"Myths muddle debate on sick leave"

In a recent newspaper contribution, Björn Johnson summed up his findings like this: "The sick leave debate has more to do with a fight for power than exploring the real reasons behind the problem. Media myths have informed the actions of several governments. The present [Swedish] government has based nearly its entire sick leave policy on the wrong basic data." 

Björn Johnson works at the Centre for Work Life Studies at Malmo University. He is a political scientist, but his book explores the wider ramifications of sick leave. He looked at sick leave between 1995 and 2009 and the public debate surrounding the issue. He analyses the debate's importance and whether the arguments have been well founded. 

"I wanted to see how a social problem is created through public debate because the way we interpret a problem informs the solution," Björn Johnson says.

Victims or cheaters?

Sweden's sick leave levels started rising towards the end of the 1990s. It was expensive and it fuelled an intense public debate. At first people presumed there had to be something wrong with working life. People on sick leave were portrayed as victims of an increasingly stressful working life - not least women in the public sector who fell foul of cuts during the economic crisis of the 1990s. 

"As a result employers were blamed for what was happening, with trade unions leading the attack," says Björn Johnsson.

Then some time in 2002 there was a change. The debate rounded on what was perceived to be cheating employees. There had been a medicalization of a private problem, the argument went.

"There was fierce criticism of the definition of sickness. There were vague diagnosis, and there was a feeling that people got ill from being on sick leave. Being on sick leave was presumed to be a conscious decision, taken especially by women in tough situations," says Björn Johnson.

These two polarised ways of describing sick leave led to different approaches for solving the problem. As long as the debate blamed the work environment, solutions were sought among employers. When the debate shifted to focus on cheating workers, the so-called  'rehabilitation chain' was introduced.

The ill must work

The rehabilitation chain consisted of several links - or stages. First, during the first three months of sick leave the Swedish Social Insurance Agency would assess the worker's ability to work. When sick leave extended beyond three months, attempts were made to find a more suitable role within the current work place for the person concerned. Finally, for those off sick for more than six months, the social insurance agency would assess whether suitable work could be found elsewhere.

There have been other changes too - in the way people on sick leave have been diagnosed, and a harmonisation of sickness benefits and unemployment benefits to avoid unemployed people seeking sick leave because it 'pays better'. 

"How to define the problem has developed into a power struggle between the parties to the labour market, and we need to find out whether the definitions make sense or not," says Björn Johnson.

No factual support

He has found that much of what has been said on both sides in the public debate has had little factual support. There are often too many myths created by media and opinion makers. We need more investigative journalism into this topic, he argues. 

For a while people who were 'burned out' at work were being blamed for much of the increase in sick leave. But this was simply not the case, writes Björn Johnson. This group never represented more than three percent of the total number of people on sick leave. Stress-related illnesses in total never represented more than 12 to 14 percent of all people on sick leave. 

The large increase in levels of sick leave was not a result of more people falling ill either. More people became long-term ill because of failing rehabilitation programmes. There was an increase in the number of unemployed people claiming sickness benefits because those who had already been off sick for a long period of time lost their jobs when the rules changed - and turned into unemployed people on sickness benefit. 

Björn Johnson also challenges the notion that Swedes are more off sick than people in other European countries. Countries like Finland, France, the Netherlands and Great Britain all have limited periods of sick leave. At the end of that period, people disappear out of the statistics - whether they are ill or not.