In the past, doctors and researchers considered absence as a result of sickness to be a (socio)economic and political matter rather than a medical or public health one, so little attention was paid to sickness absence in the general medical literature. Recently, politicians have stressed that reducing work related ill health and sickness absence is a top priority, and sickness absence is increasingly seen as a public health problem in the general medical literature.1 The doctor’s role in sickness certification has been debated because of the tension with doctors also being patient advocates; the extra work caused by certification has also made it unpopular.

The linked prospective cohort study (the Whitehall II study) by Head and colleagues (doi:10.1136/bmj.a1469) finds that the almost 30% of British civil servants who had one or more spells of medically certified sickness absence (>7 days) in 1985-8 had a 66% increased …