The agreement between the Norwegian Government and social partners on a more inclusive working life (the IA Agreement) was first signed in 2001 and has since been developed and extended five times, most recently through to the end of 2024. With the IA Agreement, companies committed themselves to working systematically to reduce sickness absence and withdrawal from working life, for example by increasing the focus on preventing sickness absence from occurring through adjustment of the working environment. Companies also gained access to NAV Working Life Centres, where they received support in their work towards the IA Agreement goals, and the possibility to use extended self-reported sickness absence (egenmelding). The aim of the IA-related measures were to increase employment by achieving the goal of a more inclusive working life, along with reducing sickness absence. Considerable resources were spent both at the national level and in individual workplaces.
The aim of this project was to assess the effects of the IA Agreement. By developing and utilising advanced statistical and causal methods for large-scale registry data, such as multi-state modelling, the project estimated the effect of the IA Agreement on sickness absence and work participation. The project also looked at how possible effects varied between gender and sickness absence diagnoses, with a particular focus on the two largest diagnosis groups in Norway: musculoskeletal and psychological diagnoses. Two large cohorts combining several national registries were used in data analysis. The first one contained 626,928 individuals born in Norway 1967-1976, whilst the other was comprised of just under 4 million individuals who lived in Norway at some point in the period 2000-2010 (“Nor-Work”). It is important to note that the project only had data on whether a company had signed the IA Agreement or not, and no data on what IA-related measures were actually used.
The results of the project indicate that work participation was higher among those who worked in a company that had signed the IA Agreement (“IA companies”), and that this effect was stronger among men compared to women and also among those with musculoskeletal-related sickness absence. Employees in IA companies also returned to work faster after a sickness absence period that lasted 16 calendar days or longer, compared to those working in companies without an IA Agreement. On the other hand, those who worked in IA companies also had higher levels of sickness absence, particularly graded (less than 100%) sickness absence, than those working in companies without an IA Agreement. This could indicate that IA companies were better at adjusting tasks to allow the employee to work to a certain degree. An article including pregnant women also found that those working in IA companies were more often in work during their pregnancy, especially during the second trimester, but that sickness absence was also higher among these women working in IA companies. All articles indicated that unemployment and economic inactivity were less likely for individuals working in IA companies, though this state was not well-defined and requires further research.
Another article published through the project looked at mean time spent in work and reasons for withdrawal from work among men and women, finding that women worked on average one year less than men during a 10-year period. Those with a lower educational level had fewer years spent in work and more years spent on sickness absence and disability benefits, compared with those who had the highest educational level.
The project was a continuation of previous projects. The first one was “Social inequalities in health: childhood health and subsequent work participation”, which was established in 2002 and received funding from RCN for the first time in 2006. Later, two sub-projects also received funding from RCN: “Work participation and work-related health: a life course perspective” and “Understanding the causes and consequences of dropping out of school: the need for a life-course approach”.
The project also builds on two Nordic projects: “Nordic Occupational Register – A Tool for Estimation of the Potential of Workplace and Population Level Interventions”, funded by NordForsk (2016–2019), and the continuation, “To what extent are work disability and exit from work preventable? Completing the Nordic Work Disability Database and utilizing it to look at ocA hybrid landmark Aalen-Johansen cupation-specific prevention potential and working life expectancy”, funded by The Nordic Council of Ministers (2018–2023).
The project was a collaboration between STAMI and the Oslo Centre for Biostatistics and Epidemiology (OCBE), with Jon Michael Gran as the overall project leader. The project received funding from the Research Council of Norway (RCN)(https://prosjektbanken.forskningsradet.no/project/FORISS/273674)
Project leader: Karl-Christian Nordby
Project group members: Ingred Sivesind Mehlum, Suzanne Merkus, Rachel Hasting, Karina Undem, Rune Hoff.
Other collaborators:
- NAV
- Columbia University, New York
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Nederland
- The National Research Centre for the Working Environment, Denmark
More information is to be found on the Norwegian project page.