Latvia: Employment opportunities for people with chronic diseases

  • Observatory: EurWORK
  • Topic:
  • Labour market policies,
  • Work organisation,
  • Disability and chronic disease,
  • Public services,
  • Working conditions,
  • Social policies,
  • Published on: 20 November 2014



About
Country:
Latvia
Author:
Raita Karnite
Institution:
EPC, Ltd.

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 chronic diseases in general are not treated as a specific target group in employment and working conditions policies. These policies and the consequent monitoring are focused on two target groups that are closely related but not identical to people with chronic diseases: people suffering from occupational diseases and people with disabilities. Policies regarding occupational diseases are focused on improving of working conditions and include assistance in treatment of occupational diseases. Persons with disabilities are a target group of employment promotion policies.

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?
  • What are the sources of these definitions (legislation, statistical sources, administrative documents, social security/health insurance systems)?
  • What concrete chronic diseases are included in these national definitions?

Definitions of “chronic diseases”

A specific definition of “chronic diseases” in an employment context does not exist.

In employment policies international definitions of chronic diseases are used or chronic diseases are understood according to definitions from the health care rhetoric.

For instance, EU DG of Heath and Consumers home page offers in Latvian the following definition: Chronic diseases are long lasting diseases that in most cases develop slowly.

The definition of the World Health Organisation is used in the health care sector.

Other definitions of chronic diseases in general were not found. In practice chronic disease is understood as long lasting disease or the health disorder that can not be averted by simple surgery or short course of medical treatment. The main criterion of identification of chronic diseases is the duration of the illness rather than its type by diagnosis. Time limit after which the disease may be considered as chronic has been discussed, however, a final determination has not been adopted.  

Two typical categories that may be connected with chronic disease (however, not always) are occupational diseases and disability. These categories are defined and are target groups of the state employment and working conditions policies.

In compliance with Latvian legislation on occupational diseases are such diseases that are typical for particular categories of workers and the single or the main reason of these diseases is physical, chemical, biological psychological or other factors (source: Ministry of Welfare, http://www.lm.gov.lv/text/551). Registration and treatment of people with occupational diseases is regulated by law. 

Disability is regulated by the Disability law. The law distinguishes predictable disability and disability.

A predictable disability is a limited functioning caused by a disease or trauma which, in case if the required medical treatment and rehabilitation services are not provided, may be a reason for determining disability. The criteria for determining a predictable disability, time periods and procedure are regulated by the Cabinet of Ministers.

A disability is a long-term or non-transitional very severe, severe or moderate level limited functioning which affects a person’s mental or physical abilities, ability to work, self-care and integration into society. The criteria for determining a disability and loss of ability to work, time periods and procedure is regulated by the Cabinet of Ministers. A person, who has been diagnosed with a disability, is issued a document certifying the disability. The document specimen and the procedure for issuing and accounting is regulated by the Cabinet of Ministers.

Chronic diseases included in national definitions

Chronic diseases are not grouped or listed neither in general nor specifically in connection with the employment. In the health care policy and statistics diseases are classified according to the international ICD-10 classification. Chronic diseases may occur in the majority of classes of diseases.

The term “chronic diseases” is rarely used in employment rhetoric and health care legislation. For instance, in the Medical treatment law (adopted on 12 June 1997) special chapters are devoted to medical treatment of some groups of diseases, namely: medical treatment of alcohol, narcotic, psychotropic, toxic substances, gambling and computer game addictive illnesses, mental illness; but these are not identified as “chronic diseases”.

Republic of Latvia Cabinet Regulation No. 899 (adopted 31 October 2006) on Procedures for the reimbursement of expenditures for the acquisition of medicinal products and medicinal devices intended for out-patient medical treatment provides a list of diseases that may be subject of the state subsidised medicine, among them chronic diseases, but do not distinguish chronic diseases in the provided list of diagnoses that are eligible for subsidised medicine.

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

National sources of statistical information dealing specifically with the issue of chronic diseases and their relation to employment and working conditions were not found.

General health statistics may give data on incidence of selected diseases that may be chronic.  However, general health care statistics does not distinguish if the disease has become chronic, as well as employment status of the patient. Data by age groups is available in some sources (for instance, regarding diabetes and oncology) but it is not known if a person in working age is employed, or seeking for job, or economically inactive.

The State Labour Inspectorate (Valsts Darba inspekcija, VDI) publishes more detailed information on occupational diseases in its homepage and in statistical appendix of the Annual report of VDI.

Further we provide information on useful sources in the health care and VDI statistics.

Register of Patients with Particular Diseases

The official name of statistical source:

  • in national language: Ar noteiktām slimībām slimojošu pacientu datubāze;
  • translation into English: Register of Patients with Particular Diseases;

Responsible body: The Centre for Disease Prevention and Control (Slimību profilakses un kontroles centrs, SPKC).

Definition of chronic diseases: not used.

Categories of chronic diseases surveyed/registered: chronic diseases are not distinguished; aggregated groups of diseases are: infectious and parasitic diseases, oncology, diabetes mellitus, mental diseases, mental and behavioural disorders due to use of psycho-active substances, multiple sclerosis, tuberculosis, injuries.

The questions in relation to employment and working conditions: not asked.

The methodology used to collect the data: permanent registration.

Statistical yearbook of health care in Latvia

The official name of statistical source:

Responsible body: SPKC.

Definition of chronic disease: is not used.

Categories of chronic diseases surveyed/registered: chronic diseases are not distinguished; aggregated groups of diseases are: infectious and parasitic diseases (tuberculosis, sexually transmitted infections and HIV / AIDS, other infectious and parasitic diseases, among them chronic hepatitis B and C), diabetes mellitus, oncology, use of drugs and addictive substances, mental health, injuries and disability statistics.

Questions in relation to employment and working conditions: not asked.

The methodology used to collect the data: methodology is not described. Based on the Register of Patients with Particular Diseases, Register of Causes of Death, the State Medical Commission for the Assessment of Health Condition and Working Ability, the state statistical reports on particular health care issues (tuberculosis, use of drugs and addictive substances) and data from the health care institutions.

Provided information: data is provided in the chapter on Public health and morbidity (55 tables and 37 pictures). The nomenclature of statistical data differs by diseases. The common indicators are prevalence, incidence and mortality and new cases of registration of diseases in total, per 100 thsd. population and by regions, For some groups of diseases data is specified by age groups and gender (for patients of diabetes and oncology), type of diabetes or location of malignant neoplasms, age standardized incidence rate and mortality rate per 100 thsd. population, leading site of malignant neoplasms by gender, proportion of patients at the end of year who have lived for 5 years or over after malignant neoplasms and in situ neoplasms diagnosis confirmation, % (for patients with malignant neoplasms)

Other info: annual source.

Statistical Yearbook of Latvia

The official name of statistical source:

in national language: Latvijas Statistikas gadagrāmata, atbilstošais gads.

translation into English: Statistical Yearbook of Latvia, respective year.

Responsible body: the Central Statistical Bureau of Latvia (Latvijas Republikas Centrālā statistikas pārvalde, CSP)

Definition of chronic disease: is not used.

Categories of chronic diseases surveyed/registered: chronic diseases are not distinguished; the statistics is detailed by groups of diseases: infectious diseases, malignant neoplasms, active tuberculosis, mental diseases, alcoholism and dependency upon psychoactive substances, HIV-positive persons. Statistics shows number of new cases of disability among working and non-working population by diagnosis (chronic diseases are not specifically distinguished). 

Questions in relation to employment and working conditions:  not asked.

The methodology used to collect the data: statistical survey, publications and databases of the Centre for Disease Control and Prevention in Latvia, State Medical commission for Assessment of Health Condition and Working Ability.  Data is classified according to CATTU and the International Statistical Classification of Diseases and Related Health Problems.

Provided information: incidence of selected diseases: number of new cases in total, by gender, per 100,000 individuals; cases under the surveillance of disease prevention institutions (at the end of the year): total and per 100,000. individuals.

Other info: annual source.

State register of persons suffering from occupational diseases and persons who were exposed to radiation as the result of the accident at the Chernobyl nuclear power plant

The official name of statistical source:

  • in national language: Valsts arodslimnieku un Černobiļas AES avārijas rezultātā radiācijas ietekmei pakļauto personu reģistrs
  • translation into English: State register of persons suffering from occupational diseases and persons who were exposed to radiation as the result of accident in Chernobyl nuclear power plant. 

Responsible body: responsible institutions - Occupational and Radiological Medicine Center of the Pauls Stradiņš Clinical University Hospital (Paula Stradiņa klīniskās Universitātes slimnīcas Aroda un radiācijas medicīnas centrs), executor -  Rīgas Stradinš University Institute for Occupational Safety and Environmental Health  (Rīgas Stradiņa Universitātes Darba drošības un vides veselības institūts).

Definition of chronic diseases: is not used.

Categories of chronic diseases surveyed/registered: chronic diseases are not distinguished; data on patients with occupational diseases and people who have been exposed to radiation as the result of accident in Chernobyl nuclear power plant.

The questions in relation to employment and working conditions: not asked.

The methodology used to collect the data: monitoring.

Provided information: not disclosed.

Other info: permanent monitoring, restricted access.

Annual report of VDI

The official name of statistical source:

Responsible body: VDI.

Definition of chronic diseases: is not used.

Categories of chronic diseases surveyed/registered: occupational diseases.

The questions in relation to employment and working conditions: causes for and conditions of occupational diseases.

The methodology used to collect the data: records of VDI activities, survey.

Provided information: chronic diseases are not distinguished; incidence of new cases of occupational diseases by regions, age groups,  gender, profession groups, sectors, groups of occupational diseases according to ICD-10,  causes of occupational diseases, division of persons with occupational diseases by size of enterprise, ownership of enterprises, duration of exposure to harmful working environment factors, length of employment, consequential work fashion (continues working at the same job, at other job in the same enterprise, does not work), measures taken in order to prevent occupational disease.

Other info: annual.

Working conditions surveys show some data on occupational diseases. For instance, Work conditions and risks survey 2012 – 2013 shows dynamics of incidence of two occupational disease – chronic infections in upper respiratory tract and chronic infections of lungs in 1996 – 2012 per 100,000 employed.  

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

The employment situation of people with chronic diseases is not monitored in Latvia. In this section answers relate to the whole population.

According to studies on the health care policy issues, the incidence of chronic diseases increases in Latvia (source: The policy of health care in Latvia. Expert’s report on elaboration of health care policy (Latvijas veselības aprūpes politika, NVO ekspertīze veselības rīcībpolitikas izstrādē). Project supported by the EU Social fund Nr. 1DP/1.5.2.2.2/11/APIA/SIF /114/742012).

The total number of people affected by the problem and incidence in relation to total population is not known, because chronic diseases are not defined as a unified group. Monitoring concerns only some groups of diseases that theoretically may become chronic.

The most frequent causes of death are cardiovascular diseases and cancer. These and other typically chronic diseases, such as chronic respiratory diseases, sugar diabetes, and psychical disorders are important in terms of potentially lost life years.

After intensive decline period in 1998 – 2009, the incidence of tuberculoses per 100 thsd. population has increased after 2009. In 2005 – 2012, the incidence of patients with diabetes mellitus per 100,000 individuals has fluctuated between 328 and 414 people and prevalence has steadily increased. Incidence of patients with malignant tumour increases. According to data on 2012, sharp increase in incidence of diabetes mellitus starts with age groups after 40 years old, while number of malignant neoplasms new cases increases with age groups after 25 years old. In 2001 to 2012 the average age of patients with newly confirmed neoplasms was 60 – 67 years old (slightly less for women). Incidence of patients with drug use disorders has increased in 2012 compared to 2009.  Incidence of alcohol addiction and alcoholic psychosis per 100,000 individuals has declined in 2006 – 2010, slightly increased in 2011 and reduced again in 2012. (Source of all data: Statistical yearbook of health care in Latvia, issue 14. Riga: SPKC, 2013).

The reason of high incidence of serious illnesses and chronic diseases is insufficient health care services (poor access, high patients’ contributions, and expensive medicine). 

The employment situation of people with chronic diseases is not observed; particular aspects of employment of people with chronic disease such as occupational and sector characteristics, the typical employment trajectories, are not known (more information is available regarding occupational diseases).  

The main problem for people with chronic diseases in the labour market is their ability to get to the workplace and to perform agreed work.

Employers do not distinguish workers according to their relation to chronic diseases, and are not obliged to employ workers affected by chronic diseases unless she or he is able to perform the agreed work. Flexible working arrangements may be used to overcome difficulties due to physical incapacity.

However, employers may have problems in connection with prohibition to terminate working contract of employee who is often on sickness leave before the period of interrupted leave does not exceed six months. Employers have also objected to too high employment guaranties for people with disabilities.   

Issues such as patterns in employment of people with chronic diseases in general, their specification by types of chronic diseases or groups of pathologies, age or gender, as well as change off patterns and crisis impact in this field are not considered.

2.2. Working conditions of employed people affected by chronic diseases

Apart from people suffering from occupational diseases and people with disabilities, people with chronic diseases are subjected to general working conditions regulation.

There is no sufficient data that allows to identify distinctive characteristics of the working conditions of the people affected by chronic diseases in comparison to the average national or sectoral level, considering the four Eurofound  working conditions  dimensions.

People with chronic diseases are not a special target group for monitoring of VDI. It is not distinguished in the Working conditions and risks surveys.

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

The state employment promotion policy includes measures specifically aimed at improving employment and working condition for people with disabilities. In aspect of working conditions, major attention is dedicated to prevention of occupational diseases. Both targets may be connected with chronic diseases, but not always.  

However, people who need special conditions in employment due to having chronic disease are not left without any assistance.

First, the Latvian Labour law provides for equal right to employment. These rights should be ensured without any direct or indirect discrimination – irrespective of a person's race, skin color, gender, age, disability, religious, political or other conviction, ethnic or social origin, property or marital status, sexual orientation or other circumstances.

Second, the Labour law sets forth that an employer does not have the right to give a notice of termination of an employment contract during a period of temporary incapacity of an employee, as well as to an employee who is declared to be a disabled person, except in cases when employee is not able to perform work due to reasons not connected with her or his health. However, the employer has the right to give a written notice of termination of an employment contract if the employee does not perform work due to temporary incapacity for more than six months, if the incapacity is uninterrupted, or for one year within three years, if the incapacity repeats with interruptions, excluding a prenatal and maternity leave in such period, as well as if the reason of incapacity is an accident at work or occupational disease.

Third, the Law on medical treatment sets forth the following norm: “Persons with mental disorders and mental illness shall be ensured all the civil, political, economic and social rights provided for by law. Mental disorders or mental illness shall not be a basis for discrimination of an individual”.

Forth, there is general approach in the health care policy that people who suffer or have suffered from chronic diseases should be supported to return to work. This approach is specified to the situation when people with chronic diseases return after the course of medical treatment or operation.

One employment measure developed by the State Employment Agency (Nodarbinātības Valsts aģentūra, NVA) may be considered as special initiative that is focused on people with chronic diseases and characterised with specific indicators.

General information of the policy measure

Name: Active employment measure “Support measure for long-term unemployed persons with addictions”.

Dates: introduced in second half of 2012, active until 2014 (including).

Responsible body: NVA.

Participants: unemployed, medical treatment institutions

Specific target group:

Long-term unemployed persons over the age of 18 who are registered in the NVA having the status of unemployed for at least 12 months and having a narcologist’s conclusion regarding addiction to alcohol, drugs or psychoactive substances.

Duration of the measure: 28 days. 

Geographical and sector scope: not limited

Objectives pursued: to provide to the long-term unemployed persons with an opportunity to treat addiction to alcohol, drugs or psychoactive substances according to the Minnesota model 12 step addiction treatment programme thus supporting the elimination of obstacles to facilitate finding a job.

Support offered: the NVA patient fee in the amount of EUR 7.11 per treatment day to the unemployed persons of the target group who are not exempted from the patient fee pursuant to legislation regulating the procedure for organizing and financing health care; costs of accommodation and catering in the amount of EUR 13.37 per day.

The long-term unemployed persons who have been able to quit the addiction can receive psychologist, psychotherapist or career specialist consultations if necessary, consider possibility to participate in other active employment measures of the Agency and receive the NVA support in searching for a job, start looking for a job and integrate in the labour market.

The treatment is carried out by “Akrona 12” Ltd. which has signed a contract with the National Health Service on addiction treatment according to the Minnesota Model.

Activities carried out:

On the basis of submitted application, engaged unemployed from the target group go to a medical treatment institution to see a narcologist and get their conclusion regarding addiction. A copy of narcologist’s conclusion should be submitted to the project career consultant in the NVA affiliate. Participants may choose a medical treatment institution and receive the appointment for treatment according to the Minnesota model 12 step addiction treatment program at the NVA affiliate. The participants should attend the selected medical treatment institution within 10 days after receiving the appointment. For this, the participant should have the NVA appointment and individual employment seeking plan.

After the finishing of the treatment according to the Minnesota model 12 step addiction treatment program (for 28 days) a person arrives at the NVA affiliate on the day specified in her/his individual employment seeking plan and, if necessary, receive psychologist, psychotherapist or career specialist consultations. The participant should also consider possibility to participate in other active employment measures of the NVA and to start looking for a regular job.

Financing of the measure: Latvian government, co-financed by the European Social Fund within the framework of project "Complex Support Measures".

Major results: 9 participants in 2012 (4 women and 5 men), 143 participants in 2013 (48 women and 95 men), 328 participants are expected in 2014 (total number is planned as 480 persons).  Of 152 participants, 145 had addiction to alcohol.

Consequences of the measure on the improvement of working conditions of people with chronic diseases:  reduced or liquidated addiction to alcohol, drugs or psychoactive substances, improved ability to work.

Assessment: The measure is considered as effective. After treatment, 56% of participants have engaged in other active labour market measures of NVA, and 14.6% of participants have obtained permanent job or became self-employed.

Link to the identified measure/initiative: http://www.nva.gov.lv/index.php?cid=433&mid=445&txt=3032&new_lang=en

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

The content of company level collective agreements is not available. Based on the Free Trade Union Confederation of Latvia (Latvijas Brīvo Arodbiedrību savienība, LBAS) database it seems that clauses to support people with chronic diseases are rarely included in collective agreements.

Without a specific survey it is not possible to find enterprises implementing special initiatives regarding persons with chronic diseases.  

Commentary

Chronic diseases are connected with health care and employment aspects. In health care chronic diseases are monitored and treated according to international classification of diseases and diagnosis. Some diseases are monitored in detail; others are not monitored at all. In employment monitoring and special policies are focused on people who have problems to perform work (usually people with disability) or have suffered due to unfavorable working conditions (occupational diseases). Both, disability and occupational diseases are closely related but not identical to chronic diseases. For this reason comprehensive information on incidence of chronic diseases among working population, as well as any information on working conditions of people with chronic diseases in general is not available and special policies dedicated specifically to people with chronic diseases are not applied, except the general principle on prohibition of discrimination in employment (additionally confirmed regarding persons with mental diseases in healthy care legislation), protection against too early dismissal of employees who are on sickness leave and employment focused rehabilitation for people suffering from severe chronic disease. Special support measure is introduced in NVA for long-term unemployed persons with addictions.

Statistics on the incidence of chronic diseases among working population is not available. Some data may be obtained from health care statistics by age groups and particular diseases and statistics on vocational diseases. Studies on working conditions of people with chronic diseases in general do not exist.

References

Statistical Yearbook of Latvia 2012. Riga: CSP, 2013.

Statistical yearbook of health care in Latvia 2012. Riga: The Centre for Disease Prevention and Control of Latvia, 2013.

The policy of health care in Latvia. Expert’s report on elaboration of health care policy (Latvijas veselības aprūpes politika, NVO ekspertīze veselības rīcībpolitikas izstrādē). Project supported by the EU Social fund Nr. 1DP/1.5.2.2.2/11/APIA/SIF /114/742012

Work conditions and risks survey 2012 – 2013. Riga: SIA “TNS Latvia”, Rīgas Stradinš University Institute for Occupational Safety and Environmental Health, 2013.

Ministry of Welfare, http://www.lm.gov.lv/

NVA, www.nva.gov.lv

VDI, www.vdi.gov.lv

CSP, www.csp.gov.lv

Latvian Employers’ Confederation, www.lddk.lv

The Institute for Occupational Safety and Environmental Health of the Riga Stradiņš University, http://www.rsu.lv/eng/science-and-research/research-organisation/structure/institutes-and-laboratories/institute-for-occupational-safety-and-environmental-health

The Centre for Disease Prevention and Control of Latvia, http://www.spkc.gov.lv/index.php?id=5

Occupational and Radiological Medicine Center of the Pauls Stradiņš Clinical University Hospital, http://www.arodslimibas.lv/

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