Work, health and activation policy

EFFECTS OF WORK AND ACTIVATION ON THE SOCIAL

INCLUSION OF CHRONICALLY ILL AND DISABLED

R e s e a r c h e r , P h . d . I b e n N ø r u p D e p . O f P o l i t i c a l S c i e n c e , A a l b o r g U n i v e r s i t y

Aim of the study

To investigate the effect of work participation on the social exclusion when taken into account the role of poor health

In particular to investigate how work participation and activation to work affects the social exclusion of people with very little work ability and a large degree of functional limitations due to health related impairments

Content of the reform Political argumentations

Strongly limited acces to disability pension

Pension is to a large extent replaced by ”ressource activation”

Ressource activation is temporary and granted for 2-5 years

De facto reduction of social benefits to chronically ill and disabled

Work participation is considered the key to social inclusion

Disabilty pension is considered a cause for deprivation

Strong emphasis on ”therapeutic” effects of work

As well as a strong emphasis on reducing expenses to disability pension

Background – reforming the disability pension

Design of the study (simple version)

Chronically illness / disability Social exclusion

Labour market eksklusion

Health risici and work / activation

Health risici and unemployment

Studies in ocupational medicin Work can be a cause for

disabilities Blue collar work is associated

with a greater risk than white collar work

Danish study of disability pensioners Leaving the workforce and

activation in particular improves the health and social life of disability pensioners

Studies of health problems and unemployment Unemployement and poor

health is highly associated. Direction of causality is

unclear

Studies of company closures and health Some relation between health

measures and unemployment

Health, work and unemployment – what do we know about the relation?

Unemployement and social deprivation

Recent Scandinavian studies

Jahoda / Marienthal Case study in a pre-

welfare state context No distinction between

financial deprivation and unemployement

Recent social-psycological studies

Coping perspective Find that individuals

responds in various to unemoployment

Unemployment and marginalization Unemployment and

marginalization are associated

But the variation in experiences of marginalization is extremely high

Unemployment and social exclusion

Data and method

”Health profile Northern Jutland” Survey of 36.000 respondents (25.000 answered) Cross sectional study

Danish Statistics Registers Health registers Income Education etc.

DREAM Database Registerdata unemployment, social benefits etc. Every week through out the year

Method: Structural Equation Modeling

3 dimensions (Bothfeld & Betzelt)

The Capability Approach (Sen)

Individual Personal autonomy Wellbeing

Social Social relations Trust, ”belongingness”

Political Social participation in

various arenas

Functionings Actual actions and

experiences

Capabilities The posibility / freedom to

act

Commodities Ressources

Social exclusion, a definition

The individual dimension

The individual dimension

The social dimension

The social dimension

The political dimension (example)

The political dimension

Conclusions I

Disability and chronically illness is a central cause for social exclusion

Disability / illness causes low personal autonomy and this causes poor social relations and low degree of social participation

Education, income etc. do not significantly alter the negative social effects of disabilities / illnesses.

…But high education and other social factors do reduce the risk of labour market exclusion

Conclusions II

Persons with disabilities and illness do not experinces social exclusion because of their lack of work participation

…And labour market inclusion does not in it self reduce the experiences of social exclusion causes by poor health

For people with very extensive health problems activation to work and pressure to particiapte in work increase the social exclusion

Perspectives on activation policy

A stronger focus on disabled / chronically ill as particular group with particular needs is highly needed

While it in general is very important to raise the work participation amongst disabled, work and activation may not be the solution for those with the weakest health

Rather than a (narrow) focus on employment as the key to inclusion, a focus on social inclusion and health improvement as a way to raise employment might be more beneficial

A more varied definition of ”work” and under which circumstances work function as a positive factor in the improvement of health and social life of disabled is highly needed