576,000 Belgians on Long-Term Sick Leave: A Nation in Crisis

More than 576,000 Belgians have been on sick leave for over a year, according to new data from the RIZIV, Belgium’s national health insurance institute. The figure — exactly 576,643 as of the end of 2025 — represents a record high and a 22% increase over five years, with profound implications for the country’s public health system and economy. The detailed demographic analysis, published by Het Laatste Nieuws, paints a stark picture of who is affected and why.

The Scale of the Problem

The 576,643 figure only covers wage earners and self-employed individuals. Tenured civil servants — including teachers, police officers, military personnel, and railway staff — are excluded from the statistics, meaning the true number is even higher. The annual cost of long-term sick leave now exceeds €10 billion, making it a prime target for the De Wever government as it searches for budget savings.

Yet there are signs of stabilization. Professor Lode Godderis of KU Leuven, a leading expert in occupational medicine, told VRT NWS that “we are on a plateau.” When the 65+ age group is excluded — a group that swelled by 1,120% due to the pension age increase from 65 to 66 on January 1, 2025 — the increase in 2025 was just 1.6%, the smallest since 2008.

Who Are the Long-Term Sick?

Women account for six out of ten long-term sick cases, with 347,475 women compared to 229,168 men. Professor Godderis explains that women are more likely to work in emotionally demanding sectors such as healthcare and education. “Guiding and witnessing the suffering of others creates heavy mental pressure, causing a greater risk of dropping out,” he said. He also noted that the unequal distribution of household and care responsibilities at home contributes to the imbalance.

Nearly two-thirds of all long-term sick are over 50. The age group 60-64 accounts for 129,558 cases, while 55-59 follows closely with 127,481. The 65+ category exploded from just 1,581 in 2024 to 19,278 in 2025 — a direct consequence of the pension age reform.

Perhaps most concerning is the rapid growth among younger workers. More than one in seven long-term sick are now under 40, and this group is growing faster than average. Professor Godderis attributes this to a “perfect recipe” for falling ill: mental health struggles, job insecurity, high expectations, and intense work pressure exacerbated by staff shortages and inadequate mentorship.

The Mental Health Crisis

Psychological disorders are the leading cause of long-term sick leave, accounting for 38.3% of cases — approximately 221,000 people. Musculoskeletal disorders follow at 31.3% (180,000 cases), while nervous system disorders, cancer, accidents, and cardiovascular conditions make up the remainder.

Within the psychological category, the numbers are staggering. Depression cases rose 27% in five years, from 78,330 to 99,558. But the fastest-growing category is burnout, which exploded by 67% — from 33,402 in 2020 to 55,802 in 2025. For context, while the total number of long-term sick grew by 22% over five years, burnout cases grew three times faster. Combined, more than one in four of all long-term sick — over 155,000 people — are home with depression or burnout.

Regional and Employment Patterns

Geographically, Flanders accounts for half of all cases (approximately 275,000), followed by Wallonia (206,000) and Brussels (50,216). Adjusted per capita, the province of Hainaut has the highest rate, followed by Liège and Limburg. Antwerp has the highest absolute number at 69,700 but the lowest rate per capita.

By employment status, blue-collar workers make up the majority at 315,000 cases, compared to 200,000 white-collar workers. However, 2023 marked a turning point: for the first time, more white-collar workers became long-term sick than blue-collar workers.

A Political Flashpoint

The long-term sick leave crisis has become a major political battleground. The De Wever government, led by N-VA and MR, has targeted the €10 billion annual cost as a source of budget savings. Recent RIZIV audits found that approximately 25% of long-term sick recipients may be receiving undue benefits, sparking fierce debate.

Minister of Health Frank Vandenbroucke (Vooruit) has taken a hard line, declaring that “the era of non-commitment is over.” Starting in 2027, a portion of sick fund operating budgets will be tied to re-integration results. The government has set a target of getting 100,000 long-term sick back to work.

Xavier Brenez, CEO of the Independent Sick Funds, pushed back against what he called “polemics,” arguing that variations in medical evaluation — not fraud — explain the audit findings. “We spend our time on polemics instead of putting energy into the right reform,” he told VRT NWS.

What Lies Ahead

As Belgium’s pension age rises further toward 67, experts warn that the pressure on the sickness system will only intensify. Professor Godderis and other specialists argue that current policies focus on “mopping up the floor” rather than “turning off the tap” — meaning prevention through better working conditions, more mentorship for young workers, and addressing the root causes of workplace mental health issues.

The question facing policymakers is whether the drive for budget savings can be balanced with genuine support for the ill, and whether Belgium can address the structural workplace issues driving its long-term sickness crisis before the numbers climb even higher.