Part 13. Issuing medical certificates : how sick do you have to actually “Be sick”?

Abstract

Absenteeism from work as a result of sickness places a tremendous financial burden on the economy of any country. In 2013, the Adcorp index revealed that 3.96 million South Africans were absent from work due to illness as compared with 700 000 in 2000. Not only did this result in billions of rand being lost on a yearly basis, but the increasing trend is a major concern for the future. Thus the question arose: “How sick do you have to be… to be sick?” In 1948, The World Health Organization (WHO) defined health in its broader sense as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” It was initially widely acclaimed for its inclusion of physical, mental and social domains.1 However, since then it has been criticized by many because of its lack of operational value, ambiguity, and the problems created by use of the word “complete” in relation to wellbeing.2 Strict application of that unmeasurable criterion could categorise most people as unhealthy, or able to declare themselves “unwell” much of the time! It is also counterproductive in that it declares those with chronic conditions and disabilities as ill, and could inhibit people’s natural capacity to adapt and cope with physical, emotional and social challenges.