Denmark: 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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Denmark
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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.

In Denmark chronic disease is defined as diseases that are recurrent or have a long-term prognosis. In an employment context, the terms disability and work disability, is more used than chronic disease because, the entitlement for social transfers (sickness absence or permanent disability benefits), is based on workability not the diagnose.. The companies are responsible for handling employees with chronic diseases. A report from the Danish National Centre for Social Research  shows that in 42% of Danish companies employed at least one disabled person  and over 1/3 of these companies offered special conditions for their disabled workers.

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 Danish National Board of Health defines chronic disease as diseases that are recurrent or have a long-term prognosis. Furthermore, the National Board of Health (NBH) (in Danish) monitors the development in chronic disease in Denmark. The NBH uses national health registers to assess the prevalence and development in chronic disease. The registers include information on hospitalisation, prescribed drug consumption and services related to the Danish health insurance. The monitoring includes the following diseases:

  • Diabetes
  • Cardiovascular disease
  • Chronic lung disease
  • Mental illnesses  
  • Arthritis
  • Osteoporosis.

In an employment context, the term chronic disease is not common. Instead disability and particularly work disability, is more frequently used. This is because, the entitlement for social transfers, like sickness absence benefit or permanent disability benefits, are not based on the diagnoses, but on the effect on the work ability.

According to statistics from the National Appeals Board (28.4 MB PDF) (in Danish), the most common diagnoses for being granted a permanent disability pension is musculoskeletal disorders and mental disorders.

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

As explained in section 1.1, the NHB monitors the development in chronic disease based on national registers. The monitoring, however, does not include data on the employment situation of people with chronic diseases. 

The National Research Centre for the Working Environment (NRCWE) monitors working conditions in Demark. The NRCWE conducts ad hoc surveys that focus on specific industries, but also conducts surveys based on representative samples of the working population. The most recent survey based on a representative sample is AH2012 (in Danish), Arbejdsmiljø og helbred 2012 / Work environment and health 2012, which has replaced the former DWECS survey. DWECS is described more in detail on the Eurofound National surveys in Europe inventory webpage. AH2012 includes about 16.000 persons (18-64 years), who filled out the survey in 2012. The population is based on a representative sample of employees and self-employed.AH2012 includes questions on pain, sleep, self-rated health, work ability, anxiety, work-related disorders and depression. Furthermore respondents are asked if they have been diagnosed with any of the following disorders:

  • asthma
  • back problems
  • cancer
  • depression
  • diabetes
  • eczema
  • reduced hearing
  • cardio-vascular disease
  • other diseases

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 NBH about 30% of the Danish population suffers from a chronic disease. This assessment is based on register based information (the definition is described in section 1.1). Furthermore, the NBH are also responsible for the National Health Profile 2010 (in Danish). The profile is based on the survey named ‘How are you?’ that draws on a national representative sample of about 18.000 participants. In the survey the respondents are asked if they have a long-term disease, long-term after-effect after an injury or other long-term disorders. The survey shows that in 2010 33% reported to suffer from a long-term disease or disability.

Table 1.1 shows the distribution by the respondent’s employment situation. The table shows that chronic disease is more prevalent among respondents who are on early retirement (88%) and among old-age pensioners (47%), whereas the prevalence is lowest among employees (25%). Furthermore chronic disease are more prevalent among women (35%) compared to men (32%) and increase by age.

This table shows the division of chronic diseases by occupational status.

Table 1.1 Prevalence of chronic disease by occupational status 2010

 

Percentage

Number

Employed

25,1%

91.275

Unemployed

37,6%

5.929

Disability pensioning

88,4%

6.191

Early retirement

36,8%

6.534

Old-age pensioner

47,1%

35.048

Others (not in employment)

59,3%

4.382

Source: The National Board of Health and the National Institute of Public Health

According to the National Institute of Public Health (in Danish), the percentage of people having a long-term disease has increased. The information is based on survey data. The respondents were asked if they had a long-term disease (lasting six months or longer). The survey showed an increase in the prevalence of long-term disease from 33% in 1987 to 40% in 2005. The questions are phrased somewhat different than in the national health profile 2010, thus the two surveys are not directly comparable. 

There are to the best of our knowledge, no information on the impact of the economic crisis on the prevalence in chronic diseases. However, a recent study from the National Research Centre for the Working Environment (209.4 KB PDF) (in Danish) showed that employees reporting a high degree of job insecurity are at increased risk for experiencing a poor self-rated health and developing a depression. This effect is stronger among the employees, who previously had experienced unemployment, were over 50 years and feared that they were not able to find new employment.

The working environment data bank (in Danish), developed by the National Research Centre for the Working Environment, contains survey data from AH2012 on self-reported doctor diagnosed diseases.  Table 1.2 shows the percentage of employees and self-employed who report a doctor diagnosed disorders in the previous year. The table shows that the most common disorders are: back pain (11%), eczema (8%), migraine (6%), depression (6%) and asthma (6%).

The prevalence of these diseases varies according to age and gender. Depression, cardiovascular disease and cancer are more prevalent among older people, whereas asthma is more prevalent among younger people. The prevalence of eczema, depression and cancer are more prevalent among women, whereas diabetes, cardiovascular disease and reduced hearing are more prevalent among men. In section 2.2 we explain how different chronic disorders are related to different occupations and sectors.

Table 1.2 Prevalence of doctor diagnosed disorders among employees and self-employed in 2012

Doctor diagnosed disorders

Percentage of respondents

Depression

5,8%

Asthma

5,6%

Diabetes

2,8%

Heart disease

1,3%

Stroke

0,6%

Cancer

1,4%

Reduced hearing

3,7%

Eczema

8,4%

Back pain

11,2 %

Migraine 

6,4%

Other

9,2%

Source: The National Research Centre for the Working Environment

Some of the most common types of diseases are also among the most disabling. Today musculoskeletal problems and mental disorders account for the largest proportion of sickness absence and disability pensioning in Denmark. During the last decade disability related to mental disorders have increased markedly. According to the National Appeals Board (28.4 KB PDF) (in Danish), musculoskeletal disorders accounted for 19% of disability cases, whereas mental disorders accounted for 48% in the last quarter of 2010. Thus in Denmark, mental disorders (most often stress, depression and anxiety) are strongly associated with becoming permanently disabled from work.

In Denmark, the municipalities (local authorities) bear the main financial burden of sickness absence and play a key role in the return to work process. Compared to other European countries, employers in Denmark have little responsibility for financing social security and few obligations for reintegrating disabled workers (Johansen, K., Sahl Andersen, J., Mikkelsen, S., Pass, O., RAffnsøe, S. and Lynge, E., 2008).  Thus Danish employers might have a lower motivation for engaging in return to work efforts, but might on the other hand be less reluctant to hire people with disabilities. Employees who become sick-listed due to a serious or long-term disease might be fired from their workplace. A recent Danish return-to-work project (5.34 MB PDF) (in Danish) showed that among sickness absence beneficiaries at high risk for becoming excluded from the labour market 73% was employed when reporting sick—however after nine months only 46% was employed.

According to the §56 of the Danish sickness benefit law, employers who hire an employee who are at increased risk for sickness absence because of long-term or chronic illness, are entitled to reimbursement from the municipality for the first 30 days of the sickness absence. Thus employers are exempted for any costs related to the disease that the paragraph refers to. Employers might also initiative efforts to help retain sick listed employees. These efforts can include gradual return to work or working accommodation. The National Research Centre for the Working Environment (in Danish) conducted a survey on work environment efforts in Danish companies in 2012 among 3,600 companies. The survey showed that 17% of the companies reported that they did not initiative individual arrangements with employees on long-term sickness absence to facilitate return to work. Companies with more than 10 employees were more likely to initiative individual arrangements and to initiate efforts to prevent sickness absence.

The Public Health Report from 2007 (in Danish) shows that there are vast differences in the health among employees in different sectors, industries and job groups. The analyses are based on survey data on working conditions and register based data on hospitalisation. The report states that musculoskeletal problems are more frequent among industrial workers, the construction industry and among employees working within the social and health care industry. Poor hearing is most often experienced by male machine workers, whereas cardio-vascular disorders are more frequent among male butchers and female cleaning assistants. Finally, the cancer risk is higher among male servants, male and female brewery workers and females working in the tobacco industry. These differences might be attributable to differences in the working environment, lifestyles and other factors.

2.2. Working conditions of employed people affected by chronic diseases

Further, Rugulies, R., Madsen, I.E.H., Nielsen, MD., Olsen, L.R., Mortensen, E.L. and Bech, P. (2010) found that depression is more frequent among un-skilled blue collared workers and the prevalence is especially high in the human service industry.

Around a quarter of people with health problems or disability live in poverty: 24.8%. The unemployment rate for people with chronic health problems or disability at the end of 2007 was around half that of the OECD average, 7.6% compared to 13.7%. But it was twice Denmark’s unemployment rate for people without health problems (OECD, 2008).   

Whether employees suffering from chronic disease are offered skills development and/or flexible working arrangements to cope with their disease depends on the company. As explained in section 2.1 employers have little responsibility for disability management. In general, however, The National Research Centre for the Working Environment (in Danish) has shown that Danish employees experience a high degree of flexibility in how, when and where to work. A survey from 2012 on working conditions among Danish employees showed that 89% of employees often or very often have influence on how their work is organised. Especially knowledge workers, usually academics, report having a high influence on how and when to perform their job.

Furthermore, as explained in section 2.1, employers who hire an employee who are at increased risk for sickness absence because of long-term or chronic illness are entitled to reimbursement for sickness absence, including if the employee needs to take time off from work because he or she has to undergo treatment in relation to the disease.

A report from the Danish National Centre for Social Research (in Danish) shows that in 2012, 42% of Danish companies employed at least one person with a disability. Over one third of the companies report that employees with a disability are working on special conditions. There has been no change between 2010 and 2012 in these trends. Furthermore a report from 2011 developed by the The Danish National Centre for Social Research (in Danish) shows that the attitudes of Danish employees towards hiring people with disabilities have not been affected by the economic crises or the increase in unemployment. Thus in 2011, 68% of responders had a positive attitude towards the company initiating special working arrangements for employees on long-term sicknesses absence and 66% had a positive attitude towards the company hiring people with a disability.

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

In 2013 the Danish Government launched a new disability pensioning reform (in Danish). As a consequence of this reform, permanent disability pensioning can no longer be granted to people under the age of 40. Only under special circumstances and if documented that there is no change of regaining full or partial workability can disability pension be granted for people under the age of 40. Instead the municipalities must initiate a holistic and multidisciplinary effort (known as a ‘ressourceforløb’) to promote workability. People receiving disability pension can work a limited amount of hours if possible. In periods where they are capable of working enough to support themselves they will not get the pension in that period.

In 2010 the Government launched the Danish return-to-work project (5.34 MB PDF) (in Danish) to reduce sickness absence and promote return to work among sickness absence beneficiaries. The programme entailed a coordinated, tailored and multidisciplinary effort, which was delivered by multidisciplinary teams located at the municipal sickness benefit offices. The evaluation showed that it is possible to implement multidisciplinary teams in the municipalities, but that it requires a considerable effort and commitment from managers. Furthermore the effects of the program differed considerably among different municipalities; whereas the program reduced the time on sickness benefits in some municipalities the programme prolonged the sickness absence period in others. The project contained different designs for the involved municipalities. For the three municipalities with a RCT-design (randomised controlled trial) the effect was a reduced sickness absence period of 2.2 weeks.    

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

To our knowledge there are no examples of enterprises and/or collective agreements implementing initiatives or establishing clauses to support people with chronic diseases in 2013.

Commentary

In Denmark the term chronic disease is not commonly used in an employment context. Instead disability and particularly work disability, is more frequently used. The reason is that the entitlement for social transfers, like sickness absence benefit or permanent disability benefits, are not based on diagnoses but instead on peoples workability.

This means that policies or initiatives are more often directed at disabilities which can come from any disease, chronic or long-term.

Ex the Danish return-to-work project (5.34 MB PDF) (in Danish) which was launched to reduce sickness absence and promote return to work among sickness absence beneficiaries. This project included people with all kinds of different diseases and disabilities.

The Public Health Report from 2007 (in Danish) shows that there are vast differences in the health among employees in different sectors, industries and job groups. Ex musculoskeletal problems are more frequent among industrial workers, the construction industry and among employees working within the social and health care industry. Poor hearing is most often experienced by male machine workers, whereas cardio-vascular disorders are more frequent among male butchers and female cleaning assistants. Finally, the cancer risk is higher among male servants, male and female brewery workers and females working in the tobacco industry. These differences might be attributable to differences in the working environment, lifestyles and other factors.

The National Research Centre for the Working Environment (in Danish) has shown that Danish employees experience a high degree of flexibility in how, when and where to work. A survey from 2012 on working conditions among Danish employees showed that 89% of employees often or very often have influence on how their work is organised. Especially knowledge workers, usually academics, report having a high influence on how and when to perform their job. This goes for both employees with diagnosed diseases and without.

Bibliography

Johansen, K., Sahl Andersen, J., Mikkelsen, S., Pass, O., RAffnsøe, S. and Lynge, E. (2008), ’controlling sickness absence: a study of changes in the Danish sickness absence legislation since 1973’, Health Policy, Vol. 86, pp.109-118.

OECD (2008), Sickness, disability and work: Breaking the barriers, OECD Publishing

Rugulies, R., Madsen, I.E.H., Nielsen, MD., Olsen, L.R., Mortensen, E.L. and Bech, P. (2010), ’Occupational position and the relation to mental distress in a random sample of Danish residents, Vol.83, pp.625-629

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