Ill health, disability, employment and return to work

Introduction

Workplaces should prevent risks and promote good health. For those with an existing health condition (for example, a chronic disease) or disability, work should not make it worse. Accommodations at the workplace can be made to support their continued working. And if they have had time off work, they should be supported to return to work.

Currently, about half of the 42.8 million people with disabilities of working age in the EU are employed^[1] and a quarter of the EU working population reports having a chronic disease^[2]. Good health-and-safety arrangements to prevent work accidents and work-related ill health and promote health and wellbeing are also very important for someone with a disability or ill-health, to prevent further health problems or disabilities. Measures that make work easier for workers may mean that a worker with an ill health condition or a disability can continue working, preventing their early exit from the labour market. The goal should be to make work as accessible and inclusive as possible for a diverse workforce, allowing as many people as possible to enter and remain in work, through reasonable accommodation and accessibility, following a universal design approach.

This OSHwiki article presents EU-OSHA’s resources related to returning to work and working with an ill-health condition or disability; it also features key resources from other organisations.

Disability, employment and EU strategy

Equal labour market participation of people with disabilities is a priority of the Commission’s Strategy for the Rights of Persons with Disabilities 2021-2030^[3], adopted together with the European Pillar of Social Rights Action Plan^[4]. The strategy aims to improve the lives of people with disabilities in the EU, upholding the pillar principles and the targets of the action plan. It also aims at supporting Member States in the implementation of the United Nations Convention on the Rights of Persons with Disabilities^[5]. In the strategy, the Commission commits to scale up European action, paying particular attention to employment of people with disabilities. One of the seven flagship initiatives within the strategy is the Disability Employment Package^[6], which was launched at the Czech Presidency conference, on 20 and 21 September 2022. The package covers all stages of employment and comprises six areas. Three of its actions are ensuring reasonable accommodation^[1] at work, retaining persons with disabilities in employment (preventing disabilities associated with chronic diseases), and securing vocational rehabilitation schemes in cases of sickness or accidents.

The resources in this OSHwiki article have been compiled to support these specific actions of the Disability Employment Package.

Disability and employment – employers’ legal duties

In the European Union, workers with disabilities are protected by both anti-discrimination legislation and occupational health-and-safety legislation. Member State legislation and arrangements may go beyond the minimum requirements set at the EU level. They may have specific legislation and arrangements on return to work.

In order to put into effect the principle of equal treatment in the Member States, Council Directive 2000/78/EC (the Employment Equality Directive^[7]) laid down a general framework for combating discrimination based on the grounds of religion or belief, disability, age or sexual orientation in the area of employment and occupation. It includes the obligation to provide reasonable accommodation for people with disabilities to enable someone with a disability to have access to, participate in, or advance in employment, or to undergo training.

Occupational safety and health (OSH) legislation requires employers to prevent risks, based on risk assessments^[8]. The general principles of prevention include preventing risks at source, prioritising the collective measures over individual measures and adapting work to the worker. In addition, workers are required to protect particularly sensitive groups against the dangers that affect them specifically. Legislation on the safety and health requirements for workplaces^[9] requires that they take account of workers with disabilities, in particular regarding doors, passageways, staircases, showers, washbasins, lavatories and workstations used or occupied directly by people with a disability. Work equipment should be suitable for the work and usable by workers without negatively affecting their health and safety^[10]. Making work safer and easier for all workers can enable a worker with a disability to continue working.

A health and safety risk assessment can be used to help determine the accommodations needed to support a worker with an ill-health condition or disability to enter a job or continue working, or to decide on measures to support a worker to return to work following time off due to sickness.

Return to work (vocational rehabilitation) and working with a chronic condition or disability

Returning to work after a medium-to-long-term sickness absence requires a systematic approach to be successful. It involves following a number of steps, and combined action from different professions that are not necessarily used to working together. This can include healthcare practitioners, occupational therapists, accessibility experts, disability experts, OSH experts and human resource managers. The workplace should be the central focus of return-to-work systems, with everyone having return to work as the goal. This includes healthcare practitioners, who should have return to work as a clinical or treatment outcome. Many adjustments to support a person to return and stay in work are simple and inexpensive.

Return to work (vocational rehabilitation), working with a chronic condition or disability and making workplace accommodations

In the workplace, the steps for managing return to work or making accommodations for individuals without sick leave are similar. They include the following:

• take action to prevent risks for all; encourage workers to report problems and promote a culture of open conversations so intervention can be carried out early;
• plan the return to work and the accommodations, and focus on a person’s work ability (not their incapacities);
• train managers and supervisors on having open conversations and supporting return to work or a worker with a health condition;
• involve the worker at all stages of the process and focus on their needs;
• get advice and support;
• and try out accommodations and review them to check whether they work or to see if any other measures are needed.

This should be done by taking a joined-up approach, which for simple cases involves the employee, their healthcare team (with the worker’s permission) and their line manager, with the common goal of helping them to stay at work and work within their abilities. Within the workplace, human resources and OSH services should cooperate. The return to work may need the input of a multidisciplinary team, where areas of expertise could include disability, accessibility, assistive technology and OSH to determine the proper accommodations for the person with the disability. Some Member States have return-to-work programmes which involve multidisciplinary teams (see Section 4.2).

Workplace accommodations could include making changes to job duties and tasks, adapting equipment and workplaces, changing hour and working patterns and providing retraining.

Evidence suggests that effective return to work requires a multidisciplinary, coordinated and tailored approach to provide support to employers and individual workers, with the focus on staying in work. According to EU-OSHA research, the most effective programmes combine early-intervention healthcare support, advice on workplace accommodations, employment advice, work-focused psychological support, vocational advice and training and social security input to provide a tailored approach to individuals and individual employers. In a tailored approach, the individual is assigned a coordinator who coordinates the different forms of support and works closely with the individual. External support is especially important for small businesses.

The ageing workforce – creating sustainable work and supporting continued working for individuals with reduced work capabilities

The percentage of people with disabilities increases with age.[11] The European workforce is ageing, and as the retirement age is increasing in many Member States, workers are likely to face longer working lives. This also means that more workers will develop chronic ill-health conditions and associated disabilities, and so good prevention, accessible workplaces and good return-to-work policies are increasingly important to keep workplaces sustainable and prevent workers exiting the workforce prematurely.

Working with specific ill-health conditions

Ill-health conditions can be associated with symptoms and disabilities that affect a person’s ability to carry out their work. For example, a heart condition can mean that someone can no longer carry out physical work. A person with diabetes may need to take their meals at work at specific times or have breaks to test their blood sugar or administer an insulin injection. Rheumatic conditions can cause function and mobility limitations, and permanent disability and fatigue; the associated pain can also affect a person’s ability to carry out tasks.

You do not have to be 100 % fit to work – many people can work around problems caused by an ill-health condition, and with the right accommodations and support, they often still work. The key steps to supporting someone with ill-health to continue working are the same for all ill-health conditions. However, the choice of individual support measures may be dependent on the condition.

Cancer and return to work

More and­­ more cancer survivors return to work. It is important to facilitate their rehabilitation, both to promote the wellbeing of this vulnerable group and to reduce the related societal and economic impacts.

Cardiovascular disease (CVD)

Circulatory diseases are a leading cause of death and permanent disability among workers. There are various occupational risk factors for CVD that should be prevented and controlled. Occupational factors that have been linked to CVD include exposure to chemical substances such as carbon monoxide or trichloroethane, extreme heat or cold, noise, strenuous work, prolonged static standing, prolonged static sitting, and night work and shift work where age and the type of shift system worked may contribute to the risk. Jobs requiring breathing apparatus increase the demands on the cardiovascular system. Stress at work, long hours and fatigue have also been linked to CVD. Some CVDs are recognised as occupational diseases under certain conditions.

Occupational exposure to risk factors for CVD should be minimised; occupational health surveillance is used to assess the resilience of the cardiovascular system and aid early detection of CVD. Night work in particular should be minimised, especially for older workers, and recommended shift-work structures used.

Workplace health promotion that complements occupation risk prevention can help to reduce risk factors for CVD and raise awareness. This could include actions to promote physical activity, healthy eating, smoking cessation and reduction in alcohol consumption. Occupational health check-ups can be used to detect risk factors such as undetected hypertension or prediabetes.

Patients with coronary heart disease should be supported to return to work. Both physical workload and psychosocial risk factors should be taken into account.

Long COVID

Returning workers can face challenges after suffering COVID-19, whether affected by acute illness or longer-term symptoms also known as long COVID; they may need support to manage getting back to work. A common symptom of long COVID is extreme fatigue. Measures to accommodate this aspect of long COVID are relevant to people with myalgic encephalomyelitis or encephalopathy (ME) (also diagnosed as chronic fatigue syndrome (CFS) or post-viral fatigue syndrome (PVFS)).

Mental health and work-related stress

Actions on mental health at work should combine the following: preventing work-related stress, as the first priority; promoting mental health and wellbeing; supporting workers to deal with work-related stress, for example by building resilience or providing counselling; supporting workers with occupational stress, including accommodations to their work to enable them to continue working or return to work after sick leave; and supporting workers with non-work-related mental health conditions. Suicide prevention should also be an integral part of a positive and proactive approach to mental health at work.

Rheumatic and musculoskeletal diseases (RMDs) and work-related musculoskeletal disorders

RMDs are chronic problems affecting the muscles, bones, joints and soft tissues: examples include rheumatism, arthritis, osteoporosis and fibromyalgia, which can affect work or be aggravated by work, but are not directly caused by work. Their causes include inflammatory diseases, ageing, injuries, and congenital and developmental conditions. If the precise cause of musculoskeletal pain is unclear, it is described as shoulder pain, back pain and so on. Conditions caused or aggravated by work are referred to as work-related musculoskeletal disorders (MSDs). Whether a musculoskeletal condition is work-related or not, steps need to be taken in the workplace to prevent work-related MSDs and support individual workers to continue working. Workplaces should also promote good musculoskeletal health.

Other disabilities, conditions or symptoms

Risk prevention and health promotion

A prerequisite for supporting individuals with chronic conditions and disabilities to remain in work is a good system for managing risks and promoting health and wellbeing.

Preventing occupation risks and work-related ill health and injury

Work accidents are a significant cause of injury, ill health and death. While work accidents can cause injury or death, an even greater burden is disability and death from work-related diseases resulting from exposure to poor working conditions. This has a significant cost for business and country economies. Preventing work risks and promoting health and wellbeing will reduce this toll, but good working conditions also make it easier for those with non-work-related conditions to remain in work.

Key prevention areas include musculoskeletal disorders (for example work-related back pain or tendonitis), work-related stress (that can lead to anxiety, depression and burnout), exposure to dangerous substances (that can result in skin diseases and respiratory diseases and cancer), exposure to excessive noise, accidents, and slips, trips and falls. Prevention measures should be based on a risk assessment, with elimination of the risk at source as the first priority.

Workplace health promotion

Many chronic diseases – for example heart diseases, type 2 diabetes and cancer – can be largely prevented by a healthy lifestyle. These changes include improving diet, enhancing physical fitness and quitting smoking. Workplace health promotion complements legal requirements to prevent exposure to occupational health risk factors. It includes the following: improving the way work is organised; improving the working environment; encouraging employees to get involved in healthy activities; and encouraging personal development. To be effective, it must take place within the context of a good OSH prevention system.