Bulgaria: Employment opportunities for people with chronic diseases

  • Observatory: EurWORK
  • Topic:
  • Labour market policies,
  • Tööaeg,
  • Health and well-being at work,
  • Working conditions,
  • Published on: 20 November 2014



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Bulgaria
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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.

Chronic or noncommunicable diseases are the leading cause of mortality and morbidity in the country according to the national statistics. Despite that comprehensive statistics and research related to employment of people with chronic diseases is lacking, except some Eurostat surveys.  The focus of strategic documents and measures is on the labour market participation of people with disabilities which to some extent overlap with people with chronic diseases. There is also lacking national definition of chronic diseases

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 national definition.

  • What are the sources of these definitions (legislation, statistical sources, administrative documents, social security/health insurance systems)?

N/A

  • What concrete chronic diseases are included in these national definitions?

There is no national definition of chronic diseases. The existing strategic documents (National Programme for Prevention of the Chronic Non-communicable Diseases 2014-2020 http://www.strategy.bg/StrategicDocuments/View.aspx?lang=bg-BG&Id=861

, National Health Strategy 2014-2020 http://www.hapche.bg/sites/default/files/na/national-health-strategy-2020.pdf

 and other sources just enumerate the most widespread chronic diseases. The statistical sources use the Eurostat definition. Chronic diseases have traditionally included the following: cardiovascular disease, diabetes and asthma or chronic obstructive pulmonary disease (COPD), many varieties of cancer, HIV/AIDS, mental disorders (such as depression, schizophrenia and dementia), etc.

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

Survey 1

  • What is the official name of this statistical source (in national language and translation into English) and its responsible body?

Employment of disabled people – Ad hoc module to the Labour Force Survey in 2011 (Заетост на хората с увреждания - Ad hoc модул на Изследване на работната сила, 2011), available at: http://www.nsi.bg/sites/default/files/files/pressreleases/LFS_AHModule_2011.pdf

Conducted by the National statistical Institute

  • What definition of chronic disease is used?

Uses the Eurostat definition. The terms longstanding and chronic diseases are used interchangeably.

Longstanding or chronic health problems or illnesses mean that the health condition or disease has lasted or is likely to last for at least 6 months. The main characteristics of a long standing condition or disease are that it is permanent and may be expected to require a long period of supervision, observation or care.

  • What are the categories of chronic diseases surveyed/registered?

See Table 2 for categories of chronic diseases registered.

  • What are the questions in relation to employment and working conditions?

The survey used the Eurostat questionnaire – the question is about employment status.There is not question about working conditions.

  • What is the methodology used to collect the data?

The  aim of the module is to provide information on the situation on the labour market of disabled people. The target group of the module is the population aged 15-64. The moduleused the common Eurostat methodology for the LFS, ad hoc module

  • What information is provided?

The results of the survey provide information on: number of persons aged 15 - 64 having at least one longstanding condition or disease by age, employment status, economic sector and gender in 2011 and also on  the reported types of longstanding health conditions or diseases by gender

  • Other info (time frequency, origin of the info, etc.)

The information was provided by the National Statistical Institute (NSI)

Survey 2

  • What is the official name of this statistical source (in national language and translation into English) and its responsible body?

European Health Interview Survey, Bulgaria 2008 (Европейското здравно интервю за България, 2008), available at: http://www.nsi.bg/sites/default/files/files/pressreleases/EHIS_BG.pdf

The survey was conducted by NSI.

  • What definition of chronic disease is used?

“Longstanding chronic health condition or disease has lasted or is likely to last for at least 6 months and more. It expresses the subjective perception and is not needed to be diagnosed by doctor”.

  • What are the categories of chronic diseases surveyed/registered?

According to the Eurostat methodology the survey studied 21 chronic health conditions and diseases.

  • What are the questions in relation to employment and working conditions?

The question about the employment status. However there are no officially published data in this respect.

  • What is the methodology used to collect the data?

Eurostat methodology for European Health Interview

  • What information is provided?

Subjective perception about the existence of chronic health condition or disease by gender, information about lifestyles and use of the health services.

  • Other info (time frequency, origin of the info, etc.)

The information is presented by NSI.

Overall, the chronic diseases as far as they are studied in the country are considered from the medical point of view without their relation to employment and working conditions. The main focus in the existing registers on absence from work due to sicknes and surveys on working conditions is on work related health problems (National working conditions survey, 2010; Work climate index, 2010, 2012) or on people with disabilities (administrative registers of the National Social Security Institute on the number of people with dissabilities in the three dissability groups according to the lost work capacity, National census 2011, different strategies and action plans in the field of employment, equal opportunities, national programmes and measures for employment). Some times the notions ‘chronic diseases’ and ‘socially significant diseases’ are used interchangeably.

Only two ad hoc modules to the Labour Force Surveys in 2008 and 2011 provide information on people with chronic diseases and their employment status.

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

According to the results of the survey ‘Employment of disabled people – Ad hoc module to the labour force survey’ conducted in 2011, 878.3 thousand or 18.2% of persons aged 15 - 64 years have at least one lasting health problem or disease. Of these, 394.8 thousand (44.9%) were men and 483.5 thousand (55.1%) – were women.

Of all persons with at least one long-lasting health problem or disease the largest is the number of people in the age group 55-64 years (429.9 thousand or 49.0%) and the smallest - in the age group 15-24 years (22.7 thousand or 2.6%). In the youngest group (15-24) the proportion of men with at least one lasting health problem or disease is higher than that of women, while for the rest age groups (in the bracket 25-64 ) the ratio is the opposite.

Table 1: Persons aged 15 - 64 having at least one longstanding condition or disease by age, employment status and sex in 2011, thousands

 

Total

Male

Female

Total

878.3

394.8

483.5

By age

15-24

22.7

12.0

10.8

25-34

49.3

23.2

26.1

35-44

134.0

63.2

70.9

45-54

242.3

113.7

128.6

55-64

429.9

182.8

247.2

By employment status

Employed

368.6

173.5

195.1

by sectors:

Agriculture, forestry and fishing

29.8

18.4

11.5

Industry

118.3

69.2

49.1

Services

220.5

86.0

134.5

Unemployed

58.9

31.5

27.4

Persons not in the labour force

450.8

189.7

261.1

Employment rate - %

42.0

44.0

40.3

Unemployment rate - %

6.7

8.0

5.7

Source: NSI, Employment of disabled people – Ad hoc module to the Labour force survey in 2011, conducted in Bulgaria

Heart problems, blood pressure or blood circulation is mentioned as the only or most serious problem by 39.4% of all persons with longstanding health problems or diseases. Problems with arms or legs (including arthritis or rheumatism) reported more than 20%.

Over 80% of cases resulting in death in Bulgaria over the past decades are due to chronic non-communicable diseases. (National Programme for Prevention of Chronic Non-communicable Diseases - 2014-2020). Regarding the death causes, traditionally heart diseases and cancer are still most common, with strokes causing 31.4% deaths and ischemic heart disease - 20.2%. Despite the decreased mortality caused by heart diseases, the standardised mortality ratio in Bulgaria remains significantly higher than in the EU and is revealing an increasing trend; the same is true also for the cancer in its different types.

Table 2: Persons aged 15 - 64 having at least one longstanding condition or disease by type of main longstanding health condition or disease, thousands

Type of longstanding health condition or disease

Total

Male

Female

Total

878.3

394.8

483.5

Problems with arms or hands (which includes arthritis or rheumatism)

85.9

35.4

50.5

Problems with legs or feet (which includes arthritis or rheumatism)

93.4

44.3

49.1

Problems with back or neck (which includes arthritis or rheumatism)

71.1

31.2

39.9

Cancer

19.7

(5.0)

14.7

Skin conditions, including allergic reactions

12.0

(4.4)

7.5

Heart, blood pressure or circulation problems

346.4

161.2

185.2

Chest or breathing problems, including asthma and bronchitis

25.1

13.0

12.1

Stomach, liver, kidney or digestive problems

63.8

34.2

29.6

Diabetes

31.9

13.2

18.8

Epilepsy

9.2

5.4

(3.8)

Severe headache such as migraine

41.0

9.3

31.7

Mental, nervous or emotional problems

49.1

23.1

26.1

Other longstanding health problems

29.7

15.1

14.6

Source: NSI, Employment of disabled people – Ad hoc module to the Labour force survey in 2011, conducted in Bulgaria

Note: ( ) - due to a small sample figures in brackets are not reliable

Longstanding or chronic health problems or illnesses mean that the health condition or disease has lasted or is likely to last for at least 6 months. The main characteristics of a long standing condition or disease are that it is permanent and may be expected to require a long period of supervision, observation or care.

According to the European Health Interview survey data 33.0% of men and 41.7% of women declare a longstanding (chronic) condition or disease.. The most common chronic disease in the country from those included in the questionnaire is high blood pressure. 23.3% of the population or 1,529,311 people have hypertension. In almost all cases, the disease is diagnosed by a doctor and existed in the last 12 months. The disease is more common among women (25.9%) than among men (20.4%). Among the older people - over 65 years more than half of respondents have hypertension. Follows the coronary heart disease according to 8.3%. It spreads more widely among women (9.8%) than among men (6.6%).

Table 3: ЕUROPEAN HEALTH INTERVIEW SURVEY- 2008 (population aged 15 and over), %

Main indicators

(self-reported prevalence)

Total

Male

Female

Diabetes

4,2

3,4

5,0

Depression

0,8

0,4

1,2

Asthma

2,0

1,6

2,4

Chronic obstructive pulmonary disease (COPD)

3,3

3,1

3,6

Ischemic heart disease

8.3

6.6

9.8

Arthritis

7.5

4.1

10.7

Infarct of the myocardium

1.7

2.2

1.3

Cancer

1.0

0.5

1.4

Stroke

2.7

2.7

2.7

High blood pressure (hypertension)

22,6

19,7

25,3

Source: NSI, European Health Interview Survey, 2008, conducted in Bulgaria

Note: Percentage of persons reporting: to have the selected disease, the disease was diagnosed by a medical doctor, the disease occurred during the past 12 months

  • 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)?

According to the data of  Employment of disabled people  Ad hoc module to the Labour Force Survey in 2011, the employment rate of people having at least one longstanding disease is low and in 2011 stands at 42%. The unemployment rate is higher for male compared to female population with chronic diseases. Of all persons with at least one lasting health problem or disease 509.7 thousand or 58.0% do not work. Of these, 43.4% were men and 56.6% - women (See Table 1).

  • Are certain chronic diseases associated to or more prevalent in certain economic sectors/occupations?

There is no statistic and surveys showing the prevalence of certain chronic diseases in some sectors or occupations. According to the NSI ad hoc module, in 2011 in the service sector work 220.5 thousand or 59.8% of all employees with at least one persistent health problem or disease, in the industry - 118.3 thousand or 32.1%, in agriculture and forestry - 29.8 thousand or 8.1%.

  • What are the main difficulties/problems for people with chronic diseases to access or stay in the labour market?

Lack of appropriate jobs and prejudice of some employers. According to the already cited survey on employment of people with longstanding health problem or disease restrictions in participation in the labour market (limitations in work) are linked to health/difficulties in basic activities. According to the results of the study because of the longstanding health problems (diseases) and / or persistent difficulty in performing daily activities 268.7 thousand of persons aged 15 - 64 years have a limitation in the duration of working time, 353.8 thousand - in the type of work that can perform, and 174.7 thousand - in the getting to and from work.

  • 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?

The main difficulties the enterprises face is the provision of appropriate working environment. The main solution is to use funding through different programmes for improvement of working environment and equipment (e.g., resources from the Agency of people with disabilities to adapt the workplace, workplace equipment and to ensure safe and healthy working conditions).

  • 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

According to the data of the Agency for people with disabilities the number of employees with chronic diseases or disability in the specialised enterprises decreased and many of those enterprises have been closed.

2.2. Working conditions of employed people affected by chronic diseases

The Labour Code provides for protection against dismissal of persons with chronic diseases and disability.  According to it when a worker due to illness or work accidents is unable to perform his job, but can perform other suitable, or the same obligations under more favourable conditions without danger for his health, he should be reassigned to another working position or to the same, but under appropriate conditions in accordance with the prescriptions of the health authorities.

Jobs for vocational rehabilitation: An employer with more than 50 employees should determine annually jobs suitable for vocational rehabilitation of disabled workers at 4 to 10% of the total number of employees depending on the sector of the national economy.

Paid annual leave: Employees with recognised disability level 50 and over 50 percent are entitled to paid annual leave of not less than 26 working days (statutory paid leave is 20 days).

Wage: An employee with a recognised disability over 50 percent, which is reassigned for a certain period and at the new workplace receives lower wage than at previous work, is entitled to monetary compensation paid by the National Social Security Institute for the wage gap under the Socia Security Code and Regulation for paiment of compensations. http://www.noi.bg/benefits/benefits/100-nerabotosposobnost/818-potu .

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

National Programme for employment and training of people with disabilities, 2003 – 2014, Ministry of Labour and Social Policy, Employment Agency and its branches. The programme is realised throughout the country.

  • Objectives pursued (staying-in-work/return-to-work), support offered, activities carried out

The programme aimed at increasing employability and return to work of people with disabilities, overcoming prejudices of employers towards disabled people through training, ensuring appropriate employment and working environment adapted to their needs.  The programme ensured training and subsidised employment for 24 months on full or part-time. Priority is given to employers, who concluded agreement for a grant under the Law for integration of people with disabilities providing for adaptation or equipment of workplace for the disabled worker

  • Specific target groups

People with disabilities

  • Financing of the measures

Financed from the State budget

  • Outcomes: major results/consequences of the measure on the improvement of working conditions of people with chronic diseases.

The success of the Programme is proved by its renewing each year since 2005. Average annual number of hired persons under the Programme is about 500.

  • Assessment (lessons learnt, future prospects)

The programme is important for encouraging employers to employ people with disabilities and should be renewed.

  • Link to the identified measure/initiative

http://www.az.government.bg/pages/nacionalna-programa-zohtu/

  • General information of the policy measure/initiative (name, dates, responsible body, participants, geographical and sectoral scope…)

‘Innovative measures in the field of occupational rehabilitation, guidance, training and employment for people with disabilities’ (project)

The project started in May 2012 and ended in April 2013, including collection of good practices, study visits in Belgium, workshops to present the practices. Actors involved: National Federation of employers of disabled people - Bulgaria, Knowledge Center Social Europe – Belgium, Association ”Horizons” – Bulgaria, municipalities, employment offices

  • Objectives pursued (staying-in-work/return-to-work), support offered, activities carried out

Aims at both staying-in-work and return-to-work through adaptation of work station and work organisation (e.g. shift/night work, transfer of workers to less demanding positions; vocational rehabilitation, training and skills development

The project presented a compendium of best practices in Bulgaria and Belgium aimed at improvement of the labour market situation and social inclusion of the disabled people through rehabilitation, training, ensuring appropriate employment and working environment adapted to their needs. The main objective of the project is to encourage social and labour market inclusion of people with disabilities through partnership between NGOs, municipalities, private business, and employment offices and to disseminate the existing Bulgarian and Belgium best practices.

  • Specific target groups

People with disabilities

  • Financing of the measures

The project is funded by the Operational Programme Human Resource Development co-financed by the ESF.

  • Outcomes: major results/consequences of the measure on the improvement of working conditions of people with chronic diseases

The participating employers of people with disabilities acquired new knowledge and used the best practices in their companies  (web-based tool)

  • Assessment (lessons learnt, future prospects)

Improved partnership between National Federation of employers of disabled people and employment offices provides for future better job placement of people with disabilities.

  • Link to the identified measure/initiative

Collection of good practices in the field of occupational rehabilitation, guidance, training and employment for people with disabilities in Bulgaria and Belgium, 2012

http://nfri.bg/documents/Sbornik-s-dobri-praktiki-BG-01-14.pdf (in Bulgarian);

Methodological guide for the implementation http://nfri.bg/documents/SDP-SBORNIK-BG_tom_2.pdf  (in Bulgarian).

It is worth mentioning that there are no special strategies, programmes and measures for retaining or returning back to work of people with chronic diseases. The focus of all political documents and practices is on people with disabilities (including the Law on Integration of People with Disabilities, National Conception for Social Economy, Long-term Strategy for Employment of People with Disabilities, National Action Plan for Employment 2014, etc.).

Operational programmes co-funded by the ESF also support the integration of the people with disabilities. The scheme ‘Chance for all’ under the OP HRD aimed at social inclusion of people with disabilities through support for specialised enterprises and cooperatives of people with disabilities, training and employment. The main goal of the operation ‘Technical renovation’ under the OP Development of the Competitiveness of the Bulgarian Economy’ is the increasing of the competitiveness of the specialised enterprises and cooperatives through investments in modern technologies, equipment and professional counselling.

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

  • Name of the enterprise(s)/collective agreement, sector, size

Economic activities KCM Ltd – Plovdiv, sector – other economic activities, size – about 100 employees

  • Objectives pursued and addressed target groups

Innovative practices in support of the employment of people with disabilities through creation a specialised enterprise based on the outsourcing of some activities of the main company and development of new types of activities or production

  • Main activities conducted and/or measures devised (i.e. physical adjustments of workstations, planned support actions by colleagues, personalised working-time arrangements, internal mobility, commuting support, mid-career review, etc.)

Ensuring employment, improvement of productivity of chronically ill and disabled people employed previously in the company KCM 2000 or registered in the municipal Employment office through vocational rehabilitation, counselling and qualification. Creation and maintaining workplaces for people with chronic diseases or disabilities, adapted to their needs, ensuring healthy and safe working conditions, improvement of the qualification and acquiring new one, successful participation in the market with the competitive production. In case of improvement of the health the employees return in the parent company KCM.

  • Main results obtained and assessment of these results

The practice proved to be very effective. Annual health analyzes show very good effect of rehabilitation of people with chronic disease or disability- the incapacity dropped from 20-30% to 0%. A sharp decline in occupational diseases and lack of new occupational diseases since 2004 is recorded. A culture of preventive thinking is implemented and the motivation for quality working increased. Good practice of the enterprise was disseminated to other companies of the group KCM 2000.

  • Link to the identified case study

Presentation of the Initiative http://nfri.bg/documents/StopdeinostiKCM.ppt (in Bulgarian)

http://www.kcm2000.bg/news/show/1105/

KCM – economic activities. Application for the EU CSR Award-2013 (in Bulgarian)

http://www.unglobalcompact.bg/wp-content/uploads/2013/03/Doc-AA_Award-Application-Stopanski-deinosti-KCM2.pdf

http://nfri.bg/documents/Sbornik-s-dobri-praktiki-BG-01-14.pdf

Commentary

The responses to this CAR are hindered by the lack of information on the employment of people with chronic diseases. The focus is on people with disabilities. Despite some overlapping of these two groups of employees the specific problems related to labour market participation of people with chronic diseases and the necessary policy measures to be undertaken are not well presented.

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