Gender equality may become an obvious part of all agreements. A break through agreement that may set a new standard has been reached.
Anna Östbom is an expert on sick-listing issues at the Swedish Association of Local Authorities and Regions (SKL). She has been part of including gender equality in an agreement between the Swedish Government and SKL regarding the annual so-called ‘healthcare billion’ to the counties.
This is the first time gender equality is integrated and clearly stipulated in this type of agreement.
The Swedish Social Insurance Agency has known for a long time that women are over-represented among sick-listed individuals. A report from Karolinska Institutet in 2005 coupled with the Left Party’s proposition in 2006 that the problem of women’s ill-health should be dealt with once and for all provided great inspiration.
‘SKL has talked to the counties about this since 2006, but not much has happened,’ says Anna Östbom.
In the following year, SKL initiated the breakthrough project ‘Jämt sjukskriven’. After a slow start, the project has had a number of teams ready to share their experiences. A handbook with practical results from the projects will be made available to all counties. According to the agreement, the counties must develop action plans for a gender-equal sick-listing process.
Lack of Knowledge and Statistics
Disappointingly, there is limited knowledge about sick leave and gender equality. The scientific literature is thin as well.
‘We have to do something even if we don’t have all the information,’ says Anna Östbom. ‘There should be a focus on the patient. The doctor should consider the possibility that his or her assessment of a patient may be affected by the patient’s gender. The doctors should ask themselves: What would I do if I had a man in front of me? The doctor’s approach is crucial.’
‘What would I do if I had a man in front of me? The doctor’s approach is crucial.’
One way to be able to analyse the differences is to ask the different actors to keep gendered statistics. The actors involved in ‘Jämt sjukskriven’ can already show that women diagnosed with depression are long-term sick-listed more often than men with the same diagnosis. The same is true for various pain conditions: Women are more likely than men to be sick-listed. The reason for this is not clear.
‘The sick-listing process tends to medicalise women’s life processes,’ says Östbom. ‘It’s like you feel bad for women. At the same time, though, women may not receive the same high-quality care that men receive. An article in Dagens Medicin issue 50, 2009, showed for example that women generally are given cheaper hearing aids and that men get two hearing aids while women get only one.
‘As much as 12 per cent of the government’s budget goes to finance the high level of sick leave. Everybody agrees that sick leave should be prescribed as part of the care and treatment of a person, and that it should be prescribed with the same restrictive approach as prescription medicines. There’s no doubt that long-term sick-listings can have as many negative side effects as some medicines.’
Large Step Forward
Can the differences in sick leave be due to something else besides how patients are approached and the quality of the basis for assessment? What about women’s situation in the workplace, with lower salaries and poor career advancement opportunities – often referred to as the glass ceiling for women? Or the fact that women carry an unproportionally heavy domestic load – four times as heavy in heterosexual couples where both partners work more than full time, according to Katarina Boye’s doctoral thesis Happy Hour from 2008. How has the overall situation of women changed since the 1980s when the difference between women and men in terms of sick leave was smaller than today? Can it be that the overrepresentation of women in the sick-listing statistics reflects the heavy burden that women face in everyday life?
Anna Östbom welcomes a discussion and more preventive work, but the larger context is not the responsibility of the county councils.
‘Gender equality shouldn’t be some fringe thing; it should be an integrated and natural part of each negotiation that SKL is involved in. The agreement breaks new ground and may set a new standard.’
‘What happens at home and in the workplace is not our responsibility. What we can do with this condition included in the agreement is to ensure that the sick-listing process per se becomes gender equal. This is a large step forward. Gender equality shouldn’t be some fringe thing; it should be an integrated and natural part of each negotiation that SKL is involved in. The agreement breaks new ground and may set a new standard.’
About the Agreement
The county councils are working to improve the quality and effectiveness of the sick-listing process. A new agreement between the Swedish Ministry of Health and Social Affairs and SKL regarding efforts to reduce sick leave in Sweden will give up to 2 billion SEK to the county councils in 2010 and 2011. An important part of the work so far has been to in various ways help people return to work when that is possible.
Some of the funding is linked to reductions in sick leave and some to certain measures that are to be carried out. For example, the county councils are to analyse and develop action plans to make sick-listings more gender equal. Women’s sick leave has decreased more than men’s, yet the number of individuals on sick leave is still considerably higher for women than men.