 |
Contribution to the IJDCR Special Issue on Aging
Response prepared by Dr. D. F. McAnaney and Dr. R. Wynne, Ireland
Adapted from Illness and inclusion-- maintaining people with chronic illness and disabilities in employment (European Foundation April 2004)
From an EU perspective, there is a growing acknowledgement of the growing burden that economically inactive older workers will place on the economy and social cohesion in the coming years Early retirement from the labour force has many causes, some of which relate to illness and acquired work related disability. The incidence rates of work related disability are high and rising throughout much of Europe. For example, in Sweden and Finland approximately 6% of the labour force are classified as being disabled, while in the Netherlands the rate is more than 10%.
There are a number of major factors associated with this emergent problem. Perhaps the most important of these relates to the ageing of the population and of the workforce-- a situation which has been well documented, not least by the Foundation (European Foundation, 1999; Ilmarinen, 1999). Here, older workers (more than 50 years old) have been demonstrated to exit the workforce early for a mix of reasons related to health, discrimination and in some cases generous benefits packages.
While not all early retirement is due to health reasons, there is ample evidence to suggest that health issues make a significant contribution. In particular, illnesses relating to lifestyle, injuries from accidents and increasingly, stress and mental health problems all play a role.
Exit from the labour force is simply the transition from active to inactive life (Employment in Europe 2003). It can happen to anyone who acquires a health condition which impacts on work capacity at any age. However, age is significantly associated with chronic illness, disability and economic inactivity and the EU population is ageing (Disability and Social Participation in Europe, 2001; The Social Situation in the European Union, 2003). 24% of what is considered to be the working age population (15 to 64 years old) are older workers. This is likely to grow to 27% by 2010. Only 38.6% of the EU population between 55 and 64 were in employment in 2001. The employment rate for the EU as a whole was 64% and 73% for 46 Ð 55 year olds in the same year. Within the EU, the average age at which people left the labour market was 59.9 years.
Given that employment is closely linked to income, this has important consequences in terms of social exclusion. In addition, an ageing population places pressure on health care systems. The relationship between age and LSHPD is almost linear and accelerates in older workers. Less than 7% of people in the age range 16-24 reported a LSHPD (EU25). The corresponding figure for 55-64 year olds was close to 30% (Dupre and Karjalainen 2003). Equally, having a moderate to severe LSHPD increases the likelihood that a person will be economically inactive, i.e. between 20-46% participation in the labour force in comparison 68% of those without a condition. The interaction between age, LSHPD and economic inactivity is clearly evident in the figures.
These high incidence rates of work related disability pose particular problems for social insurance systems not only in terms of the costs of funding disability pensions, but also in terms of the provision of services to maintain disabled employees in work or to return such employees to work. In addition, the human and financial costs of work related disability to the individual worker can be very high.
The nature of the illnesses that give rise to work related disability is changing. The importance of chronic illnesses is rising, and illnesses related to stress, such as depression, anxiety and burnout are increasingly the cause of long term absence from work. These chronic illnesses are an important focus for the study.
The burden of such illnesses most obviously falls on the individual, but there is increasing concern about the effects they are having on social insurance systems, not only in terms of the costs associated with illness, but also on terms of the quality and appropriateness of service provision. The current situation may be characterised by high and rising costs and relatively ineffective service provision, and this reflects in part the founding assumptions under which social insurance provisions were designed (rising populations and labour forces, lower life expectancy levels, high levels of employment). However, these assumptions have been challenged by socio-economic developments over the last decade or so, where perhaps all of them no longer hold to the same extent as was the case 20 years ago.
Rising levels of work related disability also carry costs for employers. In particular, there are costs in relation to long term absenteeism even though many of the wage costs are carried by Social Insurance Agencies in Europe. Employers must replace workers who are long term absent, there are effects on productivity, loss of experience and so on. There are also moves in some countries to change the benefits systems so that employers are now responsible for a greater portion of costs than used to be the case. In the Netherlands, employers are now responsible for the costs associated for the first year of absence-- an initiative designed to promote better and earlier return to work.
Many of the systemic responses to the issues of disability have been designed primarily for dealing with either persons with a congenital disability or for persons who have acquired a disability due to an injury. (It should be noted that these systems are not usually the same, either in terms of eligibility criteria, benefits or the type of services offered). However, when it comes to the case of rehabilitating people with acquired chronic illness most systems struggle to cope. In particular, rehabilitation and reintegration are difficult to achieve in the case of older people and people with mental illness. As a result, chronic illness can and often leads to social exclusion through exclusion for the workplace in particular and the labour market generally.
Despite the lack of clarity of focus within EU policy and statistics, there are a number critical implications for the European Social Model arising from people at work losing their jobs as a result of their illness or injury and consequently becoming socially excluded. These include:
- The pensions crisis-- the European population is living longer, the length of the so-called third age is extending in duration and for structural and cyclical reasons the under funding of state and private pension schemes has attracted increasing policy attention in recent years. However, this has led to a number of initiatives mainly concerned with altering the financial conditions and eligibility for pensions, rather than addressing the health related reasons for early retirement, despite poor health being a major contributor to early exits from the labour force.
- The rise of stress and mental health problems-- the causes of illness amongst the working population have been changing in recent years. A greater proportion of illnesses now relate to stress related illness and mental health problems, a trend that poses special difficulties with regard to retaining people with such illnesses in the workforce.
- Increases in rates of work disability-- many countries have seen recent and unsustainable (from the perspective of costs) rises in the prevalence of work disability. The causes of these rises relate to a complex mix of the ageing of the workforce, changes in eligibility criteria, interactions between social insurance schemes for disability and unemployment and perhaps also to the changing nature of the illnesses which give rise to disability claims.
- Anti-discrimination measures-- a substantial part of the social inclusion strategy within the EU relies upon measures and initiatives to combat discrimination on a number of grounds including disability and age. A major emphasis is placed on measures to combat discrimination in employment, in particular, in terms of recruitment and selection of jobseekers. The requirement to respond to the needs of an older employee with chronic illness has not been addressed with sufficient clarity within the framework.
These related trends in society have not given rise to a general concern across policy areas to address the issue of preventing social exclusion through maintaining people with illness in the workplace. In part, this may be because the competence to address this complex issue does not reside solely at EU level (e.g. the EU does not have a clear policy competence in relation to systems of social protection), but it may also be due to the fact that an effective response requires policy initiatives that cross traditionally separate policy areas. For example, there appears to be a contradiction between social policy and employment measures that results in relatively few Member States having systems in place to react at a sufficiently early stage to effectively prevent the risk of an employee with a chronic health condition from exiting employment on a long-term or permanent basis. Similarly, the process that creates work disability, regardless of the cause, is initiated and progresses within an employment, rather than unemployment, context and thus responsibility is divided between employers, worker representatives and statutory health, employment and social protection agencies. This fragmentation of responsibility may well contribute to the lack of an effective policy focus.
References
Dupre, D. and Karjalainen, A., Eurostat, Statistics in Focus: Employment of disabled people in Europe in 2002, Eurostat, Theme 3: population and social conditions, Statistical Office of the European Communities, 2003.
Available online at http://europa.eu.int/comm/ eurostat...
European Commission, The Social Situation in the European Union 2003. Luxembourg, Office for Official Publications of the European Communities, 2003a. Available online at www.eu-datashop.de/download/EN/inhaltsv/thema3/so_lage.pdf
European Commission, Employment in Europe 2003: Recent Trends and Prospects. Luxembourg, Office for Official Publications of the European Communities, 2003b. Available online at europa.eu.int/comm/employment_social/employment_analysis/employ_2003_en.htm
European Commission, Disability and Social Participation in Europe, Eurostat, Theme 3: population and social conditions, Luxembourg, Office for Official Publications of the European Communities, 2001b.
Available online at europa. eu.int/comm/eurostat/...
European Foundation for the Improvement of Living and Working Conditions, Active Strategies for an Ageing Workforce, Conference Report, Turku, Finland, 12-13 August 1999, Luxembourg, Office for Official Publications of the European Communities, 1999.
Available online at www.eurofound.eu.int/publications/files/EF9962EN.pdf
Ilmarinen, J., Ageing workers in the European Union: Status and promotion of work ability, employability and employment, Finnish Institute of Occupational Health, Helsinki, 1999.
Contact for correspondence
Donal McAnaney, Rehab Group Roslyn Park, Dublin, Ireland
Email: donalmcananey@rehab.ie
Fax: 353 1 205 7211
Internet: www.rehab.ie
Dr. R. Wynne, Work Research Centre, Ireland
|
