Slovenia: Employment opportunities for people with chronic diseases

  • Observatory: EurWORK
  • Topic:
  • Labour market policies,
  • Work organisation,
  • Disability and chronic disease,
  • Viešosios paslaugos,
  • Working conditions,
  • Social policies,
  • Published on: 14 Lapkritis 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.

Cardiovascular diseases are one of the most frequent chronic diseases in Slovenia and third most important cause for work-related disability. Cardiovascular diseases and other chronic diseases share common risk factors associated with unhealthy lifestyle and early detection of risk factors is of major importance. Every year more than 1000 people in employment suffer total or partial incapacity for work due to cardiovascular diseases. Most initiatives and programes in Slovenia addressing the problems and challenges of chronically ill workers focus on the prevention of chronic diseases or awareness rising campaigns for employers, stakeholders and the public.

Block 1: Concept, definitions, sources of information and methodological issues on chronic diseases and work from the national perspective

Chronic diseases are defined as:

Diseases that require long-term medical treatment, mostly for the rest of his/her life (by the Slovenian Pharmaceutical Society); the most frequent non-contagious chronic diseases are hypertension, cancer, asthma, diabetes and obesity. Unhealthy way of living and risky behaviour can lead to a chronic disease.

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

Slovene Chronic Diseases Prevention Centre CINDI at the National Institute of Public Health (Center za upravljanje programov preventive in krepitev zdravja, Nacionalni inštitut za javno zdravje) carried out a national survey on the Risk factors for the non-contagious diseases of adults in Slovenia in 2008, which was published in 2010. The survey included a sample of 15963 Slovene adults age 25 to 74 that were pulled out from the central population register, and ending up with a response rate of 49% (in the end 7352 questionnaires were used in the analysis). The survey used CINDI Process Evaluation Questionnaire that was send by post. The aim of the survey was to explore and evaluate the patters of living conditions and a spread of behavioural risk factors, connected with the health condition, mainly with non-contagious chronic diseases, like cardiovascular disease, diabetes, respiratory diseases, gastrointestinal diseases and cancer. The survey also included one question on the type of work people are involved in most of the time, with 10 different categories: hard physical labour in farming, hard physical labour in industry/ construction, physical labour (transportation, printing, warehousing, maintenance), combination of physical and service labour (tourism, retail, medical care), administrative work, research work, student, housewife, retired and unemployed.

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

Cardiovascular diseases are one of the most frequent non-contagious chronic diseases in Slovenia, along with cancer, diabetes and pulmonary illnesses. In 2008 the total compensation for sickness due to cardiovascular diseases cost more than 31 million €. The length of sick leave due to cardiovascular diseases is more than 40 days and rising over the last 10 years. The highest percentage of sick leave due to cardiovascular diseases is in the economic sector of electricity and water supply. Every year more than 1000 people in employment suffer total or partial incapacity for work due to cardiovascular diseases. Cardiovascular diseases are the third most important cause for work-related disability.

The survey on the Risk factors for the non-contagious diseases of adults in Slovenia in 2004 and 2008 reports on the frequency of different diseases that were diagnosed by physicians. The table below presents the frequency of each disease that was diagnosed by physicians and different types of labour that people having those diseases were involved in. Respondents were asked to indicate the presence of the following diseases and could report to have more than one disease.

2008

Type of chronic disease

Type of work

hypertension

diabetes

gastric ulcer

chronic bronchitis

arthritis

chest pain

back injury

Hard physical labour in farming

36%

6.9%

8.7%

1.5%

17.8%

7.2%

28.4%

Hard physical labour in industry/construction

23.9%

5.9%

11.5%

2.3%

11.5%

6.9%

24.5%

Physical labour (transportation, printing, warehousing, maintenance) and

Combination of physical and service labour (tourism, retail, medical care)

18.8%

3.8%

6.9%

2.4%

7.3%

4.5%

23.9%

Administrative work and

Research work

12.8%

2.8%

4.8%

1.6%

7.1%

1.8%

16.6%

Student

1.6%

0.8%

3.1%

2.4%

2.4%

0.8%

15.6%

Housewife

38%

9.3%

7.2%

5.2%

21.4%

6.2%

27.2%

Retired

47.7%

13.6%

10.9%

4.3%

13.3%

10%

24%

Unemployed

30.6%

7%

12%

4.3%

21.4%

12%

40.7%

Source: National Institute of Public Health, 2010  

Another survey on the prevalence of chronic diseases in Slovenia was carried out in April 2009 by the Faculty of Medicine, university of Ljubljana and University of Maribor. The survey was part of a research on “Self-medication among Slovene citizens”. The survey included 410 adults from Slovenia, age 18-89 and showed that 70.5% of respondents reported health problems. Individuals suffering from chronic diseases were on average 15 years older than those reporting no chronic health problems. The prevalence of all chronic diseases was highest at the individuals with lower education and pensioners and significantly higher in the population with lower socio-economic and employment status.

2.2. Working conditions of employed people affected by chronic diseases

In Slovene legislation, chronic disease is neither specifically defined nor regulated. The only exemption is the State Employees Act (Zakon o delavcih v državnih organih), which allows the extension of the annual leave in the amount of up to three days in cases of special social or health conditions, like chronic or other long-term diseases. The judgement whether the specific health condition is regarded as chronic or not is in the hands of the relevant physicians.

Under the Slovene compulsory health insurance, all adults are provided with preventive health examinations for non-contagious chronic disease prevention every 5 years.

Prior the employment, every worker has to go for a medical examination at the occupational medicine specialist, where health condition or other occupational capabilities are evaluated against the job description. Workers, for example with a chronic kidney disease, should avoid working tasks where they would be exposed to chemicals, biological factors, radiation. The specialist can also suggest some restrictions at the workplace. If workers are employed at the work places with a greater risk, they should be examined periodically. If occupational medicine specialist recognizes their incapacity for work, he/she can suggest their examination at the disability commission at the Pension and Disability Insurance Institute of the Republic of Slovenia. The commission decides upon the level of physical impairment and evaluates the level of disability. In case the worker suffers total incapacity to work, he has a right to a disability pension. If the incapacity is partial and worker is not able to perform tasks within his/her own occupation, but is able to perform some other tasks, has a right to occupational rehabilitation, together with compensation during the rehabilitation. If the incapacity is partial and worker can not perform his/her own job, he/she has a right to be employed at different work place. In this case, worker receives compensation for disability along with a regular salary. If worker is not able to work full time, he/she has a right to a part time work and receives compensation for disability along with a regular salary. If patient with chronic disease needs help with the basic everyday tasks, he has a right to assistance and attendance allowance, decided at the disability commission.

Unemployed workers, who are registered at the Employment Office, have a right to unemployment allowance. Workers also have a right to be included in the Active Employment Policy Programmes (counselling, training ...). If the Office finds a person incapable to work, a person can ask for a social relief at the Social Work Centre.

Employers are encouraged to include people with recognized disability. The most important program is called Employ.me/Encouraging employment of difficult-to-employ people (Zaposli.me/Spodbujanje zaposlovanja težje zaposljivih brezposelnih oseb). The Employment Office covers part of the training costs and the employer can reclaim costs of workplace adjustments. If necessary, the employer can also attain resources for opening a new workplace for a disabled person. In 2012, 1,267 people were included in this program (79% long term unemployed, 51% women, 52% 50 years of age or older, 2% younger than 25 years and 10% of people with disabilities) out of the average 110,183 registered as unemployed.

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 program of primary prevention of cardiovascular disease is a national programme of the Ministry of Health (Ministrstvo za zdravje, MZ), coordinated by the Slovene Chronic Diseases Prevention Centre CINDI for more than 10 years, and aimed at an early detection of individuals who are at a higher risk of developing cardiovascular and other chronic diseases. These diseases share common risk factors (high blood pressure, cholesterol, blood sugar levels, overweight and obesity), associated with unhealthy lifestyle and early detection of risk factors is of major importance. The basic objective of the program is to reduce early mortality of the adult population of Slovenia due to cardiovascular diseases. This preventive and counselling program is available to all people at certain age (men aged 35-65 and women aged 40-70), organized in the network of 61 reference health education centres operating normally in every health centre in Slovenia. Since 2002, more than 900,000 preventive examinations of adults at risk of cardiovascular disease were performed and 600 premature deaths were prevented every year, while the prevalence of cardiovascular diseases also reduced (National program of primary prevention of cardiovascular disease). In October 2013, Ministry of Health and National Institute of Public Health organized a conference "Together for Health" (Skupaj za zdravje) to contribute to the promotion of preventive activities and programs in Slovenia for the prevention of chronic diseases and to promote the activities of reference health centres.

Clinical Institute of Occupational, Traffic and Sports Medicine Ljubljana (KIMDPŠ), a University Medical Centre in period from April 2011 to April 2013 participated, along with 17 other European countries, in the PHWork project "Promoting Healthy Work for Employees with Chronic Illness" (Promocija zdravega dela za delavce s kroničnimi boleznimi), a 9th joint initiative of the European Network for Workplace Health promotion (ENWHP) under the campaign Work. Adapted for all. Move Europe. Project was in Slovenia financially supported by the Ministry of Health and aimed at raising awareness of employers and other stakeholders about the importance and usefulness of job retention for workers with chronic diseases and at promoting the exchange of experiences that enhance the reintegration to work of chronically ill workers. The main goals of the project were to identify cases of good company practices providing workers with chronic diseases better working conditions, easier return to work after a long time sick leave, and measures to retain them at work; to establish guidelines for employers and to convince stakeholders to invest in the programes contributing to health and well-being of workers with chronic diseases. Project resulted in the brochure "Promotion of healthy work for workers with chronic diseases: Guide to best practice" (Promocija zdravega dela za delavce s kroničnimi boleznimi: Vodnik po dobrih praksah), including 6 step action plan on return to work for workers with chronic disease after a long time sick leave. Project concluded with international conference organized in October 2013 in Brussels.

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

a) DARS Motorways Company was among other EU companies in the project Promoting Healthy Work for Employees with Chronic Illness chosen as best company practice from Slovenia with established initiatives to support personnel affected by chronic diseases. DARS employs 1,237 workers in the field of Tolling, Motorway Maintenance and Management, Construction and Reconstruction Organisation.

Objectives pursued and addressed target groups:

DARS` s employees are often exposed to specific health risks, therefore the company introduced different activities for maintaining employees healthy, with a long-term aim to reduce the extent of chronic diseases as well as the extent of changed working capacities due to disability. Target group presents blue-collar workers that work in freeway maintenance and toll collection.

Objectives that company pursued are the following:

  • actively representing the interests of the employees whose ability to work has changed by taking into account the work process needs;
  • improving the work efficiency of employees whose ability to work has changed, increasing disabled employees’ opportunities to keep their jobs through additional training or retraining, and improving conditions for employees with chronic illnesses so that they can return to work after long-term sick leave;
  • using a workplace health promotion program to maintain and enhance the health of all employees, thus managing sick leaves and the scale of changed work ability.

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.)

Main activities conducted for employees with chronic illnesses encompass direct and regular presence of HR specialists in the work units and at locations offering ongoing assistance to employees with problems connected with changed health conditions; active cooperation with authorized occupational medicine physicians and the occupational health and safety service in managing the risks of injuries and health problems; adapting the current work environment and jobs to employees whose ability to work has changed and carrying out workplace health promotion activities among employees to maintain and enhance their health (subject-specific courses and target activities). Company in 2011 established »Virtual Health Center« (Virtualni center zdravja) for electronic informing and awareness rising on health and safety at work. DARS in 2012 organized a conference “Stress on the street” (Stres na cesti) and stress management workshops for workers in the field of maintenance of highways, including organization of psychosocial support for them.

Main results obtained and assessment of these results:

The direct and ongoing presence of HR specialists among the employees at locations throughout Slovenia allows employees to obtain information, referrals, and guidance for taking timely and effective action. This enables proactive work towards the resolution of problems in the work process that result from changed work ability or other circumstances affecting employees’ social security (seeking an appropriate job within the same or a different organizational unit and location in a timely fashion, training employees, organizational or technical workplace adaptations, etc.).

Analysis of results showed some improvement, since the number of lost days due to sick leave decreased from 1,122 in 2009 to 559 in 2011.These results are also due to internal training programs on the prevention of psychological and physical violence and activities relating to the promotion of health (importance of a healthy lifestyle for safe work especially in particularly dangerous parts).

Link to the identified case study: http://www.enwhp.org/fileadmin/user_upload/pdf/PH_Work_DARS_disabled_and_employees_with_chronic_illness_Slovenia.pdf

 

b) Communally building Kostak d.d, a public limited company with 305 employees, is another good company case with initiatives for all workers, including workers with chronic illness.

Objectives pursued and addressed target groups:

Company Kostak pursued the objective to reduce the absence from work due to sick leave below 4.5% and absence from work due to work-related injuries below 0.3%. Company continues with detailed analysis of work-related injuries, measures to prevent occupational accidents and causes of observed absence from work. Initiatives are aimed at all employees, including management.

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.)

Company Kostak devised a set of measures dedicated to the promotion of health in the workplace as part of the project “Fit for Work” (Čili za delo), carried out by the Clinical Institute of Occupational, Traffic and Sports Ljubljana in 2009. The program is based on encouraging the employers to promote healthy lifestyles to employees by providing a healthy work environment with the aim of preserving health and limiting risk factors. Clinical Institute as part of the program organized trainings for health promoters in the workplace and company Kostak` s health promoter was among the first participants to this training. As a result, company promoter organized internal workshops to promote healthy lifestyle and motivate employees to participate in the sport activities organized by the company sport club, which are mostly free of charge. This activities care for the physical health of employees, but also strengthen relationships between employees. Employees and their family members are also offered the option of anonymous psychological advice. Participating clinical psychologist is available to all employees for a phone talk and e-mail chat as well as for the free individual visit.

Company Kostak plans to perform in the future also ergonomic analysis of the characteristics of certain jobs on the basis of which the company will designed workflows that will minimize negative impacts on the health of employees.

Main results obtained and assessment of these results:

The largest share of sickness in the company is bound to the musculo - skeletal system, while the proportion of respiratory diseases and circulatory diseases has also been increasing (0.28 in 2003 to 0.63 in 2007). To decrease the level of medical absenteeism, company Kostak introduced positive attitude activities, which include regular medical examinations, interviews with employees, care for improving the quality of working conditions and promoting healthy lifestyles. Assessment of the results in 2009 showed some positive effects; the share of absenteeism due to sick leave decreased from 4.69% (34,024 days) in 2006 to 3.35% (30,256)

Link to the identified case study: http://www.gzs.si/slo/regije/oz_gorenjska/48587

Commentary

There are no policy measures in Slovenia developed by public authorities or social partners to favour working conditions of people with chronic diseases. Only when workers with chronic disease obtain status of disabled person, than legislation regarding their employment status and working conditions is well regulated. Slovenian companies mostly focus on the promotion of healthy lifestyle and organize preventive health programmes such as sport activities at sports centres, preventive-active breaks at different Spa centres, trainings and workshops regarding healthy life style and medical –preventive active breaks for people with heath problems such as cronical diseases.

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