With apologies for cross posting
Helping chronically ill and disabled people into work: what can
we learn from international comparative analyses?
Final report to the Public Health Research Programme, Department of Health –
UK
Summary
• This project aimed to identify and synthesise evidence on policies and
interventions that might help chronically ill and disabled people into work
in five highly developed welfare systems: Canada, Denmark, Norway, Sweden
and the UK.
• In the UK, employment rates for people with a chronic illness and
disability are low and show a social gradient, with less skilled manual
workers suffering the most.
• Comparing these five countries in relation to macro-level policies, the
problematic employment situation in the UK for people with limiting illness
and low education may in part be a consequences of adverse long term
macroeconomic conditions combined with a relatively low level of active
labour market policies.
• In relation to focused interventions, a typology of eight different types
of intervention was developed and studies reviewed within each category.
Some intervention types produced promising results in terms of improved
employment chances for participants. Influential factors in terms of impact
included intensive personal support and substantial financial incentives.
• There are many pitfalls to interpreting the evidence on social
interventions including: biased selection of participants into the
interventions; take-up of universal initiatives by those for whom they were
least intended; measurement of outcomes too soon or inappropriately; hidden
stigma associated with some interventions; low take-up leading to negligible
population impact. All these make in-depth knowledge of the
intervention/system context and the incorporation of evidence from
qualitative studies a necessity.
• Very few studies investigated whether there was a differential impact of
the interventions for different socio-economic groups. It is essential for
future effectiveness studies to monitor differential impact. Some of the
studies that did, found that specific interventions were less accessible to
less skilled manual groups, who would need additional support to help them
return to work.
• These are the very groups that our epidemiological analyses reveal have
the poorest, and declining, employment chances in all five countries, with
the situation in the UK being of particular concern. The current recession
in all the countries make it more pressing than ever to address this problem.
A series of papers based on the research are in preparation, and a summary
of the research is available at:
http://www.york.ac.uk/phrc/PHRC_C2-06_Short_Report_9%20FV12Oct09.pdf
Details of the research team
Margaret Whitehead¹, Stephen Clayton¹, Paula Holland¹, Frances Drever¹, Ben
Barr¹ Rachael Gosling¹, Espen Dahl2, Kjetil Arne Van Der Wel2, Steinar
Westin3, Bo Burström4, Lotta Nylen4, Olle Lundberg5, Finn Diderichsen6,
Karsten Thielen6, Edward Ng7, Sharanjit Uppal7, Wen-Hao Chen7.
¹Division of Public Health, University of Liverpool; ²Oslo University
College, Oslo; 3Norwegian University of Science and Technology, Trondheim;
4Karolinska Institute, Stockholm; 5Centre for Health Equity Studies (CHESS),
Stockholm; 6University of Copenhagen, Copenhagen; 7Statistics Canada, Ottawa.
Address for Correspondence
Professor Margaret Whitehead, Division of Public Health, University of
Liverpool, Liverpool L69 3GB. Email address: [log in to unmask]
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