- Observatory: EurWORK
- Labour market policies,
- Work organisation,
- Disability and chronic disease,
- Offentlige serviceydelser,
- Working conditions,
- Social policies,
- Published on: 14 november 2014
Disclaimer: This information is made available as a service to the public but has not been edited by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.
According to a survey conducted in 2011, 2.4 million persons living in Austria, or 41.6% of the working-age population have at least one permanent health problem. Most frequent are back or neck problems. The employment rate of those with chronic diseases is significantly below that of non-impaired individuals and was at 67.2% as compared to 75.8% in 2011, with the difference rising with increasing age. Since 2013, a prevention and early intervention programme (fit2work) has been available nationwide for both employees and unemployed with health impairments preventing them from performing in their jobs, as well as for companies. First results are promising.
Block 1: Concept, definitions, sources of information and methodological issues on chronic diseases and work from the national perspective
1.1. National definition of chronic disease
There is no clear, generally and widely used definition of “chronic diseases” in an employment context in Austria. The General Social Insurance Act (Allgemeines Sozialversicherungsgesetz ASVG) distinguishes between two kinds of diseases in an employment context: work-related diseases (arbeitsbedingte Erkrankungen) and occupational diseases (Berufskrankheiten), which form a subgroup of the work-related diseases. Work-related diseases are diseases in which the working environment plays a role as a causal or worsening factor of the illness; occupational diseases are impairments to one’s health through an insured employment activity, which is compensated for by the respective statutory accident insurance. Usually, occupational diseases take the form of chronic diseases. They are defined as occupational diseases by the General Social Insurance Act. In the annex to the Act, a list of occupational diseases which currently includes 53 different types is included (see http://www.auva.at/mediaDB/MMDB128507_Berufskrankheitenliste.pdf).
Within the last decade, Statistics Austria conducted two different surveys on the health status of Austrian inhabitants, in which several questions on chronic diseases were included, the “Austrian Health Survey 2006/07” and the Labour Force Survey ad hoc module “Health problems and employment” in 2011 (which also included the relationship between chronic diseases and employment).
In the 2011 survey, one question related to “permanent health problems and chronic diseases”, in which “permanent” was defined as “at least of six months duration”. The list includes the following health problems and chronic diseases:
- problems with arms and hands (including arthritis and rheumatism)
- problems with feet and legs (including arthritis and rheumatism)
- problems with the back or neck (including arthritis and rheumatism)
- skin diseases, including allergic reactions and severe disfigurement
- problems with the heart, blood pressure and circulation
- problems with the chest or with breathing (including asthma and bronchitis)
- problems with the stomach, liver, kidney or digestion
- epilepsy (including epileptic fits)
- severe headaches, such as migraine
- learning difficulties when reading, writing or calculating
- chronic anxieties (such as panic attacks)
- further nervous or mental problems (such as schizophrenia, affective disorders, anorexia, burn out)
- further progressing diseases (including multiple sclerosis, HIV, Alzheimer’s disease, Parkinson’s disease)
- further longlasting health problems (including obesity, alcohol and drug dependency)
In the (earlier) survey of 2006/07, chronic diseases are defined as “diseases of long duration”. A list of 18 chronic diseases and health problems includes:
- spinal problems
- high blood pressure
- migraine, frequent headaches
- arthrosis, arthritis, joint rheumatism
- chronic anxiety, depression
- gastric and intestinal ulcer
- urinary incontinence
- chronic bronchitis, emphysema
- allergic asthma
- different form of asthma
- apolectic stroke, cerebral hemmorhage
- myocardial infarction
1.2. Information on national sources of statistical information dealing with the issue of chronic diseases and their relation to employment and working conditions
There is only one statistical survey which has dealt with the issue of chronic diseases and their relation to employment and working conditions in the last decade in Austria, the Labour Force Survey ad hoc module “Health problems and employment” 2011 (Erwerbstätigkeit von Menschen mit gesundheitlichen Beeinträchtigungen) performed by Statistics Austria. As mentioned above (1.1), in one question the occurrence of “permanent health problems and chronic diseases” is asked, in which “permanent” is defined as “at least of six months duration”. The list includes the above mentioned health problems and chronic diseases (see 1.1).
The following questions in relation to employment and working conditions are included in the survey:
- Are you limited in the number of hours you can work per week due to your health condition?
- Are you limited in the kind of work and activities due to your health condition (e.g. problems with carrying heavy loads, working outdoors, sitting for a long time)?
- Are you limited in getting to and from work due to your health condition?
- Does your workplace have special equipment (e.g. voice computer) or workplace adaptations (e.g. access ramp) due to your health condition?
- Do you have special working arrangements (e.g. sitting while at work, specific working hours, telework, flexible hours or less strenous work) due to your health condition?
- Do you receive personal assistance due to your health condition in order to be able to work? If yes, who do you receive personal assistance from (colleagues, supervisors, parter, family members, relatives, friends, neighbours, social services and NGOs, other)?
- Have you ever received a confirmation of disability through one of the respective institutions in Austria, like the Federal Social Welfare Office (Bundessozialamt), the Old-Age Insurance Office (Pensionsversicherungsanstalt) or the Austrian Workers’ Compensation Board (AUVA) or any other body?
The survey was administered in the course of all four quarters in 2011 and the questions were asked following the questions of the labour force survey (microcensus). The basis for the sample was the central register of residents. A stratified random sample according to provincial state was drawn. The sample units were households, i.e. all members of a household (from 15 to 64 years of age) were asked via personal (face-to-face) CAPI interviews. Third-party interviews (i.e. one person answering the questions for another member of the household) were allowed. The sample totalled approximately 20,000 individuals.
Block 2: Prevalence, recent evolution and effects of the problem
2.1. People affected by chronic diseases and employment
In Austria, data on the situation of workers with chronic diseases is scarce. Thus, in the following section, the results of the above mentioned Statistics Austria survey of 2011 are reported, which can answer some, but not all of the bullet points (i.e. no data on typical employment trajectories, problems to access or stay in the labour market, problems and solutions for entreprises, changes in recent years).
According to the representative survey, a total of 2.7 million persons (i.e. 46.8% of the working-age population of 15-64 years) were health-impaired in 2011. Of these, 2.4 million persons (or 41.6%) had at least one permanent health problem. Considering the above mentioned definition of ‘permanent health problem’ used in the survey, this number can be related to persons with chronic diseases. About 1.3 million persons (corresponding to 23.5% of the working age population) had at least one limitation in their daily activities and 1 million persons (or 18.2%) had both a permanent health problem and a limitation in their daily activities. In an earlier survey module in 2002 on the employment of people with impairments at work, only 12.6% of the population (685,000 persons) aged 15 to 64 reported having permanent health problems. Thus, the number of persons reporting at least one health problem lasting for more than six months has more than tripled within less than a decade. However, due to differences in the wording of the two questionnaires, the results are not comparable. While in the 2002 survey, only one question was asked on the presence of long-standing health problems, the respondents in the 2011 survey were presented with a list of possible permanent health problems, which makes respondents more likely to report on them.
The most frequent health problems and limitations turned out to be back problems. Some 22.9% of individuals of working age reported such problems, followed by 11.8% with leg or foot problems, 10.9% with cardiovascular disorders, 8.8% with problems affecting arms and hand, 6.6% suffering from migraine or strong headaches, 5% having skin conditions or allergic reactions and another 5% having problems affecting the digestive system or respiratory tract. Some differences in the prevalence of chronic diseases and health impairments according to gender are observable: Women are more frequently than males concerned by back problems (23.9% vs. 22%), by problems with arms and hands (9.6% vs. 8%), by heavy headaches like migraines (8.8% vs. 4.3%), by skin conditions and allergic reactions (6% vs. 4.8%), by depression (4.1% vs. 2.7%), by chronic anxieties (2.3% vs. 1.4%) and by cancer (1.3% vs. 0.8%). On the other hand, males are more concerned by problems with legs or feet (12.1% vs. 11.5%), by cardiovascular problems (11.3% vs. 10.4%), by problems with the chest and breathing (4.9% vs. 4.5%), and by diabetes (2.4% vs. 1.8%).
The survey shows that the presence of health impairments has a significant impact on employment and employment rates. The employment rate of people with health impairments is significantly below that of non-impaired individuals: While the employment rate of health-impaired 15-64 year old persons was at 67.2%, it was at 75.8% among those with no health condition in 2011. Even though all age groups were affected by this difference, it rose with increasing age. While the employment rates of persons with a health impairment and those with none were about the same in the age group of 15-24 year olds, the difference was at 2.8 percentage points among the 25-34 year old age group, and rose to 6.2 percentage points among the 35-44-year old age group and to 9.7 percentage points among the 45-54 year old age group. The difference in employment rates between health impaired and healthy persons is prevalent among both men and women; however, it is more pronounced among the male group.
When looking at employment rates of persons with health impairments, one has to take into consideration that health impairments are more frequent with increasing age, and thus non employed persons – among them retirees – are more frequently concerned. Thus, the following results were corrected for age: 69.2% of persons with a health impairment are employed, 4.2% are unemployed and 26.7% are non-employed. The share of employed persons is especially low among persons with mental health impairments as compared to persons with other health impairments. About a third (33%) of persons with anxiety and 35.3% of those with a depression were employed when the survey was conducted, as compared to 68% of those with a skin condition or with back problems.
Among all persons with a health condition, 3.6% were unemployed, whereas the rate among those with no health impairment was at 2.7% when the survey was conducted. When comparing the length of unemployment, it can be observed that persons who have a health condition are more frequently concerned by long-term unemployment than those with no health impairment (43% of all health-impaired unemployed are long-term unemployed, whereas the rate lies at around 15% among those unemployed with no health condition).
Health impairments are not evenly distributed among all occupations and job positions. The results show that employees with chronic diseases are most frequent in the agricultural sector (57.5% of all employed persons in the sector are concerned by chronic diseases, with problems with the musculoskeletal system ranked first, by which 37.5% of all sectoral employees are concerned), in unskilled labour (52.8%, about a third of all sectoral employees being concerned by back problems) and among employees who are operating machinery (50.9%, about a third of these employees being concerned by back problems). On the other end of the spectrum, technicians and employees in similar non-technical occupations are least concerned by chronic diseases (35.9%), followed by academic and comparable occupations (36.6%), managers (38.2%) and office workers (39.8%). Generally speaking and not surprisingly, employees engaged in manual work are more frequently concerned by chronic health issues and health impairments than white-collar workers.
2.2. Working conditions of employed people affected by chronic diseases
Data on working conditions of employed people affected by chronic diseases in Austria is scarce. Thus, only few of the bullet points can be satisfactorily answered in the following section with the information taken again from the above mentioned 2011 survey conducted by Statistics Austria.
As mentioned in the last paragraph of 2.1, certain occupations are associated to specific chronic diseases, according to the results of the survey. In the following, reported sector-specific (NACE economic activities) health impairments with above-average rates of chronic diseases are reported for both those currently or (in case of unemployment or retirement) previously employed 15-64 year old persons in the sector:
In the agriculture, forestry and fishing sector, 37% report chronic problems with the back or neck (overall average across all sectors: 22.9%), 22.4% report chronic problems with legs and feet (average: 11.8%), 20.5% of (former) employees report chronic problems with arms or hands (overall average: 8.8%) and 15.6% report chronic problems with the heart, blood pressure or circulation (average 10.9%).
In the manufacturing sector, all reported health impairments lie below the reported averages across all sectors. Problems with the back or neck are the most frequent health impairments in the sector, with some 22.6% reporting having problems in this area.
In the construction sector, above-average rates among problems with arms and hands (11.2%), legs or feet (13.6%) and back or neck (25.8%) are reported.
In the commerce sector, no above-average rates are reported. Problems with the back or neck are the most frequent health impairments (21.9%).
In the transportation and storage sector, above-average rates are reported with regards to chronic problems with the back or neck (27.9%) and cardiovascular diseases (13.4%).
In the accommodation and food services sector, problems with arms or hands (9.5%), legs or feet (13.8%) and skin conditions (5.6%) among its (former) employees are above the overall average. Problems with the back or neck are reported most frequently (21.8%).
In the information and communication sector, reported health problems lie below the overall average. Also here, problems with the back or neck are reported most frequently (19%).
The same applies to the financial and insurance activities sector, with chronic back or neck problems being reported by 18.7% of (former) employees, as well as to the sector ‘professional, scientific and technical activities’, where some 17.2% of (former) employees report such problems.
Persons (formerly) engaged in administrative and support service activities are concerned with a greater than average frequency by strong headaches (12.3% with the average being 6.6%), cardiovascular problems (15.8%) and back or neck problems (29.7%).
In the sector public administration, defence and compulsory social security, above-average rates concerning back or neck problems (27.2%) and cardiovascular diseases (11.9%) are reported.
In the education sector, skin conditions (6.9% vs. 5.4% overall) and strong headaches (7.5% vs. 6.6% overall) with above average rates are reported.
In the human health and social work activities, problems with the back and neck (25.7%) and cardiovascular diseases (11.3%), as well as strong headaches (6.9%) and problems with the stomach, liver, kidney or digestion (5.7% vs. 5.3% overall) are over-represented among its employees.
Based on these (descriptive) quantitative data, no correlation between the sector and the encountered health problems can be proven. However, as mentioned in 1.1, work-related and occupational diseases have been defined clearly by the General Social Insurance Act and persons who encounter occupational diseases are compensated for by the statutory accident insurance. In the list of occupational diseases (see 1.1), clear relations between certain health issues and types of companies are assumed.
According to the survey results, 5.9% of all employed persons are limited in the amount of hours they are able to work due to their health condition(s), 1.6% of all employed persons (1.5% of employed females and 1.8% of employed males) report that they have specific work arrangements due to their health condition. This means that the work situation and environment is being adapted to the health needs of the respective employee so that he/she is enabled to work. Measures include having a job with primarily sedentary activities, reduced hours, the possibility to schedule the working time flexibly, telework, less strenuous activities and other (non specified) specific arrangements.
No information on career and employment security, skills development and changes in working conditions of employees with chronic diseases in recent years is available.
Block 3: Policies and measures adopted by public and private agents to favour the employment situation and working conditions of people with chronic diseases
3.1. Description of main policy measures/initiatives developed by public authorities or social partners
In 2011, the Work and Health Act (Arbeits- und Gesundheitsgesetz) was implemented in Austria at the national level. Within its framework, a prevention and early intervention programme called ‘fit2work’ was installed, which is a low-threshold, free-of-charge consulting service (including case management, if opted for) for employees whose job is endangered due to health problems or for persons who have difficulties finding employment due to their health condition. Since 2013, the programme has been available in all nine federal provinces of Austria. fit2work is open for all employees facing health problems, no matter if they are chronic diseases or not, and of all age groups. The aim of the programme is to prevent morbidity and disablement and thus an early exit from the labour market and to sustainably secure the employability of health-impaired persons. The programme is open for both individual workers and unemployed persons, as well as for companies. It is targeted at
- employees taking long periods of sick leave or having a physical or mental impairment;
- unemployed people with a medical impairment or who are at risk;
- works councils; and
- companies (especially those with a high prevalence of illness-related absences).
The programme does not create a new framework of measures – instead, it acts to increase awareness of existing measures provided by various authorities and institutions and to link them to increase their use and thus acts as a one-stop shop for concerned employees. It seeks to intervene at an early stage when there are signs that someone could be prevented from employment soon due to their health problem(s). Workers are provided with information and consultation on all support and preventive measures with an individual case management (AT1110011I).
The programme was prepared by the social partners and government. Preparations for the programme started in mid-2009; three federal provinces (Styria, Vienna and Lower Austria) piloted the project from 2011 onwards and by the beginning of 2013, nationwide coverage in Austria’a all nine federal provinces was reached.
The programme is financed through the Public Employment Service (AMS), the regional health insurance funds (GKK), the Pensionsversicherungsanstalt, the AUVA and the Bundessozialamt. For 2013, the budget allocated by the government for fit2work lies at EUR 5 million. It is to be increased to EUR 10 million in 2014 and EUR 15 million in 2015 and 2016 each, adding up to EUR 45 million for the period 2013-2016 (cf. BMASK 2013: 482).
The number of employees, unemployed and companies using the fit2work programme naturally increased between 2011 and 2013 with more regional provinces having implemented the measure. In 2013, the first year of nationwide coverage, over 17,000 persons received basic information on the programme; 9,319 received first consultations; 4,353 persons started case management; 2,324 persons finished their case management; 2,467 persons were in the process of receiving case management in the course of 2013; and 265 companies received basic information on the programme (cf. Fit2work Jahresbericht 2013). The high motivation and high readiness for cooperation with case managers is seen a success factor of the programme, as well as the cooperation with the AMS and the openness to all potential target groups due to the programme being voluntary and free of charge. However, the commitment of companies towards health promoting measures is to be increased; clients of fit2work have often reported that they are overstrained health wise, but that they would not dare to talk about their problems to their employer – this concerns especially the older age group of workers of 50 years and older. Furthermore, the programme is not yet that well known in all regions of Austria, which also has to do with the fact that the programme is fairly new (cf. ibid.). According to earlier pilot projects, about two thirds of employees who have received consultation can better manage and cope with their work afterwards. These employees feel less limited and restricted in their work and see their (new) tasks as less strenuous. Around a quarter of the consulted persons could keep their jobs, and more than 40% of formerly unemployed found employment again after the consultation (cf. IOS Management, fit2work Argumentarium ArbeitnehmerInnen/Arbeitslose).
3.2. Examples of enterprises and/or collective agreements implementing initiatives or establishing clauses to support people with chronic diseases
No specific initiatives to support personnel affected by chronic diseases by individual companies or such clauses in collective agreements could be identified. With the implementation of the fit2work programme (see 3.1), companies and concerned employees now both have access to free of charge consultation and case management which includes being consulted on support measures for personnel affected by chronic diseases.
More than 40% of the working age population in Austria is concerned by permanent health problems. This naturally has an impact on the employment situation, which is reflected by considerably lower employment rates of those with health impairments (67.2% vs. 75.8% among those with no health impairments). In order to prevent workers from an early exit from the labour market, the government has implemented (after preparations by the social partners) an early intervention and prevention programme nationwide in 2013. The target groups of the measure are not only employed persons endangered from performing in their jobs, but also unemployed with health impairments, as well as companies. While the programme so far shows considerable popularity among concerned individuals, this is not (yet) the case for companies. It is thus necessary to raise employers’ awareness for employment- or job-related health problems and impairments and encourage them to seek consultation targeted towards improving the situation or potentially abolishing structural employer-related causes (e.g. working culture of long hours, high flexibility demands, low planning security, and so on).
BMASK (2013): Aktive Arbeitsmarktpolitik in Österreich 1994-2013, Vienna.
fit2work Jahresbericht (2013)
IOS Management, fit2work Argumentarium ArbeitnehmerInnen/Arbeitslose (2013)