The inequality of incapacity

This post was first published on the collaborative blog OpenPop.

While many inequalities are extensively researched, particularly around income and health, it is perhaps surprising to still find other inequalities that are barely mentioned in the literature.  Yet this is true for one inequality around disability and work: almost no research focuses on why some people with disabilities are working and others are not, even when they have the same disabilities. What are the advantages that enable some – but only some, usually better-educated – sick and disabled people to stay attached to the labour market?

The answer, as I argue in a paper just published in Social Policy and Administration, can be summed up in the three ways how people could successfully make their job compatible with their sickness and/or disability: (1) job flexibility, (2) job adjustments, and (3) changing jobs – which I explain below.  The study is based on 32 qualitative interviews conducted in London in 2009-10, where respondents were recruited via GP surgeries and welfare-to-work providers. All names used below are pseudonyms.

Making work compatible with sickness and disability

The first way of responding to a fitness-for-work limitation was for respondents to themselves change their work to fit around their sickness and disability. Some people were lucky enough to have what Johansson & Lundberg (2004) call ‘adjustment latitude’, as Yvette explained for her auditing job:

‘ “Do I work as quickly when I’m in a lot of pain?” I think well hand on heart I’ve got to say no [. . .] You know, the amount of work I do at the end of the day is the same, but it takes more effort and, you know, if I feel like one day I’ve had a crap day, then maybe the next day I’ll try and work harder.’

But not everyone had adjustment latitude. It was the better educated people who had more autonomy, and worse educated people – like the bus driver Khaled, whose work was governed by motion sensors and cameras – for whom a lack of adjustment latitude could be a problem. In a previous study using quantitative methods (Baumberg 2011), I confirmed what many of us would suspect: that job autonomy was much more common for better educated people across the population.

The second way of shaping a job around sickness/disability was to ask the employer to make an adjustment to the job. This could be crucial, partly allowing people the flexibility that others had without asking (as above), partly giving people phased returns to work (e.g. allowing them to work shorter hours at first), and partly allowing people to avoid specific tasks that they couldn’t do. However, this requires the person to tell their employer about their disability, which people could be reluctant to do – not just because of a desire for privacy, but because of a genuine fear of being made redundant.

Moreover, despite a legal obligation of employers to make ‘reasonable’ adjustments to working conditions, these adjustments came up against limits in practice. Sometimes people had difficulties with tasks that were too core to the job to be removed (e.g. epilepsy and looking after children). And crucially, employers were unwilling to permanently reduce the amount of work people were expected to do. The only exception to this was someone who was employed through a friend as a caretaker at a church, a job he described as ‘a gesture’ – i.e. an act of charity by a religious organization, which only served to emphasise the usual impossibility of reducing the demands of work.

The final way that people could make their work fit around their impairments was to leave their old job, and to find a new, more suitable job. Whether this is possible obviously depends on how ‘employable’ someone is – which is not just a matter of skills but also age, language skills, location, and timing. But it is also more than this, as sometimes people’s sickness/disability made it impossible to continue with their previous work. For example, Ali had been a successful Indian chef, but was now unable to continue with that line of work, and had poor language skills and no other qualifications:

‘If I got a good education, then I got a choice, I can do [chef work] or not, take it or leave it. Because I haven’t got any education. I have to do it’.

He was left in a catch-22 situation where he was not employable enough to get the jobs he was fit to do, and not fit enough to do the jobs he could get.

Inequalities in moving from impairment to incapacity

Inequalities rarely operate as pre-determined destiny. Some lower-qualified people were able to continue working despite their sickness/disability, whether because of employer adjustments or through finding suitable work through various strokes of good fortune. But in general, better-educated people simply had more choices, despite the often considerable challenges that they faced. To my mind this is a strangely neglected aspect of disability-related inequalities, and my hope is that others will join me in trying to explore its nature more fully.

To get an open access version of the paper, then go to my personal website’s publication list (for the initial version before peer review), or contact me directly.