- 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.
The study justifies why the term a “chronic disease” is applied in Slovakia with a term “disability” interchangeably. In this line agenda on employment opportunities for people with chronic diseases is presented as the agenda of national disability related employment policy being embodied in the general Labour code, legislation aimed on employment services or social insurance. The author brings some evidence about still only a poor employment situation of persons with disabilities in working age (majority of them gain status of inactive persons) despite current political effort to change it. Consequently, some conditional factors to clarify the unfavourable situation are offered.
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?
There is no explicit definition of chronic diseases in an employment context in Slovakia. The applied definition refers to terms disability and both terms “chronic disease” and “disability” will be utilised in the questionnaire interchangeably.
- What are the sources of these definitions (legislation, statistical sources, administrative documents, social security/health insurance systems)?
The Labour Code (Act No. 311/2001 Coll. as amended) applies a term employee with a disability (zamestnanec so zdravotným postihnutím). Specification is constituted by Act on employment services (Act No. 5/2004 Coll. as amended) which applies a term person with a disability (občan so zdravotným postihnutím) and Social insurance act (Act No. 461/2003 as amended) with a term invalid (disabled) person. A person is invalid (disabled) when due to unfavourable health status his/her earning capacities are decreased longer than a year more than 40% in comparison to healthy person.
- What concrete chronic diseases are included in these national definitions?
According the Report on health situation of citizens in years 2009-2011 (Správa o zdravotnom stave obyvateľstva v rokoch 2009-2011) among prioritized chronic diseases in Slovakia belonged in 2011 circulatory system diseases, tumors, diabetes mellitus, respiratory system diseases, digestive system diseases and mental health disorders.
Social insurance act constitutes, in Annex 4, totally 15 chapters in which the chronic diseases are ordered. There are three main health reasons leading to partial or full invalidity in Slovakia: muscular diseases, circulatory diseases, and mental health disorders. Severe disabilities are associated most often with tumors.
1.2. Information on national sources of statistical information dealing with the issue of chronic diseases and their relation to employment and working conditions
- Výsledky výberového zisťovania pracovných síl (Labour Force Sample Survey Findings), responsible body – the Statistical Office of the Slovak Republic (ŠÚ SR)
Used definition: disabled employed, disabled unemployed
Categories of chronic diseases are not specified
Questions: numbers of disabled employed and unemployed
Methodology: based on data provided by Social insurance agency
- Doplnkový modul za 2. štvrťrok 2011: Zamestnanosť osôb s dlhodobým zdravotným problémom (Ad-hoc module 2011: Employment of disabled people), responsible body – ŠÚ SR
Used definition: person with a disability/long-term health problem
Categories of chronic diseases: as most prevalent were problems with back or neck (23.4%) and heart, blood pressure or circulation problems (25.2%).
Questions: numbers of disabled employed, unemployed and inactive people; the employed by economic activity and occupation; employed by work limitation and work adjustment needs; main reasons for work limitations not caused by a disability (chronic/ longstanding health problem)
- Správy o sociálnej situácii obyvateľstva Slovenskej republiky (Reports on the social situation of population in Slovakia), responsible body – Ministry of Labour, Social Affairs and Family of the Slovak Republic (MPSVR SR)
Used definition: person with a disability as a disadvantaged job seeker
Categories of chronic diseases are not specified
Questions: number of persons with disabilities in a special register; number of disabled recipients of employment services schemes
Methodology: based on register of job seekers and persons who are provided with schemes for job seekers (general schemes and special disability related schemes)
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
EU-SILC monitoring is only one source about incidence of self-reported chronic diseases among adult population in Slovakia. Evolution in period 2008-2012 is illustrated in following graphs.
Graph1: Incidence of chronic diseases among adult population in Slovakia by gender – developments in period 2008-2012
Source: Zisťovanie o príjmoch a životných podmienkach domácností v SR (roky 2008, 2009, 2010, 2011)
Constantly around one third of the adult population reported in period 2008-2012 suffering by chronic diseases, while women have been consistently higher represented (by 7%-9% over men).
Graph 2: Incidence of chronic diseases among adult population in Slovakia by age – developments in period 2008-2012
Source: Zisťovanie o príjmoch a životných podmienkach domácností v SR (roky 2008, 2009, 2010, 2011)
Prevalence of chronic diseases grew up by respondents´ age, mainly among population 65+ and most rapidly among population 75+ (more than 80% of the 75+ population reported suffering by a chronic disease). Developments in the monitored period were practically stabilised. There was only one exception of a decrease by 4% between 2011 and 2012 in age category 65-74 without no valid evidence to clarify it.
- 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)?
In general, employment situation of persons with disabilities has been longstanding very poor in Slovakia when in period 2005-2011 only around 10-12% of those in age 15-64 were employed, 3-5% of them were registered as unemployed jobseekers and almost each of the ninth out of ten of persons with disabilities in working age gained status of the inactive (Repková and Kešelová, 2012). In 2013, the employment rate of persons with disabilities remained still very low, when only 13.2 % of them were employed compared to 65% in total population (http://portal.statistics.sk/files/vzps132_publikacia.pdf).
- Are certain chronic diseases associated to or more prevalent in certain economic sectors/occupations?
According Ad-hoc module 2011 "Employment of disabled people in 2nd quarter 2011", totally 301,500 persons with disabilities were employed, most often in sectors as manufacturing (24%), wholesale and retail trade (12%), education (9%), public administration and social security (8%), transportation and storage (7%) and health and social care (7%) (http://portal.statistics.sk/files/publikacia_vzps114-ahm112.pdf). There is no evidence about association of certain chronic diseases (disabilities) to certain economic sectors.
- What are the typical employment trajectories of workers affected by chronic diseases? (entry/exit patterns)
That depends on an employment history of a certain person with a disability. When chronic disease (disability) is caused by serious work-related injury or illness the typical trajectory leads to an invalidity (disability) and disability pension entitlements. Requalification and rehabilitation schemes which are a part of the injury insurance system have been, up to now, not applied.
For the “new-comers” (young persons with disabilities after graduating education and vocational preparation) work two typical trajectories: (1) one leads to inactivity with an invalidity (disability) pension entitlements, (2) another leads to work in a sheltered setting supported by public measures.
- What are the main difficulties/problems for people with chronic diseases to access or stay in the labour market?
Very high general unemployment rate in Slovakia (in 2012, about 14% of general population in working age) and a general lack of appropriate job opportunities (Ad-hoc module 2011); low trust of general population in working abilities of persons with disabilities; only a poor self-confidence of persons with disabilities; barriers in general and working environment (Analýza potrieb a charakteristík osôb so zdravotným postihnutím z hľadiska Dohovoru o právach osôb so zdravotným postihnutím, 2011).
- What are the main difficulties/problems for enterprises with workers affected by chronic diseases? What solutions do enterprises adopt to deal with these workers affected by chronic diseases?
Low trust of employers in work abilities and performances of persons with disabilities; a fear of very often absence in work due to chronic disease; necessity to adjust working place to fit their needs; necessity to offer and ensure training to perform a job and demanding occupational safety conditions; a poor level of information about public schemes supporting possibilities to employ persons with disabilities (Pavlíková and Kondášová, 2002; Hanzelová et al, 2007).
- Are there differences in the previously mentioned patterns by types of chronic diseases or groups of pathologies? are there differences according to age or gender
Researchers found out that professionals working at labour offices used to expect more problems by persons with multifaceted diseases and mental and behavioural disorders; vice versa, no serious problems expected by persons with physical disabilities (Kostolná, Z. et al, 2007).
- Is it possible to identify some changes in the previously mentioned patterns in recent years?, reasons for this and possible specific effects of the economic crisis
Above mentioned main reasons to problematize employment of persons with disabilities from enterprises´ side have been not dramatically changed over recent years (those of them which were identified by Pavlíková and Kondášová, 2002 and also Hanzelová et al, 2007).
Due to economic crisis a general unfavourable un/employment situation in Slovakia was escalating (14% of unemployment rate for a general working age population in 2012). On the other hand, since 2009 employment rate of persons with disabilities went slightly up, from ca 9% in 2008 up to ca 13% in 2013. However, the general development in employment rate of persons with disabilities remained still very poor up to days.
2.2. Working conditions of employed people affected by chronic diseases
Persons with chronic diseases (disabilities) are recognised as a special group of employees in terms of employers´ obligations in occupational safety and health (OHS) field (Act No. 124/2006 Coll. on Occupational safety and health as amended). They have obligations to offer employees such job positions and working conditions which correspond with their health status, age or qualifications. Comprehensive studies (reports) on working conditions of persons with disabilities are missing. Even so, the labour inspectorates have not conducted in previous years reviews aimed explicitly on this question.
There are only some small sampled research studies - for instance, a qualitative research conducted by Kordošová (2012). The author found out that employees with disabilities were exposed by only small or middle scaled working risks accompanied by necessary training to prevent breaking of their working safety. Employees with disabilities were aware of importance of the appropriate working conditions and preventive OHS measures at working place and a majority of them evaluated their working conditions as satisfied.
There is no evidence about association of certain chronic diseases (disabilities) to certain economic sectors or type of jobs.
- 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.?
According labour legislation (the Labour Code), all employees regardless of their health status are entitled for seven days per year to attend medical treatment. Moreover, there is possibility to negotiate with employers atypical work arrangement, part-time job or telework, for instance. In 3rd quarter 2013, about 1.5% of general working population worked in part-time regime (more often men and self-employed persons) and about 8.4% worked regularly or partially as teleworkers (more often women). About 7% of workers worked in temporary, causal or seasonal jobs (more often men). There is no specific information about utilising of atypical work arrangements among workers with chronic diseases (http://portal.statistics.sk/files/vzps133_publikacia.pdf).
- 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?
When people with chronic disease (disabilities) are employed they gain all employment rights as general employed population.
Special rules pay for a concurrence of invalidity pension and work remuneration. According the valid Slovak legislation, persons gaining status of invalid (disabled) persons according the Social insurance act are entitled for invalidity (disability) pension what does not prevent them to perform a full/partial job and to be fully/partially remunerated. Nevertheless, only a very small part of disabled persons utilise this possibility as of a very low employment rate of this population.
Hanzelová, E. et al (2007) were interested in strategies of employers in a case of worsening employees´ health status. They found out that majority of reviewed employers tended to offer such employees a new job position and related necessary training rather than an adjustment of the original workplace and career position.
- 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?
As showed some research findings employers principally declared preparedness to ensure training opportunities and life-long job-related learning for their employees with disabilities. On the other side, they did not have real interest to care for improvement of job-related skills of such employees because of only a poor own education policy for all employees and only a low effectiveness of sources expended for a such purpose (Hanzelová, E. et al, 2007).
- Are there any significant differences in these working conditions according to different groups of affected workers (type of disease, gender, age, sector, etc.)?
There is no evidence about the question.
- Are there any significant changes in recent years? Possible effects of the economic crisis on these situations, if any.
Economic crisis did not explicitly lead to general worsening of employment situation of persons with disabilities in terms of their employment rate or a scope of public support within employment services. Total expenditure of public sources, both the national and the ESF, increased in period 2005-2011, mainly when speaking about support of establishing sheltered workshops or sheltered workplaces (Repková and Kešelová, 2012).
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
All labour related rights are guaranteed in Slovakia for all without any exception on ground of (except of others) unfavourable health status or a disability (Labour Code, Act No. 311/2001 as amended). Employers are obliged to provide employees with chronic diseases or disabilities with all necessary training and study opportunities to gain a requested qualification and to improve their job related skills.
Act No. 5/2004 Coll. on employment services as amended constitutes two sets of supportive employment measures: (1) measures (schemes) for general population of unemployed job seekers (including job seekers with disabilities; (2) special measures (schemes) determined only for those who gain status of persons with disabilities according Social insurance act. For the latter group the National project “Employing of persons with disabilities” is running.
- Objectives pursued (staying-in-work/return-to-work), support offered, activities carried out
Objectives of the public employment policy is to better employment situation of persons with disabilities, to increase their employability (qualifications, job skills) and real chances to find and retain a job. On the other hand, there is an ambition to encourage labour market (employer) to utilise a mass working potential of persons with disabilities.
In line of the mentioned objectives a comprehensive set of measures stays at disposal:
- Quota system – each employer who employs at least 20 employees is obliged to employee 3.2% of workers with disabilities
- Supportive financial schemes: contribution to establish sheltered workshop or sheltered workplace; contribution to retain a job; contribution to establish and to run a self-employment; contribution for running sheltered workshop or sheltered workplace; contribution for job assistant
- Other supportive schemes: job preparation of a person with disability; Supported employment agencies; Counselling and informational centres
- Specific target groups
Unemployed job seekers with disabilities; employed persons with disabilities in order to retain a job; employers who want to employee persons with disabilities. For instance, providing them with all appropriate information related to supportive public schemes, diagnostic of working potential of disabled job seekers, mediation between employers and employees with disabilities, their support in a phase of adaptation at certain working place.
- Financing of the measures
Combination of sources from national state budget and the ESF. In period 2011-2013 totally €29.2 million. has been estimated to utilise from the ESF. It covers majority of expenses necessary for implementing the planned public support.
- Outcomes: major results/consequences of the measure on the improvement of working conditions of people with chronic diseases.
In 2012 contributions aimed to establish sheltered workshop or sheltered workplaces and to cover their running costs were as the most popular schemes. More than 2,000 persons with disabilities were supported within the sheltered working environment and over 8,500 employment subjects were supported to cover their running costs related to the sheltered workplaces. Expenditures were covered primarily from the ESF sources, its operational program “Employment and Social Inclusion”.
- Assessment (lessons learnt, future prospects)
Public schemes aimed to support employability and employing of persons with chronic diseases/disabilities in Slovakia are fragmented, procedures to apply for them are administratively demanding, what can be discouraging for all interested stakeholders - persons with disabilities, their potential employers, staff of labour offices and involved supported agencies. Moreover, a majority of expenditures utilised for implementation of the mentioned schemes comes from the ESF what can be risky from a future perspective.
- Link to the identified measure/initiative
Link to the national project II-2/A (all Slovak regions without region Bratislava):
Link to the national project II-2 (region Bratislava):
Report on active labour market measures 2012: http://www.upsvar.sk/statistiky/aktivne-opatrenia-tp-statistiky/aktivne-opatrenia-trhu-prace-2012.html?page_id=153418
Slovakia has been participating in the campaign ‘Promoting Healthy Work for People with Chronic Illness’ being organised by the European Network for Workplace Health Promotion (ENWHP). The Slovak National Contact Organisation is the Department of the Normal and Pathological Physiology of the Slovak Academy of Science (UNPF) (link: http://www.enwhp.sav.sk/index.php/en/aktualne). Another link: http://www.enwhp.org/enwhp-initiatives/9th-initiative-ph-work/national-campaigns.html).
3.2. Examples of enterprises and/or collective agreements implementing initiatives or establishing clauses to support people with chronic diseases
In period 2010-2013 the Company IBM Slovakia in cooperation with the Slovak Disability Council implemented a project “Education of persons with disabilities for better labour market enforcement” (Vzdelávanie osôb so zdravotným postihnutím pre lepšie uplatnenie sa na trhu práce). There was a goal to increase chances of persons with disabilities to get a job at open labour market by increasing their English language and ICT skills. Only a condition to gain English language at a communicative level or to gain a basic PC skills, was stated. Totally of 37 persons with disabilities were interested out of which 14 were selected to attend the trainings. Some of the education (trainings) participants stayed to work in the IBM Company.
What concerns collective agreement initiatives, according the national legislation employers are obliged to employ persons with chronic diseases (the quota system). That might be a reason why they are not encouraged to constitute special conditions and rules in collective agreements or to make this issue a particular aspect of a collective bargaining. Even so, representatives of the national umbrella organisations (National Union of Employers (RUZ SR) and Trade Unions Confederation (KOZ SR) used to state that un/employment situation of a general working age population is so unfavourable and serious that there is no reason to be interested particularly in employment situation of persons with chronic diseases (disabilities).
Undoubtedly, Slovakia has developed an extensive political effort to improve employment situation of persons with disabilities, mainly by implementation of active labour market measures. Nevertheless, absolute majority of them has stayed out of the labour market in the inactive status relying on disability pension as a main pillar of their income. We can assume several reasons, namely an unfavourable employment situation of the general working age population in Slovakia; a lack of interconnectivities between disability entitlements, work remuneration and labour market incentives in line to support an integrative rather than compensatory effects; prejudices about working capacities of persons with disabilities, mainly among employers; administrative obstacles to gain public support schemes flexibly.
Analýza potrieb a charakteristík osôb so zdravotným postihnutím z hľadiska Dohovoru o právach osôb so zdravotným postihnutím (Analysis on needs and characteristics of persons with disabilities in perspective of the UN Convention of human rights of persons with disabilities). Bratislava: Národná rada občanov so zdravotným postihnutím v SR. 2011.
Doplnkový modul za 2. Štvrťrok: Zamestnanosť osôb s dlhodobým zdravotným problémom (Ad hoc module 2011 Employment of disabled people). Bratislava: Štatistický úrad Slovenskej republiky. 2011. Available at: http://portal.statistics.sk/showdoc.do?docid=47328
Hanzelová, E. et al (2007) Občania so zdravotným / zrakovým postihnutím v optike postojov a názorov zamestnávateľov (Citizens with disabilities / visual impairments in optics of employers´ attitudes). Bratislava: IVPR.
Available at: http://www.sspr.gov.sk/IVPR/images/IVPR/SIZAR/SIZAR2.pdf
Kordošová, M. (2012) Bezpečnostná úroveň pracovných podmienok vybraných skupín zamestnancov (Safety level of working conditions for selected groups of employees). Trnava: MTF STU v Trnave. Dizertačná práca.
Kostolná, Z. et al (2007) Verejné služby zamestnanosti a občania so zdravotným /zrakovým postihnutím (Public employment services and citizens with disabilities / visual impairments). Bratislava: IVPR.
Pavlíková, E. and Kondášová, A. (2002) Analýza doterajších skúseností subjektov vstupujúcich do procesu zamestnávania osôb so zdravotným postihnutím (Analysis on current experience of subjects entering process of employing persons with disabilities). Bratislava: Výskumný ústav práce, sociálnych vecí a rodiny.
Repková, K. and Kešelová, D. (2012) Chránená práca pre občanov so zdravotným postihnutím v EU a odporúčania pre Slovenskú republiku (Sheltered employment for persons with disabilities in the EU and recommendations for Slovakia). Bratislava: IVPR. Available at: http://www.ivpr.gov.sk/IVPR/images/IVPR/vyskum/2012/Repkova/repkova_2408.pdf
Správa o zdravotnom stave obyvateľstva v rokoch 2009-2011 (Report on health situation of citizens in 2009-2011). Bratislava 2012. Available at: https://lt.justice.gov.sk/Attachment/vlastny_material.pdf?instEID=1066&attEID=46924&docEID=253424&matEID=5328&langEID=1&tStamp=20120917112625213
Zisťovanie o príjmoch a životných podmienkach domácností v SR: EU-SILC 2008, 2009, 2010, 2011, 2012 (Monitoring of households´ income and living conditions in Slovakia: EU-SILC 2008, 2009, 2010, 2011, 2012). Available at: http://portal.statistics.sk/showdoc.do?docid=24731)
 Based on consultations with representatives of the mentioned umbrella organisations.