Chronic Conditions, Disability, Return to Work, Occupational Safety and Health (by Sarah Copsey)

Introduction

Having safe and healthy working conditions is a key component in retaining workers with chronic illnesses and disabilities and making their work sustainable throughout their lives (¹). 100% work efficiency is not essential for people, and workers with a chronic medical condition can learn to cope and overcome their problem: with the right adjustments, they can usually continue working. The measures required are often simple and inexpensive. This article explores the role of occupational safety and health (OSH) in enabling people with chronic condi-tions and disabilities to continue working and provides some examples of good practice.

How Can Occupational Safety and Health Support Workers with Disabil-ities and Chronic Illnesses?

In the EU, health and safety regulations require employers to prevent risks, based on risk assessment. The priority is to eliminate risks at source and take collective measures to make work safer and healthier for all workers. This is important, as measures that make it easier for all people to work could enable those with re-duced work capacity to remain in employment (²).

Particularly sensitive groups, such as chronically ill workers, need to be protected from risks that specifically affect them. However, making workplaces more in-clusive for all workers, for example when purchasing equipment, planning activ-ities or modifying buildings, consequently reduces the need for changes for indi-viduals.

(¹) See EU-OSHA, The ageing workforce: implications for occupational safety and health. A research review, 2016.

(²) See EU-OSHA, The OSH Framework Directive, in osha.europa.eu.

In addition, legislation setting minimum standards for health and safety at work requires workplaces to take account of workers with disabilities, particularly in relation to doors, corridors, stairs, showers, washbasins, toilets and workplaces used or occupied directly by people with disabilities (³).

These health and safety requirements complement employers’ duties under EU equal employment opportunity legislation to provide workplace accommoda-tions for people with disabilities (⁴). Employment equality legislation requires employers to provide reasonable accommodation for employees with disabilities, such as providing equipment, adjusting working hours, changing jobs or provid-ing trainprovid-ing. Some countries have more detailed requirements than the minimum standard set by the EU, including returning to work after sick leave.

The right way to provide these collective and individual protection measures for workers is to be sensitive to diversity when carrying out health and safety risk assessments. Adopting a diversity-sensitive approach to risk assessment has been considered a priority in the European Commission’s Safety and Health Strategy 2014-2020, as presented in its Communication Safer and Healthier Work for All – Modernisation of the EU Occupational Safety and Health Legislation and Policy (COM(2017)12 final). See the Box.

European Commission’s OSH Strategy 2014-2020 (diversity extracts)

• The Framework Directive creates a legal obligation for the employer to take the necessary measures for the safety and health protection of all workers. It stipu-lates that particularly sensitive risk groups must be protected from hazards that specifically affect them.

• Risk management measures must therefore pay attention to the specific risks in-curred by women and men, young workers, older workers, migrants or people with disabilities.

• The Directive requires the design of specific preventive and protective measures according to the requirements of these groups of workers.

• The risk assessment should consider the job requirements in relation to the indi-vidual’s abilities and health.

Health and Safety Risk Assessment

Health and safety risk assessments should follow a number of steps:

• hazard identification

• risk assessment;

(³) See EU-OSHA, Directive 89/654/EEC – workplace requirements, in osha.europa.eu, 19 March 2021.

(⁴) See EU-OSHA, Directive 2006/54/EC – equal opportunities, in osha.europa.eu, 4 October 2017.

• taking into account ‘sensitive’ groups;

• decisions on prevention measures following a hierarchy of measures:

– starting with combating risks at source;

– adapting work to workers;

– replacing the dangerous with the less dangerous;

– giving collective measures priority over individual measures (such as personal protective equipment);

– define priorities;

– implement, monitor and evaluate the measures.

Employers are also obliged to provide workers with information, instructions and training and must consult workers and their representatives on risk assess-ment and prevention measures.

Risk Assessment for a Diverse Workforce

EU-OSHA publications on risk assessment and diversity and disability (⁵) sug-gest a number of success factors for taking disability and diversity in general into account when assessing occupational health and safety risks and implementing prevention measures, including:

• employers should consider diversity in the workforce as an asset and be committed to ensuring the safety and health of everyone;

• employers should take disability and diversity into account in the de-sign and planning stages, when changes are proposed or new purchases are planned;

• it is important to avoid assumptions about who is at risk or how they work and to consider everyone, taking into account individual differ-ences;

• the risk assessment process should take into consideration the actual work done;

• the work should be adapted to workers;

• consultation and participation of workers is fundamental to an effec-tive risk assessment; this includes the participation of disabled workers;

• coordination between safety and equal opportunities staff is needed;

• diversity training is needed for everyone in the workplace, including managers and workers, safety and equality staff and human resources,

(⁵) Cf. EU-OSHA, Workforce diversity and risk assessment: Ensuring everyone is covered, 2009;

AGENZIA EUROPEA PER LA SICUREZZA E LA SALUTE SUL LAVORO, La diversità della forza lavoro e la valutazione dei rischi: garantire che tutti siano inclusi Sintesi di un rapporto dell’Agenzia, EU-OSHA Facts, 2009, No. 87 IT; AGENZIA EUROPEA PER LA SICUREZZA E LA SALUTE SUL LAVORO, Garantire la salute e la sicurezza per i lavoratori disabili, EU-OSHA Facts, 2004, No. 53.

in order to raise awareness of the issues and ensure that all parties un-derstand what it actually means to have a different approach;

• external expertise should be sought if necessary.

Inclusive Workplaces

Measures to support workers with reduced working capacity (who may be older workers or those with difficult health conditions or disabilities) often make work-places safer and more accessible for all workers and customers as well, and many of the measures to be taken are low-cost and simple. A ramp to a building en-trance or automatic doors will be used by all workers, but they can make the difference between being able to work or not for a person with a disability.

Making workplaces accessible and inclusive will benefit everyone and this should be the overall aim. This reduces the need for specific measures for individuals, which means that workers do not have to suffer the stigma of having to ask for special treatment and helps prevent early exit from the workplace by reducing obstacles and facilitating work activities. There is an opportunity to make a work-place more inclusive whenever changes to the workwork-place are planned, new equip-ment is purchased or work is reorganised. Other examples of inclusiveness measures include height adjustable workstations, ergonomic tools and flexible working time policies (⁶).

Elements for a Workplace Support Policy

The strategic elements for providing workplace support for people with chronic illnesses aim at:

• preventing risks through high OSH standards;

• encouraging early reporting of problems;

• having an effective return-to-work policy;

• promoting health through the workplace;

• promoting a culture of open conversation.

Early Intervention and Early Access to Advice

The earlier a problem is reported, the easier it is to deal with. It is up to the worker to decide whether or not to disclose their medical condition. However, their employer will need to know how the job is affected by the symptoms felt (⁶) See J.O.CRAWFORD ET AL., Working with chronic musculoskeletal disorders. Good practice advice report, EU-OSHA, 2021.

by the worker; an employer cannot act if they are not aware of the problem. For what concerns the workplace, this means encouraging and enabling employees to report health problems as soon as they arise, ensuring that they will be listened to and supported. If any employee has a persistent health problem that affects their work, they should be encouraged to see a doctor as soon as possible. Med-ical advice, if shared with the worker’s permission, should help the employer to understand what support the worker needs (⁷).

Success Factors for Making Accommodations

EU-OSHA publications have highlighted a number of important success factors to make the necessary accommodations. These include the following:

• having an employer who shows that they are supportive and willing to help;

• focusing on the worker’s abilities, not their disabilities;

• having an open conversation with the worker that includes knowing what symptoms they are experiencing and how they vary, what tasks they find challenging and what support they need;

• involving the worker, his/her health team and supervisor;

• allowing sufficient time for the process and trying out different measures to see which one will be most helpful (usually several measures are needed);

• finding out what external information and support is available and get-ting expert help in the most difficult cases;

• reviewing the measures to make sure they are working and checking if anything else is needed; making further changes if the worker’s condi-tion changes in the future.

Simple Adjustments

Examples of adjustments include:

• changing tasks and duties, e.g., swapping or rotating tasks with colleagues, giving extra breaks or adjusting work to prevent fatigue;

• adapting equipment and the workplace, e.g., providing an ergonomic mouse or voice-activated software, providing ergonomic tools, using adaptive controls for guidance or repositioning equipment to reduce fatigue;

• modifying working hours, e.g., through flexible or reduced hours, e.g., by postponing the start and end of working hours, in order to avoid trav-elling at peak times or if the criticality is more significant in the morning (⁷) Ibidem.

or working from home, perhaps on certain days. A gradual return to work after sick leave, with reduced hours at the beginning, can be very helpful.

Often these measures, such as ergonomic improvements and flexible working hours, translate into benefits for the whole workforce.

A successful example of measures provided to support a return to work concerns the case of a female receptionist with osteoarthritis and osteopenia working for a medium-sized company (⁸). As a result of a domestic accident, she suffered back fractures, a torn ankle ligament and a sprained right knee ligament. This resulted in a six-month absence from work. Her return to work was gradual: she worked part-time for 1 month and 7 hours a day for the following month before returning to her full 7.5-hour working day. Colleagues helped her with some of her tasks, such as carrying heavy loads in postal deliveries. A health and safety risk assessment led to a number of changes to the workstation. These included a better designed telephone headset to reduce hand movement, a new footrest for better support and a filing cabinet that was easier to move. The rapid imple-mentation of the return-to-work process enabled the worker to return to her original job with minimal changes to her tasks.

Conclusions

All too often chronic illnesses or disabling conditions cause workers to leave their jobs early. However, with the right employer attitudes and workplace ad-justments, combined with support from the public health system, many workers with chronic medical conditions can continue to work. Occupational safety and health (OSH) have an important role to play, in a multidisciplinary approach, in supporting people with chronic conditions to remain active at work.