A farewell to welfare?

In many western countries, sickness or injury prevents a great number of people from working. In Sweden, for example, every seventh person of working age is longterm absent from work because of ill-health. For the individual, long-term sick leave often spells worsened economy and social stigmatisation. For the employer, absence from work causes severe administrative and practical headaches, while for the community the economic consequences are great and growing. Sweden’s bill for long-term sickness absence and disability pensions in 2000 was about twice as big as for the whole education system, or about the same as for the whole health-and-medical-care apparatus. Small wonder, then, that increasing emphasis has been put on vocational rehabilitation aiming to return sick or injured people to the workforce. Yet despite its obvious relevance, vocational rehabilitation has been but little studied. Few papers explicitly focus on this area, and of those even fewer consider the return-to-work process. Could this be because of the complex nature of vocational rehabilitation? Vocational rehabilitation is a multifactorial process tending to sprawl across diVerent disciplines such as medicine, psychology, sociology, ergonomics, economy, and law, and involving physicians, physiotherapists , employers and rehabilitation counsellors, to say nothing of the unfortunate absentee and her or his family. To understand this complex process, researchers in the diVerent ®elds need to think and cooperate in multidisciplinary ways. This is not always easy. DiVerent disciplines have diVerent methods and standards. Sociologists often work in a culture that diVers very much from the physicians’, while language and writing styles among economists often diVer from what is current among psychologists. For a better understanding of vocational rehabilitation, these di culties, however, need to be overcome. These are the assumptions that make this special issue special. Vocational rehabilitation is focused from diVerent angles. The contributing authors represent medicine, psychology, occupational therapy, rehabilitation counselling, economics, sociology and social work. In the ®rst article, risk factors in vocational rehabilitation are reviewed, con®rming that it is a complex process linking numerous individual, organisational and societal factors with return to work after rehabilitation. The second article focuses on client motivation, concluding, among other things, that a client’s wishes (`want to do’) do not constitute an isolated opinion, but clearly re ̄ect other aspects, particularly his or her own competence, a perception of `can do’. The third contribution to this issue also has a client perspective but focuses on economic incentives to show that these do play an important role in sickness absence and vocational rehabilitation. The doctors’ role is discussed in paper four. From interviews it is concluded that feelings of isolation and diminished control, lack of time and increased demands are obstacles to optimal rehabilitation, as is insu cient knowledge of the labour market. The next article examines co-operation between diVerent actors involved in vocational rehabilitation, and investigates communicative action in what are termed `rehabilitation group meetings’. It shows that the client in many ways plays a passive role in his/her own rehabilitation with, for example, the doctor and the employer playing more prominent roles. The sixth study also addresses organisational matters, discussing some important organisational prerequisites for interdisciplinary work. It follows the practical implementation of an interdisciplinary rehabilitation model for patients with long-term pain. The seventh paper, entitled `Disability management in a sample of Australian self-insured companies’, has an employer perspective. The authors give a clear picture of the thoughts underlying disability management and investigate how far disability management was implemented in companies investigated. The conclusion is that the companies need to work more on integrated approaches to preventing and managing workplace disability. The last paper investigates the eVect of early versus late vocational rehabilitation on return to work. A four-year follow-up study, it concludes that, especially among women, early intervention seems more eVective than late. By spreading the net wide and highlighting vocational rehabilitation from diVerent angles and perspectives, we hope to oVer the reader a better understanding of this complex and still relatively uncharted ®eld. John Selander Guest Editor DISABILITY AND REHABILITATION, 2002; VOL. 24, NO. 14, 703