1. Absence from work A question of attitude? Results from the IPAW * study * Intervention Project on Absence and Well-being T. S. Kristensen, L. Smith-Hansen & M. L. Nielsen National Institute of Occupational Health Copenhagen, Denmark

2. The normal model of absence from work Work environment Non-work environment Sickness Sickness absence

3. The simple model assumes: that it is simple to distinguish between good health and sickness that sickness (automatically) leads to absence from work Both of these assumptions are questionable

4. When is a person sick? No disease Disease Biomedical health Two problems: where should we draw the line? what about inconsistent patterns? Can do everything Can do nothing Functional (dis)ability Excellent Very poor Self-rated health

5. Perhaps the person’s attitude plays a role when the person decides to have or not to have sickness absence? Attitude AbsenceHealth

6. How we measured attitude to absence: AbsenceWork 1.You have pain in your wrist because of a particular work process. Another day with the same kind of work is waiting 17%83%

7. How we measured attitude to absence: AbsenceWork 2.You have a very bad head ache and nausea (a hangover) after only two hours of sleep. There is an important meeting at work 10%90%

8. How we measured attitude to absence: AbsenceWork 3.Your child has fever, but the neighbour can look after the child 37%63%

9. How we measured attitude to absence: AbsenceWork 4.It feels as if you are getting the flue. You know that there are already too few colleagues at your workplace to cope with the work load 10%90%

10. How we measured attitude to absence: AbsenceWork 5.Your children have a day off school between Ascension Day and Saturday. There is little to do at work 16%84%

11. How we measured attitude to absence: AbsenceWork 6.You have had diarrhoea until 3 o’clock in the night, but it feels as if it is over 34%66%

12. How we measured attitude to absence: AbsenceWork 7.You have had one of your recurring asthma attacks. You know that the poor indoor climate at your work place will make it worse 72%28%

13. Example: You are getting the flue Would choose Absence (10%) Work (90%) Absence days: 199619.312.5 199716.415.1 Absence periods: 19963.82.7 19973.62.8

14. Results With regard to absence days the expected pattern is found in 10 out of 14 comparisons (7 items, 2 years). One item shows the opposite pattern: “Children have a day off”. With regard to absence periods the expected pattern is found in all 14 comparisons. The average “excess risk” of absence is approx. 10% for absence days and 20% for absence periods among those with positive attitudes to absence.

15. Association between absence days and overall attitude to absence N=1676 15.2 12.2 13.4 11.7 14.2 16.0 14.5 16.0 8 10 12 14 16 Very negative Very positive Days/year 1996 1997

16. Association between absence periods and overall attitude to absence N=1676 3.3 3.5 2.2 2.5 3.0 3.3 2.5 2.1 2.0 2.5 3.0 3.5 Very negative Very positive Periods/year 1996 1997

17. Conclusions There is no clear consensus among employees about the issue of sickness and absence. This means that there is an element of choice in absence behaviour, and that attitude plays a role. Those with a positive attitude to absence have slightly more absence days and clearly more absence periods.

18. This presentation can be seen at: www.ami.dk/ presentations