenomenon, and is associated with health, socioeconomic factors, work-related factors, individual factors and attitudes in deciding to call in sick. The paper argues that broad campaigns and crusades against people on sick leave have not been successful in reducing sickness absence, and that interventions have to be focused on population health and equity in the society. Contemporary political strategies are expanding socioeconomic gaps in Demark, as well as in other western countries, and this will result in more ill health and more absence in the coming years.