At present, the vast majority of data collected and published about Australia’s compensation systems and related organisations is financial. Return to work rates are measured, although not using consistent methodology across jurisdictions. There is no umbrella data set that allows us to look at the proportion of people out of work across various private and publicly funded systems.

This means that, while we do have some useful information about workers’ compensation in Australia, there is even more that we don’t know.

How, for example, do the health outcomes of workers with compensable injuries vary between jurisdictions? What might this information tell us about how different compensation schemes operate as a social determinant of health?

According to the World Health Organisation (WHO) “the conditions in which people are born, grow, live, work and age” have a strong influence on health. (You can read more about the social determinants of health here.) People’s experiences with compensation systems affect not only their working lives, but also their families, their leisure time and their health. These affects may be long lasting.

Consider the two case studies below.  

David is a 45 year old working as a pipe setter in the mining industry. He developed a shoulder problem in 2006 through an injury at work. After two operations and a strong focus on rehabilitation after each the problem had not improved.  David saw in the second shoulder specialist and had his third operation.

When the third operation didn't sort out his shoulder problem he became depressed and essentially gave up on rehab. Faced with a combination of pain, not being able to do his job and marriage problems he became increasingly isolated and angry.  His dose of narcotic analgesics gradually increased.

His comp claim was settled for about $500,000, and within six months that had been spent on buying a property, a car, and some went on illicit drugs. He then discovered he was ineligible for social security payments for five years.

One year post settlement of his claim he is smoking heavily, using narcotics, both prescribed and  illicit, and separated from his wife with shared custody of their children.

Marie is a 54-year-old personal care attendant who developed neck pain in her full time role.  After a range of hands-on treatment through physiotherapy, hydrotherapy and chiropractic treatment there was little improvement in her condition. The doctors suggested she shouldn't return to heavy work.

A modified duty program was put in place, but withdrawn by the employer six months later. Marie was very upset when this occurred, and has lost hope of getting another job. She doesn't think she will be back in the workforce. Since her neck problem developed she's gained 15 kg in weight, continues to see her doctor monthly, and has lost contact with her previous work mates.

The failure to satisfy “the fundamental human needs of autonomy, empowerment, and human freedom” is, according to Professor Sir Michael Marmot, “a potent cause of ill health.”

Professor Marmot is a champion of the social determinants approach, which sees health outcomes as the responsibility of all policy makers, regardless of whether they are dealing with hospital restructurings, economic bail-outs, or workers’ compensation systems. It is an approach that calls on all of us within the “work and health” industry to be active players in improving health outcomes.

The first step is for policymakers to start measuring health outcomes with people who have had work injuries. This is something that has been talked about for the last five years but it is yet to come to fruition. Intentions might be good, but you can't set goals for improvement when you don’t know what the current situation is.  

The health outcomes of the two cases above are some everyday examples of what happens to people within the complex systems we have developed. Encouragingly, there are the focus is shifting from compensation to rehabilitation. But are we going to be quick enough to do it in a generation? This is the gauntlet that the WHO has thrown down.

Dealing with individual claims is challenging. A broader conversation is needed, one that acknowledges health inequities and the negative consequences of poor management of individual claims, and compensation systems more generally.  Will our policy makers lead the way?