Czech Republic: 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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Czechia
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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.

People with persisting health-related problems have difficulties to integrate in the labour market in the Czech Republic. Lower employability, worse working conditions and employment positions for people with chronic diseases, missing pro-active employment policies addressing this specific group of workers, and an emphasis on financial compensation result in a tendency of chronically ill persons to opt for disability or early retirement pension.

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

National legislation does not define chronic diseases in an employment context, but it defines health disability for the purposes of Act No. 435/2004 Coll., on employment (in Czech). The definition is included in Act No. 198/2009 Coll., on equal treatment and legal provisions protecting against discrimination (‘Antidiscriminatory Act’) (in Czech) which stipulates that health disability is understood as a corporal, sensual, mental or other affection which hinders or can hinder persons their right to equal treatment in the areas such as access to employment or self-employment, employment status and remuneration, employee representation etc. Further, only long-term health affections which last or are expected to last at least one year can be considered to be a health disability.

Disability is further defined by Act No. 155/1995 Coll., on pension insurance scheme (in Czech) as a decrease in ability to work at least by 35% due to persistent unfavourable health status, i.e. as a consequence of a limitation in corporal, sensual and mental abilities in comparison to the health status before the persistent unfavourable health status aroused. The Act then distinguishes three levels of disability (which correspond to three different levels of disability benefits):

1st level – work capacity decline by 35% - 49%;

2nd level – work capacity decline by 50% - 69%;

3rd level – work capacity decline by 70% and more.

For the purposes of the Act on Employment, also a person which re-attained full ability to work during the past 12 months, after having suffered from the 1st or the 2nd level of disability, is considered to be a disabled person.

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

Two surveys which provide information on chronic diseases and selected aspects of employment and working conditions were identified:

Table 1: Overview of relevant surveys

Survey

Labour Force Survey (Výběrové šetření pracovních sil, VŠPS; LFS), in particular ad hoc module (AHM) 2011 on the relation of health status and employment

European Health Information Survey in the Czech Republic (Evropské výběrové šetření o zdraví; EHIS)

Provider

Czech Statistical Office (Český statistický úřad, ČSÚ; CZSO)

Institute of Health Information and Statistics of the Czech Republic (Ústav zdravotnických informací a statistiky ČR, ÚZIS ČR; IHIS CR)

Definition of chronic disease

Regular VŠPS contains questions on disability and its level as specified by the Act on Employment (see Block 3.1). AHM 2011 used the international definition of long-term health problems, i.e. problems which last or are expected to last at least six months and that require long-term health care.

Long-term diseases or health-related problems defined as those which last or are expected to last at least six months. Included are chronic diseases which occur regularly, e.g. in a specific season, although their symptoms appear continually only for a shorter period, and diseases and health-related problems which have not been diagnosed by a physician.

Categories of chronic diseases

Problems with upper and lower limbs, with back or neck, dermal diseases, diseases of heart and circulation system, pulmonary and respiratory complaints, stomach diseases, diabetes, headaches, mental or nervous disorders, etc.

The questionnaire focused on 26 specific chronic diseases, including problems with the spine, hypertension, allergies, arthritis, gynaecological problems, headaches, diabetes etc.

Questions on employment and working conditions

The same as standard LFS.

For relevant questions see Block 2.

Methodology

VŠPS is carried out quarterly on a randomly selected sample of persons aged 15+ from 25 thousand households on average (around 50 thousands respondents); AHM 2011 was carried out on a sample of more than 30 thousand persons aged 15-64.

Conducted in 2008 on a sample of 1955 respondents aged 15+ with a place of permanent or long-term residence in the Czech Republic, based on a two-stage stratified random sampling and via face-to-face interviews; second wave is to take place in 2014. Comparable survey conducted every three years in 1993-2002 (Sample Survey of the Health Status of the Czech Population; Výběrové šetření o zdravotním stavu české populace; HIS CR), in 2002 a sample of 2476 respondents.

Information provided

Employment status and employment position of people with long-term diseases.

Health status of the population, use of health care, determinants of health etc.

Source: Author / 2014

Other surveys and statistics are either restricted (to a specific group of people with diseases or specific group of diseases) or they do not distinguish diseases of a chronic nature from other health-related problems or do not include information on employment and/or working conditions.

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 AHM 2011 of the LFS 18.3% of persons aged 15-64 suffer from long-term health-related problems, more often women (19.5%) than men (17.1%). The greatest proportion of diseases is due to diseases of locomotive organs (4% of the population reported problems with back or neck and 3.7% with upper or lower limbs) and diseases of heart and circulation system (3.5%). Relatively spread are further dermal diseases which affect 1.1% of the population aged 15-64 (Petráňová et al. 2012).

 

Note: The figures express the percentage of people aged 15-64 who described the disease as their main health-related problem.

Source: ČSÚ 2012

Moreover, 41% of those respondents who indicated that they had a chronic health-related problem declared that they were limited in their locomotion or sensual perception, mostly in walking and lifting or carrying objects (ČSÚ 2012).

EHIS 2008, which operates with a broader definition of a long-term disease, implies a considerably higher incidence of persistent health-related problems: 43.8% of interviewees of this survey (40.3% of men and 47% of women) indicated to have long-term health-related problems. In comparison to the situation in 2002 (based on 2002 HIS data) the number of persons with long-term health-related problems considerably decreased from 53% for men and 64% for women. This corresponds to a general trend to evaluate one’s own health increasingly well over the past two decades (Daňková et al. 2011; EHIS 2008).

The most significant factor of health status is the age. Whereas only five percent of persons aged 15-19 declared having a chronic disease within AHM 2011 of the LFS, after 30 years of age this percentage considerably increases and reaches 42.7% in the age category 60-64. Hence, it can be assumed that two-fifths of population suffer from a chronic disease already before reaching the retirement age (ČSÚ 2012; Petráňová et al. 2012).

According to the LFS 2010 only 22.5% of people with disabilities or health-related disadvantages were active in the labour market. Persons with the 3rd level of disability worked only in 4.1% of cases, persons with lover levels of disability or health-related disadvantages in 44.9% of cases. The employment rate of people with disabilities or health-related disadvantages was more than three times lower than in the case of people without health-related problems (17.1% and 57.2% respectively); on the contrary, their unemployment rate was 3.5 times higher (23.9 and 6.8% respectively). AHM 2011 confirmed a high incidence of long-term diseases among unemployed persons, mostly diseases of locomotive organs, which is a serious issue in particular in the case of people with a low level of educational attainment who are often supposed to perform manual labour. The figures about economic activity of people with long-term diseases however do not take in consideration the role played by age since 81.7% of persons with disabilities or health-related disadvantages were aged 45+ (Krause 2011).

EHIS 2008 brings similar results as for the employment situation of people with long-term diseases; the high incidence of long-term diseases within economically inactive persons is however due to the age of respondents. Nevertheless, when controlling for the age of the respondents, certain differences appear between the category of persons in employment and unemployed, especially in the age category 25-34 in which persons in employment report a long-term health-related problem in 24.3% of cases, whereas unemployed persons in 45.5% of cases. Those persons in higher age who have difficulties in the labour market due to health-related problems often opt for an early retirement or disability pension so that they move from the category of unemployed to the category of economically inactive people. In both surveys health status was found to be one of the most important factors for the decision whether to continue working or retire after having achieved the retirement age.

AHM 2011 of the LFS further revealed that the occupation exercised plays a significant role in the incidence of chronic diseases. The lowest proportion of workers with chronic diseases was found to be in the categories of managers, professionals, and technicians and associate professionals (ISCO-08 codes 1 – 3), whereas the highest proportion of workers with chronic diseases was identified in manual and physically demanding professions, in particular among elementary workers (code 9) of which one-quart suffer from chronic diseases. Occupational differences are closely related to the sectors of the economy in which chronically ill people mostly work, i.e. workers with chronic diseases concentrate in particular in the agriculture and the industry. The occupational differences are further reflected in the types of diseases which prevail in individual occupational categories. The category of managers is the only segment of working population which suffers the most from diseases of heart and circulation system. All the other occupational categories contend the most with diseases of locomotive organs (Petráňová et al. 2012). EHIS 2008 further suggests that intellectual workers suffer more from allergies.

According to AHM 2011 of the LFS the persisting health-related problems impact not only on the economic activity and the type of work which the person affected perform but sometimes also on the number of working hours which applies especially to younger retirees. Indeed, those people with chronic diseases who are not economically active (e.g. are in early retirement) conform their decision about economic in/activity to their health-related problems and opt for working only in the case they find a job position which is appropriate to their health status in terms of the job content, flexibility and extent, i.e. they return to work for example only under condition that they find an appropriate part-time job. Pensioners also appear to be the most frequent users of flexible forms of work such as part-time jobs in the Czech Republic (see CZ1108019I).

Only a very low proportion of working persons with chronic diseases use special equipment or workplace arrangement such as barrier-free entrances. Higher chance is to adjust the working activity itself, e.g. by means of flexible working hours, part-time or less physically demanding tasks. The data suggests that for unemployed and economically inactive persons it is quite difficult to find a job position with the potential to use some of these arrangements. Therefore, the proportion of those who would need some specific adjustments is relatively high among unemployed and economically inactive persons:

Table 2: Proportion of persons with a long-lasting disease who need special arrangements at work (population 15-64, in %)

Type of special need

Percentage of persons with special needs in the total number of persons with long-lasting diseases

Percentage of chronically ill persons in employment who use special arrangements

Percentage of chronically ill unemployed persons who need special arrangements

Percentage of chronically ill economically inactive persons who need special arrangements

Personal assistance

7.0%

0.2%

2.2%

14.8%

Special equipment or workplace arrangement

12.2%

1.4%

9.7%

23.8%

Adjustment of working activity

27.6%

11.4%

37.3%

43.2%

Source: ČSÚ 2012

As EHIS 2008 reveals, the presence of a long-term disease has a considerable influence on the probability of workers to be temporarily unable to work. Within the subsample of those who were in employment, the interviewees with long-term health-related problems were twice more likely (35.5%) to interrupt their working activity due to a health-related problem than the other respondents (18.3%). Moreover, the presence of a long-term disease appears to influence the length of the incapacity to work.

Figure 2: The length of the incapacity to work related to the presence of a long-term disease (subsample of persons in employment)

Notes: Those were asked who declared that they had had to interrupt completely their work due to health-related problems over the past 12 months.

Category of persons in employment includes both employees and self-employed.

Source: ÚZIS ČR: EHIS 2008

However, it is not possible to indicate on the basis of the data whether the ‘long-term health-related problem’ represents a chronic disease or a nonrecurring long-lasting disease which is expected to be cured; therefore, this result does not allow for an estimate of the level of predictability of the interruption of work.

2.2. Working conditions of employed people affected by chronic diseases

The data from EHIS 2008 reveals a slightly higher probability to be subject to psychological pressure and/or to sexual harassment for the persons with a long-term disease or a health-related problem. This applies in particular to women and persons aged 25-34. Persons with long-term health-related problems are further more subject to the violence and threads of violence, and to noise and vibrations. Those who suffer from a long-term disease also indicated that they were heavily subject to chemical substances, dust, products of combustion, smoke, gas etc. twice more often (14.4%) than the other respondents (7.4%) and similar is the situation with the exposure to work in an unnatural position, moving of heavy loads etc. (13.2% of persons with a disease, 7% of the others) and with the exposure to the risk of injury (17.4% and 12% respectively). The data further reveals that people with long-term diseases are slightly more often (in 19.7% of cases) exposed to a tobacco smoke than those who do not have any health-related problems (14.5%), which, however, concerns only men. Interesting is the situation of people with long-term diseases in relation to the exposure to a time pressure and excessive workload: in this case the tendency is antithetic for men and women. Whereas men with a long-term disease are less likely to experience overload at work in comparison to the other men, women with a long-term health-related problem are, on the contrary, subject to a higher level of workload than the other women.

Table 3: Exposure to time pressure and/or excessive workload (%)

 

Extent of exposure to the overload

Heavily

Moderately

Not at all

Men

with disease

15.1%

41.8%

43.2%

without disease

15.2%

52.4%

32.4%

Women

with disease

21.5%

41.2%

37.3%

without disease

11.2%

40.2%

48.7%

Notes: Data based on answers to the questions “To what extent are you exposed to time pressure / excessive workload in your workplace?” and “Do you have any long-term disease or health-related problem? ‘Long-term’ refers to a problem which lasts or is expected to last at least six months.”

Those were asked who declared that they were in employment.

Source: ÚZIS ČR: EHIS 2008

This finding can be explained by a better health status of persons in high positions such as managers which are related to a high level of workload and are mostly performed by men. The high percentage of women with a long-term disease who are exposed to an excessive workload corresponds to a relatively high percentage of chronically ill persons heavily exposed to time pressure and / or excessive workload in such professions as clerical support workers and service and sales workers, which are exercised mostly by women.

Nevertheless, in the majority of cases the data does not make it possible to indicate whether the incidence of long-term diseases is a consequence of worsened working conditions or whether people with health-related problems work under such conditions more often than the other workers. Such inference is possible only on the basis of a question on whether a disease or a health­-related problem experienced over the past 12 months had been caused or worsened by the employment. Although the result of the analysis has to be interpreted only as an indirect indicator of factors which contribute to the development of long-term diseases, the findings suggest that at least in the cases of exposure to noise and vibration and to chemical substances, dust, products of combustion, smoke, gas etc. the negative influence on health status of workers is highly probable. Not only is a high level of these phenomena associated with a high incidence of diseases caused or worsened by the employment, but also with a higher proportion of persons with long-term health-related problems:

Figure 3: Percentage of diseases or health-related problems which were caused or worsened by the employment according to the level of exposure to noise and/or vibrations

Notes: Subsample of persons in employment (both employees and self-employed) who have had a disease or a health-related problem over the past 12 months.

Data based on answers to the questions “Do you think that some of the diseases or health-related problems you have had over the past 12 months had been caused or worsened by your employment or the work you performed in the past?” (the figure represents the percentage of answers “yes, I have had at least one disease within the past 12 months which was caused or worsened by my employment”); “To what extent are you exposed to noise / vibrations in your workplace?” and “Do you have any long-term disease or health-related problem? ‘Long-term’ refers to a problem which lasts or is expected to last at least six months.”

Source: ÚZIS ČR: EHIS 2008

Figure 4: Percentage of diseases or health-related problems which were caused or worsened by the employment according to the level of exposure to chemical substances, dust, products of combustion, smoke, gas etc.

Notes: Subsample of persons in employment (both employees and self-employed) who have had a disease or a health-related problem over the past 12 months.

Data based on answers to the questions “Do you think that some of the diseases or health-related problems you have had over the past 12 months had been caused or worsened by your employment or the work you performed in the past?” (the figure represents the percentage of answers “yes, I have had at least one disease within the past 12 months which was caused or worsened by my employment”); “To what extent are you exposed to chemical substances, dust, products of combustion, smoke, gas etc. in your workplace?” and “Do you have any long-term disease or health-related problem? ‘Long-term’ refers to a problem which lasts or is expected to last at least six months.”

Source: ÚZIS ČR: EHIS 2008

As for the working hours, LFS 2010 suggests that persons with disabilities or health-related disadvantages worked part-time considerably more often than the other respondents (42.1% and 5.1% respectively). The data however does not indicate whether the limited hours are chosen voluntarily (as a complement to the disability pension) by persons with health-related problems or are imposed by the labour market (Krause 2011). The data from EHIS 2008 reveals the same tendency in the subsample of persons who are currently in employment: 46.2% of part-time workers reported a long-term disease whereas among persons working full-time it was 33.7%. Nevertheless, the probability of workers with long-term diseases to work shorter working hours is increased by the tendency of economically active pensioners, who suffer from a long-term health-related problem more often than younger workers, to work part-time.

LFS 2010 further suggested that in comparison to the other interviewees the persons with disabilities or health-related disadvantages were more often employed on the basis of a fixed-term contract (18% compared to 7%) which applies mostly to full-time jobs. In the case of part-time jobs the tendency is inverse, i.e. almost three-quarters of people with health-related problems who had a part-time job worked on the basis of a permanent contract whereas people without a health-related problem had such a contract in 64% of cases when working part-time (Krause 2011). EHIS 2008 shows similar results in the subsample of persons currently in employment: 44.4% of employees with a fixed-term contract declared that they had a long-term health-related problem whereas in the subcategory of employees with a permanent contract it was only 33.9%.

People with long-term diseases have worked more often as employees than as self-employed according to EHIS 2008. The data shows that 47.8% of those who currently work or worked in the past as employees declare having a long-term health-related problem, compared to 31.3% of self-employed. This finding can by partially explained by a high proportion of employees among pensioners, who are the most affected by long-term diseases. When taking in consideration only those who are actually in employment, the difference is minor (35.4% of people with long-term diseases among employees and 27.8% among self-employed) ant not very statistically significant.

Finally, the data reveals a higher probability to be subject to discrimination in the case of persons with long-term diseases (9% of those who have a long-term disease and currently work compared to 4.9% working persons without any disease).

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

Act No. 435/2004 Coll., on employment (in Czech) declares that the government employment policy in the Czech Republic includes, among other things, measures which aim at higher level of employment and equal treatment in terms of access to employment, requalification, preparation for work, specialized training and other measures, of those groups of workers which are in a disadvantageous position in the labour market, such as people with disabilities.

In the recent past, the labour offices could classify applicants for jobs who were not recognised to be disabled but who suffered from a long-term disease, which limited their potential to find an employment, as persons “with a disadvantage in the labour market in terms of health”. These persons were granted the same employment conditions as people with disabilities (e.g. higher protection in the labour market, allowance for employers who have disabled employees etc.). The status of a person with a health-related disadvantage has been cancelled since 2012 within the framework of austerity measures taken by the right-leaning government of that time in response to the economic crisis so that the same rules have applied for this category of workers as for workers without any health-related limits. However, the government is currently preparing an amendment to the Act on Employment, which should re-introduce the category of persons with a health-related disadvantage; it is, however, still being discussed whether these particular persons will be granted the same employment conditions as people with disabilities – as it was the case until 2011 – or whether they will be accorded a lower level of protection than disabled people. The amendment should come into force within 2014.

The Labour Office of the Czech Republic (in Czech) provides people with disabilities with “work rehabilitation” which consist in a continuous support in attainment and retaining of employment of workers with disabilities and includes guidance on suitable professions, jobs and other economic activity, theoretical and practical preparation, intermediation of employment, and adjustment of working conditions.

Act No. 262/2006 Coll., Labour Code (in Czech) stipulates that the employer must not allow employees to perform tasks the difficulty of which would not correspond to their skills and health ability. The Labour Code further binds employers to transfer to another job those employees who are not able to perform the tasks related to their job positions due to a long-term disease or an irreversible reduction of capacities, including occupational diseases or a threat of such disease, and consequences of occupational injuries, as soon as a suitable position is available. In doing so, the employer is obliged to take account of health status and skills of the employees and as far as possible also of their qualification. However, if there is no available job position in the establishment which would be suitable for the employee, the employer has the right to dismiss such an employee, except for the cases when the employee is on sickness leave.

Special measures in terms of technology and work organization provided by the employer are stipulated only for employees with a disability. These measures include adjustment of working conditions, work station arrangements, establishment of sheltered working places, training and increase of qualification. The introduction of the measures has to be consulted with trade union organization.

Antidiscrimination legislation and employment quotas, despite recent changes, generate universal but not necessarily very strong or binding obligations for individual employers. The employer is obliged to accommodate work conditions in response to the worker’s abilities and health competence or offer a different job in case of long-term disability as proven by a medical certificate. On the other hand, the employer has no obligations regarding vocational rehabilitation of people with chronic diseases or disability (OECD 2010).

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

The Czech legislation does not allow employers to get information on the health status and specific limits of employees; the employer is given only a recommendation on which activities should be avoided in the case of individual employees. Thus, the Czech Republic did not join the 9th initiative of the European Network for Workplace Health Promotion (ENWHP) entitled ‘Promoting Healthy Work for People with Chronic Illness’ which provides employers with guidance when employing people with specific chronic diseases. However, individual establishments have introduced specific measures in order to encourage chronically ill workers to stay at work. Kožená (2013) indicates two examples of such companies, i.e. Siemens Mohelnice (in Czech), which established a protected working place for those who would have to leave the job for health-related reasons otherwise, and AGC Flat Glass which transfer workers with chronic diseases or after an injury to another job position with a compensation for the previous wage level.

Commentary

The incidence of chronic diseases and disabilities increases with age which has become a serious issue in view of population ageing. The situation is alarming in the Czech Republic in particular due to the fact that the country has the highest employment in industry in the EU, the sector in which the health status of workers is relatively poor and in many cases does not allow for further professional activity of older workers (Petráňová et al. 2012).

The Czech Republic is characterized by comparatively underdeveloped employment and rehabilitation policies related to people with disabilities and chronic diseases among OECD countries and a stronger compensation orientation which makes employment integration of this part of population more difficult (OECD 2010). Therefore, relevant measures are still to be done in relation to persons with chronic diseases.

References

ČSÚ 2012. Zdravotní problémy populace v produktivním věku v ČR [Health-related problems of the population in productive age in the Czech Republic]. Prague, ČSÚ.

Daňková, Š., Holub, J., Láchová, J. 2011. Evropské výběrové šetření o zdraví v České republice EHIS 2008 [European Health Information Survey in the Czech Republic EHIS 2008]. Prague, ÚZIS ČR.

Institute of Health Information and Statistics of the Czech Republic 2004. HIS CR 2002: Sample Survey of the Health Status of the Czech Population 2002. Prague, ÚZIS ČR.

Jakubka, J. 2009. Nový antidiskriminační zákon a jeho aplikace v pracovněprávních vztazích [New antidiscriminatory act and its application in employment relations], in Práce & mzda 57: 9, Pp. 10-16.

Kožená, L. 2013. Chronické choroby v produktivním věku [Chronic diseases in productive age]. Presentation. Státní zdravotní ústav.

Krause, D. et al. 2011. Zpracování metodologie sběru dat pro účely sledování statistiky OZP (skupina definovaná v § 67 zákona č. 435/2004 Sb.), s navazujícím pilotním ověřením a nastavením podmínek pro opakování [Elaboration of a data collection methodology for the purposes of monitoring of statistics on persons with disabilities (as defined in the section 67 of Act No. 435/2004 Coll.) with a consequential pilot verification and setting of conditions for recurrence]. Prague, VÚPSV.

OECD 2010. Sickness, disability and work: Breaking the barriers. A synthesis of findings across OECD countries. Paris: OECD

Petráňová, M., Mejstřík, B., Dubcová, I. 2012. Každý pátý trpí dlouhodobými zdravotními problémy [Every fifth person suffers from long-term health-related problems], in Statistika & my 5: Pp. 30-31.

Stádník, J., Kieler, P. 2013. Plánovaná novela zákona o zaměstnanosti a zákona o inspekci práce [Planned amendment to the Act on Employment and the Act on Labour Inspection], in Práce & mzda 61: 11, Pp. 35-40.

ÚZIS ČR. EHIS 2008 (dataset).

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