- Observatory: EurWORK
- Labour market policies,
- Work organisation,
- Disability and chronic disease,
- Public services,
- Working conditions,
- Social policies,
- Published on: 20 November 2014
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.
Over the past few years, the number of people suffering from chronic diseases in Luxembourg seems to have increased. However, the notion of chronic disease is not clearly defined in Luxembourg and as a consequence, the issue of the employment situation of people with chronic diseases is not very apparent. When dealing with working conditions, the focus is more commonly placed on the broader category of 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
From the research conducted, no particular general definition of chronic diseases was found. However, when referring to chronic diseases, the definitions used in Luxembourg seem to be very close to the one provided by the WHO.
For instance, the NGO Doctors Without Borders Luxembourg states in an article that “ So-called non-communicable chronic diseases include cardiovascular diseases, high blood pressure, diabetes, asthma and cancers. Most often incurables, their evolution is progressive. They are generally asymptomatic, until complications arise : heart attacks, strokes, renal failure, vision loss, etc. Becoming increasingly common all over the world, more specifically in urban and peri-urban centres, those diseases have common risk factors: sedentary behaviours, poor diet, tobacco consumption. Preventing complications is possible through suitable, on-time and on-going care.” (http://www.msf.lu/sur-le-terrain/newsdetail/artikel/1/refugies-syr-2.html)
Obviously, definitions of chronic diseases used in Luxembourg also include communicable chronic diseases, the most important being HIV.
There is also no limitative list of chronic diseases available in Luxembourg.
As there is no strict definition of chronic diseases in Luxembourg, other terms covering the same notion can also be used, such as long term health problems.
As far as the legal framework is concerned, workers with chronic diseases are subjected to the same rights and obligations than any worker with work disability. According to article L. 121-6 of the Labour Code, the worker who is unable to work due to illness or accident has to inform the employer or his representative on the same day of the impediment. The employer can not terminate the employment contract for 26 weeks maximum after the occurrence of the incapacity to work. The worker is entitled to full maintenance of his wage up until the end of the month during which the 77th day of work disability occurs, in a 12-month reference period.
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 main national public body identified that is dealing with health at work issues is the Service de Santé au Travail Multisectoriel – STM (“multisectoral health at work service”). It is a public institution placed under the authority of the Ministry of Health. Its tasks and missions are mostly preventative in nature and are established by article L. 323-1 of the Labour Code. For instance, it is qualified, amongst others, to :
- identify health risks in the workplace
- monitor workplace's factors likely to affect the employees' health
- give advice on health and safety issues and on working organisation
- monitor the employees' health in relation to their employment by conducting medical examinations
The STM has implemented an internal database which allows providing statistics according to each type of chronic diseases. However, these data are not representative at the national level because the STM is not qualified to deal with all sectors. It mostly operates for SMEs. Large industries, the banking sector or railways are excluded from its scope and they have their own private occupational health services.
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
In an article published in 2009 (http://www.statistiques.public.lu/catalogue-publications/vivre-Luxembourg/2009/63-2009.pdf), the CEPS/INSTEAD – a center of reference for research in the social and economic sciences in the Grand Duchy of Luxembourg under the jurisdiction of the Ministry of Higher Education and Research – focuses on the prevalence of chronic diseases and risk factors to health.
This article is based on the WHO definition and aims at exploring the distribution and the nature of declared chronic diseases affecting the Luxembourgish population.
In 2007, 26% of residents above 16 years old declared suffering from a chronic disease. Among them, 76% claimed that they are suffering from one chronic disease, 18% from two chronic diseases and 6% from three or more.
The prevalence of chronic diseases increases with the age. It represents 16% amongst the 16-49 year old, 35% amongst the 50-64 and 50% amongst the 65+.
For all ages, women are more affected than men (28% and 24% respectively).
Certain types of chronic diseases are more frequent. The more prevalent are :
- osteoarticular diseases (38%)
- endocrine diseases (26%)
- respiratory diseases (22%)
- diseases of the circulatory system (21%)
Women are more likely affected by osteoarticular diseases than men (42% and 32% respectively) and by endocrine diseases (29% and 22% respectively). On the opposite, men are more affected by respiratory diseases than women (25% and 20% respectively).
Smoking, overweight and lack of physical activities are important risk factors.
Data regarding smokers are not so obvious. 25% of daily smokers claim to suffer from chronic diseases whereas 26% of non-smokers declare suffering from chronic diseases. There is no difference according to their status regarding smoking. However, a gender analysis shows that chronic diseases prevalence varies according to the smoking status. Yet, for men, data take the opposite direction : 24% of non-smokers are affected by chronic diseases, compared with 21% of daily smokers and 16% of occasional smokers. For women, 28% of non-smokers suffer from chronic diseases, compared with 30% of daily smokers and 31% of occasional smokers. These figures have to be balanced because some non-smokers used to be smokers in the past : amongst non-smokers, 27% are ex-smokers of which 32% claim to suffer from chronic diseases, compared with 24% of people that have never smoked.
38% of interviewed obese people declared suffering from chronic diseases, compared with 27% of overweight people and 21% of normal weight people. For men, 35% of obese people declare suffering from chronic diseases compared with 18% for normal weight people. For women, these numbers are respectively 40% and 23%.
The prevalence of chronic diseases is lower for people that are engaged in regular physical activities (20% for men and 23% for women) or occasional physical activities (19% and 20% respectively) than for people who that do not get physical activities for reasons not related to their health condition (23% and 27% respectively). Obviously, prevalence is higher for people who do not get physical exercise because of health issues : 79% for women and 66% for men.
Socio-economic conditions are also key factors.
In the field of education, for all ages there is a social gradient for men and women. For instance, for the 50-64 years old, 47% of men and 40% of women having primary eduction level declare suffering from chronic diseases whereas only 26% of men and 29% of women with higher level of education are affected.
29% of people belonging to the blue-collar regime declare suffering from chronic diseases compared with 23% of white-collars and 24% for civil servant. Without distinction of gender or age (except for the 16-49 years old) blue collars are suffering from chronic diseases more than white collars or cicil servants. Moreover, the impact of the working and living conditions differences between blue collars and white collars on the prevalence of chronic diseases seems to be more noticeable as from 50 years old for men and women.
More recently, the report “Work and Social cohesion 2012” has been published, based on statistics coming from the Labour Force Survey 2011 (http://www.statistiques.public.lu/fr/publications/series/cahiers-economiques/2012/114-cohesion-sociale/index.html).
The number of people affected by a chronic disease appears to be on the rise as, amongst the 15-64 years old, 37% of the population in Luxembourg declare suffering from long term health problems. This represents approximately 128000 persons.
Such a condition may have impacts on the employment situation of affected people. 14% of the 15-64 years old declare suffering from a long term health problem that restricts them in the exercise of a professional activity.
Back or neck problems are the most commonly reported pathology. This represents 11% of the 15-64 years old. The second most commonly reported diseases are cardiovascular diseases, blood pressure or blood circulation problems, which affect 4% of the population in that age group. Mental health issues (depression, chronic anxiety) affect 2% of this population.
The prevalence of chronic diseases increases with the age : 18% for the 15-24 compared to 51% for the 55-64. With age, the probability for two or more long term health problems to appear simultaneously also increases. For the 15-24 category, 14% declare suffering from one long term health problem and 4% from two or more pathologies. Whereas for the 55-64 category, 24% indicate suffering from a long term health problem and 27% report 2 or more problems.
All age categories together, the proportion is higher for women (41%) than for men (33%).
Workers with few or no qualifications are more likely to develop chronic diseases than people with higher education (40% and 30% respectively). Therefore, blue-collar workers are performing jobs that expose them less to the risk of developing a disease than white-collar workers.
2.2. Working conditions of employed people affected by chronic diseases
The purpose of this section is to analyse whether there are any distinctive characteristics of the working conditions of the people affected by chronic diseases in comparison to the average (national, sectorial), considering the four EF’s WC categories (Health and well-being; Reconciliation of working and non-working life; Career and employment security issues; Skills development) :
When it comes to looking at working conditions of people affected by a chronic disease, the report “Work and Social cohesion 2012” relates to the issue of disabled workers. This is explained by the fact that working conditions vary with the degree of disability associated to the different types of chronic diseases.
As such, the link between long term health problems and employment is more difficult to gauge : for people in good health condition, 65% are employed and for people reporting long term health problems, the employment rate is 64%. However, disparities are more pronounced depending on the type of pathologies. Employment rates are relatively high for people suffering from migraine attacks (74%), digestive or kidney problems (72%) and for people having back or neck problems (69%). However, for people suffering from cancer or depression, employment rates are significantly lower (respectively 41 and 48%).
The 2012 report also acknowledges that “it is well known that the exercise of a professional activity may be the source of chronic health problems” and takes the example of “back problems caused by heavy and repetitive handling [that are] common in a certain number of manual jobs”.
The 2012 report also takes the example of back problems to illustrate that some specific professional activities are closely linked to the development of specific chronic diseases. As a matter of fact, it is often noticed that manual jobs requiring heavy and repetitive handling are more likely to lead to back problems than intellectual jobs.
Suffering from a chronic disease has impacts on the career and employment security of affected workers. 29% of affected workers are working part-time, whereas only 15% of people in good health conditions are. Often, this part-time is not entirely voluntary but is largely due to the consequences involved by the disease.
Besides, workers affected by a chronic disease are likely to be subjected to changes in their career path depending sometimes on the evolution of the disease. This is also more generally true for people affected by any disease. If, for health reasons, a worker is unable to continue to perform his job, he can benefit from the vocational rehabilitation regime. This rehabilitation is decided after a medical examination and can be internal (another more suited position in the same company) or external (another more suited position in another company). In the case of an internal rehabilitation, some guarantees are protecting the affected worker. If the new position involves a reduction in the working-time, this reduction cannot be more than 50% of the working time stated in the employment contract. Likewise, if the new position involves a decrease in the remuneration, the worker is entitled to a compensatory allowance which represents the difference between the former and the new remuneration, calculated on the basis of the gross monthly salary earned during the last 12 months.
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 Luxembourg, the public authority in charge of dealing with chronic diseases issues is the Ministry of Health. The Ministry of Health is taking general initiatives to tackle these issues. Therefore, there are no particular measures taken specifically to handle chronic diseases in the employment context, but rather general measures according to each type of chronic diseases and all the impacts it can have on affected people (for example, activity reports on the situation of people affected by HIV in Luxembourg or white paper on colorectal cancer in Luxembourg).
People affected by chronic diseases (or long term health problems) are also included in measures aiming at improving the employment situation of disabled workers. 8 different types of measures designed for disabled workers or workers with a reduced working capacity were implemented and financed by the government :
- Compensatory allowance
Designed for workers who have been reclassified to a lowest-paid new position (see above).
- Professional integration and re-integration measures for disabled workers
The disabled workers service from the public employment agency (ADEM) can allocate subsidies to disabled workers looking for a job or threatened of losing their job.
- Job creations for disabled workers
Each year, the Economic and Rationalisation Committee from the Ministry of State submits a proposal to the government to reserve within the public administrations a certain amount o working hours for disabled workers.
- Additional leave for disabled workers
Disabled workers are entitled to 6 days of additional leave. Employers can ask for reimbursement of these extra days to the ADEM.
- Subsidies for the remuneration
Employers can benefit from a subsidy on the salary costs when they recruit a worker on the basis of internal or external rehabilitation
- Reconversion measures
The Employment Fund can pay for the expenses necessary for reinsertion and reconversion measures for workers with a reduced working capacity.
- Professional orientation, training, rehabilitation and readjustment measures for disabled workers
The ADEM can financially support trainings aiming at the vocational initiation or reconversion for disabled workers
- - Adaptation of workstations for disabled workers.
The ADEM can financially support the adaptation of workstations or the purchase of specific equipments for disabled workers. The ADEM can also pay for travel costs.
In terms of expenses, those measures represent 67.9 millions euros in 2010, compared with 3.5 in 2001. This amount represents 40% of the total amount for active policies, as compared with 8% in 2001.
Even though there are 8 different measures in favour of disabled workers, 2 main measures (compensatory allowance and professional integration and re-integration measures for disabled workers) represent 95% of the total expenses, that is 64.8 millions euros. Job creations for disabled workers costed 1.3 millions euros in 2010 and represent 2% of the total expenses. Additional leave represented 1,3% of the total expenses, that is 900.000 euros.
Basically, those 8 measures can also be classified according to their purpose :
- Subsidies (approximately 98% of the total expenses) : the government intervenes directly in the labour costs, such as for compensatory allowance, integration and re-integration measures, additional leave and subsidies for remuneration
- Job creation (approximately 2% of the total expenses) : the government directly creates jobs that are reserved for disabled workers
- Training and adaptation (less than 1% of the total expenses)
The number of people benefiting from these measures went from 318 in 1999 to 1485 in 2010. The share of women amongst those beneficiaries went from 25% to 38%.
From the research conducted, it results that in Luxembourg, there are few information available regarding the specific issue of employment and chronic diseases.
However, more general information is available. Different reports exist on each specific type of disease but do not specifically pinpoint the employment situation of affected workers. Also, workers affected by chronic diseases are often merged into the larger category of disabled workers even if all people affected by a chronic disease are not necessarily classified as being disabled.
Finally, on the specific issue of chronic diseases, it seems that Luxembourg is mostly relying on studies and information provided at the european level. For example, the Ministry of Health website page about chronic diseases (http://www.sante.public.lu/fr/catalogue-publications/maladies-traitements/maladies-chroniques/index.html) refers only to reports published by european or international bodies.