Italy: Employment opportunities for people with chronic diseases

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In Italy, the Labour Force Survey 2011 ad-hoc module carried out by ISTAT is the only available survey focusing on chronic diseases. The ISFOL quality of work survey investigates their distribution. Participation in employment is lower especially for those with chronic diseases with more than one health problem or functional impairment. The most relevant work-related limitations of workers with chronic diseases are the type of tasks they can perform and the number of working hours they can work. Lack of adequate opportunities is the main problem employees’ with chronic diseases face. There is some indication that those reporting specific chronic diseases with the time increases the probability of retiring and reduce the amount of working hours. In Italy, policies addressing the situation of people on chronic disease do not focus on employment aspects and there is a lack of diversity management strategies.

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 2013 report “ Limitazioni nello svolgimento dell’attività lavorativa delle persone con problemi di salute” (“Limitations while carrying out work activities by persons with health problems”), carried out by Istat, the National bureau of statistics,  summarizes the main findings from the Italian LFS ad hoc module “Health problems and employment” carried out in 2011, 2^nd quarter. The definition of “health problems” considers those diseases showing  “permanent or long term problems requiring long periods of control and care lasting from, or expected to last, about 6 months”: it includes health problems at both upper and lower limbs (including arthritis and rheumatisms), back/neck pain (including arthritis and rheumatisms), malignant  cancers, skin problems including allergic reactions or serious disfigurements, hearth diseases, such as hypertension and circulatory problems, respiratory diseases including asthma and bronchitis, digestive problems (such as stomach, liver, kidney), diabetes, epilepsy,  migraine, learning difficulties in reading, correct writing and calculating, chronic anxiety, depression, mental problems such as psychosis, schizophrenia, panic crisis, anorexia and degenerative diseases such as multiple sclerosis, HIV, Alzheimer and Parkinson diseases.

The 3^rd Report on social cohesion includes as “serious chronic diseases” diabetes, stroke, angina pectoris; other hearth diseases, ictus, cerebral hemorrhage; chronic bronchitis, emphysema; cirrhosis of the liver; malignancy (including lymphoma / leukemia); Alzheimer and Parkinson diseases and senile dementia.

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

The above mentioned 2011 LFS ad-hoc module carried out by Istat is the only available survey focussing on chronic diseases.  Relations with working conditions is limited to adapted working times and to adapted job spositions.

The Isfol quality of work survey (QWS) include only those chronic diseases as outcomes of  both work-related diseases or work accidents. In the former case, diseases (Q103_1) are classified as “without consequence”, “chronic but not invalidating” and “invalidating”, the latter as “mild”, “serious but solvable” and “invalidating”. See the Eurofound “national surveys” and Survey data reports for the methodology. The report on the 3^rd Isfol QWS  investigates their distribution by sector and occupation, and their association with working times and arduousness (physically demanding/psychologically demanding)

Costa (2005) summarizes the main results of the epidemiological studies addressing health inequalities and professions carried out since mid 90s: chronic diseases is one of the investigated indicators, although not the main one. These studies made recourse to various sets of microdata.

Block 2: Prevalence, recent evolution and effects of the problem of chronic diseases among workers and companies

http://www.istat.it/it/files/2013/05/Report-Statistica_Limitazioni-a-lavoro-delle-persone-con-problemi-di-salute_per-diff.pdf?title=Problemi+di+salute+e+lavoro+-+03%2Fmag%2F2013+-+Testo+integrale.pdf

http://www.salute.gov.it/imgs/C_17_pubblicazioni_1985_allegato.pdf

2.1. People affected by chronic diseases and employment

According to 2013 Istat report above mentioned, both the employment and unemployment rates decline as chronic health problems increase: the former declines from 59.9% among those without any health problem to 55.9% among those with one health problem and 45.6% among these with more than one health problem, the latter from 5.2% to 4.2% to 3.9% (table 1).

Source: Istat, 2013

Similarly, while among those reporting at least one chronic health problems, employment rate is almost the same among those without any limitation and to one limitation, it strongly declines when limitations increases to around 35% (table 2).

Source: Istat, 2013

38.9% of those reporting a chronic diseases also report at least one limitation, men less than women (respectively 36.9% and 40.6%): the most widespread regards the type of tasks (35.8%) and 26% the hours they are able to work, while limitation in their mobility affects 15.3% of them. Those in employment report about 10% less limitations in their working abilities, while unemployed report 7% higher rates in their limitations, especially in the type of tasks and commuting opportunities. Finally, inactive population display more than 10% higher rate in their limitations, especially in the tasks (14% more than general average). 

Source: Istat, 2013

Less than 10% of those reporting at least one limitation also report one form of support: men more in terms of personal support than women (respectively 2.4%  and 1.7%) and adaptation of their work stations (respectively 2.4% and 2.1%)  but less in terms of working times flexibility (respectively 6.6% and 7.2%). Similarly, personal assistance and workplace technical adaptation decline and working times adaptation increases as age increases (table 4).

Source: Istat, 2013

In general, those reporting at least one limitation for reasons for related to their health or disability, report the lack of adequate work opportunities as their main problem (53.4%, especially men 59.6%) then care from relatives (19%, especially women, 26.4%) and lack of adequate experience or skills (19.6%, especially men 18.4%). Those in employment, on their own agree about the former (52.1%) but express more difficulties with the lack of flexibility provided by their employer (table 5).

Source: Istat, 2013

According to the 2008 report of ANMAR (the national association of  sufferers of arthritis rheumatoides) carried out by Censis, outlines that 22.7% of employed affected by arthritis had to change their work habits or stop to work (table 6): such a share increases with the number of year they suffer this disase (from 17.9% among those coping with it from less than 2 years to 30.1% among those reporting more than 10 years of disease). Among the former, almost one third had to retire, while over 10%  applied for retirement and another 10% was forced to leave their job, while 39% had to reduce their 8% had to change

Source: Censis, 2008

2.2. Working conditions of employed people affected by chronic diseases

According to the 3^rd Isfol QWS, 16.4% of respondents report at least one work accident in their working life and 4% a work-related disease. 23.4% report the work accident as “serious but solvable” and  2% as invalidating : their share is higher for both among those aged more than 55, self employed in a strict sense and armed forces.

Source: Isfol, 2013

33.7% of those reporting a work-related disease consider it as “chronic but not invalidating” while 3.7% as “invalidating”. While differences by gender are negligible, aged 45-54 (respectively 44.6% and 8%) and especially unskilled (80.6%  and 5.2%) among occupations (although the share of those reporting invalidating w-r disases is higher among clerks, technicians  and  professionals), and construction among sector (69% of “chronic but not invalidating”) report the highest rates.

According to a Costa (2005), summarizing an epidemiological study carried out by Ispesl (The national prevention institute for health an safety, now research unit of INAIL, the National insurance against work accidents) and epidemiological unit of Regione Piemonte, outlines that wood carpenters, miners, ceramics workers and construction finishers and road pavers among men and machinists, food and paper industries workers are the most exposed in reporting at least two chronic diseases.

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 general, national policies in supporting both people and employees affected by chronic diseases do not differ from those addressed to disabled, while the National Coalition of Associations for Patients suffering Chronic Diseases (CnAMC) does not consider employment within their priority. The set of law regulating the is the same and lever on both paid and unpaid leaves, the right to choose a workplace the closest to home as far as possible, and the right to part time in case of oncological care: those reporting a certified incapacity above 50%  are eligible to 30days per year for medical care, while in case of disability 3 working days of leave per months (or a 2-hours per day reduction in their daily working time) are paid only for serious disabilities: relatives within the 3^rd degree are eligible in this latter case.

Most national labour contracts exempt employees with chronic diseases from the 180 limit of absence days over 3 years allowing employers to fire them. Continuous vocational training plays important part of national health policies addressing chronic diseases in order to develop an integrated approach among health operators considering both health, social and educational aspects.

Reasons for a limited attention to indirect costs, especially for those in the employment, is a study carried out by Dal Negro et al. (2009) in the case of the Chronic Obstructive Pulmonary Disease, showing that indirect costs are low (8% of total cost) as only 7.7% of the affected population is in employment because of their age.

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

No evidence available. It is worth to note that employers can “sell” their quota of both disabled and people suffering of chronic diseases with incapacity above to 60% to cooperatives having social goals, which benefit of extensive fiscal and social security discounts. Thus, these practices can be seen as “good” in terms on maintaining or bringing people with some serious incapacities at work with suitable adaptation in terms of workstations and working times arrangement, but not so that good in terms of diversity management and earnings.

Commentary

The issue of employment opportunities for people suffering of chronic diseases is a quite recent issue, by extending to them policies addressed to disabled. This is due to the increasing restrictions to incapacity retirements since 1992, combined with reduction of early retirement opportunities and increasing retirement age. Employment rates are significantly lower and lack of diversity management strategies is probably the most challenging issue.

References

Dal Negro R.W.; Tognella S.; Tosatto R.; Dionisi M.; Turco P.; Donner C.F.- Costs of chronic obstructive pulmonary disease (COPD) in Italy: the SIRIO study. Respir. Med., 2008; 102: 92-101