Working with a chronic condition

According to Eurofound’s Third European Quality of Life Survey 2001–2012, about 28% of Europeans report having a chronic (longstanding) physical or mental health problem, illness or disability, though with much variation depending on member states. 1 in 4 people of working age (15 to 64) are estimated to live with long standing health problems that restrict their daily activities. The majority of these health problems come directly from chronic diseases. Furthermore, about 350 million working days are lost in the European Union each year due to work-related health problems. Furthermore, disability and ill-health are both a cause and consequence of poverty. On average the incomes of people with disabilities are 12% lower than the rest of the population. In some countries, the incomes can be as much as 30% less. The costs are not only incurred by the individual; OECD countries have been spending 1.2% of GDP (up to 2% when including sickness benefits) on disability benefits. The cost of systemically excluding people with partial capacity from the workforce has a serious impact on the public expenditure. In some countries the public spend on disability benefits is more than 2.5 times what is spent on unemployment benefits. It is this interrelation that makes workplace health such an important element of modern public health policies.

Employment is fundamental to staying connected to community, maintaining skills and continuing to develop professionally. Conversely, unemployment can contribute to further ill health for people with chronic conditions such as mental health conditions for example: the longer unemployment lasts, the more difficult it is for patients with mental health conditions to go back to work.

While some people with chronic conditions cannot continue their professional activity due to their health condition, many continue working or wish to do so, while for others this might have a beneficial impact on their recovery. With adequate support, those who wish to, can work, resulting in a hugely improved quality of life that minimises the negative financial impact of chronic illness, risk of social exclusion, poverty and positively contributes to their mental health. For some people with mental ill health, employment can be a part of the recovery process and be a means to conduct a meaningful life. This illustrates that for people with chronic conditions, the value of staying at work goes beyond providing financial stability - it contributes to social inclusion and well-being.

In the workplace, people with chronic conditions often face low levels of awareness from their employers on managing chronic conditions. Employers do not always have the processes in place to react to a changing workforce and are ill-informed about the ability of people with chronic conditions to continue working. They may have (unfound) concerns about costs (of adaptations for example, which are often zero), productivity, and absences. Because of negative perceptions, people with chronic conditions may not disclose their condition or may not ask for the necessary adaptations.

People with chronic conditions may face stigma and discriminatory attitudes from employers or colleagues such as inappropriate disclosure of their condition, lack of support when returning to work after sick leave, or even difficulties after a long-term absence (e.g. some people with chronic conditions are “side-lined”). The Eurofound study on employment opportunities for people with chronic conditions shows that they may have more difficulties obtaining training opportunities and promotion.

Combining a health condition with professional responsibilities can be challenging. For example, people with chronic conditions may need to take medical appointments during working hours or work with symptoms such as pain, tiredness, or anxiety. Experiential knowledge shows that people with chronic conditions will first sacrifice their leisure, social, and resting time to deal with health, which can lead to isolation and worsening of their condition.[1]

It goes without saying that the increase of public awareness and sensitivity will reduce discrimination in the workplace, open the way for more increased employment, reduce social exclusion and add to the quality of life of the people with chronic conditions.

It is vital the people with partial work capacity are supported to stay in or return to work through clearly defined programmes run by professionals experienced in providing vocational rehabilitation. An appreciation of the intersectionality of disability, exclusion and poverty would also be useful to moving this issue to a point where the focus is on an individual’s ability, first and foremost.