Norway: Employment opportunities for people with chronic diseases

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



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Regardless of the definition used, the number of workers who are chronically ill in Norway increased significantly in recent years.  More than 200,000 people have a chronic health condition or disability that limits their work capacity, and from a public health perspective, chronic diseases emerge as a worrisome "epidemic" that affects a growing part of the population, particularly cardiovascular diseases, cancer and COPD. The main policy measure developed to favor the employment situation and working conditions of people with chronic diseases is the tripartite agreement on a more inclusive working life, which was last extended in March 2014.

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

As far as we know, there are no absolute definitions of the concept of chronic disease in Norway today. However, although the definition of chronic disease varies from source to source, chronic disease generally refers to diseases that do not go away by itself or after treatment as acute diseases do. This general definition is used by both The Norwegian Labour and Welfare Services (NAV), Statistics Norway (SSB), social security/health insurance systems, the National Insuranse Act, etc. The diseases most commonly classified and described as chronic relative to this definition are cardiovascular disease, cancer, mental health problems, diabetes, lung disease and musculoskeletal diseases.

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 important national sources of statistical information that deal with chronic diseases and their relation to employment and working conditions, is the SSB Labour Force Survey (AKU), describing the development of the labor market. This is the official employment figures, and each quarter, 17,000 Norwegians are interviewed about their jobs and employment situation. Reduced disability or disabilities are in the labor force survey defined by the interviewees own consideration in that he or she has physical or mental health problems of a more permanent nature (six months or more), which can cause limitations in everyday life. While this covers most chronic diseases, the definition of chronic disorders is not always absolute for all the interviewees. Among individuals with musculoskeletal problems, for instance, previously seen that up to 40 percent changed their perception of own disease condition in course of two years.

The other main source for statistical information on this issue is the sickness absence statistics of The Norwegian Labour and Welfare Administration and their analyses of this data. The Statistics Registers for medical and sickness benefits are formed monthly, and the statistics are published quarterly on www.nav.no. It shows the number of cases of sickness absence and sick leave days in number and as a percentage of man-days ("Sickness absence rate"). The figures are given by gender, age, county of residence, disability, diagnosis, industry, institutional and corporate sector "IA status". The statistics include medical certificates for all workers with an employment record in IA-register aged 16-69 years who are registered as resident in Norway.

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

Hundered years ago it was contagious infectious diseases and tuberculosis that took thousands of Norwegian life. Today there are, according to the report "Public Health Report 2010 - Health conditions in Norway" chronic diseases such as cardiovascular disease, cancer, mental health problems, diabetes, lung disease and musculoskeletal diseases that are the major challenges for public health in the country. Many people have a chronic illness today, and a major reason for this is that most chronic diseases increase with age. As there are number of older people increase, it will become increasingly more patients with chronic conditions. This is a trend that will continue because life expectancy is steadily increasing, and because the boundaries of how seriously ill and how old people we choose to provide advanced medical care, are increasingly stretched. Another reason is that the medical products has become so effective that people survive the acute phase, and can live a long time with a chronic illness. From a public health perspective, chronic diseases emerge as a worrisome "epidemic". An epidemic that affects a growing part of the population, and that in the long term cannot be solved by treatment alone. Although an increasing number have to live with chronic diseases, most health indicators show that the Norwegian population has never been as healthy as today. The last 20 years, all groups in the country have gotten better health, but the improvement has been greater for people with higher education and high income than for people with little education and low income. In particular, it is those with the lowest social status which are lagging behind, but the differences are present throughout the socioeconomic hierarchy. Health differences relates to children, adolescents, adults and the elderly, and the differences for both physical and mental illness. In the Level of Living Survey 2012 (LKU 2012), which is conveyed by Statistcs Norway, the proportion of economically active reporting long-term illness, health problems, disability or nuisance resulting from damage, has been categorized by profession. This working group is further divided into three groups:

  1. People who report a chronic condition, but does not feel that it goes beyond their everyday chores.
  2. People who report a chronic condition and who feel that it goes beyond their everyday chores.
  3. Individuals who meet both criteria under paragraph 2, and in addition find that the chronic condition limits how long they can work and / or what kind of tasks those can perform.

Among all workers, about 30 percent said they have a long term illness or disability, which is equivalent to approximately 700,000 people. Of these, approximately 40 percent reports that health condition has limited everyday chores for a period of more than six months. Three out of four who experience limitations in daily life, feel that the health condition affects how long they can work and what kind of tasks they can perform. This means that more than 200,000 people have a chronic health condition or disability that limits their work capacity.

2.2. Working conditions of employed people affected by chronic diseases

Chronic obstructive pulmonary disease (COPD) has emerged as a disease which is widespread in Norway. COPD is the name for a collection of lung conditions including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD have difficulty breathing, primarily due to the narrowing of the airways. Typical symptoms include breathlessness, a persistent phlegm-producing cough and frequent chest infections. The effects of COPD cannot be reversed, but its symptoms can be relieved. Death rates from COPD are relatively high. In Norway during the 1990s, 25% of patients with the disease died within two years of diagnosis and 50% within five years. The extent of the disease in Norway is not only far greater than experts thought, but the prevalence of COPD has also increased much more quickly than expected. The Norwegian Labour Inspection Authority records between 2,000 and 3,000 new cases of work-related COPD each year. Some professions are more exposed to risk factors that may affect the progression of the disease, and research suggests that without the work-related exposure, many workers would not develop COPD. In 2013, as many as 400,000 Norwegians were estimated to have contracted the disease. In 80% of cases, tobacco smoking is the main cause of COPD. Although cause of the disease has been almost exclusively attributed to smoking, it has long been suspected that environmental factors in the workplace also contribute. Large groups of workers, particularly in the manufacturing sector, are known to be susceptible to contracting occupational COPD, whether smokers or non-smokers. Some industries have information about the relationships between specific exposures and COPD, and this applies especially to professions where workers regularly come into contact with dust and gas. It has been known for some time that workers in smelting, the metalwork sector, mining and tunnelling have been exposed to a mixture of different substances that may cause COPD. The asphalt industry has also acknowledged the link between harmful fumes and COPD. However, results from the Hordaland Health Study (in Norwegian, 729KB PDF), also shows that people working in hairdressing, painting and cleaning have an increased risk of developing COPD. Others at high risk include workers exposed to sewage sludge and those in wood processing industries. Data on farmers also shows that COPD was significantly more likely to be found in livestock farmers than in crop farmers. The risk of contracting COPD for livestock farmers is two to three times higher, even among non-smokers, and up to six times greater among smokers.The authors of the study concluded that ammonia, hydrogen sulphide and organic and inorganic dusts were a probable cause, but they say the impact of specific biological agents could also be significant. The results show that farmers with atopy also appeared to be more susceptible to developing farming-related COPD.                                                                            

Although many forms of cancer can be linked to occupational exposure, there are big differences in how well a correlation can be documented. In a report Occupation and Cancer (in Swedish, 657Kb PDF) (Eggen, T., et al, 2010), emphasis was put on cancers where a significant proportion of cases were attributable to occupational exposure. This included lung cancer (18%), mesothelioma (cancers of the breast and peritoneum, 83%), nasal and sinus cancer (30%), bladder cancer (2%) and laryngeal cancer (6%). The occupational cancers investigated in this report were particularly prevalent among construction workers and craftsmen, but also exist in varying degrees for occupations in manufacturing, service industries, primary industry and shipping. Data from the survey also show that workers in these occupations in general seemed to be more commonly exposed to one or several of these factors compared to workers in other occupational categories. Incidences of lung cancer, mesothelioma, nasal and sinus cancer, bladder cancer and laryngeal cancer were found to be especially elevated in the construction industries and among craftsmen. Elevated risks were also seen in some occupations in manufacturing industries and service industries. Among men, plumbers had a particularly increased risk of mesothelioma. Traditionally, women have had less occupational exposure due to gendered norms in career choices and lower labour force participation. Even so, the NOCCA study shows a particularly increased risk of lung cancer for female painting and wallpapering workers, as well as machinery and motor carriers, than in the general population. There is, however, some uncertainty associated with these findings. Although an increased risk of mesothelioma is not widespread among female professionals, an increased risk of breast cancer in women was seen in a variety of jobs traditionally carried out by people with higher education qualifications. The risk increased, for example, among female managers in administration and management and in academia. This increased risk was primarily explained by the childbirth patterns among these women. In another study (Lie et al, 2011), night work and risk of breast cancer was investigated. When using consecutive night shifts as the exposure parameter, the risk was found to be 70–80% higher for nurses who had worked for more than five years, regularly working at least six night shifts in a row. The observed increase of risk for this group not only supports an association between night work and breast cancer, but also suggests that breast cancer risk may be related to the number of consecutive night shifts.       

The largest proportion who report having a chronic health condition, and who say that this limits their ability to work, are found within the primary industry occupations and among hairdressers, cleaners and service personnel in hotels and restaurants, where between 16 and 18 percent are experiencing this. Among the five least vulnerable groups, the proportion varies between 2 percent (physician, psychologist, dentist, pharmacist, and veterinarian) to 4 percent (other occupations with higher university education). Among all employees who report limitations with regard to what tasks they can perform, just above one in two reports that  their employment situation have been adapted to their disability in terms of other working tasks, changed working hours and physical arrangements, or a combination of these measures. Of those who have not had their employment situation adapted, one in five states that there is a need for such an adjustment. Of those who have already received some support, 25 percent report a need for more adjustments.

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 main policy measure developed to favour the employment situation and working conditions of people with chronic diseases is the tripartite Agreement on a More Inclusive Working Life (IA Agreement). The agreement was first signed by the Norwegian government and the social partners in 2001. With the assistance of companies and an emphasis on including those with chronic illnesses and older people in the labour market, the focus of the agreement has been to ensure the recruitment of those with disabilities and other vulnerable groups, reduce the incidence of sick leave and the payment of disability benefits as well as increase the retirement age. After the first extension of the agreement in 2006, Government and the confederations of employers and employees last agreed on a new IA agreement for the period 2013-2018 on the 4th March 2014. This new agreement replaces the first letters of intent and the declaration by the parties on continuation of the original agreement. The Agreement entail, among other things, facilitation grants (see Insurance Act § 8-6) to businesses to encourage employers to organize work so that workers can remain in work despite chronic disease and other health problems.

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

An example of enterprises that have implemented measures to support people with chronic diseases are FMC Technologies Norway FMC Technologies is a leading global provider of technology solutions for the energy industry, and the company considers it important to invest in their employees and their expertise. Facilitating the workplace therefore is seen as an investment and utilization of employee expertise. The company received an IA-award in 2012 for their working environment policy. Automatic door openers, remote control of security barrier to make it easier for disabled people, fitness centre for disabled and facilitated climate for employees with MS, are some examples of how FMC actively facilitate a good working environment. The company also shows commitment by supporting "Active against cancer." The company is concerned with that all employees are important in the development of the work environment. All managers undergo management- and HSE training. In addition, all managers received training in the monitoring of sick leave. The aim of safety training is to reduce sickness absence, strengthen job attendance, better work environment and prevent exclusion and withdrawal from working life due to chronic diseases.

Commentary

Life expectancy in Norway is among the highest in the world, and is still increasing. As a direct consequence, the number of chronically ill has also increased significantly in the past few years. From a work perspective, the societal challenges necessitate intensified efforts to improve public health, prevent disease and injury and prevent people with chronic diseases to be excluded from the labour market due to their condition. The most important measure that has been launched by the social partners to meet this challenge is the preparation and implementation of the Agreement on a more inclusive working life (IA-agreement).

References

Lie, J.A., Kjuus, H., Zienolddiny, S., Haugen, A., Stevens, R.G., Kjaerheim, K. (2011), ‘Night work and breast cancer risk among Norwegian nurses: Assesment by different exposure metrics’, American Journal of Epidemiology, Vol. 173, No. 11, pp. 1272–1279.

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