Portugal: Employment opportunities for people with chronic diseases

  • Observatory: EurWORK
  • Topic:
  • Labour market policies,
  • Timpul de lucru,
  • Health and well-being at work,
  • Working conditions,
  • Published on: 20 Noiembrie 2014



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Portugal
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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.

There is no clear definition of chronic disease in Portugal.Existing data show that 40.5% of the persons aged 15-64 years have chronic disease. Musculoskeletal problems, heart problems, high blood pressure and blood circulation are the most prevalent chronic diseases. Women are particularly affected by chronic diseases, including among those who are in employment.The Portuguese Labour Code includes a set of measures aiming at protecting and supporting workers with a chronic disease or a disability. And three collective agreements dated of 2012 established clauses to support workers with reduced capacity to work.

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

In Portugal, the definition of chronic disease varies according to the source and is mainly based on legislation. The table below shows the main definitions used in Portugal.

Definition

Source

Chronic diseases

Disease that lasts, or is expected to last, for a long time, usually for more than six months. It usually requires medical intervention for its healing or control.

Statistical source: Portuguese National Health Survey (Inquérito Nacional à Saúde)

Instituto Nacional de Estatística - INE / Instituto Nacional de Saúde Doutor Ricardo Jorge – INSA (Statistics Portugal / National Health Institute Doutor Ricardo Jorge

Diabetes; asthma; high blood pressure; chronic pain; rheumatic disease; osteoporosis; glaucoma; retinopathy; malignant tumour/cancer; renal insufficiency; chronic anxiety; chronic wound; emphysema; chronic bronchitis; stroke; obesity; depression; myocardial infarction; kidney stones.

Diseases that according to medical opinion require frequent consultations, examinations and treatments and are a potential cause of early disability or significant reduction of life expectancy.

Ordinance 349/96 of 8 August

Genetic disease with severe clinical manifestations; congestive heart failure; cardiomyopathy; chronic obstructive pulmonary disease; chronic active hepatitis; hepatic cirrhosis with severe symptoms; disabling arthritis; lupus; dermatomyositis; paraplegia; myasthenia gravis; demyelinating disease; motor neurone disease.

Disease or sequelae that result from cardiovascular, respiratory, genito-urinary, rheumatic, endocrine, digestive, neurological pathologies and psychiatric disorders, as well as other situations that are cause of premature disability or a significant reduction in life expectancy.

Order 349/96 of 18 June

Not further specified.

Chronic disease, long-term disease, with multidimensional aspects, with gradual symptoms and potentially disabling evolution, implying gravity by the limitations on the possibilities of medical treatment and acceptance by the patient whose clinical situation must be considered in the context of family life, school and work, this last one being particularly affected.

Order 861/99 of 18 September

Not specified.

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 on chronic diseases and their relation to employment

Official name of statistical source

Módulo ad-hoc do Inquérito ao Emprego 2002

“O Emprego de pessoas com deficiência – uma breve análise do módulo ad-hoc de 2002”

[LSF ad-hoc module 2002]

‘Employment of persons with a disability’

Responsible body       

INE – Serviço de Estatísticas das Condições de Vida

Statistics Portugal – Service on Living Conditions Statistics

Definition of chronic disease

Disease that lasts, or is expected to last, for a long time, usually for more than six months. It usually requires medical intervention for its healing or control.

Questions in relation to employment and working conditions

Do you work in sheltered or supported employment?

Does your health problem or disability restrict the type of work you can do, for example, needing to do light work, or to sit down or to work indoors?

Does your health problem or disability restrict the amount of work you can do, for example, the number of hours or days you can work or when you can work?

Does your health problem or disability restrict your ability to get to and from a place of work?

Do you have any personal help, or get any other type of assistance, for example special equipment or work arrangements to do your work?

Would you need any personal help or other type of assistance, for example special equipment or work arrangements in order to work?

Which type or types of assistance do you get/need?

Methodology used to collect the data

The information was collected through computer assisted face-to-face interviews. The survey questionnaire was based on a Eurostat questionnaire template. The work for the module was carried out jointly with the Labour Force Survey in the second quarter of 2011. This ad hoc module was based on self-assessment regarding health problems. No strict definition was applied, but rather an individual self-reporting of the participants.

Information provided

This module characterises the main health problems and chronic diseases and the self-assessed difficulties in the completion of basic activities among Portuguese persons aged 15-64. It aims to analyse the impacts of those health problems in the duration and type of work; the difficulties in moving to and from workplace and the need for particular conditions in terms of personal assistance, equipment or adjustments within the workplace and work regime.

Time frequency

Non-periodic

National sources of statistical information on chronic diseases and their relation to employment

Official name of statistical source

Módulo ad-hoc do Inquérito ao Emprego 2011

“O Emprego das pessoas com deficiência – Módulo ad hoc do inquérito ao Emprego de 2011 ”

[LSF ad-hoc module 2011]

‘Employment of persons with a disability’

Responsible body

INE – Serviço de Estatísticas das Condições de Vida

Statistics Portugal – Service on Living Conditions Statistics

Definition of chronic disease

Diseases that existed for over 6 months or that are expected to last for more than 6 months.

Questions in relation to employment and working conditions

The health condition(s)/The difficulty(ies) you have indicated limit the type of work that you can do (for instance, do you have problems carrying heavy loads, working outdoors or sitting for a long time)?

The health condition(s)/The difficulty(ies) you have indicated limit the type of work that you can do (for instance, do you have problems working outdoors or sitting for a long time)?

Is this limitation caused by the longstanding health problem(s) or disease(s); by the difficulties in the development of the basic activity(ies); or by both reasons?

The health condition(s)/The difficulty(ies) you have indicated limit you getting to and from work?

Is this limitation caused by the longstanding health problem(s) or disease(s); by the difficulties in the development of the basic activity(ies); or by both reasons?

Do you have a personal assistance to enable you to work because of the health condition(s)/difficulty(ies) you have indicated?

Do you have a special equipment or workplace adaptations to enable you to work because of the health condition(s)/difficulty(ies) you have indicated?

Do you have a special working arrangement to enable you to work because of the health condition(s)/difficulty(ies) you have indicated? (for instance, sedentary jobs, teleworking, flexible hours, less strenuous work)?

Is there any other reason that restricts the work you can do, i.e., a reason apart from longstanding health conditions or diseases or to the existence of difficulties in the development of basic activities?

Methodology used to collect the data

The information was collected through computer assisted face-to-face interviews. The survey questionnaire was based on a Eurostat questionnaire template. The work for the module was carried out jointly with the Labour Force Survey in the second quarter of 2011. This ad hoc module was based on self-assessment regarding health problems. No strict definition was applied, but rather an individual self-reporting of the participants.

Information provided

This module characterises the main health problems and chronic diseases and the self-assessed difficulties in the completion of basic activities among Portuguese persons aged 15-64. It aims to analyse the impacts of those health problems in the duration and type of work; the difficulties in moving to and from workplace and the need for particular conditions in terms of personal assistance, equipment or adjustments within the workplace and work regime.

Time frequency

Non-periodic

National sources of statistical information on chronic diseases and their relation to employment

National statistical source

Instituto Nacional de Estatística / Instituto Nacional de Saúde Doutor Ricardo Jorge

Statistics Portugal / National Health Institute Doutor Ricardo Jorge

Official name of statistical source

Inquérito Nacional de Saúde 2005/2006

Portuguese National Health Survey 2005/2006

Responsible body

INE / Instituto Nacional de Saúde Doutor Ricardo Jorge – INSA

Statistics Portugal / National Health Institute Doutor Ricardo Jorge

Definition of chronic disease

Disease that lasts, or is expected to last for a long time, usually for more than six months. It usually requires medical intervention for its healing or control.

Questions in relation to employment and working conditions

How many days of work have you missed in the last 12 month, due to those pains?

Methodology used to collect the data

The information was collected through face-to-face interviews addressed to a representative sample of households in Portugal.

Information provided

This survey characterises the Portuguese population regarding its socio-demographic characteristics, general health information, temporary disability, long-term disability, chronic illness, healthcare, medicine consumption, oral health care, expenditure and income, consumption of tobacco, consumption of food and beverages, reproductive health, physical activity, mental health, preventive care, quality of life and food insecurity.

Time frequency

Non-periodic

Other information

The field work for a new National Health Survey is currently taking place.

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 results of the 'Portuguese National Health Survey 2005/2006’ (Inquérito Nacional de Saúde 2005/2006) show that high blood pressure,  rheumatic disease, and chronic pain were the most prevalent chronic diseases (Figure 1).

 

Source: Portuguese National Health Survey 2005/2005 (Inquérito Nacional à Saúde 2005/2006), INE/ INSA.

The same source indicates that chronic diseases increase with age, independently of sex, with the exception of the asthma which affect all ages and sex in a similar way.

According to the LFS ad-hoc module 2011 entitled ‘Employment of persons with disabilities’ (“O emprego das pessoas com deficiência”), 40.5% of the persons aged 15-64 years have chronic disease. Musculoskeletal diseases are the main health problems (35.3%), following by heart problems, high blood pressure and blood circulation, affecting 11.8% of the respondents with health problems, respectively.  Women are more affected by chronic diseases (44.5%) than men (36.5%). The chronic diseases increase with age (Figure 2).

 

Source: Labour Force Survey 2012: 3rd quarter of 2012 – Statistics Portugal – INE [Estatísticas do Emprego: 3º trimestre de 2012 – Instituto Nacional de Estatística - INE].

Additionally, the report ‘Prevent the disease, monitoring an rehabilitate the patient’ (Prevenir a doença, acompanhar e reabilitar o doente) from the Portuguese Pulmonary Foundation, reveals that in 2012 13,908 persons died of respiratory disease, to which 4,012  deaths by traquea, bronchi and lung cancers should be added. This means that in 2012, 50 persons affected by respiratory diseases died per day. This number represents an increase of 16.6% compared with 2011, and of 24.1% compared with 2005.

According to this report, 14.2% of persons aged 45 years and over are affected by chronic obstructive pulmonary disease. Between 2003 and 2011 there has been a progressive decrease in hospitalizations due to this disease. However, in 2012 the number of hospitalizations started to increase again, more 10.9% than in 2011. Additionally, the mortality by chronic obstructive pulmonary disease has been increasing since 2005.

The report ‘Portugal – cerebrum-cardiovascular diseases in numbers 2013’ (Portugal – doenças cérebro-cardiovasculares em números 2013) notes that the mortality rate by cardiovascular diseases decreased significantly in the last two decades. Between 2007 and 2011 the standardized mortality rate for cardiovascular disease decreased 22.4%. However, cardiovascular diseases still is the main cause of death in Portugal, followed by the oncological diseases.

The National Health Plan 2012-2016 (Plano Nacional de Saúde 2012-2016) evidences that ageing and unhealthy lifestyles result in a higher prevalence of chronic diseases, namely cardio-cerebrovascular diseases, hypertension and diabetes. According to the Plan, quoting other sources, between 1999 and 2006, the population reporting to suffer from hypertension rose 34%, with a 38% increase for diabetes (INE/INSA, 2009). It is estimated that the prevalence of hypertension is around 46% (Espiga de Macedo, 2007) with diabetes at 12.3% (OND, 2010).

  • 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)?

Existing data do not provide a general picture of the employment situation of people with chronic disease in Portugal. The focus is more on chronic diseases as such and not as much on the employment situation of people with chronic diseases.

Chronic diseases are more prevalent among retired persons, affecting 73.2% of these. However, over 41% of employed women, compared with 33% of employed men have a chronic disease. Chronic diseases affect 40.6% of the unemployed and 43.7% of the so-called ‘other inactive’.

Regardless of the employment status, women are the most affected group.

Figure 3 - Population with chronic diseases, by employment status and sex (2011)

Notes: The category ‘other inactive’ includes students, household workers and persons permanently incapacitated to work.

Source: Labour Force Survey 2012: 3rd quarter of 2012 – Statistics Portugal – INE [Estatísticas do Emprego: 3º trimestre de 2012 – Instituto Nacional de Estatística - INE].

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

The skilled workers on agriculture, forestry and fishery workers are more affected by chronic diseases: 57.7% of those workers have a chronic disease. The percentage of workers with chronic disease in the occupational major group 7-8 (craft and related trades workers; and plant and machine operators, and assemblers) and in the group 9 (elementary occupations) is higher than in the average employed population.

Figure 4 - Workers with chronic diseases, by occupational major groups (2011)

Notes: Occupational major groups: 0 - Armed forces occupations; 1 – Managers; 2 – Professionals; 3 – Technicians and associate professionals; 4 – Clerical support workers; 5 – Service and sale workers; 6 – Skilled agricultural, forestry and fishery workers; 7 – Craft and related trades workers; 8 – Plant and machine operators, and assemblers; 9 – Elementary occupations.

Source: Labour Force Survey 2012: 3rd quarter of 2012 – Statistics Portugal – INE [Estatísticas do Emprego: 3º trimestre de 2012 – Instituto Nacional de Estatística - INE].

  • What are the typical employment trajectories of workers affected by chronic diseases? (entry/exit patterns)

According to our research there is no information available on this topic.

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

According to the self-assessment of the workers with chronic diseases, the main limitations to their staying in the labour market are related to the type of work that they can perform (38.3%), followed by the number of working hours per week (32.1%). Once again, women are more affected by these limitations than men (Figure 5).

Figure 5 – Workers with chronic diseases, by type of limitations to work, by sex (2011)

Source: Labour Force Survey 2012: 3rd quarter of 2012 – Statistics Portugal – INE [Estatísticas do Emprego: 3º trimestre de 2012 – Instituto Nacional de Estatística - INE].

Figure 6 shows that 18.3% of these female workers with chronic disease and 13.6% of the male ones need to rely on special working arrangements to enable them to work.

 

Source: Labour Force Survey 2012: 3rd quarter of 2012 – Statistics Portugal – INE [Estatísticas do Emprego: 3º trimestre de 2012 – Instituto Nacional de Estatística - INE].

  • 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

There is a broad consensus on the reasons for the evolution of chronic diseases. According to the reports mentioned above, the economic crisis cannot be excluded, as this may represent a potential constraint to access healthcare services. Signs of this may be found in the decrease of the medical consultations and to the purchase of medicines. Additionally, the response time to the requests for Hospital Primary Care Services is 114.2 days (4 months).

The unemployment, poverty, and insanitary living conditions are recognized as potential factors for weakening of the immunological defenses, and consequently have particular impact on the vulnerability to chronic diseases.

2.2. Working conditions of employed people affected by chronic diseases

According to our research there is no information available on this topic.

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 Portuguese Labour Code (Código do Trabalho) includes a set of measures aiming at protecting and supporting workers with a chronic disease or a disability:

Article 85 determines the same rights and duties as for any other worker regarding the access to employment, to training, to career progression and to working conditions. Moreover, the law establishes that it is up to the State to stimulate and support the employer in what regards the hiring of a worker with a chronic disease or a disability and his/her professional readjustment.

Article 86 establishes that the employer must take adequate measures so that the person with a chronic disease or a disability has access to a job and is entitled to perform it and progress on it, as well as to receive vocational training, except if such measures imply disproportionate costs.

Article 87 establishes that the worker with a disability or chronic disease may be exempted from a task if this jeopardises his/her health or safety at work, especially if this implies a working schedule organised according the adaptability regime, the bank of hours, or the concentrated schedule; or if this implies working hours between 8 p.m. and 7 a.m..

Article 88 determines that the worker with a chronic disease is not obliged to perform overtime work.

One policy measure was identified which may be perceived as a prevention strategy that benefits persons with chronic diseases. The law 37/2007 of 14 August  adopts rules to protect citizens from exposure to involuntary tobacco smoke and measures to reduce demand associated with dependence and cessation consumption. According to its article 4(c) it is forbidden to smoke at the workplace.

In addition, the Directorate-General of Health (Direcção-Geral da Saúde - DGS) through a National Programme for Occupational Health (Programa Nacional de Saúde Ocupacional – 2º ciclo 2013/2017) established a set of 51 measures for the protection and promotion of the workers’ health. Once again, the Programme focusses particularly on the issue of occupational illnesses/diseases. However, an activity aiming at “establishing referral models for differentiated care regarding chronic illnesses, mental health and others by the services of health at work/occupational health” was developed, within the scope of the fourth specific objective “Promotion of health and labour and healthy lifestyles”. In order to fulfil this objective, an Orientation on “Occupational Health and Diabetes” is currently underway.

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

It was possible to identify three collective agreements, dated of 2012, that have established clauses to support personnel affected by chronic diseases.

Collective agreement 1

Name of the collective agreement

Collective agreement between HPEM – Higiene Pública, E. E. M. [Public Health], and STAL – Sindicato Nacional dos Trabalhadores da Administração Local e Regional [National Labour Union of the Local and Regional Administration Workers]

Sector

NACE Rev. 2 - 81.29: other cleaning activities

Size

Large company – more than 250 workers

Objectives pursued

Re-conversion and re-qualification of workers

Addressed target groups

300 workers of HPEM

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.)

The clause 62.ª establishes specific measures for employees with permanent or temporary disease or injury:

  • occupation in functions compatible with their clinical status;
  • vocational training;
  • measures for the adaption of the workstation;
  • part-time work;
  • training leave;
  • possible new job.

Main results obtained and assessment of these results

No information available

Link to the identified case study

http://bte.gep.msess.gov.pt/completos/2012/bte35_2012.pdf

Source: Bulletin of Work and Employment No 35, 2012 [Boletim do Trabalho e Emprego - BTE (1ª Série) n.º 35 de 2012].

Collective agreement 2

Name of the collective agreement

Collective agreement between ANCAVE - Associação Nacional dos Centros de Abate e Indústrias Transformadoras de Carne de Aves [National Association of the Slaughterhouses And Manufacturing Industries of Poultry Meat] and the SETAA – Sindicato da Agricultura, Alimentação e Florestas [Farming, Food and Forestry Union]

Sector

NACE Rev. 2 – 10.12: processing and preserving of poultry meat

Size

52 companies

Objectives pursued

To facilitate the employment of workers with reduced working capacity.

Addressed target groups

52 undertakings, with a total of 4,750 workers, in the all national territory.

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.)

The clause 93ª establishes specific measures for employees with reduced work capacity, either due to age, disease or accident:

  • adequate working conditions and wages;
  • adequate vocational training or professional perfecting.

Main results obtained and assessment of these results

Information not available

Link to the identified case study

http://bte.gep.msess.gov.pt/completos/2012/bte35_2012.pdf

Notes: *.

Source: Bulletin of Work and Employment No 35, 2012 [Boletim do Trabalho e Emprego - BTE (1ª Série) n.º 35 de 2012].

Collective agreement 3

Name of the collective agreement

Collective agreement between CNIS — Confederação Nacional das Instituições de Solidariedade [Confederation of National Institutions for Solidarity] and the FNE — Federação Nacional da Educação e outros [National Federation for the Education]

Sector

NACE Rev.2 - 88.99: other social work activities without accommodation n.e.c.

NACE Rev.2 – 94.20: activities of trade unions

Size

4,000 employers

Objectives pursued

To facilitate access to employment

Addressed target groups

Workers in Instituições Particulares de Solidariedade Social – IPSS [Private Social Solidarity Institutions] represented by CNIS who are or become members of the signatory unions. This applies to Portugal Mainland and Autonomous Region of Madeira.

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.)

The clause 5ª establishes that workers with reduced work capacity, workers with disabilities or with chronic diseases have preference for filling job posts in the institutions, given that they satisfy the necessary conditions.

Main results obtained and assessment of these results

No information available

Link to the identified case study

http://bte.gep.msess.gov.pt/completos/2012/bte6_2012.pdf 

Source: Bulletin of Work and Employment No 6, 2012 [Boletim do Trabalho e Emprego - BTE (1ª Série) n. º 6 de 2012].

Commentary

The existing data point to a relatively high prevalence of chronic diseases in Portugal. However, these data not only lack up-dating but they do not cover properly the employment situation and, in particular, the working conditions of persons with chronic disease. Evidences though show that over 37% of the employed population suffers from chronic disease, and that women are particularly affected, regardless of employment status.

The relevance of further and more detailed data on employment opportunities and working conditions for persons with chronic diseases is thus fully justified, namely as a basis for the formulation of adequate policy measures and initiatives in favour of this vulnerable group.

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