Healthcare company Abbott worked with Weber Shandwick and The Work Foundation to achieve a real first for the pharmaceutical industry: groundbreaking research to show that early intervention can enable people with musculoskeletal disorders (MSDs) such as rheumatoid arthritis to remain in work, making them more productive. The resulting multi-stakeholder campaign, Fit for Work Europe, lobbies politicians, doctors and policymakers on the value of supporting people with MSDs to stay at work. Patients across Europe are now benefiting from policy and healthcare changes.

Musculoskeletal disorders (MSDs) affect more than 2m workers in the UK and 40m across Europe and are the greatest cause of work absenteeism after mental health issues. Some of the most severe, such as rheumatoid arthritis, can lead to disability: approximately 40% of people with rheumatoid arthritis stop working within five years of diagnosis.

Early intervention can enable people to remain in work, making them more productive, mobile and independent. But musculoskeletal disorders do not command the attention or resources of cancer or heart disease despite accounting for 9.4m lost working days a year, equivalent to £833m in lost production in the UK and €252bn across Europe.

There have been significant advances in the therapies available to help people with MSDs, but lack of understanding of the clinical, societal and economic benefits of early, preventative treatment meant uptake was low.

Healthcare company Abbott worked with Weber Shandwick to develop a pan-European campaign to:
• Raise public and political awareness of the impact of MSDs on people’s ability to work, the importance of early diagnosis and intervention to allow patients to remain in work, and the socio-economic benefits
• Persuade rheumatologists, policy-makers and health technology assessment bodies of the importance of considering work as a clinical and health economic target
• Change European policy so people with MSDs receive better prevention and care and are able to carry on working
Abbott and Weber Shandwick partnered with think tank The Work Foundation to carry out groundbreaking research in 26 countries that for the first time would demonstrate the benefits of early intervention to patients, doctors, and politicians. The aim was to provide compelling evidence for the value of early intervention in managing musculoskeletal disorders, engaging stakeholders at the highest clinical, social and political levels to raise awareness and understanding, and to drive policy change at national and EU level and beyond.

Collaboration with organisations such as the Arthritis and Musculoskeletal Alliance (ARMA) and European League Against Rheumatism (EULAR), as well as leading politicians and healthcare professionals was key, as was ensuring recommendations from the research were grounded in the public interest and aligned with UK and EU policy.

The team ran a comprehensive healthcare professional and policymaker engagement programme in the UK and with Brussels policy influencers. Key messages were aligned with national and EU policy initiatives around reducing incapacity at work and maintaining the working population.

During 2009-2010 the public affairs campaign coupled advocacy at national and EU level with multi-stakeholder engagement:
• Meetings with hundreds of politicians at EU level and national level across Europe
• Fit for Work report launches in Brussels and national capitals from September 2009
• Fit For Work reports published in Austria, Croatia, Denmark, Finland, France, Germany, Greece, Ireland, Israel, Lithuania, Norway, Spain, Switzerland, the UK and Canada
• Fit for Work roundtables in the UK parliament, Italian Senate, French Assembly, among others
• Patients and doctors in Europe collaborating on Work Charters so employers and employees have approaches for keeping people with MSDs in work

No other health company or agency had commissioned research on how long-term chronic conditions affect patients’ ability to work. Fit for Work broke the mould of pharmaceutical company initiatives by partnering with a think tank to undertake research to inform policy and practice development based on an integrated approach to health and work.

Fit for Work has changed policy and health service delivery in the UK and Europe, and is having a significant effect on the lives of people with MSDs:
• In the UK, the NHS Operating Framework for the first time has classified work as an outcome. Wider societal costs will be considered as part of drug assessments, and higher thresholds for medicines will be allowed for medicines that can demonstrate wider societal benefits within the new value based pricing mechanism. Finally, patients are now given ‘Fit Notes’ rather than ‘sick notes’, so they have a definition of what they can do at work rather than what they can’t.
• In France, the health chair of the influential university Sciences Po ran a national seminar devoted to chronic diseases and work, and included recommendations from Fit For Work France.
• In Greece, the research inspired public-private collaboration to develop a national Guide for Citizens with Rheumatic Diseases.
• In Spain, the government announced a national strategy for MSDs and regional action plans were developed, with Catalunya’s presented in Brussels as Best Practice.
• In Italy, the Senate Health Commission unanimously approved a national inquiry into MSDs/chronic degenerative disease.
• In Denmark, additional funding has been earmarked for improving MSDs/chronic diseases, and Fit for Work objectives will become election themes in 2011.
• In Austria, a think tank was formed to discuss MSD policy targets, and agreed the need for an Austrian Fit Note. Fit for Work became the main subject of talks during European Forum Alpbach.
• In Belgium, questions were put to ministers in parliament, and the Royal Society of Rheumatologists agreed to discuss work productivity as a clinical outcome.
• In Croatia, the Fit for Work report was supported by parliament and the National Insurance Institute allocated a special fund for biologic therapy in rheumatic diseases.
• In Finland, the Government backs more support for people with MSDs, and the leading opposition party said chronically ill patients willing to stay in work was an election theme for 2011.
• In Germany, the Commissioner for the disabled in Rhineland Palatinate agreed to develop a national plan for improving working conditions for disabled people.
• In Ireland, a National Clinical Lead for Rheumatology was appointed, and has agreed funding for 24 physiotherapists to lead MSD early intervention clinics.
• The Israeli government agreed specific improvements to manage MSDs, and established work productivity as a health technology evaluation measure.
• In Canada, the launch of Fit For Work was a catalyst for the development of a National Arthritis Framework.
At EU level, Fit for Work influenced the EU Health Work Programme to highlight MSDs, secured ‘early intervention’ as a key component in the EU’s consultation on Chronic Diseases, and the outcomes from the Fit For Work Europe launch conference fed into the Belgian Presidency health priorities for 2010. The international multi-stakeholder Fit for Work Europe Coalition was officially launched on 30 September 2010 to bring its policy and practice recommendations to national health systems, where change will be the most lasting.

The Work Foundation’s MD Steve Bevan said: ‘Abbott and Weber Shandwick broke the mould of pharmaceutical company initiatives by partnering with us to undertake some serious policy development and independent research that reached beyond the health arena and tackled a huge societal issue: how do we - and should we - support people with chronic illnesses in the workplace? They have shown great thought leadership and we are honoured that the Fit for Work partnership has begun to effect real change in policy and health service delivery in the UK and in Europe.’