Too many workers leave the labour market permanently due to health problems, and yet too many people with a disabling condition are denied the opportunity to work. This third report in the OECD series Sickness, Disability and Work explores the possible factors behind this paradox. The report examines the challenges and obstacles for Denmark, Finland, Ireland and the Netherlands, and looks at the promising steps of those countries of transforming sickness and disability schemes from passive benefits to active support systems that promote work. A range of reform recommendations is put forward to deal with specific challenges facing the four countries