Lithuania: Employment opportunities for people with chronic diseases

  • Observatory: EurWORK
  • Topic:
  • Labour market policies,
  • Working time,
  • Health and well-being at work,
  • Working conditions,
  • Published on: 14 November 2014



About
Country:
Lithuania
Author:
Rasa Zabarauskaite
Institution:
Institute of Labour and Social Research of the Lithuanian Social Research Centre

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.

Lithuanian legislation does not provide a clear definition of a chronic disease. Neither there are national sources of statistical information that would specifically focus on the issue of chronic diseases. According to available statistical data, a percentage of employed people having a long-standing illness or health problem in Lithuania has been steadily decreasing since 2005 (the decrease was particular pronounced in 2008 with the onset of the economic crisis in the country). This could be determined by reduced labour market integration opportunities for people with chronic diseases. Similarly, there have been no special studies conducted in Lithuania to address the working conditions of employed people affected by chronic diseases, as well as there are no policies and measures adopted by public and private agents to favour the employment situation and working conditions of people with chronic diseases.

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

Lithuanian legislation does not provide a clear definition of a chronic disease. Approved by the order of the Minister for Health of the Republic of Lithuania, the modified International Statistical Classification of Diseases and Related Health Problems (10th  revision) “Systematic list of diseases” have been in effect in Lithuania since 1 April 2011 for identification of diseases. The mentioned extension contains a list of certain diseases (some of which are chronic ones), but it does not provide a separate list of chronic diseases.

It should be noted to this effect that according to the National Programme for the Prevention of Non-communicable Chronic Diseases 2008-2010 approved by the order of the Minister for Health of the Republic of Lithuania, the group of the most widespread non-communicable chronic diseases (NCD) is comprised of diseases of the circulatory system, malignant neoplasm, and diabetes mellitus.

Draft No. 13-0014-03-SN of the Lithuanian Health Programme for 2014-2021 identifies non-communicable chronic diseases as long-standing and usually slowly progressing diseases such as cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory diseases and mental health 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

There are no national sources of statistical information in Lithuania that would specifically focus on the issue of chronic diseases. General statistical data on health conditions (including chronic diseases) of the Lithuania population, activities of health care establishments and resources of the health care system is collected and provided by the Health Information Centre of the Institute of Hygiene (HI).

As it was mentioned above, the International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian modification (IDC-10-AM) is in use in Lithuania for morbidity coding.

In the second quarter 2013, the Lithuanian Statistics (STD) conducted a statistical survey of accidents at work and other work-related health problems to assess the number of work-related diseases, accidents at work, duration of the time not worked, etc. However, this survey contains a general analysis of disease-related data without singling out chronic diseases. According to the mentioned survey, every ninth person (11%) aged 15 years and over, who is in employment or was in employment during the last 12 months, reported having had physical or mental health problems. Health problems caused or aggravated by work were commonly related to bones, joints or muscles (61%), as well as to stress, depression or anxiety (13%).

In Lithuania, information is collected on occupational diseases that can be partially related to chronic diseases. According to STD, 393 cases of occupational diseases were registered in Lithuania in 2012; musculoskeletal diseases and diseases of the nervous system and sense organs accounted for the most of them (64% and 30% respectively).

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

  • Extent of the phenomenon of people with chronic diseases in your country, percentage of people affected by the problem in relation to total population. Evolution of the problem in recent years (Increase/decrease) and reasons for this evolution. More frequent pathologies/diseases.

Surveys on incomes and living conditions of the population in Lithuania have been carried out by STD since 2009 to obtain information on the self-perceived health status of the population. According to the survey data, approximately 29% of persons aged 16 years and over reported that they had one or another chronic disease or long-standing health problem (lasting for at least 6 months) in 2012 (Table 1).

Table 1. Share of population aged 16 years and over having a chronic disease or long-standing health problem (%)

 

2009

2010

2011

2012

Share of population

27

31

28

29

Source: STD, Income and Living Conditions, 2009 – 2012

Similar trends can be seen in Eurostat’s data (Table 2). According to the Eurostat’s figures, in Lithuania slightly less than one third of the population (29.6%) had a long-standing illness or health problem in 2012. The share of such persons actually remained stable during a period from 2005 to 2012 (decreased from 30.3% to 29.6%).

  • What is the employment situation of people with chronic diseases in your country (% of people in employment/unemployment/inactivity that are affected by chronic diseases)?

Eurostat’s data suggests that the share of employed people having a long-standing illness or health problem has been decreasing every year in Lithuania since 2005 (from 17.8% to 11.9%) (Table 2). A particularly pronounced decrease in the share of persons in this group was observed in Lithuania in 2008, which marks the onset of the economic crisis in the country. Considering that the total share of people having a long-standing illness or health problem in Lithuania remained almost the same throughout the period 2005-2012, it can be presumed that the decreasing share of employed people with a long-standing illness or health problem in Lithuania has to do with more difficulties faced by people having chronic diseases to survive in the Lithuanian labour market.

Table 2. People having a long-standing illness or health problem in Lithuania in 2005-2012 (%)

 

2005

2006

2007

2008

2009

2010

2011

2012

Share of employed

17.8

20.5

18.3

15.2

14.6

12.3

12.1

11.9

Share of total population

30.3

33.5

31.7

29.1

28.5

26.9

29.0

29.6

Source: Eurostat database

The data collected in 2011 in the context of a Labour Force Survey ad-hoc module provide some figures on the employment of disabled people in Lithuania. According to the data, in 2011 in Lithuania 74.8% of the disabled people aged 15-64 reported having no longstanding health condition or basic activity difficulty; 12.1% of them reported only a longstanding health condition; 11.3% - both a longstanding health condition and a basic activity difficulty.

  • Are certain chronic diseases associated to or more prevalent in certain economic sectors/occupations?

There are no statistical data or special surveys in Lithuania giving grounds to judge on whether or not certain chronic diseases are associated to or more prevalent in certain economic sectors/occupations. According to the accident survey carried out by STD in 2013, every fourth employed person identified a tiring body posture or body movements while working and activities requiring intense visual work as factors encountered by them at work and likely to affect their physical health; every fifth person mentioned risks of accident at work. Findings of the aforementioned survey suggest that a tiring body posture or body movements while working and activities requiring intense visual work have been mainly faced by people employed in industry and trade, whereas risks of accidents at work have been more common in industry and construction. These economic activities can be therefore presumed as prevailing among people having chronic diseases associated with physical environment factors.  

  • What are the main difficulties/problems for people with chronic diseases to access or stay in the labour market?

There have been no special studies/surveys carried out in Lithuania enabling to identify difficulties/problems for people with chronic diseases to access or stay in the labour market. Taking into account that the Procedure and criteria for establishing the level of disability, as approved by the Minister for Health of the Republic of Lithuania, the Minister for Social Security and Labour of the Republic of Lithuania and the Minister for Education and Science of the Republic of Lithuania, stipulates that persons having chronic diseases of the respiratory, circulatory, digestive and other systems shall be established a certain level of disability, it can be presumed that persons with chronic diseases face similar problems to integrate into the labour market as people with disabilities. According to research studies on integration of disabled people into the labour market conducted in Lithuania, the main difficulties/problems for people with disabilities to access or stay in the labour market include: poor physical health status, negative treatment of the disabled by employers, low wages, limited mobility of the disabled, environment not adjusted to their needs, and low prevalence of part-time work (Skuciene et al. 2005, Zalimiene et al. 2006-2007, Okuneviciute Neverauskiene et al. 2008-2009, Okuneviciute-Neverauskiene 2012).

  • Are there differences in the previously mentioned patterns by types of chronic diseases or groups of pathologies? are there differences according to age or gender.

STD’s data shows that the percentage of people having chronic diseases and log-standing health problems increased with age. In 2012, the percentage of people having long-standing problems in Lithuania was 68% in persons aged 65 years and over; this share was 8% among persons aged 25–34 and  5% among persons aged 16–24. The same trends are demonstrated by Eurostat’s data (Table 3).

Table 3. People having a long-standing illness or health problem in Lithuania in 2012 by age (%)

 

16-24

25-34

35-44

45-64

65-74

Share of population

5.1

7.0

12.2

32

61.5

Source: Eurostat database

According to the Eurostat’s data, chronic diseases are more common in women than in men in Lithuania. In 2012, 33.1% of women and 25.4% of men reported having a long-standing illness or health problem.

  • Is it possible to identify some changes in the previously mentioned patterns in recent years?, reasons for this and possible specific effects of the economic crisis

As it was mentioned above, the share of employed people having a long-standing illness or health problem in Lithuania decreased during the economic crisis. To a certain extent, such a situation can be explained by an increase in the number of disabled people in Lithuania over the mentioned period. Table 4 shows quite a marked increase in the number of the disabled during the crisis of 2008-2009. It is probable that increased tension in the labour market and lower employment opportunities in Lithuania made people with long-standing health problems seek recognition of disability entailing the right to receive disability pension.

Table 4. Number of disabled persons (thousands) over 18 years from 2005 to 2011 and number dynamics (%)

 

2005

2006

2007

2008

2009

2010

2011

Number of disabled persons over 18 years

233

235

237

243

253

251

248

Change y-o-y (%)

-

0.8

1.2

2.4

4.1

-0.6

-1.5

Source: STD database

It should be noted, however, that the procedure of establishing disability levels was tightened in Lithuania in 2010. As a result, the number of disabled people has been steadily decreasing in Lithuania every year. This trend is clearly demonstrated by the analysis of the number dynamics for working-age persons to whom disability has been established for the first time in Lithuania (Table 5).

Table 5. Number of working-age persons for whom disability has been established for the first time

 

Total

Tuberculosis

Malignant neoplasm

Mental and behavioural disorders

Nervous system diseases

Circulatory system diseases

Diseases of connective tissues and musculoskeletal system

Occupational diseases and intoxications

2012

13,993

190

2,401

1,395

2,016

2,740

2,176

3

2011

14,880

370

2,507

1,385

1,885

2,998

2,370

4

2010

15,432

399

2,706

1,303

1,501

3,525

2,566

15

2009

22,507

539

2,996

1,717

2,428

5,511

4,492

37

2008

26,649

597

3,128

1,784

3,068

6,365

5,536

95

2007

25,557

732

2,921

1,643

2,693

6,187

5,143

121

Source: STD database

2.2. Working conditions of employed people affected by chronic diseases

  • Health and well-being: Are certain occupations/jobs/sectors associated to certain chronic diseases? Possible relation between occupations and chronic diseases; what are the factors behind this (exposure to risks and hazards, job intensity, type of work, etc.); are special H&S measures implemented at workplace level to avoid/palliate this?

There have been no special surveys/studies conducted in Lithuania to address possible relations between occupations and chronic diseases in the country. Some conclusions regarding the spread of chronic diseases among employees in certain occupations can be drawn from the analysis of the spread of occupational diseases. According to the data of HI, in Lithuania, the majority of occupational diseases are diagnosed to machine operators and assemblers (in 2012 – approx. 58%), as well as skilled workers and craftsmen (in 2012 –19%). In Lithuania, occupational diseases are mainly caused by such physical factors as vibration or noise and ergonomic factors like carrying or moving heavy loads, lifting, repetitive and intensive motions while working, poor body position.

Chronic diseases are probably widespread in the service sector, too. For example, a research conducted in 2011 has revealed that 32% hairdressers suffer adverse skin effects from the exposure to products used to perform work tasks. 31.3% of them have reported acute effects and 18.8% – chronic effects. 13.3% of hairdressers have reported having had acute and chronic negative effects on the hands from customer’s hair (35% and 10% respectively).

  • Reconciliation of working and non-working life: are people with chronic diseases allowed special conditions in terms of work-life balance, flexibility at work to cope with the diseases/attend treatment, ability to set their own working time arrangements, etc.?

In Lithuania, employees with chronic diseases are not allowed any special conditions in terms of work-life balance or flexibility at work to cope with the diseases or attend treatment. However, the Labour Code of the Republic of Lithuania (LC) provides for the opportunity to set part-time daily working time or part-time weekly working time at the request of the employee due to his/her health status according to a conclusion of a health care institution. Yet, considering that part-time employment accounts for quite a small portion in Lithuania (in 2012, part-time employees accounted for 8.8% of total employees in Lithuania) and more than one third of them are in part-time work involuntary (this portion stood at 33.5% in 2012), part-time work can be presumed to have a low prevalence amongst people having chronic diseases.  

  • Career and employment security: to which extent and how is the employment status of people with chronic diseases affected by their health situation? is there an impact in their remuneration levels/conditions? in what measure is there a repercussion on their employment security and working career? are they allowed/forced to changes in their jobs?

In Lithuania, people with chronic diseases are not allowed any special conditions in terms of their career and employment security. In compliance with valid Lithuanian legislation, people having chronic diseases are applied usual employment security schemes and provided equal career opportunities as any other employees.

  • Skills development: in what measure have chronic diseases an impact in the access of workers to training activities promoted by the employer? Has the training anything to do with the disease situation?

In compliance with valid Lithuanian legislation, employees with chronic diseases have equal access to employee training activities as any other employees. 

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

There have been no special measures implemented in Lithuania to favour the employment situation and working conditions of people with chronic diseases. As one of the initiatives relating to chronic diseases, we can mention the national research programme Non-Communicable Chronic Diseases which was launched by the Lithuanian Research Council (LMT) in 2010. The purpose of this programme is to obtain new scientific knowledge for reducing morbidity, prevalence of disease, mortality and disability caused by such diseases, as well as to draw up strategic principles of prevention, to create better prevention and diagnostic methods for non-communicable chronic diseases. Programme implementation period is from 2010 to 2014.

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

Unfortunately, there are no collective agreements implementing initiatives or establishing clauses to support people with chronic diseases. Neither there are publicly available examples of enterprises that would support people with chronic diseases.

Commentary

Unfortunately, there is actually no publicly available information in Lithuania addressing employment and working conditions of people having chronic diseases. This situation is partially due to the loose definition of a chronic disease in Lithuania and the lack of a clear list of such diseases. In general, it can be stated that people with chronic diseases are not applied any support or special conditions to favour their integration or survival in the labour market. Special employment measures or certain palliatives are available only for disabled persons with chronic diseases. Overall, the problem of employment and working conditions of people having chronic diseases appears to be relevant in Lithuania. However, it is neither escalated nor given sufficient attention.

References

Okunevičiūtė Neverauskienė L., Gruževskis B., Pocius A. Assessment of active labour market policy measures efficiency for disabled individuals and preparation of proposals for increasing efficiency thereof. Research report. 2008-2009. Vilnius, Institute of Labour and Social Research.

Okuneviciute Neverauskiene L. Integration of the disabled into the labour market:

Situation assessment and employment opportunities. Phylosphy . Sociology. 2012. T. 23. No. 2, p. 136–144.

Skučienė, D.; Šumskaitė, L. Analysis of the situation of people with disabilities in the labour market. Research report. 2005. P. 19-20.

Žalimienė L. Česnuitytė V., Okunevičiūtė Neverauskienė L. Analysis of the situation of people with employment difficulties in the labour market and measures to improve their employability. Research report. 2006-2007. Vilnius, Institute of Labour and Social Research.

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