Employment and People with Non Communicable Chronic Diseases: PATHWAYS Recommendations and Suggested Actions for Implementing an Inclusive Labour Market for All and Health in All Sectors

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MAPPING
Strategies for inclusion, integration and reintegration of PwCDs at both European and national levels, implemented at policies, systems, and services levels were mapped. (WORKPACKAGE 4)

EVALUATION OF EFFECTIVENESS
The effectiveness of policies, systems and services strategies targeting professional integration and reintegration of persons with chronic diseases was evaluated in a systematic review. (WORKPACKAGE 5)

ASSESSMENT OF EMPLOYMENT NEEDS OF PWCDs
Persons with six different chronic conditions living in nine European countries participated in an esurvey reporting the factors they perceived as favorable or unfavorable to obtain and retain employment. (WORKPACKAGE 6)

EVALUATION OF NATIONAL AND EUROPEAN STAKEHOLDERS' PERSPECTIVES
The perspectives of European and National-level stakeholders -policy makers, unions, professionals and employers -on existing strategies for work re-integration of persons with chronic diseases were explored using an online survey. (WORKPACKAGE 7)

PATHWAYS 7 POLICY RECOMMENDATIONS 1# Raise Awareness about the role of employment for persons with chronic diseases
The needs of PwCDs in the area of integration, inclusion and reintegration into the labour sector must be prioritized through targeted actions where biological, psychological, social factors and their complex interactions are considered. Health in all policies implies that Governments have a responsibility for the health of their people. This can only be fulfilled by the provision of adequate health and social measures including awareness raising and information about chronic diseases and their impact on employment as well as the impact of employment on PwCDs.

2# Strengthen EU-Level Policies that promote inclusive labour markets for all
Reduced unemployment, social equality and higher labour market participation are the main priorities of the EU's 2020 Disability Strategy. The European Commission has highlighted the importance of building an inclusive labour market for all of all ages, , where all working-age and especially vulnerable and disadvantaged persons, should be given an equal opportunity to enter and remain.

3# Ensure adequate National legislation that promotes inclusive labour markets for all
In many EU-countries persons with specific chronic health conditions can receive support in employment only if their condition is legally recognized as a "disability". Such frameworks, however, create an "invisible" category of working-age PwCDs that are "not disabled" and will not be eligible for national policies, although they face obstacles to participate in the open labour market.

4# Develop and monitor strategic approaches and directions that promote inclusive labour markets for all
The achievement of the inclusion and full participation of each person in the employment sector necessitates strategic actions on the part of employees, employers and all other stakeholders involved, in order to combine incentives and obligations that together achieve inclusion. A shift in attitudes of all parties and a genuine willingness/commitment of all to eliminate workplaces' restrictions for all, thus including PwCds, is a must-factor in the changing process.

5# Develop and monitor measures that promote inclusive labour markets for all
Promotion of sustainable employment of PwCDs involves the development of measures that take into account PwCDs' need for job security, employment support and reasonable accommodation as well as employers' need for economic sustainability.

6# Develop and monitor services that promote inclusive labour markets for all
Biopsychosocial factors that limit employment reintegration or integration of PwCDs are diverse and multidimensional. They include personal, societal and environmental work-related parameters. Thus, different types of services and supports to address this heterogeneity are needed.

7# Promote research on effective and innovative strategies and use the available evidence for developing solutions for inclusive employment
The development of agreed study protocols and the assessment of strategies should be at the centre of the governance structure in order for policy makers to collect and rely on valid and reliable information for establishing and monitoring the effects of existing strategies for work integration and reintegration. This contributes to evidence-based decisions and policies.

1# Raise Awareness of the role of employment for persons with chronic diseases PATHWAYS FINDINGS MAPPING
 In many European countries awareness of the role of employment for persons with noncommunicable diseases (NCDs), also known as chronic diseases, CDs, is still lacking.

EVALUATION OF EFFECTIVENESS
 Stigma and discrimination were identified as factors limiting the effectiveness of strategies aiming to improve work reintegration of PwCDs.  Effective strategies are highly affected by the way disclosure of illness and the need for social support is handled in the work environment.

ASSESSMENT OF NEEDS
 PwCDs, regardless of the type of health condition, diagnosis or symptoms, highlighted as part of their most important needs: awareness raising for co-workers, human resources and employers on health conditions and their specific management.

EVALUATION OF THE PERSPECTIVE OF STAKEHOLDERS
 Stigma, discrimination and the lack of awareness were considered barriers for the effective implementation of inclusive working strategies by National and EU level stakeholders  Awareness raising and training for staff and management were considered of crucial importance by both National and EU level stakeholders for promoting labour market participation of PwCDs

EVALUATION OF EFFECTIVENESS -ASSESSMENT OF NEEDS
 Legislations that allow to be legally protected against being dismissed due to discrimination were reported as very favorable by at least 80% of people. In contrast, legislations that allow legally terminate contracts in case productivity decrease because of health conditions were perceived as very unfavorably by participants suffering from chronic health conditions  Differences emerged between PwCDs belonging to countries with different welfare Models, indicating the need for country-tailored actions.

EVALUATION OF THE PERSPECTIVE OF STAKEHOLDERS
 «Inadequate legislation» was one of the most frequently mentioned barrier hindering the promotion and implementation of more inclusive work related strategies.

4# Develop and monitor strategic approaches and directions that promote inclusive labour markets for all PATHWAYS FINDINGS
MAPPING  Integrated employment support systems that encompass various areas of support (i.e. job-search support, access to training, individualized and specialized support by professionals)

5# Develop and monitor measures that promote inclusive labour markets for all PATHWAYS FINDINGS
MAPPING  Existing measures targeting work reintegration of PwCDs take different forms and orientations while their effectiveness and degree of implementation vary according to the welfare model adopted by different EU-countries.

ASSESSMENT OF NEEDS
 Physical adaptations of workplace and receiving appropriate education and training to promote professional development were among the most favorable domains reported by PwCDs participating in the Pathways needs assessment survey.

EVALUATION OF THE PERSPECTIVE OF STAKEHOLDERS
 EU level stakeholders emphasized the need to maintain a balance between protection and activation of PwCDs, and the importance of providing financial supports during participation in employment activation measures.

EVALUATION OF EFFECTIVENESS
 The service-level strategies that were identified as effective by PATHWAYS research were:  Individual Placement and Support  A work-focused, early ergonomic and personalized intervention  Psychological or behavioral strategies  Multidisciplinary interventions  Educational training/ re-training

ASSESSMENT OF NEEDS
Regarding the area of employment services two factors were rated as relevant, helpful and favorable by more than 70 % of participants: a) the possibility of establishing positive relationships with health care professionals, social security or employment officers and b) that health services are provided outside typical working hours.

EVALUATION OF THE PERSPECTIVE OF STAKEHOLDERS
 EU-level stakeholders highlighted the development of services for employers and the promotion of a person-centered approach to services for PwCDS.

PATHWAYS RECOMMENDED ACTIONS Level
1 PROVIDE ACCESS OF PWCDS to adequate and customized employment support services both at local and regional levels.

EVALUATION OF EFFECTIVENESS
 Data from national reports could not be exploited to the full extend; they were heterogeneous, with complex language and mostly structured according to the information required by the contracting authority.  Similar obstacles were identified in scientific publications; poor research methodology, large variability of outcomes and unclear definition of investigated concepts were identified as main obstacles.

ASSESSMENT OF NEEDS
 Current evidence on employment needs of PwCDs was found to be mainly focused on the negative impact of chronic health conditions on "work-functioning" or ability to work of the person and -for some diseases -evidence was extremely limited.

EVALUATION OF THE PERSPECTIVE OF STAKEHOLDERS
 There are not or many of the stakeholders don't know any specific outcome measure to evaluate effectiveness of existing strategies

PROMOTE AGREED STUDY PROTOCOLS and sound evaluation methods
and parameters related to inclusive labour markets. Policy 2 DEVELOP and SET SPECIFIC OUTCOME MEASURES for evaluating existing policies, systems and services related to work inclusion, integration and reintegration of PwCDs.

3
CONDUCT RESEARCH ON IDENTIFYING STRATEGIES that promote more inclusive working environments for all (i.e. identify the various employment needs of PwCDs; identify effective work reintegration strategies, identify strategies of involvement of all sectors for more inclusive policy development).