Lars-Gunnar Engström

Predictors of work presence – Sickness absence in a salutogenic perspective

The objective of the study was to identify determinants of work presence, i.e. factors that counteract short and/or long term sickness absence. The analyses were based on logistic regression analyses on Swedish regional survey data. Individuals who had not reported sickness absence during the preceding year were compared to on one hand individuals with short term sickness absence (< 28 days) and on the other hand with long term sickness absence (> 28 days). We found predictors of work presence in personal background as well as in work related variables. A high level of sense of coherence was found to counteract short as well as long term sickness absence. Gender specific differences were observed. Although a set of predictors common for the short and long term perspective were found the predictors in general were found to differentiate substantially with respect to short or long term sickness absence. Implications for sickness absence prevention and health promotion could be drawn from the results. Primarily different aspects of control over working situation, work satisfaction and for women a high level of sense of coherence were believed to have these implications.

Stress-related sickness absence and return to labour market in Sweden

Purpose. To analyse factors influencing chances of returning to work after long-term sickness absence with a stress-related psychiatric diagnosis. Primary focus is on employer- and occupational categories as explanatory variables. Method. Data was collected from the regional social insurance office in the county of Värmland for 911 individuals, all with stress-related sickness absences during November in the year 2000. Logistic regressions were carried out on outcome states from long-term sickness absence on two follow-up occasions after two and three years. Results. The results indicate that the employer- and occupational categories only had a minor effect on return to work after the long-term sickness absence. Age and health-related factors together with time factors seem to be more relevant in explaining return to work. Conclusions. The findings suggest that individual labour market position, as occupation, employer, branch etc, seems to be less important than expected in explaining return to work from sickness absence due to stress-related psychiatric disorders.

Falling between two stools; how a weak co-operation between the social security and the unemployment agencies obstructs rehabilitation of unemployed sick-listed persons

Purpose. To explore significant factors behind the weak co-operation between local social insurance and unemployment agencies impairing the rehabilitation of unemployed sick-listed persons. Method. Individual, semi-structured face-to-face interviews with main actors directly involved in the sick-listing and rehabilitation process were conducted in the year 2000. In all 39 persons were interviewed: 25 professionals (physicians, public employment and social insurance officers) and 14 clients. Data were analysed according to Grounded theory method. Results. The majority of unemployed sick-listed persons were declared too sick to work and were erased from the unemployment registers. This measure weakened the incentives for co-operation between the two main rehabilitation actors. The implication was that the unemployed sick-listed persons lost the opportunity of the co-ordinated rehabilitation they were entitled to. Three significant factors behind this process were identified by the main actors: indistinct regulation of co-operation, shifting political goals over time and conflicting goals between agencies; the last factor mainly a consequence of the other two. Conclusions. The findings suggest that labour market changes and manifest political goals influence the rehabilitation efforts giving low priority to difficult-to-place individuals such as unemployed sick-listed persons. In fact, a labour market problem turns into a medical problem. The hypothesis needs further testing in quantitative studies.

Can differences in benefit levels explain duration and outcome of sickness absence

Purpose : The aim of this study is to examine the long- and short-term economic incentives inherent in the sickness and unemployment insurances. In particular, how the differences, in, for instance, benefit levels between the two systems, affect the duration and outcome of long-term sickness for the unemployed. Method : A sample of 280 sick-registered unemployed in the county of Värmland, Sweden was used in two regression models. Sickness duration was modelled in a linear regression and the outcome (healthy and non-healthy) in a logistic regression. Results and conclusion : The study shows that economic incentives, i.e. differences in benefit levels, help in explaining sickness duration. The proven fact, that benefits from the sickness insurance are in general higher than from the unemployment insurance, results in the sickness spells being prolonged. Indications are also found of a preference for long-term income security through the sickness and disability insurances, using the length of unemployment before sickness registration, as a determinant of the outcome of the sickness spell.

The woman as problem and solution—analysis of a gender equality initiative within the Swedish Rescue Services

Abstract The aim of this article is to study how problem definitions of gender equality affect the possible outcomes of gender equality initiatives. The Swedish Municipal Rescue Services were chosen as the empirical example because they offer a workplace where women are greatly under-represented despite years of gender equality efforts. The article analyses how reasoning around gender equality shapes and constructs problem formulations around gender and equality. This article contributes to the debate on the conditions of gender equality founded on gender equality definitions, and how this relates to the potential for change. The gender equality efforts within the Rescue Services are problematized based on Bacchi’s policy analysis model. We do so by analysing the applications attracted by a call for a gender equality initiative within the Municipal Rescue Services—A Fire Station for Everyone. The article argues that, to some extent, the problem definitions in this case undermine gender equality initiatives as they place women—whom they wish to recruit to the Rescue Services to make it more gender equal in a numerical sense—in a paradoxical position as both problem and solution. Nor do they problematize power issues. It is stated that the given problem descriptions do not leave a lot of room for change, but that the method used to analyse the problem descriptions can be an important tool for understanding why gender equality initiatives may struggle to achieve their intended objectives.