![]()
Part 1
Work Disability Policy Context
![]()
Chapter 1
Work Disability Policy
Current Challenges and New Questions
Ellen MacEachen
After several decades of developing work disability policies (which encompass diverse but related workersâ compensation, sickness and disability policy, and social security legal and regulatory frameworks), central questions remain about their design, focus, and effects. Within and across jurisdictions, work disability policies have been adjusted, formed, and reformed as policy makers strive to find the right balance of rules and inducements for agencies, employers, and workers to maximize labor-force participation. Despite this activity, a key and pressing question is why we have not been more successful at helping people to remain in the labor force. Indeed, an Organisation for Economic Co-operation and Development (OECD) report, Sickness, Disability and Work: Breaking the Barriers, described work disability as âone of the biggest social and labour market challenges for policy makers . . . [that] hinders economic growth as it reduces effective labour supplyâ (OECD, 2010, p. 9).
We have arrived at a point where it is time to reflect on the social security system changes made so far to stem work disability: their ideals, what worked, what did not, and why. Even more fruitful is to consider these issues by jurisdiction: Why did one jurisdiction take a particular route to improve work integration and another take a different route? What are relevant contexts that shaped the different pathways? Although a great deal of scientific research has been generated about work disability, interventions and policy are also confronted by the reality of implementation, budgets, and political favor. It is as important for analysts to reflect on the politics of work disability policy as it is to complete the science.
This chapter provides an overview of the field of work disability research and policy conditions and argues for the need to ask new questions about work disability policies, including why they are designed differently across jurisdictions and how well they function. It begins by describing social security challenges and shifts in understandings about health and activation that contributed to the growth of the field of work disability research and policy. Issues facing implementation of work disability policies are then examined, including aging populations and weakly coordinated work disability policies. The chapter then turns to approaches to understanding policy effectiveness and the need to consider work disability policies in their specific contexts; that is, what are the social, political, and economic conditions within individual countries that have led to their current configuration of work disability policies? The chapter concludes with overviews of the other chapters in the book.
Development of Work Disability Policy and Research
Policies, including those relating to work disability, are shaped by social contracts: social expectations and tolerance within a society that help to explain and justify its legal, political, and economic structures (Lessnoff, 1990; Paz-Fuchs, 2011). For work disability policy, social contracts shape how far citizens view the state as responsible for their employment and income security, whether employers see themselves as obliged to employ people with impairments or ill health, and how individuals understand their own responsibility for seeking and participating in employment. For instance, Americans have a different view of what is work limiting than do Europeans, and this is associated with more restrictive disability policies (Yin & Heiland, 2017).
Work disability policies emerged in advanced economies within a context of increased social security costs and emerging theories about work absence and health. Social security systems that developed after World War II to offer income security and healthcare to citizens began to shift in the 1990s, as spending on disability benefits began to be considered unsustainable (Organisation for Economic Cooperation and Development, 2010). At the same time, theory developed about the moral and health virtues of work activation and labor-force engagement (Bertram, 2013; Elbers et al., 2016; Martin, 2015). Work absence was now described as a social rather than a medical phenomenon (Waddell, Burton, & Aylward, 2008), and time away from work began to be considered psychologically harmful due to social exclusion (Shrey, 1996). These theories, together with a âcultural revolutionâ on how to manage back pain through activity rather than rest (Valat, 2005, p. 194; Waddell, 1998), spurred the growth of work disability prevention (MacEachen, Ferrier, Kosny, & Chambers, 2007), defined as management of health or impairments in conjunction with maintaining employment (Loisel & CĂŽtĂ©, 2014).
The movement to integrate work-disabled people into the workforce coincided with and was buttressed by labor-market-activation strategies that emerged in the same era, such as workfare, a welfare system that required those receiving benefits to perform some work. This work-for-benefits approach emphasized a social contract of mutual obligation of citizens and the state: if citizens received state benefits then they should provide the state with something in return, that is, their labor (Martin, 2015). At the same time, successful disability-rights advocacy movements during the 1990s and 2000s prompted the creation of integration laws, including the Americans with Disabilities Act in the United States, and international conventions about the right of people with disabilities to participate fully in society (Putman, 2005). The labor-force integration goals of people with disabilities, who were fighting stigma and discrimination that prevented them from accessing employment, fit well with emerging work disability principles of social inclusion and labor-force engagement.
Broadly speaking, this activation movement shifted policy and programmatic emphasis away from income security and toward discourse on worker health, financial, and social issues. For example, income-support benefits that might passively encourage people to not work began to be depicted not only as expensive for insurers, but also unhealthy for workers (MacEachen et al., 2007). Across advanced economies, laws and policies were drafted to encourage workers and employers to implement return to work after injury or illness, and to reduce sick leave with innovations such as accommodations and modified duties for workers and financial incentives to employers. The last initiative includes financial penalties for worker absenteeism due to injury or illness (Clayton, 2012).
A new field of research on work disability prevention developed in the 1990s, concurrently with emerging labor-market-activation policies. Work disability prevention has focused on shifting injured workers from leaving work and dependence on state disability benefits to active recovery while working. It is focused on work accommodation, return to work, and social inclusion. Importantly, the term work disability refers primarily to employment situations; that is, being unable to stay at work or to access work.
Demographic and Policy-Coordination Challenges
Since the 1990s, many studies have investigated the health and fiscal effects of active labor-force engagement. Research has shown that unemployment is associated with ill health (Milner, LaMontagne, Aitken, Bentley, & Kavanagh, 2014; Orchard, 2015; Zhang & Bhavsar, 2013), that return to work reduces the duration of disability (Franche, Cullen et al., 2005; Viikari-Juntura, Kausto, Shiri, Kaila-Kangas, & Takala, 2012), and that return-to-work practices are cost-effective for employers (Bardos, Burak, & Ben-Shalom, 2015; Squires, Rick, Carroll, & Hillage, 2011). Yet, despite a burgeoning scientific-evidence base demonstrating that employment is healthy and that work reintegration is cost-effective for employers, work disability policy has been difficult to implement.
One challenge to work disability policy implementation may lie with the focus in research and policy on the health of workers, and the relative neglect of industrial relations. In research that focuses on workers, positive psychosocial and physical work environments are assumed; however, in reality these conditions are not always present in workplaces. For instance, when it adversely affects their business, employers may avoid implementing return-to-work policy (OâGrady, 2013; Seing, MacEachen, Ekberg, & Stahl, 2015). As well, a growing body of North American research shows that workers avoid reporting work injury because of their concerns about social stigma or employer reprisals (Kirsh, Slack, & King, 2012; Lewchuk, 2013; Lipscomb, Schoenfisch, & Cameron, 2015; Manapragada & Bruk-Lee, 2016). Poor work environments have been found to adversely affect health (Rueda et al., 2015) and return-to-work opportunities (Josephson, Heijbel, Voss, Alfredsson, & VingĂ„rd, 2008; Nyberg, 2012; St. Arnaud, Bourbonnais, Saint-Jean, & RhĂ©aume, 2007). Therefore, although research studies find that employment in general promotes health, it is realistic for policy designers to consider how work disability may be managed for individuals employed in less-than-ideal work environments (MacEachen, Kosny, Ferrier, & Chambers, 2010).
Aging populations and concerns about labor shortages and social security expenditures are an additional challenge in implementing work disability policy. These challenges have led to policy changes to encourage older workers to stay in the labor force; for instance, through delaying the start of old-age pensions (Börsch-Supan, 2000; Hering & Klassen, 2010; Turner, 2006). It is estimated that, by 2035, the over-65 population will double in advanced economies (Curry & Torobin, 2011; European Commission, 2015; Fields, Uppal, & LaRochelle-CÎté, 2017). With a greater proportion of people aged 45 and over in the workforce, disability-benefit costs are expected to further increase (Beatty & Fothergill, 2015; Belin, Dupont, Oules, Kuipers, & Fries-Tersch, 2016; Burkhauser & Daly, 2012). Greater pressure will be placed on work disability systems to accommodate these older workers with increased healthcare needs and reduced ability to recover quickly from injury and illness (Berecki-Gisolf, Clay, Collie, & McClure, 2012; World Health Organization, 2015).
Changing workplaces pose further challenges for implementation of work disability policies. These policies expect employer accommodation of workers at a time when employers, in the face of intensely competitive global-trading conditions, have moved toward more flexible contracts with workers and fewer long-term responsibilities (Kalleberg, 2009; Stone, 2000). There has been a growth over recent decades of nonstandard businesses and precarious employment conditions, and increasing numbers of individuals are now self-employed or working on temporary contracts. The quickly growing gig economy, characterized by freelance work (Steinmetz, 2016) and automation (Brougham & Haar, 2017) further increases employment precariousness. In many jurisdictions, nonstandard forms of employment limit workersâ access to income security and benefits coverage (Broughton et al., 2016; Fudge & Strauss, 2014).
System complexity is a further challenge for implementation of work disability policy, because this is not one single policy but rather a series of policies and initiatives that span areas of health, disability, employment, joblessness, and public health. Newer activation-oriented policies operate in conjunction with older systems developed at different times and for different reasons, and these various policies do not always coalesce to form coherent and consistent work disability policy (Belin et al., 2016; Prince, 2010; Stapleton, Tweddle, & Gibson, 2012). Indeed, lack of coordination between related work disability policies was identified as a key deterrent to effective policy implementation in a cross-jurisdictional analysis of European work disability policies (Belin et al., 2016). Particular challenges include cost shifting among programs; for instance, when tightening time limits or eligibility requirements for one program leads to shifting impaired workers to other programs, which can be the lowest-paying social assistance programs (LaDou, 2010; Mansfield et al., 2012; McInerney & Simon, 2012; StĂ„hl, MĂŒssener, & Svensson, 2011; Stapleton et al., 2012).
Certainly, the social and legal environment of work disability is complex. The Work Disability Arena model, developed by Loisel et al. (2001), aptly situates work disability at the intersection of complex and interwoven ...
