Ill health, disability, benefit and work: a summary of recent research.

AuthorBeynon, Penny
PositionSurvey

Abstract

The Ministry of Social Development's Centre for Social Research and Evaluation has a programme of research and evaluation that explores issues related to employment and benefit receipt for people with ill health and disability. This paper summarises findings from research carried out since 2003 that explores people's attitudes to work and the challenges that they face moving into and sustaining employment. The paper proposes that while people with ill health and disability have positive attitudes to work, their capacity to work is limited by multiple and often mutually reinforcing barriers.

INTRODUCTION

In recent decades there has been a steady rise throughout the developed world in the proportion of working-aged people receiving social assistance for ill health or disability-related reasons. In many countries these groups now constitute the majority of welfare recipients, with disability benefit costs being higher than unemployment benefit costs in 17 out of 18 OECD countries (OECD 2003:17). The situation is no different in New Zealand.

Sickness Benefit (SB (2)) and Invalid's Benefit (IB) are forms of income support provided in New Zealand to people who cannot work for health- or disability-related reasons. IB is for people with permanent and severe conditions, (3) SB is for people with less severe or temporary conditions.

Since 2003 the service delivered through Work and Income to people receiving SB or IB has been redesigned, and the focus is now broader than administration of benefits. Known as the New Service for SB/IB, its overarching goal is to assist people with ill health or disability into sustainable employment, where appropriate, so they can participate and contribute socially, economically and culturally, as other New Zealanders do. Key reasons for this change include:

* growth in the numbers of people receiving SB/IB

* indications that many people receiving SB/IB wanted to work and could work with the right assistance or conditions

* indication of a commitment from Government to assist people with disability associated with physical or mental impairment or ill health to participate in all areas of life (evidenced by the Ministry of Health's publication of the New Zealand Disability Strategy in 2001)

* a prolonged period of economic growth and a buoyant labour market, which has generated labour shortages in some industries and occupations.

Until recently there has been limited evidence from the New Zealand context to inform policy and service development relating to SB/IB. An element of the New Service has been a programme of research designed to understand the characteristics and reasons for growth of the SB/IB population and to identify approaches and interventions that support socioeconomic wellbeing and employment participation for this group. Evaluation research has also contributed knowledge in these areas.

Under the New Service, Work and Income assists people towards employment where that is their goal. As such, employment is a key focus of research and evaluation activity. Policymakers and service developers ultimately want to know: what works for whom in which circumstances? This question can be unbundled into four questions:

* Is work a goal that SB/IB recipients aim for?

* What are the barriers to work for SB/IB recipients?

* What assistance will address those barriers?

* Can the appropriate assistance be provided, and is it practical and cost effective to provide it?

This paper synthesises findings from recent research, including evaluation research, to explore the first three of these questions. In particular, the paper draws on data from research and evaluation activity carried out or commissioned by the Centre for Social Research and Evaluation. Analysis of two surveys is augmented with qualitative data collected through semi-structured interviews with SB/IB recipients to explore their work goals and challenges to entering and sustaining employment. Four studies discussed in the paper (Barriers Survey, New Zealand Health Survey, interviews with SB/IB recipients, and interviews with participants in an employment trial initiative) are described in Appendix I and other studies are described in footnotes throughout the paper. The fourth of these questions is not addressed in this paper and requires ongoing research and evaluation to answer it.

IS WORK A GOAL FOR SB/IB RECIPIENTS?

An underlying assumption of the New Service is that SB/IB recipients want to work. We have examined SB/IB recipients' attitudes to work by using quantitative and qualitative research and evaluation data in order to understand this assumption more fully. Research suggests that while some SB/IB recipients do have positive attitudes to work, their expectations of and capacity to undertake work is limited by a range of barriers.

The Barriers Survey found that 66% of respondents receiving SB and 45% of those receiving IB were interested or very interested in looking for work. (4) The survey also investigated respondents' expectations of entering work, and found that 17% of SB respondents and 15% of IB respondents were already engaged in some form of paid work. An additional 30% of SB and 13% of IB said they were likely to be in some form of paid work in a year's time. This leaves 53% of SB and 72% of IB respondents neither in work nor expecting to move into work in the near future. (5) Sample selection and non-response bias means we might expect this survey to overestimate the proportion of SB/IB recipients who expect to work at some time.

Of the respondents who reported being interested or very interested in finding work, 11% of SB respondents and 16% of IB did not expect to be in any paid work ever. Having an interest in working is a necessary factor to enter employment. However, as survey responses show, interest in working may not be a good predictor of work readiness or capacity for work. This raises the question, what do people mean when they report being interested in finding work?

Employment functions in myriad ways in a person's life. The most obvious function is to generate income, which enables an individual to have a certain lifestyle, maintain and expand social relationships and have a sense of power and control over their lives. Employment also functions in less obvious ways to impose routine, define aspects of an individuals' status and identity, link individuals to shared goals, enforce activity and create opportunity for regularly shared experiences (Rantakeisu et al. 1999:878). Following this logic, an interest in finding work may in fact be an expression of a desire for changes across a range of factors considered important in a person's life.

Q-Methodology research (6) carried out to investigate SB/IB recipients' perceptions of wellbeing, employment and independence (Centre for Social Research and Evaluation 2004a) found that participants' perceptions could be grouped into five distinct sets of views. One group expressed views that indicated a "sense of being ready for work". Participants who reported that their sense of wellbeing was "happy" or "pretty happy" tended to be associated with this group. Their views converged around the idea that work is more important than being on benefit, with work contributing to a sense of freedom and identity. Where people constitute wellbeing at least in part through employment, then employment-related policy initiatives may be more successful.

Interviewees who took part in the employment trial initiative (7) also spoke of the social and emotional value of being in employment. They identified motivation to keep living, emotional wellbeing, distraction from illness, being part of the community and friendships as important benefits of working. Their comments included:

"I got bi-polar, and I suffer from boredom and anxiety all the time. Even now, like I struggle to stay there [in work], but it gives me a purpose to get out of bed in the morning. I'd be dead if it wasn't for that job."

Oh, I feel better about myself. You can answer questions on what you do for a crust and that sort of thing a lot better. You just feel ... 'in society' and you have workmates automatically rather than trying to find relationships and things like that, so general wellbeing."

Comments made during interviews with SB/IB recipients indicated a desire to be in work. They said they "would love to be out working" or "ached to get back to work". Around half of these interviewees said they would like to work, but most went on to say they could not work because of their health condition. It may be that for some interviewees, saying they wanted to work was a way of expressing the hope or dream that their situation would change, that one day they would get well, be off the benefit and back to a "normal life". Even so, their desire to work would seem to indicate that SB/IB recipients valued the contribution that work could make to their lives and the contribution they could make to society through working.

WHAT ARE THE BARRIERS TO EMPLOYMENT FOR SB/IB RECIPIENTS?

As the data suggest, people who receive benefits because of ill health or disability can have positive attitudes to work. However, this may be an expression of a wish to have improved outcomes across a range of areas in their lives, and work may contribute to these desired improvements. The reality is that, often, people who receive benefits for reasons of ill health or disability are restricted in the work they can do by multiple and often mutually reinforcing barriers.

Looking at the position of SB/IB recipients from a social exclusions perspective provides an understanding of the multiple challenges that people face in getting back to work and the benefits, such as better income and the development of human capital, that are expected to accrue through gaining employment. Social exclusion may be triggered by life events such as the onset of ill health. There are also life transition points where the risk of...

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