A spotlight on health and social care shows the need for an EU directive on musculo-skeletal disorders.
Workers in Europe experience many occupational diseases but the most common are musculo-skeletal disorders. MSD affect the bones, joints, muscles and connective tissues, causing pain and loss of function. They stem mainly from work involving repetition, weight and force, as well as awkward and static postures. Although MSD represent a risk in all workplaces—even when that is the home, due to poor ergonomics—they are most prevalent in health and social care.
MSD have a particular gender and age profile. According to a study by the European Agency for Safety and Health at Work, ‘There is a higher proportion of women than men and a higher proportion of older workers than younger ones with recognized MSD-related occupational diseases in the EU Member States.’
The gender aspect is most visible in healthcare—heavily dominated by women, who are significantly more exposed to back pain. It also represents, along with age, a significant challenge in central and eastern Europe, which already suffers from an ageing healthcare workforce: in Poland, for instance, the average age of a nurse is 53 years.
Work organisation
The pandemic exacerbated the situation, with many health and social-care workers quitting or considering doing so. Improving working conditions through prevention of MSD could play a crucial role in making the sector safer and more resilient, and a more attractive workplace for current and future generations.
As highlighted by presenters at a recent conference organised by the European Federation of Public Service Unions (EPSU), the particular exposure of workers in health and social care to musculo-skeletal risks is a matter not just of ergonomics but also work organisation. High work demands, low autonomy, long working hours and shift work cause stress as well as fatigue. Thus workers are also exposed to disproportionate psychosocial risks (PSR), which affect not only the mental but also the physical health of workers, in turn exacerbating MSD.
It is important therefore to recognise the strong connection between organisational factors causing stress at work and those related to muscular pain. Prevention of these risks in health and social care requires a reprioritisation of the allocation of resources. Crucial is the remedying of staff shortages, with a disturbing estimate in Europe of two million vacancies.
Directive lacking
Despite growing concern about the spread of MSD, there is no individual directive to address these risks. In addition to the Framework Directive on occupational safety and health dating from 1989, legal obligations to protect workers from MSD are dispersed across seven directives—none of which refers to MSD explicitly:
• 89/654/EEC on workplace requirements,
• 89/655/EEC and 2009/104/EC on use of work equipment,
• 89/656/EEC on use of personal protective equipment,
• 90/269/EEC on manual handling of loads,
• 90/270/EEC on display screen equipment,
• 2002/44/EC on vibration and
• 2003/88/EC on working time.
The European arena thus represents a legal labyrinth for workers, their representatives and indeed employers. The existing directives do not address all aspects or scenarios around MSD, nor the interconnection with PSR.
These legal gaps were already acknowledged in 2007 by the European Commission: ‘The current individual directives do not cover all types of work situations or address all risk factors leading to work-related musculoskeletal disorders.’ Despite the accumulated evidence that there is a need to complement the existing framework, the commission did not however plan to initiate adoption of an individual directive on MSD in the EU Strategic Framework on Health and Safety at Work 2021-2027.
Idea not new
In the absence of a bespoke directive, workers have to rely on their respective countries’ particular classification and recognition of MSD, which means workers across the EU are not equally protected. And there is no standardised way at the national level to recognise, classify and record MSD.
The idea of developing an individual directive is not new: it was already proposed before the pandemic by the European trade unions and federations (the EPSU, the European Trade Union Confederation, Uni Europa and the European Federation of Building and Woodworkers). Indeed, back in 2004 the commission consulted on a directive on MSD, with a second phase of consultation in 2007.
As the European Trade Union Institute encapsulates the story, however, ‘After years of drawn-out debates and two social partner consultations, the Commission finally tabled a draft directive in January 2010. In early 2013, the European Commission gave in to business organization lobbying and dropped the idea of a directive in favour of a simple non-binding recommendation.’
As we discuss making health and social care more resilient to face future health emergencies, it is more than ever clear that we need an MSD directive. The discussions might have stopped ten years ago but it is time to return to this urgent threat to workers’ wellbeing.
Important signal
The 2017 European Pillar of Social Rights stipulates: ‘Workers have the right to a high level of protection of their health and safety at work. Workers have the right to a working environment adapted to their professional needs and which enables them to prolong their participation in the labour market.’ Given that MSD are the most common work-related disease, it seems obvious that Europe should develop a specific directive to ensure workers are better protected in their workplaces.
Such a directive, along with one on PSR as advocated by the European trade-union movement in the End Stress in the EU campaign, would finally provide adequate protection for health and social-care workers—much needed after the pandemic from which they are still recovering. It would also send an important signal to frontline workers that the EU cares about them.
Strong protection on other particular risks (such as chemicals) shows that occupational safety and health has always been a legitimate field of action at EU level. Opposition to new directives on MSD and PSR is politically, not legally, driven. The increasing evidence that workers are suffering in the absence of action should see a different focus—on more safety for workers all over Europe.
Adam Rogalewski is policy officer for health and social services in the European Federation of Public Service Unions, having worked for the British public-services union Unison, the Swiss general union Unia and the Polish federation of trade unions, OPZZ. He has a PhD from London Metropolitan.
Aude Cefaliello is a senior researcher at the European Trade Union Institute, with a PhD from the University of Glasgow on how to improve the legal framework for occupational safety and health in the European Union.
Lova Andersson is a masters student in European studies at Lund University in Sweden. In 2023 she conducted an internship at the European Federation of Public Service Unions in the health and social-services sector.