Belgium: Employment opportunities for people with chronic diseases

  • Observatory: EurWORK
  • Topic:
  • Labour market policies,
  • Work organisation,
  • Disability and chronic disease,
  • Avalikud teenused,
  • Working conditions,
  • Social policies,
  • Published on: 20 November 2014



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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.

As there is no univocal definition of the term ‘chronic disease’ in Belgium, it is rather difficult to create a total view on the labour market situation of persons with chronic diseases in Belgium. The different sources report very varying numbers of persons having chronic diseases. Still, sources indicate the same trends: an increasing number of chronically ill persons, more risk of unemployment and less opportunities of a paid job for people with chronic diseases, a link with age, education level, occupations and gender. The Belgian labour market policy gives special attention to this target group, with protective legislation at the federal level and labour market activating measures at the regional levels.

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

The term ‘chronic disease’ in Belgium is not univocally defined and differs even within the employment context. 

For the services and institutions of Belgian social security, the term chronic disease is rather a synonym for ‘long term not at work due to disease’. Chronic disease is seen as a labour disability and the duration determines the right on the status of chronic disease (which has to be officially recognised in a medical attest). After fourteen days (for blue collar workers) or one month (for white collar workers) of sickness absence, a period of ‘primary labour disability’ starts in which the worker no longer receives his salary but a (lower) sickness-allowance paid by the Health Service. From the thirteenth month of labour disability on, the statute changes automatically in a statute of ‘disability to work’ (Belgium.be, the official information site).

In the labour market policy, the term ‘labour disability’, defined at the Vlaams Agentschap voor Personen met een Handicap (VAPH) and the Agence Wallonne pour l’Intégration des Personnes Handicappées (AWIPH), includes all persons having long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others (based on the UN- Convention on the Rights of Persons with Disabilities - 2006). The disability is not the medical or functional disorder as such, but the resulting participation problem.

Surveys often make use of ‘self-definition’: the respondents label themselves as (labour) disabled or chronically ill. Examples are the Health Interview Survey (HIS), the Survey on Living and Income Conditions (SILC) and the Labour Force Survey (LFS).

1.2. Information on national sources of statistical information dealing with the issue of chronic diseases and their relation to employment and working conditions

  • Data Warehouse Labour Market and Social Protection (LMSP)

The research project Handilab (2012) is especially focused on the socio-economic profile of people with chronic diseases (definition see 1.1) and is based on the Data Warehouse LMSP, a permanent link of databases of different Belgian social security institutions.. VDAB – Persons with disability on the labour market

The Flemish Employment Office VDAB creates monthly statistics on the number of ‘labour disabled’ unemployed people (definition see 1.1), including information on gender, age, domicile, education level, unemployment duration, … In 2010, a report was made on the situation of disabled people on the labour market.

  • Labour Force Survey 2002 – 2007 – 2009 – 2011 - 2012

The European Labour Force Survey (LFS) covers a large representative sample of the Belgian population (50,000 households) and included a question on chronic diseases in 2002-2007-2009. In 2007 and in 2011, an ad hoc module was added on health problems.

Questions:

2007 – 2009 – 2010 – 2011 – 2012: Do you experience troubles (at work or elsewhere) due to a disability or a chronic disease? Yes – Yes, to a certain extent – No.

2011 (ad hoc questionnaire): Do you suffer one or more of following chronic (= at least six months) diseases? (followed by a detailed list of diseases)

In 2011 an extra question asked if the chronic disease or labour disability was recognized by an official institution.

  • Health Interview Survey - Gezondheidsenquête – Enquête de Santé 1997 – 2001 – 2004 – 2008 - 2013

Since 1999, the Scientific Institute of Public Health (Wetenschappelijk Instituut Volksgezondheid – Institut Scientifique de Santé Publique) organises every 3 to 4 years a Health Interview Survey (HIS). The survey covers a representative sample of the Belgian population (10,000 participants) and is based on a detailed list of chronic diseases on which the respondents can indicate if they suffer one or more of those. The results show the evolution in years and gives details on gender, age, region, education level and type of disease. The survey is the Belgian part of the European Health Interview Survey (EHIS).

  • Questions:

Do you have one or more chronic diseases or disabilities? Yes - No

Are you troubled with your chronic disease(s) or disability(ies) in your daily activities? Continuously – Sometimes – Never or seldom

Are you confined to your bed a long period as a consequence of those chronic disease(s) or disability(ies)? Continuously – Sometimes – Never or seldom

  • Sociaal-Culturele Verschuivingen in Vlaanderen – SVR-SCV Survey

Since 2002, the yearly SCV-survey van de Studiedienst Vlaamse Regering (SVR) includes two questions in order to have a view on the labour market situation of persons with a chronic disease or disability. The survey covers a representative sample of the Flemish population (1,500 persons). Results of the survey are pooled over the last three years in order to assure a sufficient large sample size.

  • Questions:

Do you have one or more chronic diseases or disabilities? Yes - No

Are you troubled with your chronic disease(s) or disability(ies) in your daily activities? Continuously – Sometimes – Never or seldom

  • Employability Monitor (2004 – 2007 – 2010 – 2013)

The Employability Monitor is a three-yearly written survey in order to measure the workability on the Flemish labour market. The survey covers a representative sample of 20,000 employees. Since 2007, the following question is added:

Are you troubled with a chronic disease or disability) in your daily activities? Yes, seriously – Yes, to a certain extent - No

  • Securex – SD Worx

Securex and SD Worx are service companies in the social administration and human resources area. As they have access to a lot of administrative information on the employees of their custom-companies, they can analyse different human resources related issues, including sickness leave and chronic diseases. Their databases are not public accessible, but the results of their analyses are published on the websites and are an interesting source (BE1307011I, BE1212021Q, BE0911039Q).

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

As there is no univocal definition of the term ‘chronic disease’, the different sources report very varying numbers of persons having a chronic disease. Especially between the administrative sources (based on officially recognitions) on the one hand and the survey results (based on self-definition) on the other hand, large differences can occur. An extra question in LFS 2011 learns that half of the self-reported persons with a chronic disease have no official recognition and are thus not counted in the administrative sources. The effect can also be seen in the employment rate of chronically ill persons, which is higher in the surveys than in the administrative sources. The surplus of persons with a chronic disease in the surveys gives a view on the group chronically ill (but not officially recognized in administrative sources) persons. In this group, the illness has (less) impact on their labour participation (Samoy, E. 2014 – Handicap en arbeid).

The administrative databases give the lowest figures. The research project Handilab, based on the Data Warehouse AMSB, registered 7.4% persons with a chronic disease in the Belgian population, which is only a quart of the results of the Health Interview Survey (HIS), reporting 27.7% persons with a chronic disease. Other sources are situated between those two extremes: 15% according to LFS 2012, 17% according to the Employability Monitor 2013 and 20% according to SCV 2010-2012.

As well the HIS as the LFS are registering an increase of persons with chronic diseases during recent years. In the analyses of the results, the growing life expectancy and the ageing population are mentioned as part of the explanation.

In the HIS, pain in the back, allergy, high blood pressure and arthritis are most reported. In comparison to 1997, chronic diseases as high blood pressure, diabetes, arthritis or cataract occur clearly more, while diseases as chronic fatigue or migraine are significantly less reported.

People with chronic diseases have more risk of unemployment and less opportunities of a job than on average. More than half of the chronically ill persons on working age are not active on the labour market, about 5% is unemployed and about 40% has a job - compared to 66.9% of the healthy persons (VDAB-report, based on own statistics and on the LFS 2009). A recent study of the Nederlandse Sociaal en Cultureel Planbureau supports this figures and reports an employment rate of 45% for people with a chronic disease in 2012. The SCV-survey 2010-2012 reports an employment rate of 31.4% for persons with chronic diseases (compared to 58.6% employment rate for healthy persons). Handilab finds only 19% of the persons with chronic diseases at paid work (see supra for explanation of the large difference).

In LFS 2012, 15% of the unemployed mentioned having troubles with health problems, in the total group of non-active people on the labour market, this percentage even increases up to 31%. Two thirds of the non-working people indicate their chronic disease or disability trouble them too much to have a paid job. On average, 7.3% of the employees have a chronic disease. For blue collar workers (10.5%), the percentage almost doubles the percentage for white collar workers (5.5%). Elementary occupations (such as production workers) count the highest percentage employees with a chronic disease (15%), up to the threefold of the percentage chronically ill persons in the occupations for highly skilled employees. No more than 3.4% of the managers reports having a chronic disease. The type of disease makes also a difference: the employment rate is decreasing from 52.5% for persons with skin diseases or allergy to 15% for persons with a mental handicap (LFS 2012).

The results of the SCV-survey 2010-2012 also indicate the extent of the disability: the larger the limitations, the less opportunity of having a paid job. Persons with a disability have more chance of a paid job in the age group 25-54 years old than in the younger or older age groups, men and persons with a higher income have more opportunity of having a paid job than women and persons with a lower income.

The higher rate of persons with chronic diseases in the older age groups, in the female group and in the less skilled groups is also found in the results of the HIS.

The workability for persons with and without chronic diseases can be compared based on the results of the Employability Monitor 2013. In the group employees without chronic diseases, 41.9% reports at least one workability problem. In the group employees with moderate chronic diseases, this percentage has increased to 58.7%, in the group employees with serious chronic diseases to 78%.  

The VDAB-report illustrates the dynamic of in- and outflow between the unemployment segment and the employment segment is lower for people with chronic disease or disability, on the one hand because they more often can start in subsidized (more stable) jobs and on the other hand because the flow towards the non-active segment is higher.

During the first part of the economic crisis (2008-2011), VDAB registered an increase of the unemployed people with a chronic disease or disability. After a temporary decrease in 2011, the increase started up again due to the second part of the crisis. In December 2013, VDAB counted 32,903 unemployed persons with a chronic disease or disability, of which 52% women and 48% men. The percentage is increasing with the age group: from 21% for the 20-29 years olds to 33% for the more than 50 years olds. The majority (68.5%) is low skilled, 26.5% is medium skilled and 5% is high skilled.

65% of the non-working people with chronic disease or disability judging they are still able to have a job, indicate they could be helped with extra supporting measures. Adapted tasks (53%), adapted quantity of work (38%), adapted equipment (11%) and extra help from the colleagues (12%) are most mentioned. The survey results suggest this support is realized in the same proportions, although at somewhat lower level than asked (LFS 2012).

Supporting measures for persons with chronic diseases or disabilities

 

Asked support

Realised support

Adapted tasks

53%

34%

Adapted quantity of work

38%

25%

Extra help in transport to/from work

5%

3%

Extra help in moving at work

2%

2%

Adapted equipment

11%

10%

Extra help from the colleagues

12%

10%

At least one of the measures

65%

53%

Note: The percentage of persons with chronic diseases or disabilities asking and receiving extra support on the job

Source: LFS 2012

SD Worx and Securex register both an increase of the long term (more than one month) sickness leave (from 1.30% in 2002 to 2.29% in 2011 at SD Workx and from 1.06% in 2001 to 2.01% in 2012 at Securex), in contrast with a stable short term (less than one month) sickness leave. The increase is especially notable from 2008 on. SD Worx and Securex are suggesting as explanations the ageing population, the increasing stress, motivation problems and burnout. The long term sickness leave increases by age and is higher for women than for men. Sectors with a high rate of long term sickness leave are the social services transport, construction and food industry. Since 2010, the number of blue collar workers on longterm sickness leave exceeds the number of blue collar workers on short term sickness leave.

2.2. Working conditions of employed people affected by chronic diseases

In Belgium, no recent studies nor surveys on the working conditions for employed people affected by chronic diseases were made. However, the Belgian legislation gives explicitly attention to the non-discrimination and the protection of chronically ill persons on the labour market.

  • Health and well-being: Are certain occupations/jobs/sectors associated to certain chronic diseases? Possible relation between occupations and chronic diseases; what are the factors behind this (exposure to risks and hazards, job intensity, type of work, etc.); are special H&S measures implemented at workplace level to avoid/palliate this?

The law of 4 August 1996 on wellbeing at work is created to assure the health and safety at work for all employees. Employers are legally obliged to protect their employees and to provide the necessary measures in order to protect all employees at work.

Despite protecting measures, the health risks can differ among the jobs. As such, blue collar workers are on average more exposed to health risks than white collar workers. SD Worx and Securex explicitly mention the limited job variation, the higher physical workload and the higher risk of accidents at work as an explanation for the higher rate of chronic diseases in the blue collar workers’ group.

The risk on an accident at work is not a direct indicator for the working conditions of employees affected by chronic diseases, but can give an indication of sectors confronted with a work-related disability to work of their employees. The risk on an accident at work followed by a disability to work of at least 30 days is the largest in the construction sector  (20.9 cases per 1,000 FTE), the manufacture sector of non-metallic products (12.9 cases per 1,000 FTE and the manufacture sector of metal products (10.2 cases per 1,000 FTE). The lowest risk on an accident at work is the lowest in the wholesale and retail sector (4.8 cases per 1,000 FTE) and in the accommodation and food service activities (6.0 cases per 1,000 FTE).

Accidents at work by sector

Sector

2012

Construction

20.9

Manufacture of non-metallic products

12.9

Manufacture of metal products

10.2

Manufacture of food products and beverages

8.9

Manufacture of motor vehicles

7.3

Manufacture of basic metals

6.4

Human health and social work activities

6.3

Wholesale and retail trade and repair of motor vehicles

6.2

Accommodation and food services

5.0

Wholesale and retail products

4.8

Note: Number of accidents at work per 1,000 FTE by sector in 2012

Source: Fonds voor arbeidsongevallen – Fonds des accidents de travail

  • 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.?

The law of 10 May 2007 on combatting discrimination gives every employee the right on a reasonable adaptation at his working place. Those adaptations can consist of a special phone or computer screen, a reallocation of tasks, more flexible working hours, … LFS 2012 reports that 53% of the working persons with chronic diseases is supported by at least one measure (see table in section 2.1).

Working persons with chronic disease have the possibility to switch their working regime to a part time regime (maximum 50%) in combination with a sickness-allowance.

  • 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?

After fourteen days (for blue collar workers) or one month (for white collar workers) of sickness absence, a period of ‘primary labour disability’ starts in which the worker no longer receives his salary but a sickness-allowance paid by the Health Service (60% of the gross wage with a maximum amount; in other words limited for the higher wages). From the thirteenth month of labour disability on, the statute changes automatically in a statute of ‘disability to work’ (Belgium.be, the official information site). All days of sickness absence are counted as working days and have no influence on the calculation of future retirement pay.

  • In case the chronic disease makes it no longer possible to execute the previous function, the employer is obliged to offer another, suitable job (law of 10 May 2007 on combatting discrimination). In case this is not possible, this conclusion has to be confirmed by a prevention advisor/medical officer in a declaration of definitive working disability. Without this declaration, the employer can only dismiss the chronically ill employee following the standard procedures and compensations.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?

Employees with chronic diseases have at least the same rights on training as their colleagues.

Their employers have the right on extra premiums and compensations for possible extra costs (such as extra training) of employing persons with chronic diseases, such as the Vlaamse Ondersteuningspremie or the tegemoetkoming in de kosten van een arbeidspostaanpassing  in the Flemish Region and the Prime à l’intégration or the contract d’adaptation professionnelle in the Walloon Region (see Block 3).

  • Are there any significant differences in these working conditions according to different groups of affected workers (type of disease, gender, age, sector, etc.)?

No differences (law of 10 May 2007 on combatting discrimination).

  • Are there any significant changes in recent years? Possible effects of the economic crisis on these situations, if any.

No significant changes reported.

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

As Belgium has a federal constitution, the labour market policy is divided at different levels. The ‘passive’ policy (social security regulations and legislation) is mainly situated at federal level. Examples are for instance some specific laws on protecting employees at work (and thus all persons with chronic diseases), such as the law of 4 August 1996 on wellbeing at work and the law of 10 May 2007 on combatting discrimination. See for further details the previous section, point 2 and 3.

The ‘active’ labour market policy is mainly situated at regional level, although the regulations are based on the federal CAO 26 regulating the wage of persons with chronic disease in a normal labour statute. The Flemish Region as well as the Walloon Region have several subsidized or sheltered workshops for persons with difficulties on the labour market. Re-entering persons with chronic diseases at work are allowed to switch over to a part time regime in combination with a sickness-allowance. Employers have right on extra premiums and compensations for possible extra costs (such as extra training) of employing persons with chronic diseases, such as the Vlaamse Ondersteuningspremie, the tegemoetkoming in de kosten van een arbeidspostaanpassing, and the Prime à l’intégration or the contract d’adaptation professionnelle in the Walloon Region (Samoy, E. 2014 – Handicap en arbeid).

An evaluation report of the ‘Vlaamse Ondersteuningspremie (VOP)’ was made in 2010. Compared to the general population of employees, VOP-employees are in majority male (64,5%), young (58.9% is younger than 40 years old), low skilled (39.4%), more working in a SME (63.3% compared to 36.5% in general) and less working in the health and social services sector (30.7% compared to 41.5% in general). The report revealed that a majority of employees was not informed about the VOP received by their employer. A reform of the system in 2010 solved this by giving the right to apply for a VOP to the employee. Once the employee has right on a VOP, the employer can start the procedure to receive the premium.

Prevent, an organisation on prevention and protection on the workfloor, was the Belgian partner in the  European campaign Promoting Healthy Work for People with Chronic Illness and created a website move-europe.be with all the relevant information.

3.2. Examples of enterprises and/or collective agreements implementing initiatives or establishing clauses to support people with chronic diseases

At the end of 2008, Wheelit is established as a national online recruitment platform for employers and employees with chronic diseases or disabilities. Wheelit provides information on supporting measures.  Persons with chronic diseases can put their curriculum vitae on line and immediatly indicate their competences and disabilities. Employers receive information and training on successfully employing and integrating a chronically ill person in their company. They can leave their company logo on the website to express their respect for diversity at work.

The temporary agency startpeople is one of the first organisations following the training on employing persons with chronic diseases. The agency mentions explicitly having attention for such groups-at-risk on the labour market.

Commentary

As there is no univocal definition of the term ‘chronic disease’, it is rather difficult to create a total view on the labour market situation of persons with chronic diseases in Belgium. Nevertheless, the different sources are all suggesting an increasing trend in the number of chronically ill persons on the labour maket. Part of the explanation can be found in the ageing population and the increasing stress at work. The Belgian labour market policy gives special attention to this target group, with protecting legislation at the federal level and labour market activating measures at the regional levels. Still, the employment rate of persons with chronic diseases is far beneath the employment rate of their healthy colleguaes.

Reference

Samoy, E. (2014), Handicap en arbeid, Definities en Statistieken over de arbeidsdeelname van  mensen met een handicap - Beleidsontwikkelingen, Departement Werk en Sociale economie.

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