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Disability as an Asset? Reflections on Employment Patterns in the Health and Social Care Sector

Disability as an Asset? Reflections on Employment Patterns in the Health and Social Care Sector
Abstract
The number of people with health problems and disabilities living outside the labor market and on public income security puzzles politicians. The problems associated with having a disability seem to be counteredby measures directed either towards people with disabilities (employability programs) or towards employers (anti-discrimination legislation). These problems are at the forefront of many policy discussions. In this article I discuss an alternative perspective, reflecting on whether, in some segments of the labor market, there are dynamics which indicate that disability is an asset, not a liability. I use the Norwegian labor market as the casefor this discussion.The proportion of workers with disabilities is higher in the health and social care sector than in the total Norwegian labor market. This over representation of workers with disabilities has remained constant since 2000 and may indicate a particularly unhealthy and impairment-producing sector. This article examines whether this over representation might also indicate that this sector of the labor market considers disability to be an asset — a unique qualification required for certain tasks in the sector.

Introduction

In Western industrial countries’ political attention to the labor market participation of people with disabilities has increased (Marin, Prinz, & Queisser, 2004). The fact that the number of inhabitants relying on public income security due to health problems or disability increases while the average health status of the inhabitants improves is a troublesome puzzle (OECD, 2010). Active labor market policies are implemented based on arguments for reduced public budgets and for labor force enlargement (Hvinden, 2003). In response, for two decades, Norwegian policy has turned its attention to the increasing number of citizens on long-term benefits and disability pensions, searching for a political means to reverse this trend.

Research seems to mirror the policy. Norwegian research on the labor market participation of people with disabilities has paid attention to the supply side of the labor market, that is, the individuals: to their increase in long-term sickness absence and exit from the labor market into disability benefits, and to the effectiveness of policy measures intended to improve their position in the labor market or to prevent increasing numbers of benefits recipients. These studies often explain variation by focusing on individuals’ characteristics. Explanatory factors such as gender, education level, family situation and type and severity of impairment have all been investigated (Aakvik, 2003; Aakvik & Dahl, 2006; Bjørngaard et al., 2009; Brage & Thune, 2009; Børing, 2002, 2004; Ekhaugen, 2006; Gjesdal & Bratberg, 2002; Gjesdal, Ringdal, Haug, & Mæ land, 2008; Møller, 2005).

Research on variation in rates of employment of persons with disabilities in different sectors of the labor market is limited, and clearer insights are required to determine whether these variations can best be explained by workers’ personal preferences in terms of choice of occupation, employer or sector in the labor market, or, alternatively, whether they are linked to the attitudes of employers towards workers with disabilities, which also may vary across labor market sectors. Only in the last few years has Norwegian research been able to rely less heavily on the person with a disability as the sole unit of analysis, now taking into account employer, workplace and sector-specific factors in order to better understand variations in rates of employment (Alm Andreassen, 2009b; Alm Andreassen, Haualand, & Widding, 2007; Bø & Håland, 2009; Eriksen & Mehlum, 2007; Skog Hansen & Svalund, 2007; Spjelkavik & Widding, 2005; Widding, 2009). While these preliminary analyses are noteworthy, they also highlight the fact that more research is needed.

When examining the employment patterns of people with disabilities, differences between sectors of the labor market are revealed. The health and social care sector employs more people with disabilities compared to the sector’s share of the total labor market. In 2008, the sector employed 19.8% of the total work force and 27.4% of the workers with disabilities. This over representation is documented in every Labor Force Survey (LFS) from 2002 to 2008, which is the length of time the LFS of Statistics Norway 1 has included questions on disability (Bø & Håland, 2009). This suggests that the characteristics of the various elements of the labor market are worthy of attention. By investigating these we might learn more about the opportunities and barriers to labor market participation for people with disabilities. The over representation of employees with disabilities in the health and social care sector may point to an unhealthy and impairment-producing sector, or alternatively to a sector particularly open to employees with disabilities.

A review of research on employment for people with disabilities (Barnes, Thornton, & Campbell, 1998) identifies a number of particular work opportunities for people with disabilities in specific types of work organizations — for example, self-employment in a disability-related area, employment in organizations for people with disabilities, in social employment cooperatives and in social firms. This literature suggests that some specific workplaces or working conditions likely favour people with disabilities, and indicates a need for further investigation into whether variation in employer attitudes towards disability and in workplace suitability to employees with disabilities can be attributed to characteristics of the employers and/or to specific sectors of the labor market.

Several non-mutually exclusive dynamics may give rise to the over representation of workers with disabilities in the health and social care sector. The work in the sector might be particularly difficult and straining, and thus produce and/or aggravate impairments. On the other hand, other dynamics might be at play. For example, the widespread use of part-time work in this sector might allow workers with disabilities to stay in their jobs when they reduced work capacity requires an adapted work schedule. The employers in the sector might also experience a particular social responsibility to hire and retain people with health problems and impairments. Additionally, people experiencing health problems and impairments might be motivated to seek work in the sector, finding the type of work interests and feeling their experience provides a knowledge base which suits their work practices. For some tasks in the health sector, knowledge about living with health problems or impairments is a requested qualification, and thus disability is considered an asset. It is these last kinds of situation that will be the focus of this article. If such dynamics are indeed at play, they indicate that certain aspects of labor market participation have received too little attention in policy and research.

Existing data sources which shed light on the aforementioned dynamics are sparse. Knowledge is lacking about the job-seeking motivations of people with disabilities and on whether they and their employers or colleagues consider their disability an asset. In my reflections I therefore rely on research undertaken for other purposes. Nonetheless, the data presented hints that such dynamics are at play. It is important to emphasise, however, that my presentation is not conclusive but rather an effort to raise some questions which deserve further research.

Impairment-Producing Work?

Several indicators signal that the work in the health and social care sector may well be disability-producing in the sense that the work may cause or be incompatible with health problems. In 2005, the health and social care sector had the highest exit rate to disability pension of all sectors in the labor market — i.e., 16 out of 1,000 workers from the health and social care sector went from working in the sector to receiving a disability pension, compared to an average of 13 out of 1,000 in the labor market as a whole (Eriksen & Mehlum, 2007). In a recent survey of Norwegian employees, 5 % of respondents indicated they assume they will have to leave the labor market within five years, and almost three out of four of them cited health problems or disability as the reason (Bergene, 2012). Compared to other sectors of the labor market, the health and social care sector stands out with a higher level of people assuming that they will leave the labor market and a lower level assuming that they will stay (op.cit.). In addition, according to Statistics Norway, the health and social care sector has the highest level of sickness absence of all sectors in the Norwegian labor market. Also, the workers with disabilities in the health sector are, on average, older than the non-disabled workers in the sector (Hansen & Svalund, 2007). The frequency of impairments increases as age increases (OECD, 2010). More than 40% of the workers with disabilities report that their impairment occurred after starting their current job (Bø & Håland, 2009), indicating that some impairments are acquired during the employees’ working lives. These various findings provide evidence to suggest that the higher level of employees with disabilities in the health sector might be due to the working conditions of the sector, which can sometimes cause or reinforce disability.

Part-Time Opportunities

Sixty-three percent of employees with disabilities in the health sector work part time, which may indicate that they have made adjustments due to their impairment by reducing working hours (Hansen and Svalund 2007). This explanation is supported by other studies. For example, a study of hospitals found that part-time workers had more health problems than full-time workers (Christensen, Enersen, & Holmer, 2004; Holte et al., 2004), a finding that may suggest that those with the greatest health problems have also reduced their working hours. Similarly, a study of nurses found that those working full time had a larger chance of being on sick leave than those working part time (Fevang, 2003). Part-time work might therefore be used by workers with health problems to reduce the need for sickness absence. Nearly 60% of workers with disabilities reported that their disability limits the amount of work they can undertake, either per day or per week (Bø & Håland, 2009). Norway is among the OECD countries with the highest level of part-time work among workers with disabilities (OECD, 2010). Compared to non-disabled part time-workers, part-time workers with disabilities seem to have a higher preference for part-time work and higher levels of job satisfaction (Pagán, 2007).

While part-time work is a coping strategy found in other sectors, in the health sector the general use of part-time work is extensive, with nearly half (45%) of the total work force in the sector being employed this way (Hansen & Svalund, 2007). Compared to sectors of the labor market where part-time jobs are less common, part-time work might be an easier coping strategy in the health sector because it is common, non-stigmatizing and even suitable for the employers. By comparison, in the Information and Communications Technology (ICT) sector, 18% of employees with disabilities work part time, while part-time workers within the sector’s total work force comprise only six percent. In the construction sector, 17% of employees with disabilities have part-time work, compared to a part-time worker rate of only 8% for the sector’s total work force (Hansen & Svalund, 2007). (See Table 1).

Table 1. Employees with disabilities in different sectors of the Norwegian labour market.
Health and social care ICT Construction Other sectors
Percentage of total employment 19 3 7 71
Percentage of employed people with disabilities 24 2 7 67
The share of the total work force in a sector with disabilities (9% of the total labor market) 11 6 9
The share of workers with disability having part time work, compared to the share of part-time workers in the sector as a whole 63/45 18/6 17/8
The share of workers with disabilities combining work and a disability pension 37 8 14 20
Source: The Norwegian Labor Force Survey (LFS) 2005, reported in Hansen & Svalund 2007

The higher prevalence of part-time employment opportunities in the health sector may enable working-hour adjustments for employees which, in other sectors, might lead to the exclusion of people with impairments from that sector. This hypothesis is supported by statistics on the share of workers with disabilities who combine employment with a disability pension in each sector (see Table 1). A disability pension is a long-term benefit granted to people with severely and permanently reduced work capacity, but can compensate for partially reduced work capacity. In the health sector, 37% of employees with disabilities receive a disability pension, compared to 20% of all workers with disabilities in the Norwegian labor market (versus 14% in the construction sector and 8% in the ICT-sector) (Hansen & Svalund, 2007). This above average level of workers receiving a disability pension may indicate that the health sector is able to accommodate workers with more severe impairments, including those which would perhaps lead to exclusion from the labor market in other sectors.

Employers’ Social Responsibility

The increased prevalence of workers with disabilities in the health sector could also indicate that employers in this sector feel they have a higher than average social responsibility to employ people with disabilities. An explanation for this might be that more public sector employers consider it to be a moral obligation to have employees with disabilities. The proportion of employees with disabilities in the public sector has been growing in the UK from 1998 to 2004, and at a faster rate than non-disabled employees (Hirst & Thornton, 2005). This might indicate a positive attitude among public sector employers. Within the public sector, specific efforts to promote employment of persons with disabilities have been initiated (Bull & Alm Andreassen, 2007; Reegård, Hansen, & Mandal, 2009; Roulstone & Warren, 2006; Skarpaas & Rusnes, 2008).

A review of several studies on employers’ attitudes toward workers with disabilities showed that most public sector employers were found to have positive attitudes towards workers with disabilities (Hernandez, Keys, & Balcazar, 2000). Among the studies that identified negative employer attitudes, almost no public sector employers appeared. Although the type of questions asked (for example, global attitudes versus specific disabilities) might help to explain the result, these findings may indicate support for the hypothesis that public sector employers employ workers with disabilities more often than private sector employers. However, potentially higher levels of employment of people with disabilities in the public sector due to more positive employer attitudes are not necessarily synonymous with positive employee experiences, as suggested by reports that job adjustments for employees with disabilities has led to instances of bullying by managers in some areas of the public sector (Foster, 2007). Furthermore, even private sector enterprises have initiated programs to promote the employment of people with disabilities (Skøien, Hem, & Tyrmi, 2006).

In Norway, not all parts of the public sector demonstrate an overrepresentation of workers with disabilities. In 2008, for example, the education sector employed 8.7% of the total work force and only 9.1% of workers with disabilities (Bø & Håland, 2009). The private sector also varies when it comes to the rates of employees with disabilities. In 2005, the construction sector employed 7% of the total work force and 7% of workers with disabilities; the ICT sector employed 3% of the total work force, but only 2% of workers with disabilities (Hansen & Svalund, 2007). It should therefore be stressed that differences in rates of employment of people with disabilities are evident in both the public and private sectors of the Norwegian labor market, rather than simply between the two sectors. This points to a need for more sector-specific explanations.

Greater knowledge of health problems and disability might provide employers in the health sector a more accurate and less prejudiced approach when judging the (reduced) work capacity of workers with disabilities. Furthermore, the nature of the work and awareness of having human pain and problems could motivate employers in the health sector to employ and retain people with impairments. As a result, it seems likely that employers in the health sector might consider employing workers with disabilities less risky than employers in sectors less acquainted with disability.

Results from a survey of a representative sample of Norwegian employers support these assumptions. “The Employer Survey on Disability” was conducted by telephone in March 2007 on behalf of the Work Research Institute and the FAFO Institute for Labor and Social Research in Oslo, Norway. The sample consisted of 100 employers in the health sector, 100 employers in the ICT sector, and 100 employers in the construction sector, as well as a comparative sample of 201 employers from the rest of the Norwegian labor market. Recruitment managers were interviewed about employment practices and attitudes towards people with disabilities. Table 2 presents results from this survey.

The survey found that 72% of employers in the health sector reported employing people with disabilities, compared to 46% of employers in construction, 31% in the ICT sector and 47% in other sectors. Hence, many health sector employers have experience with workers with disabilities and may have replaced prejudice with actual knowledge about whether or not disability constitutes a problem in the workplace. Furthermore, employers in the health sector differed from employers in other sectors in other important aspects. For example, 58% of health sector employers emphasized that their reputation as employers served as motivation forretaining workers with disabilities. The next highest level of employers who considered reputation important was the construction sector, where 48% of employers agreed that reputation was a very significant reason to retain workers with disabilities. In the ICT sector, only 26% of employers thought this was important. Additionally, 61% of the health sector employers considered it a moral obligation to retain workers with disabilities. In other sectors of the labor market, 47% considered this very important, except for the ICT sector where only 29% of the employers put weight on moral obligations to retain workers with impairments.

Table 2. Employers’ attitudes towards disability
Health and social care ICT Construction Other sectors
Employers reporting they have employees with disabilities 72 31 46 47
Employers answering that their reputation as an employer is a significant motivation to retain employees with disabilities 58 26 48
Employers answering that retainingemployees with disabilities is a moral obligation 61 29 47 47
Employers answering that their reputation as employers is a significant motivation to recruit employees with disabilities 25 7 7 18
Employers answering that recruitingemployees with disabilities is a moral obligation 25 9 11 25
Source: The Employer Survey on Disability, 2007

These statistics suggest that health sector employers seem to be more conscientious of their social responsibility to ensure persons with disabilities are part of their staff. A slightly different pattern appeared in employers’ attitudes concerning the recruitment of people with impairments. A smaller share of employers considered their reputation as a factor when hiring new personnel. However, compared to other sectors, a larger share of employers in the health sector (25%) recognized a potential reputational advantage for hiring persons with disabilities. In the construction and ICT sectors, only 7% of employers considered their reputation as a motivation for hiring people with disabilities, compared to the remaining sectors where 18% of the employers considered this important. In the health sector, 25% of employers also considered “moral obligation” very significant in decisions concerning the recruitment of workers with disabilities. Again, the construction and ICT sectors deviated, with only 11% and 9% giving weight to moral obligations, respectively. On this matter the level of supportive employers was about the same in the remaining sectors of the labor market as in the health sector.

It seems that health sector employers are very aware of their reputation and moral obligations when it comes to actions towards their own employees, but they do not differ significantly from several other labor market sectors when it comes to recruiting people with impairments. Results of the 2005 Labor Force Survey (LFS) support this finding. In 2005, for example, 3% of the workers with disabilities in the health sector combined employment with compensatory benefits for permanent disability (Hansen & Svalund, 2007). These benefits are most often allocated to people with congenital impairments or those impairments that are acquired early in life. The largest group of new recipients are those below 18 years of age, with the eligibility criteria implying that many recipients continue to receive the benefits into their adult life. The health sector employs people receiving compensatory benefits for permanent disability and this suggests that the sector recruits young people with disabilities, albeit to a limited degree. However, the share of employees holding such compensatory benefits is no higher in the health sector than in the total labor market. Thus, the higher level of workers with disabilities in the health sector seems not to be caused by an extraordinary recruitment of young people with disabilities. As described in the previous paragraphs, it is rather the level of part-time work available and the combination of employment and disability pension collection that make the health sector exceptional.

Employees’ Motivation

Although health sector employers do not seem more motivated than those in other sectors to recruit young people with disabilities, people experiencing disability might be particularly motivated to enter health sector work. Personal experience with health problems and disability are motivations to engage in helping others in similar situations and to improve the living conditions of social groups with which one experiences a common identity (Alm Andreassen, 2004). Another motivation for people with health problems and impairments to work in the health sector could be that it allows them to put their knowledge of living with a disability to use.

There is some research that supports the hypothesis that people with disabilities turn to the health sector for employment. Blekesaune’s (2005) analysis of young people on disability pensions shows, for example, that the percentage of young men who receive a disability pension and who also claim to have had work experience in the health sector is higher than that same demographic’s employment level in the population as a whole. Thus, young men with disabilities try out employment in the health and social care sector more often than their non-disabled counterparts. It might be their own experience with disability and use of health and social services that give young people with disabilities knowledge of the sector and motivation for working in the sector. This seems to be the case for young men who otherwise seldom turn to the health and social care sector when looking for job opportunities.

The research on choice of education and occupation is, to a high degree, based on registry data. This data reports extensively on the impact of parents’ social class, education and income, but lacks information on people’s personal motivation when making choices concerning education and occupation. Furthermore, the national registers lack indicators which identify disability. Studies that do screen for disability, such as the LFS, are often surveys based on self-reported disability, and do not include questions pertaining to motivation for choice of education and occupation. Qualitative analyses show that young people with disabilities determined to get a higher education to enhance their job opportunities experience a straightforward path to employment (Vedeler & Mossige, 2010). Compared to older generations, young people with disabilities also tend to develop their life projects/career choices with more reference to individual interests and are less compelled to follow segregated work trajectories (Sandvin, 2003). Nonetheless, despite these insights derived from qualitative analyses, little is known about the role personal interests and education choices play when it comes to employment and disability.

Disability As An Asset

A trend of growing importance in the health sector seems to be an interest in wanting to make use of the users’ experiences of the health services. Below I will outline three aspects of this trend, but first I need to identify some reservations about the data that are currently available. First, to what degree this trend results in employment and salaried work remains to be seen. Secondly, to explore the possible impact of this dynamic, one has to rely on illustrative cases, which might be considered as anecdotal evidence. This lack of direct evidence demonstrates the need for further investigation into this particular aspect of the health sector.

First, in patient education centers, where people with chronic illnesses and impairments learn to master their situation, people with personal experience are hired as teachers, co-therapists or as advisors in peer-help or self-help groups (Strøm, 2010). This is a new kind of health service founded in recognition of the practical knowledge of living with impairments, as well as the value in encountering one’s peers, and thereby avoiding othering and distinctions between ‘them’ and ‘us’. Expert Patient Programmes in England and US are based on similar ideas (Taylor & Bury, 2007). The research on such lay-led, self-help support programmes has, however, focused on programme content and impacts on people with chronic illnesses and disabilities, rather than on the work and the working conditions experienced by the people who lead the courses.

Second, in efforts towards quality improvement and development of patient-oriented services, user representatives, often members of various user associations or groups, are involved as advisors, consultants or team members of developing projects. Such user, consumer or patient involvement is also taking place in other European countries (Barnes, Newman, & Sullivan, 2007; Crawford et al., 2003; Davies, Wetherell, & Barnett, 2006). This user involvement is founded on the idea that positive user experience results when there is an eye for the needs of the patients and for solutions to problems experienced by the patients, and the notion that regular health professions are blinded to these needs and solutions by everyday practices and organizational routines (Alm Andreassen et al., 2007). Traditionally, philanthropic organisations have simply implemented public policy on behalf of government (Salamon, 1987). User involvement, however, actively involves members of user groups in the process of reforming health and welfare services (Alm Andreassen, 2008). Every state-owned Norwegian hospital (or health enterprise), both somatic and psychiatric, is obliged to have a user council. Several hundred people work within these councils as representatives of health care users. Many user council members come from associations of people with disabilities and almost one-third of them receive a disability pension, as documented in a 2006 survey (Alm Andreassen & Lie, 2007). The work of these user representatives is most often remunerated, thus providing both work and income for persons with disabilities, although most often on a temporary and part-time basis.

Third, public services engage employees holding personal experience with disability to teach professionals and patients, to provide peer support, and to contribute user knowledge to service development. ‘User employment’ stands for employment in the kind of services in which the employees personally hold user experience. In mental health care, user employment has developed in several countries (Andersen, 2010; Harding, 2005; Perkins, Buckfield, & Choy, 1997; Perkins, Rinaldi, & Hardisty, 2010; Perkins, 1998; Solomon, 2004). In Norway, user employment is now found in hospitals, out-patient services, municipal services and education (Rådet for psykisk helse, 2008; Schafft, 2008), and examples of user employment are also found in somatic health care (Kjeken, Aanerud, & Reinsberg, 2009).

Fourth, empowered users of health and social care have refused patronizing and bureaucratically-regulated professional services, establishing instead user-led service provision of daily life assistance (Askheim, 1999). When it comes to employment in this non-profit enterprise of user-led service provision for independent living, personal experience with disability seems to be an important qualification. Similarly, personal experience with disability is valued in paid employment in organizations of people with disabilities.

The Norwegian user involvement policy, which stipulates user experience as a means to quality-improvement and the development of user-directed health services, has contributed to the establishment of what I conceptualize as a border sphere labor market. This concept is meant to denote a sphere of work on the periphery of the regular labor market, in between ordinary employment and exclusion from the labor market, and also partly in between the paid work of the regular labor market and the unpaid work of the voluntary sector. Disability and/or reduced work capacity is a ticket of entry, facilitated in part through entitlement to integration measures such as wage subsidies and on-the-job training or supported employment. Disability and/or reduced work capacity is particularly favoured in the border sphere labor market when employers request disability-specific knowledge and competence. Such is the case in posts requiring user experience, where, for example, user representatives undertake peer support or consultancy work, often on behalf of user groups and voluntary organizations of people with chronic illness and/or disability. The sphere is composed of paid, temporary and/or part time-work most often performed by people receiving some form or degree of income via disability benefits or vocational rehabilitation measures. The work is not always recognized as a form of open employment, though it may be paid for, at times on an occasional basis. The work can also be converted to ordinary paid employment. This occurs when a worker in a training position acquires the necessary skills and the training position becomes an ordinary appointment, or when the adapted tasks and activities of the worker become those attached to a regular position. The scale of this border sphere labor market and the degree to which its activities are converted to regular paid jobs remains under-researched.

The number of positions in which having a disability or impairment is a requirement or advantage might not be large enough to explain the overrepresentation of employees with disabilities in the health and social care sector. However, the sector’s high employment rate of individuals who have an impairment and receive a disability pension suggests that this kind of employment might be part of the explanation. The diffusion of “user employment” and “peer employees” in various health services might indicate a growth in employment in which personal experience with health problems and disability is a job requirement.

Disability Employment Policy And Conceptualization Of Disability

In policy making and policy implementation, the definition of the disability concept implies an interpretation of the causes and consequences of disability; encapsulated in this interpretation are directions for disability policy. The interpretations of what disability is about have implications for political action dealing with disability. If the problem of disability is located in individual defects, as in an individual (or medical or biological) model of disability, political measures must be directed toward individual needs. If the problem of disability is located in social exclusion, as in a social model, political measures must focus on societal barriers and hindrances. The individual model of disability entails curing impairments and compensating for disadvantages due to the non-curable; the social model requires environmental adjustments, equalization and legislation against discrimination.

Two conceptions of the low labor market participation of persons with disabilities seem to influence today’s labor market policy discussions. The first interpretation is that people with disabilities need adjusted working conditions and supportive measures to enter and stay in the regular labor market. This interpretation sets the focus on the supply side of the labor market — i.e., on the workers with disabilities — and on integration policy measures like medical and vocational rehabilitation programmes, training schemes, wage subsidies and support. An emphasis on a medical model of individual impairment leads to measures for adapting people with disabilities to the needs of employers (Hyde, 2000 ).

The other interpretation is that people with impairments are disabled by barriers and discriminatory action and are therefore prevented from accessing paid work – a problem that should be met with legislative protection. This interpretation focuses on the demand side of the labor market – the employers – and on monitoring the factors that limit workers with impairments (Roulstone & Warren, 2006). In Norway, the first conception has founded the system of vocational rehabilitation developed after the Second World War, which has now turned into an integration policy that is employed by Norway to a higher degree than most other OECD countries (OECD, 2010). The second conception grounds recent anti-discrimination regulation.

Both of these conceptions — that which views disability as a health problem or an impairment that needs to be reduced by compensatory measures, and that which views disability as a barrier or hindrance to accessing paid work – conceive disability as connected to difficulty, a problem that demands political action directed either towards the individual with the impairment, or towards the employers and the work environment. The conception of disability as a need to endow individuals with resources places the problem at the level of the individual with the disability; the conception of barriers and discrimination as disabling people with disabilities puts the problem within the society, the labor market and workplaces. The social model redefines ‘the problem’ but has not, in itself, underpinned a non-tragic view of disability (Swain & French, 2000).

The implication of conceptions of disability as problems is that it is only when the disability is ignored, bypassed or compensated that people with impairments can become included in society and that successful integration can be achieved. Successful integration means, according to some researchers (van de Ven, Post, de Witte, & van den Heuvel, 2005), that people with impairments are able to ‘mix with others that are not disabled’ and ‘function ordinarily without receiving special attention’. Implicit to the definition of integration is the notion that when receiving attention because of the disability, the attention is negative. According to Goffman (1986), disability is a stigma, and a discrediting sign or attribute in social interactions which affect peoples’ social identity (Goffman, 1986). This perspective suggests that successful integration is achieved when the potentially stigmatizing attribute is not noticed. On the contrary, however, if experiential knowledge of disability is considered desirable, advantageous, and of value to others, then disability is actually worthy of special attention.

While much academic research on disability and employment seems to rest on conceptions of disability as a negative aspect of an individual or a barrier to ordinary employment, the employment pattern in the health and social care sector suggests that experience with disability may be a motivation for prospective employees to look to the sector for employment, as well as a desirable attribute or required qualification for some tasks, occupations and organizations. These findings points to a different meaning of disability: here disability is considered an asset, an experience that generates particular qualifications for specific tasks in the health and social care sector. For example, physiotherapists with disabilities have described their disability as advantageous in the workplace (French, 1991). Physiotherapists with visual impairments described their perceived ability to understand and empathize with their patients and clients as an important advantage, and believed that their visual disability gave rise to a more balanced and equal relationship with their patients. Such a ‘professionalization’ of disability has been reported by others (Barnes et al., 1998): employees with disabilities in occupations such as nursing have described that they employ their personal experience with chronic illness and disability to provide better care. In addition, many persons with disabilities seem to choose occupations in which the experience of being disabled is a qualifying condition. Thus, the emerging conceptualization of disability in the health and social care sector can culminate in a conception where ‘disability as a problem’ is turned upside down: in its place a new perspective on impairment and disability as an asset is appearing. To keep pace with this new perspective taking shape in the health and social care sector, a positive conceptualization of disability is required in academic literature and at policy tables. John Swain and Sally French (2000) are providing such a conceptualization: their aim is to develop a non-tragic perspective, an ‘affirmation model of disability’ that redefines disability as ‘a positive personal and collective identity’ that allows people with disabilities to have ‘fulfilled and satisfying lives’ (Swain & French, 2000). The affirmation model of disability appears to have gained more interest in identity politics and culture studies, but may also contribute to future labor market policy and studies of disability and employment. Exploring the conceptualization of disability and its implications for disability employment policy now seems essential.

Conclusion

The health and social care sector employs a higher share of people with disabilities than its share of the total work force. While disability appears to be conceived as a job requirement for some employment opportunities in the health sector, it is not the only explanation accounting for the large employment rate of persons with disabilities in this sector. The dynamics of an unhealthy impairment-creating sector seem to be at work as well.

Nevertheless, the health and social care sector appears to employ people with disabilities despite their impairment, which means that disability is not considered a hindrance (assuming that the employee is qualified for the job). Employers in the health sector even seem to consider persons with disabilities as qualified to work in the sector because of their disability, i.e., experience with a disability is considered a positive attribute and/or a desired qualification. The latter example can be better understood via the affirmation model of disability.

The new positions for workers with disabilities in health and social care services have grown out of the disability movement, the demand from people with disabilities for influence on decisions affecting their lives, and the belief that the experiential knowledge they possess is an asset (Alm Andreassen 2004). The valuation of disability as an asset is no longer promoted solely by people with disabilities and the disability movement; it is also carried by the employers and managers in health and social care who recognize the knowledge derived from the experience of people with disabilities as both a useful resource and necessity in the development of patient and client-centred care (Alm Andreassen, 2009a). Further research on the dynamics underpinning the recognition that experiential knowledge of disability is and can be a positive attribute and motivation for employment might lead to expanded perspectives for disability employment policy.

This article is a result of the research project “Disability, employment and the welfare state”, financed by the Norwegian Research Council.

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Endnotes

  1. Statistics Norway is the national institution responsible for Norwegian official statistics.
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Disability as an Asset? Reflections on Employment Patterns in the Health and Social Care Sector

Work Research Institute

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