- Observatory: EurWORK
- Labour market policies,
- Health and well-being at work,
- Working conditions,
- 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.
Official statistics for the year 2011 indicate that, in Romania, 1.7 million persons suffered from chronic diseases, and that almost a quarter of them - 400,000 - were in employment. Employment of chronic patients has not been addressed by special legislation, their problems are covered by the regulations that govern disabled persons. The employment of chronic patients has not been a topic of prime concern for the organisations of the social partners. The rights and interests of disabled chronically ill persons are defended mostly by non-government organisations.
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
- What definitions of “chronic diseases” in an employment context are used in your country?
Chronic diseases are defined as afflictions causing health problems over long periods of time, or, in any case, no less than 6 months. The main feature of chronic diseases is that they are permanent, and require surveillance and treatment over a long time interval.
- What are the sources of these definitions (legislation, statistical sources, administrative documents, social security/health insurance systems)?
The source of the definition is the inquiry into the 'Employment of Disabled Persons', carried out by the National Institute of Statistics (Institutul Naţional de Statistică, INS), as a complementary module to the 'Household Labour Force Survey – Second Quarter 2011' (AMIGO).
- What concrete chronic diseases are included in these national definitions?
Long-time or chronic diseases include: afflictions of the arms, hands, legs, (thighs, shins, soles), back, and neck; cancer; skin diseases, severe mutilations, allergies; afflictions to the circulatory system (high blood pressure, heart diseases); afflictions of the respiratory tract (asthma, bronchitis); afflictions of the stomach, liver, kidneys, or digestive problems; diabetes; epilepsy; acute headaches, migraines; learning difficulties; persistent anxiety, depression, other mental, nervous or emotional health problems; progressive diseases (multiple sclerosis, HIV, Parkinson, Alzheimer, etc.); other long-term health problems.
1.2. Information on national sources of statistical information dealing with the issue of chronic diseases and their relation to employment and working conditions
- Are there national statistical sources (censuses, administrative registers, ad-hoc surveys on chronic diseases, working conditions surveys, other surveys, etc.) that analyse the issue of chronic diseases and their relation to employment and working condition? If so, identify them and provide information on the following issues (per identified information source if it is the case):
- What is the official name of this statistical source (in national language and translation into English) and its responsible body?
'Ocuparea persoanelor cu dizabilităţi/Employment of disabled people', conducted by the INS, as a complementary module to the 'Household Labour Force Survey – Second Quarter 2011' (AMIGO).
The National Institute of Public Health (Institutul Naţional de Sănătate Publică, INSP) of Romania makes a study every year on occupational morbidity, with data about persons in employment recorded as new patients.
INS made a study on 'Accidents at work and work-related health problems', in QII 2007 and QII 2013, as an additional module to AMIGO, which gives details regarding the physical and mental disorders caused or worsened at the work place.
These studies and inquiries do not include information on chronic diseases.
- What definition of chronic disease is used?
Chronic afflictions/diseases are those that generate long-lasting health problems or are expected to cause such problems for at least 6 months. They are permanent and require constant supervision and treatment.
- What are the categories of chronic diseases surveyed/registered?
The INS list of chronic diseases includes the diseases presented at point 1.1.
- What are the questions in relation to employment and working conditions?
The questionnaire used for this study consisted of the questions and multiple choice answers provided by the Commission Regulation (EU) No. 317/2010.
- What is the methodology used to collect the data?
The main purpose of the complementary inquiry was to obtain data on the rate of disabled persons in employment, by comparison to able persons in employment. The data collected are based on the respondents' self assessment.
The sample of respondents chosen for face-to-face interviews were persons in the age segment 15 to 64 years, residing permanently or temporarily in Romania, and being members of the households singled out for the AMIGO survey (26,740 households).
The non-response rate of the module was 2.32%.
- What information is provided?
The inquiry collected data regarding:
- Long-term health problems reported by respondents;
- Respondents' difficulties in carrying out basic activities;
- Limitations imposed by illness on the respondents' occupational life;
- The health care the respondents received or would have required.
- Other info (time frequency, origin of the info, etc.)
Block 2: Prevalence, recent evolution and effects of the problem of chronic diseases among workers and companies
2.1. People affected by chronic diseases and employment
The data available from the Ministry of Health (Ministerul Sănătăţii, MS), and the Coalition of Romanian Chronic Patients' Organisations (Coaliţia Organizaţiilor Pacienţilor cu Afecţiuni Cronice din România, COPAC) show that the total number of chronic patients on record in Romania is some 3.5 million persons, i.e. 16.6% of the entire population.
Of these, 1.7 million suffer from hepatitis B or C, 1 million suffer from diabetes, and 400,000 suffer from cancer.
The INS inquiry reveals that, in the Second Quarter 2011, in the age segment 15 to 64 years, (14.6 million persons), some 2.7 million (18.5%) are affected by at least one long-lasting health problem or complain of functional limitations of their capacity to perform certain activities.
The 2.7 million were divided into the following categories: 1.1 million people were exclusively suffering from long-lasting health problems; 186,717 persons were functionally limited by illness; and 1.4 million persons declared to be suffering from both long-term diseases and functional limitations.
- What is the employment situation of people with chronic diseases in your country (% of people in employment/unemployment/inactivity that are affected by chronic diseases)?
The same inquiry indicates that of a total employed population of 8.78 million persons in the age segment 15 to 64 years, some 1.76 million persons (12.3% of all) had at least one long-lasting health problem or functional limitations. Of these, 568,303 persons were afflicted exclusively by long - lasting health impairment; 118,000 were affected exclusively by functional limitations; and 389,613 persons claimed sufferings from both long lasting illness and functional limitations.
Among the unemployed, the share of individuals suffering from at least one long lasting health problem or functional limitation was 10.8%, and among inactive persons the share was 30.2%.
- Are certain chronic diseases associated to or more prevalent in certain economic sectors/occupations?
Of a total number of 373,768 disabled persons in employment, affected by persistent health problems, 55.3% of them were working in agriculture, 20.4% in manufacturing and constructions, and 24.3% in services.
The highest share (66.4%) of persons affected by diseases of the circulatory system was working in agriculture. It was also in agriculture that the largest numbers of employed people with various other sufferings were found: 60% of the patients with respiratory problems, 58% of persons suffering from stomach, liver, kidney or digestive disorders. Agricultural workers, again, came first with 55% of all the people in employment suffering from leg disorders (shin, soles, etc.).
- What are the main difficulties/problems for people with chronic diseases to access or stay in the labour market?
The conclusion of the inquiry was that of all the population aged between 15 and 64 and complaining of long-lasting health problems or various forms of malfunction, a share of 57.4% of them admitted that there were also other causes that limited their professional performance.
Among the causes, 26% of the respondents claimed personal reasons, 23.5% claimed the inadequacy of their job, 13.1% blamed it on family obligations, 9.7% ascribed it to the lack of appropriate training and experience, 8.4% said the limitation was due to the termination or reduction of certain welfare benefits, 6.2% was due to the lack of flexibility on the part of the employer, 1.7% said the cause was the lack of means of transport to and from work, and 11.4% invoked other reasons.
2.2. Working conditions of employed people affected by chronic diseases
The data available in 'Ocuparea persoanelor cu dizabilităţi/Employment of disabled people', (INS 2011) indicate that 30% of the disabled persons in employment received special health assistance for them to perform their professional duties.
The segment above was further divided into: 74.3% who received personal assistance, 47.7% benefited from special conditions at the work place, and 9.5% had special equipment and/or special adjustment to the workstation.
Most of the persons receiving special assistance (69.1%) were agriculture workers, 17.6% were working in services, and 13.3% were working in manufacturing and construction.
Only 29.9% of them were permanently employed.
In the group of persons receiving special assistance, 63.7% were full-time employees, and 36.3% were part-timers.
- Reconciliation of working and non-working life: are people with chronic diseases allowed special conditions in terms of work-life balance, flexibility at work to cope with the diseases/attend treatment, ability to set their own working time arrangements, etc.?
As it appears from the inquiry, the total number of disabled persons in employment found in the Second Quarter 2011 fell into the following categories: some 2/3 (61.6%) who said that their professional activity was limited by the type of work schedule for which they were employed, and 89.5% who stated that their professional activity was limited by the type of work they were doing.
Other 28.5% said that limitations arise from transportation problems to and from work.
- Career and employment security: to which extent and how is the employment status of people with chronic diseases affected by their health situation?; is there an impact in their remuneration levels/conditions?; in what measure is there a repercussion on their employment security and working career?; are they allowed/forced to changes in their jobs?
In the Second Quarter 2011, the total disabled population in employment was formed of: 40% employees, 37% self-employed, and 22% unpaid family workers.
In most of the cases, the limitation of professional activities for wage earners came from the type of work they could do (claimed by 88.5% of the wage earners), which shows that the status of employees depends on the type of work such persons are able/allowed to do; the next cause for limitation is the working schedule, which limits professional activities for 40% of the disabled wage earners.
- Skills development: in what measure have chronic diseases an impact in the access of workers to training activities promoted by the employer? Has the training anything to do with the disease situation?
The inquiry also shows that over 40% of the unemployed disabled persons had a low level of education, and 55.7% had high-school education.
One can say that there is a two-way cause-effect relationship between health and work: on the one hand, a poor health condition limits access to education and training, and, on the other, a lower level of skills and training narrows the chances to find a job, and, by consequence, the prospects of career advancement.
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
No formal information exists with regard to persons with chronic diseases. Such persons are included in the general measures and initiatives concerning disabled people.
a) The National Strategy for the Social Inclusion of Disabled Persons 2014-2020, in preparation by the Government of Romania (Guvernul României, GR), through the care of the Ministry of Labour, Family, Social Protection and the Elderly (Ministerul Muncii, Familiei, Protecţiei Sociale şi Persoanelor Vârstnice, MMFPSPV), was in the first months of 2014 still in the phase of public debate, and has national coverage.
At the beginning of June 2014, the Strategy was still in the project stage. In the following period will be completed and modified with the proposal and sugestions made by civil society organisations and parliament members', respectively: more concrete actions and resources to be identified, a clear demarcation of responsibilities between institutions involved, etc.
The Strategy proposes a number of steps to sustain the employment of disabled persons:
- develop the legal framework promoting and guaranteeing the rights and liberties of disabled persons with regard to their employment opportunities;
- put in place the supportive measures enabling disabled persons capable of work to be employed, to advance, and to stay in work;
- extend employment services to the categories of disabled persons who are capable to work, with a special focus on the most vulnerable groups (disabled youths and women; unemployed; persons in rural areas; persons with a criminal record, etc.).
- stimulate the employment of disabled persons by channelling social protection funds from the passive reserve to the domain of support services for vocational training, employment, and staying in work;
- render employment support through 'assisted work';
- stimulate employers in the public and private sectors to hire disabled persons;
- support disabled young entrepreneurs to start a business in the tertiary and secondary sectors in rural areas;
- encourage and support social businesses;
- support projects with finance from the European Social Fund (ESF), the purpose of which is the employment of disabled persons;
- promote social dialogue and partnership between entities that have a say in the employment of labour.
The money for all these actions will come from the state budget, the unemployment benefit budget, and the ESF.
b) Every year, the National Employment Agency (Agenţia Naţională de Ocupare a Forţei de Muncă, ANOFM) develops and carries out a National Employment Plan, for all the regions of Romania and all economic sectors, the aim of which is to find employment for all types of persons, including the disabled ones.
In 2010, 2011 and 2012, the ANOFM had to its credit the following:
- promoted active social inclusion measures for disabled persons capable of work, and found employment for 718 persons in 2010, for 815 in 2011, and for 612 persons in 2012;
- of those above, 218 persons were employed in 2010, 233 persons found employment in 2011, and other 184 persons in 2012, by way of subsidies granted to employers.
These measures were financed from the unemployment insurance fund.
ANOFM has 20 employment brokering and vocational counselling centres for disabled persons, of which 8 are the result of implementing a project for 'Counselling Services for Persons with Disabilities', with money from the World Bank (WB) (RO4616);
Starting from 2007, ANOFM has been in a partnership with Rumänienhilfe Alsterdorf, a Romanian - German Association working for the sustainable inclusion of disabled persons in the Romanian labour market.
c) The Sectoral Operational Programme for the Human Resources Development (SOP HRD) 2007-2013, Priority Axis 5, 'Promotion of Social Inclusion', has for a general aim to improve the inclusion of disfavoured groups, including disabled persons, in the labour market ('Annual Report of Implementation SOPHRD 2012').
Some of the specific activities financed: to promote the employment opportunities for disabled persons; support partnerships between entities involved in employment; increase awareness among employers with regard to the problems of persons afflicted by rare neurological diseases when they look for employment and wish to stay in it; create educational and training facilities assisted by modern information and communication technologies for the visually-impaired persons; provide support and accompanying services meant to increase the chances of employment for persons with intellectual disabilities.
In the time span 2009-2012, 15,628 disabled persons received social inclusion assistance through projects with ESF finance.
The measures taken under the SOP HRD, Priority Axis 3, 'Increasing the adaptability of workers and businesses', included 251 disabled persons, and the 'Active employment measures' taken under Priority Axis 5 included 797 disabled persons.
3.2. Examples of enterprises and/or collective agreements implementing initiatives or establishing clauses to support people with chronic diseases
The Protection and Rights of Disabled Persons Act 448/2006 provides that companies with 50 or more employees have the obligation to recruit at least 4% of their workers from among the disabled persons.
Failing this, the companies of this size have the following alternative options:
a) monthly payment to the state budget of an amount representing 50% of the gross national minimum wage for each job for which the company did not hire a disabled person;
b) purchase of products or services manufactured by disabled persons working in licensed protected enterprises (under the authority of the MMFPSPV), based on partnership, in an amount equal to that owed to the state budget according to (a) above.
Protected enterprises provide vocational training to disabled persons, for them to be able to find employment in other companies.
No information available regarding the protected enterprises activities.
Employment of chronic patients is not regulated by special legislation in Romania. The problems of the people suffering from chronic diseases are addressed in the legislation dealing with disabled persons. At institutional level, there are two non-government organisations promoting the rights and interests of disabled persons: the National Organisation of Disabled Persons in Romania (Organizaţia Naţională a Persoanelor cu Handicap din România, ONPHR), and the COPAC, which deals with chronic patients.
ONPHR, for example, conducted as beneficiary, the SOP HRD project for the period 2010-2013 regarding the 'Social Economy Network – a prerequisite for the inclusion of disabled persons in the labour market'. Its objective was to open three employment offices offering evaluation, counselling, brokerage, insertion, and maintenance in the labour market, and three cooperative associations, in three development regions (North-East, South-East, and South).
Through the projects implemented, COPAC lays the stress of its actions on the identification of consultation mechanisms between the public authorities and patients associations for the purpose of obtaining free access to medication and health services.
'Ocuparea persoanelor cu dizabilităţi/Employment of Disabled Persons– Second Quarter 2011', INS, Bucharest, 2013;
'Morbiditatea profesională în România 2012/Ocupational morbidity in Romania 2012', INSP, http://www.insp.gov.ro/cnmrmc/images/pdf/rapoarte/Morbiditate_profesionala_in_Romania_2012.pdf, Bucharest, 2013;
'Accidents at work and work-related health problems', QII 2007 and QII 2013, INS, Bucharest, 2008 and 2014;
'National Strategy for the Social Inclusion of Disabled Persons 2014-2020', MMFPSPV, http://www.mmuncii.ro/j33/index.php/ro/transparenta/proiecte-in-dezbatere/3191-2014-02-12-strategie-dppd, Bucharest, 2013;
'Annual Activity Report 2012 /Raport anual de activitate 2012', ANOFM, http://www.anofm.ro/files/raport%20de%20activ%202012.PDF, Bucharest, 2013;
'Annual Report of Implementation SOPHRD 2012/Raport anual de implementare POSDRU', MMFPSPV, http://www.fonduri-ue.ro/res/filepicker_users/cd25a597fd-62/Documente_Suport/Rapoarte/3_Rapoarte_POSDRU/03.09.2013/rai2012_-_POSDRU.pdf, Bucharest, 2013;
'Annual Activity Report Labour Inspection Office 2013/Raport anual de activitate al Inspecţiei Muncii 2013', IM, http://www.inspectmun.ro/site/RAPORT%20ANUAL/Raport_2013/RaportIM_2013.pdfBucharest, Bucharest, 2014;
INS official website, www.insse.ro;
MMFPSPV official website, www.mmuncii.ro;
ANOFM official website, www.anofm.ro;
IM official website, www.inspectmun.ro;
INSP official website, www.insp.ro.