Chronic illness and disability has high economic costs for individuals, their families and society. Employment rates of people with chronic illness or disability are low (49%) and 2.7 million people with a disability or a chronic illness are on state benefits, such as Incapacity Benefit. These make up the largest group of benefit claimants, and account for 25% of social security benefit expenditure, representing 1.5% of GDP. The personal costs to the out-of-work individuals are considerable and may include economic hardship and social exclusion, both of which are threats to health. As both chronic illness/disability and non-employment are socially patterned, with increasing risk with decreasing socio-economic status, these trends have the potential to generate further social inequalities in health, with their attendant health care costs.
Other European counties are facing similar problems, even if the magnitude varies. In Sweden almost 15% of the population of working age is outside the labour market due to ill-health. The total costs for the national social insurance system (sickness benefit, rehabilitation, activity payment and occupational injuries) were about SEK 113 billion in 2003.
While the employment prospects of people with chronic illnesses and disabilities is a major policy issue, very little is known about the impact on employment and health of measures to increase economic activity rates for this target group. In a systematic review of the effectiveness of the UK’s welfare-to-work programmes for people with a disability or chronic illness, most studies were small-scale pilot schemes without a control group and none considered if impacts differed for different socio-economic groups. Likewise, our review of Swedish initiatives to tackle long-term sickness absence established that there were very few evaluations, with these mostly limited to small-scale local projects.
Cross-national evaluations provide a way of addressing this evidence gap. The proposed study compares outcomes in countries that vary in their policies for people with chronic illnesses and disabilities. The comparison includes:
Outcome measures include mental health and quality of life impacts, employment status, and type and quality of employment obtained, disaggregated by socio-economic position.
International collaborators have been identified, including members of the WINNER network (Work and Inequalities in Health in Europe), the EU Barcelona network and research teams in Canada. Countries indicating strong interest in a cross-sectional evaluation include Sweden, Finland, Norway, Denmark, and Canada. The extent and nature of the datasets available in each country varies substantially and informed the final selection of comparator countries.