Spain: 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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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.

In 2011 in Spain there were 7.6 million persons aged 16-64 who suffered from at least one chronic disease (24.8% of the total of persons in that age range). Amongst them, 3.9 million persons were occupied (i.e. 21.3% of all the occupied in Spain). In particular, back or neck problems were the most recurrent chronic health issue, affecting more than 2 million persons in total. From an age perspective, older workers are more likely to suffer from chronic diseases. On the other hand, initiatives developed by public authorities or social partners to favour the employment situation of people with chronic diseases seem to have been poorly developed in Spain.

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

The INE (Spanish National Institute of Statistics) defines chronic diseases as long-term diseases with a length of at least 6 months, as explained in the methodology of the ‘National Health Survey 2011-2012’ (‘Encuesta Nacional de Salud 2011-2012’ in Spanish). Similarly, the ad-hoc module on ‘Health problems and their relation to employment’ of the Spanish Labour Force Survey (EPA), also conducted by the INE, uses the term ‘chronic’ to refer to diseases or health problems which have lasted (or will last) at least 6 months. Finally, the ‘Survey on Disabilities, personal autonomy and dependency situations’ (‘Encuesta sobre Discapacidades, Autonomía personal y situaciones de Dependencia’ in Spanish) carried out by the INE, also includes persons affected by chronic diseases, which are defined as long-term diseases (i.e. versus sharp processes or specific accidents) which are diagnosed as such by healthcare professionals. These diseases include, for instance, heart and blood pressure problems, arthritis, back or neck problems, diabetes, cirrhosis, cancer, migraines, chronic depression and chronic anxiety, etc.

No other legislative or administrative source giving a definition of ‘chronic disease’ has been found.

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

One of the most significant sources on the issue of chronic diseases is the ad-hoc module called ‘Health problems and their relation to employment’ (‘Problemas de salud y su relación con el empleo’ in Spanish), included in the Spanish Labour Force Survey (EPA), and conducted in 2011 by the INE (Spanish National Institute of Statistics). This specific module only took into account limitations or health problems lasting 6 months or longer (i.e. ‘chronic’ diseases). The people surveyed were aged between 16 and 64 years old, distributed over the whole Spanish territory. According to the methodology dossier, 36,554 households were interviewed.

In addition to analysing the percentage of persons affected by chronic diseases (by different variables, such as age, gender or employment situation), the questionnaire also asked if the chronic diseases limited the number of hours worked per week or the type of work they could carry out, as well as if they needed to have personal assistance or special equipment, amongst others.  

On the other hand, another important source of information is the ‘National Health Survey 2011-2012’ (‘Encuesta Nacional de Salud 2011-2012’ in Spanish), carried out by the INE (Spanish National Institute of Statistics). In general terms, its objective was to collect information about the Spanish population’s health status, main diseases and health problems, etc., as well as about health services and life habits. The survey interviewed persons aged 15 or more, distributed over the whole Spanish territory. In the period 2011-2012, 21,508 households were effectively interviewed, via personal interviews. The survey offers information about Spanish population with chronic diseases and their employment situation.

Finally, it is worth mentioning the ‘Survey on Disabilities, personal autonomy and dependency situations’ (‘Encuesta sobre Discapacidades, Autonomía personal y situaciones de Dependencia’ in Spanish) carried out also by the INE (Spanish National Institute of Statistics). The last edition is from the year 2008. The objective of this survey is to estimate the number of persons with disabilities who live in Spain in family households, to know their limitations in everyday life and their characteristics, to identify the different types of deficiencies and related causes, to evaluate the equality of opportunities and discrimination of these persons in labour/ education/ leisure fields, and to identify their needs and assistance demands. In particular, the survey is conducted following three stages, with different questionnaires per stage: one for households, two questionnaires for individuals (one for persons aged 6 years or more, and another one concerning limitations for children between 0 and 5), and another one for carers. Remarkably, the survey provides some limited data on the labour situation of persons with disabilities.

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

To begin with, the National Health Survey 2011-2012 provides information on the number of persons suffering from chronic or long-term diseases in the last 12 months and diagnosed by a doctor. According to this source, 18.6% of the Spanish adult population (that is, persons aged 15 or more) suffered from lumbar backache (7.2 million persons in total), 18.5% suffered from high blood pressure (7.1 million persons) and 18.3% from arthritis or rheumatism (7 million persons). Other common chronic diseases suffered by Spanish adult population were high cholesterol (16.4% of the Spanish adult population), cervical backache (15.9%), chronic allergies (10.7%), and varicose veins in legs (10.4%).

On the other hand, according to the ad-hoc module ‘Health problems and their relation to employment’ of the Spanish Labour Force Survey (EPA), in 2011 there were 7,607,500 persons in Spain aged 16-64 who suffered from at least one chronic disease (understood as long-term health issues with a length of at least 6 months, including persons in a very critical condition or terminal patients). This means that among the 30.7 million persons in total aged 16-64, 24.8% of them suffered from at least one chronic disease. Likewise, there were 2.3 million persons aged 16-64 who suffered more than one chronic illness (70.3% of them were aged between 45 and 64).

Amongst the above-mentioned 7,607,500 persons, back or neck problems were the most recurrent chronic health issue; in fact, 26.7% of those who suffered from at least one chronic disease said that they were affected by this particular problem and considered it the most significant one. This means that more than 2 million persons aged 16-64 were affected by back or neck problems. Moreover, legs or feet problems were the second most extended chronic disease, affecting 9% of the population suffering from at least one chronic disease (683 thousand persons in total).

Looking at the ten most recurrent chronic diseases among persons aged 16-64, and from a gender perspective, it can be observed that migraines and depression are much more extended among women (68% of the persons suffering from depression and 71.1% of the persons suffering from migraines are women), whereas diabetes and heart and circulation problems are more recurrent among men (58.9% and 58.5% respectively).

Table 1: Spanish persons aged 16-64 who suffer from at least one chronic disease, and ten most recurrent chronic diseases, by age and gender, 2011

 

Total (number of persons)

Age (% over total)

Gender (% over total)

16-24

25-44

45-64

Men

Women

Total

7,607,500

6.0%

35.6%

58.4%

46.6%

53.4%

Back or neck problems

2,033,200

3.2%

37.1%

59.7%

41.6%

58.4%

Legs or feet problems

683,300

3.3%

26.0%

70.7%

48.7%

51.3%

Heart, blood pressure or circulation problems

650,600

1.6%

19.4%

79.0%

58.5%

41.5%

Chest and breathing problems, including asthma and bronchitis

586,400

16.6%

45.9%

37.5%

52.0%

48.0%

Arms or hands problems

497,300

2.6%

29.1%

68.3%

36.1%

63.9%

Diabetes

414,200

3.2%

19.9%

76.9%

58.9%

41.1%

Kidney, stomach, or liver problems, or other digestive problems

410,700

6.2%

43.0%

50.9%

53.1%

46.9%

Skin diseases, including allergic reactions and severe deformations

370,500

17.5%

54.5%

28.0%

55.2%

44.8%

Depression

262,500

2.7%

33.4%

63.9%

32.0%

68.0%

Migraines

244,500

13.7%

53.4%

32.9%

28.9%

71.1%

Source: ‘‘Health problems and their relation to employment’ (‘Problemas de salud y su relación con el empleo’ in Spanish), specific module of the Labour Force Survey (EPA). 2011.

Note: Data refer to persons aged 16-64 who suffer from at least one chronic disease; in case they suffer from several diseases, respondents are classified according to the most important disease (i.e. only one answer per respondent).

From an age perspective, it is clear that older persons are much more likely to suffer from at least one chronic disease (58.4% of the Spanish persons between 16 and 64 years old who suffer from at least one chronic disease are aged 45-64). In any case, it is worth mentioning that there are a few illnesses that are more recurrent among persons aged 25-44, namely, skin diseases, migraines, and chest and breathing problems.

Linked to this, and according to the report ‘Analysis of the labour market, working conditions and occupational risks from an age perspective’, published by the National Institute of Safety and Hygiene at the Workplace (INSHT), it can be said that young workers have a better self-perception of their health and they suffer less from chronic diseases. Meanwhile, older workers are more likely to experience this type of diseases, and the duration of their temporary incapacities (i.e. temporary contingencies protected by the Spanish social security) is normally longer.

With regard to employment characteristics, the ad-hoc module ‘Health problems and their relation to employment’ of the EPA provides data on chronic health issues affecting Spanish persons aged 16-64, by employment situation. Among the 7.6 million persons who suffer from at least one chronic disease, 3.9 million are occupied, 1 million are unemployed and 2.7 million are inactive. This means that 35.6% of the total inactive population aged 16-64 suffers from at least one chronic disease. This percentage is higher than the rates of the occupied (21.3% of the whole occupied) and the unemployed (20.5% of all the unemployed). The most significant health problem is ‘back or neck problems’, which affects almost 1.2 million occupied persons (6.4% of all the occupied are affected by this problem).

Table 2: Spanish persons aged 16-64 who suffer from at least one chronic disease, and ten most recurrent chronic diseases, by employment situation, 2011

 

Total

Employment Situation

Occupied

Unemployed

Inactive

Total

%

Total

%

Total

%

Total

7,607,500

3,825,100

21.3%

1,024,600

20.5%

2,757,900

35.6%

Back or neck problems

2,033,200

1,153,300

6.4%

281,700

5.6%

598,200

7.7%

Legs or feet problems

683,300

331,200

1.8%

74,600

1.5%

277,500

3.6%

Heart, blood pressure or circulation problems

650,600

318,000

1.8%

61,900

1.2%

270,600

3.5%

Chest and breathing problems, including asthma and bronchitis

586,400

321,300

1.8%

92,400

1.8%

172,700

2.2%

Arms or hands problems

497,300

245,200

1.4%

68,600

1.4%

183,500

2.4%

Diabetes

414,200

203,300

1.1%

64,100

1.3%

146,800

1.9%

Kidney, stomach, or liver problems, or other digestive problems

410,700

222,700

1.2%

59,400

1.2%

128,500

1.7%

Skin diseases, including allergic reactions and severe deformations

370,500

230,900

1.3%

56,800

1.1%

82,900

1.1%

Depression

262,500

78,500

0.4%

50,700

1.0%

133,300

1.7%

Migraines

244,500

151,600

0.8%

39,200

0.8%

53,600

0.7%

Note: Data refer to persons aged 16-64 who suffer from at least one chronic disease; in case they suffer from several diseases, respondents are classified according to the most important disease (i.e. only one answer per respondent). Percentages are calculated over the total of occupied (17,953,300), the total of unemployed (4,996,000), and the total of inactive (7,757,200).

Source: ‘‘Health problems and their relation to employment’ (‘Problemas de salud y su relación con el empleo’ in Spanish), specific module of the Labour Force Survey (EPA). 2011.

As well as this, the National Health Survey 2011-2012 provides some data on chronic diseases related to the economic activity of the surveyed. Not surprisingly, the collectives of the retired and the disabled are the two groups who more frequently suffer from chronic diseases. As well as this, domestic workers are also characterised by high percentages. Meanwhile, students boast the lowest proportions of incidence of chronic diseases, probably due to their younger age.

Focusing on the group of workers, it can be said that the most recurrent chronic illnesses among them are lumbar backache (which affects 14.6% of all workers, 2.5 million workers in total), high cholesterol (12.6%, 2.2 million workers in total) and cervical backache (12.2%, 2.1 million workers in total). Among the list of the 10 most common chronic diseases, the only chronic disease which is suffered by workers and unemployed more frequently than the average is ‘chronic allergies’. In particular, 11.2% of all the workers and 11.1% of all the unemployed suffer from chronic allergies, in contrast to 10.7% on average.

Table 3: Percentages of Spanish adult population (grouped by economic activity) who did suffer from chronic diseases. List of the 10 most common chronic diseases, 2011-2012

 

Total

Worker

Unempl.

Retired

Student

Disabled

Domestic workers

Other

Lumbar backache

18.6%

14.6%

14.2%

30.1%

5.0%

36.4%

27.7%

15.2%

High blood pressure

18.5%

9.8%

10.3%

45.1%

0.6%

28.7%

28.4%

18.2%

Arthritis or rheumatism

18.3%

7.8%

7.8%

47.4%

0.6%

30.4%

34.9%

10.5%

High cholesterol

16.4%

12.6%

9.5%

31.6%

1.0%

26.1%

23.5%

17.3%

Cervical backache

15.9%

12.2%

11.7%

25.7%

4.3%

30.6%

25.5%

15.2%

Chronic allergies

10.7%

11.2%

11.1%

8.2%

14.3%

13.0%

10.1%

10.8%

Varicose veins (legs)

10.4%

7.0%

5.4%

18.8%

0.9%

16.2%

23.1%

4.9%

Migraines

8.4%

7.2%

8.4%

7.6%

5.6%

20.3%

15.0%

11.9%

Diabetes

7.0%

3.1%

2.8%

19.1%

0.5%

13.4%

9.6%

11.3%

Chronic anxiety

6.7%

4.0%

7.4%

9.4%

1.2%

31.3%

11.8%

8.3%

Note: Percentages of adult persons (aged 15 or more) who were affected by each one of the chronic diseases listed, with respect to totals in each group. Chronic diseases diagnosed by a doctor in the last 12 months.

Source: ‘National Health Survey 2011-2012’ (‘Encuesta Nacional de Salud 2011-2012’ in Spanish)

Finally, looking at changes in recent years, the Spanish ‘National Health Survey 2006’ shows that the most common chronic diseases suffered by Spanish adult population in 2006 were practically the same in 2011-2012 (and virtually in the same order of importance). However, the percentages of persons suffering from those diseases were higher in 2006. Thus, in 2006, 21% of the Spanish adult population suffered from lumbar backache (17.1% of workers), 20.7% suffered from high blood pressure (11.7% of workers) and 20.7% from arthritis or rheumatism (9.2% of workers).

2.2. Working conditions of employed people affected by chronic diseases

The ad-hoc module ‘Health problems and their relation to employment’ of the EPA provides information on the limitations experienced by persons aged 16-64 (without including persons in a very critical condition or terminal patients) who have some chronic disease or some limitation for carrying out basic daily tasks. In particular, in Spain there were 7.5 million persons under this situation in the year 2011. As the following table shows, amongst them, 2.5 million persons stated that the type of work they can carry out is limited and 1.7 million persons said that the number of hours they can work per week is limited. Unfortunately, it is not possible to disaggregate these data by employment situation.

Table 4: Limitations related to work suffered experienced by people aged 16-64 who have some chronic disease or some limitation for carrying out basic daily tasks, 2011

 

Absolute numbers

% over total*

The type of work they can carry out is limited

2,500,400

33.4%

Their number of hours worked per week is limited

1,732,100

23.2%

They need to have some type of special conditions for being able to work

982,800

13.4%

Their journeys to and from their workplace are limited

966,500

12.9%

They need to have some type of special equipment for being able to work

599,500

8.0%

They need to have some type of personal assistance for being able to work

573,000

7.7%

*Note: The total is the whole of persons in Spain aged 16-64 (not including persons in a very critical condition or terminal patients) who have some chronic disease or some limitation for carrying out basic daily tasks (7,479,100 persons in 2011).

Source: ‘‘Health problems and their relation to employment’ (‘Problemas de salud y su relación con el empleo’ in Spanish), specific module of the Labour Force Survey (EPA). 2011.

On the other hand, information available concerning health and well-being related to working conditions is scarce and dispersed. There are some sources, such as sectorial health and safety guides, which comment on the incidence of chronic diseases derived from work in some particular sectors, but not on the working conditions of the affected workers. For instance, the National Commission of Safety and Health at Work (CNSST) explains in its report about ‘Occupational diseases in the agriculture sector’ that workers in this sector can develop chronic musculoskeletal problems (lumbar or cervical backache, amongst others) as a consequence of their work. Among aged workers, it can be very difficult to determine if these diseases are directly related to work or they are a consequence of their older age (chronic-degenerative health problems). Moreover, many of these health problems lead to temporary or permanent incapacities (i.e. contingencies under the social security system).

Similarly, a report by the Foundation for the Prevention of Occupational Risks and UGT Trade Union about ‘Occupational diseases in the metal sector’ states that extreme temperatures can cause skin diseases and chronic fatigue, chemical products and powders can cause chronic intoxications or breathing problems, whereas inadequate positions and weights can cause musculoskeletal disorders, and excessive work and psychological demands (mainly related to working shifts) could cause chronic stress. As well as this, the report ‘Occupational diseases in the natural stone sector’, by the Foundation for the Prevention of Occupational Risks, describes the risk of lung or breathing diseases (such as chronic silicosis) and chronic dermatitis after long contact with some stones, or the risk of developing chronic musculoskeletal problems derived from weight manipulation. Interestingly also, an article in the magazine ‘Practical Management of Occupational Risks’ (September 2007) talks about the risk of developing cancer for workers in the wood sector, as well as other chronic diseases affecting the skin or the lungs and the breathing system.

On the other hand, it is interesting to comment on the results of a survey conducted by GEPAC (Spanish Group of Patients with Cancer) and published in May 2012. The sample is composed of 2,067 persons over 18 years of age who voluntarily took part in the study via an online survey. The results show that 3 out of 10 surveyed had felt discriminated at work as a consequence of their disease; 12% had lost their job and 13% had had problems with their labour reinsertion.

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 Spain, initiatives developed by public authorities or social partners to favour the employment situation and working conditions of people with chronic diseases have been poorly developed and few examples can be mentioned.

An example of this type of initiative could be the specific section on this issue created by the National Institute of Safety and Hygiene at the Workplace (INSHT) in its web site. More precisely, the website of the INSHT includes a section known as ‘Portal for workplace health promotion’, which offers useful information on the issue and presents good practices for the promotion of health and safety at work. This web site explains that health promotion implies not only avoiding accidents and risks, but also improving workers’ health and wellbeing. Thus, a comprehensive workplace health management strategy should include the management and support of workers with chronic diseases. Concerning these, several recommendations are suggested such as:

  • adapting the employee’s working space to his/her disease,
  • studying the compatibility between the employee’s functional capabilities and his/her job,
  • avoiding work accidents related to the possible effects of medication (somnolence, etc.).

As well as this, in its 2013 Training Catalogue, the INSHT included a training course for businesses and workers named ‘Workplace Chronic diseases: how to act at the company’. From a general perspective, the report ‘Promotion of active ageing at the workplace’, also by INSHT indicates that the average age after which chronic diseases affect Spanish population is 38 years for women and 41 years for men. Linked to this, the report recommends that companies should promote health and wellbeing among workers, and ensure that older (and more experienced) employees remain working so that they can transfer their knowledge to younger employees.

Apart from these examples, there is little evidence on concrete initiatives supporting explicitly people with chronic diseases. However, a related issue is currently high in the agenda related to the Labour Reform approved by the Spanish Government in 2012 (Royal Decree-Law 3/2012). With the Labour Reform, it is considered as an objective reason for dismissal the absence of a worker on 20% of the working days during 2 months, or on 25% of the working days during 4 discontinuous months in a period of 1 year (sick leaves longer than 20 days straight are not considered). This clause could affect particularly workers suffering from chronic diseases or subjected to long-term medical treatments. Therefore, trade unions criticise that the 2012 Labour Reform has facilitated employees’ dismissal related to intermittent non-attendance (even if it is justified by an illness situation), as explained by CCOO trade union. Linked to this, it is interesting to comment, for example, on the case of a woman who was dismissed for not having gone to work during 15 days (intermittently) due to chronic migraine. She took her case to court and the judge obliged the company to reinstate the woman, considering that the dismissal was discriminatory. This sentence brings into question this clause of the Labour Reform.

Interestingly, it is worth mentioning the ‘Partial Permanent Incapacity for the ordinary profession’ (‘Incapacidad permanente parcial para la profesión habitual’ in Spanish), regulated by the Spanish Ministry of Employment and Social Security. According to Spanish regulation, this type of incapacity can derive from an illness or accident (occupational or not) and causes a decrease in the normal performance of the worker which cannot not be lower than 33% (but without being certified as a ‘total incapacity’), and which does not stop the worker from carrying out the main tasks of the post. The approval of the ‘Partial Permanent Incapacity for the ordinary profession’ means the concession a specific economic amount, which is given on a single payment (once per incapacity). The economic amount provided equates approximately to 24 monthly gross salaries. However, the regulation does not include any type of stipulations for adapted working conditions or support measures for the affected worker or the employer company.

On the other hand, it is worth mentioning the legislative proposal made by the political party ‘Galician Nationalist Block’ (BNG) in December 2013 at the Spanish Parliament, for protecting persons suffering from cancer in the labour sphere. The proposal aims at protecting the professional career of affected persons, establishing rights which guarantee, for instance, the preservation of job positions and promotion prospects. Moreover, it also asks for economic guarantees during the medical treatment. Until now, this proposal has not been further developed.

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

Information consulted shows that in many cases initiatives are aimed at both workers with chronic diseases and workers with disabilities, so both conditions are somehow mixed up. In this sense, it is worth mentioning the existence of the so-called Special Employment Centres, a formula created in 1985 for the labour integration of people with disabilities (after the 1982 Law for the Social Integration of the Disabled). More precisely, Special Employment Centres are companies where 70% of the staff is composed of workers with disabilities. FEACEM is the Spanish Federation of Special Employment Centres.

On the other hand, the ‘Spanish Confederation of Groups of Relatives and Persons with Mental Illnesses’ (Feafes) has recently created the Foundation ‘Employment and Mental Health’, aimed at promoting the labour insertion of persons with severe and chronic mental illnesses. It is estimated that 80% of the persons suffering from severe mental diseases are unemployed, and they have worse labour insertion expectations than the rest of the disabled. Thus, the newly established Foundation ‘Employment and Mental Health’ expects to improve the employment situation of persons suffering from severe and chronic mental diseases.

Commentary

Data available show that in 2011 there were 7.6 million persons in Spain aged 16-64 who suffered from at least one chronic disease (almost one quarter of the total of persons aged 16-64). More precisely, there were 3.8 million occupied persons suffering from at least one chronic disease (21.3% of all the occupied). This is a large number of persons, and public authorities and social partners should try to devote more resources to their labour insertion. Unfortunately, available information shows that there are not many initiatives dealing with this issue, and only a few ones have been identified.

Moreover, companies should take into account that workers affected by chronic diseases experience limitations, which require the adaptation of the business organisation (facilities and material, working time, assignation of tasks, etc.). It is recommended to promote affected workers’ insertion and adaptation, for their better performance, avoiding relapses and absences. As a whole, health promotion programmes result in economic benefits for companies: they reduce occupational diseases and support workers’ health, reduce absenteeism and increase productivity and competitiveness, and reinforce social capital and staff motivation.

On the other hand, and as a conclusion, it is necessary to highlight the lack of information/data on chronic diseases actually linked to working conditions.

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