Rapid Responses to:

LETTERS: Miles J Stanger Incapacity, work, and benefits BMJ 2008; 336: 735-a [Full text]

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"Validity of healthy worker effect" following reformed sick note

A hassan   (10 April 2008)

"Validity of healthy worker effect" following reformed sick note 10 April 2008
A hassan, Clinical Fellow M19 3LF Send response to journal: Re: "Validity of healthy worker effect" following reformed sick note	I followed with interest the rapid responses to the report "calls for shake up in management of sick notes". A part from the economic and other implications, one wonders whether this will have any research implication e.g effect on the validity of "healthy worker effect" on future studies on British working population (assuming it is fully implemented). Healthy worker effect (HWE) as described in the Dictionary of epidemiology by Last: Workers have lower overall death rates than the general population because severely ill and chronically disabled are excluded from employment. HWE is a common problem where we can not generalise findings from working population to the general population. There was a lot of debate in recent years about HWE. Some see it as a selection bias, a confounding or a comparsion problem. Whatever that may be, it would be interesting to see whether implementation of the report affect this phenomena. Competing interests: None declared