Disability and employment: lessons from natural policy experiments

Abstract

Across Europe, the situation for working age people not in employment through disability or ill-health is a serious issue for public health and social welfare policy. Why? The scale and upward trend is one reason. In the UK, incapacity benefits are paid to those who are unable to work because of ill-health or disability. The numbers on incapacity benefits trebled during the 1980s and 1990s and now stand at more than 2.6 million people,1 accounting for 25% of total social security benefit expenditure, corresponding to 1.5% of Gross Domestic Product (GDP).2 In the Nordic countries, Sweden has also seen a trebling of the proportion of the population receiving sickness or activity compensation in the past 30 years,3 with almost 15% of the working age population outside the labour market due to ill-health. Nearly 8% are on disability pensions and the cost of sick leave and disability pensions together corresponds to around 4% of the Swedish GDP. In Denmark and Norway, the proportion of the working age population in receipt of disability pension has risen to 8 and 10%, respectively. There is recognition across Europe that the ageing of populations will exacerbate these trends: in the near future, it is estimated that there will be eight non-working persons per 10 working persons in the European Union (EU), as a result of the twin trends of the ageing of the population and the increase in the proportions leaving the labour force due to ill-health. These figures are not just about a financial problem for governments, but about opportunities for large sections of the population to participate fully in society as a whole and have a better quality of life. For public health, the issue is intricately linked to health inequalities. Being in poor health is an important risk factor …