Tuesday, November 10, 2009

[EQ] Helping chronically ill or disabled people into work: what can we learn from international comparative analyses?

Helping chronically ill or disabled people into work:
what can we learn from international comparative analyses?

Final report to the Public Health Research Programme, Department of Health – UK  Revised 28 April 2009 version

University of Liverpool team:
Margaret Whitehead (PI.), Stephen Clayton, Paula Holland, Frances Drever, and Public Health Specialist Registrars Ben Barr and Rachael Gosling.


Professor Espen Dahl and Kjetil Arne Van Der Wel, Oslo University College, Professor Steinar Westin, Norwegian University of Science and Technology, Trondheim.

Sweden: Professor Bo Burström and Lotta Nylen, Karolinska Institute, Stockholm. Professor Olle Lundberg, Centre for Health Equity Studies (CHESS), Stockholm.

Denmark: Professor Finn Diderichsen and Dr Karsten Thielen, University of Copenhagen, Copenhagen.

Canada: Drs Edward Ng, Sharanjit Uppal and Web-Hao Chen, Statistics Canada, Ottawa.

Division of Public Health, University of Liverpool UK

Available online PDF [118p.] at: http://www.york.ac.uk/phrc/PHRC%20C2-06_%20RFR.pdf


“….This project has added to knowledge in five main areas:

It has mapped the range and types of policies and interventions that have been implemented in Canada, Denmark, Norway, Sweden and the UK that may influence employment chances for chronically ill and disabled people. By doing so it has added to understanding about what has actually been tried in each country and what might be considered in others.


It has refined a typology of the focused interventions that have been identified, based on the underlying programme logic of the intervention, which aids strategic thinking about national efforts to help chronically ill and disabled people into work.


It has produced systematic reviews of the impact of the focused interventions on the employment chances of chronically ill and disabled people and demonstrated the use of the typology in helping to interpret the results of the evaluations.


The project’s empirical analyses of individual-level data have identified how chronically ill people from different socio-economic groups have fared in the labour markets of the five countries over the past two decades. It has then tested these findings against hypotheses about the impact of macro-level labour market policies on chronically ill people to provide insights into the influence of the policy context.


The project has contributed to methodological development in evidence synthesis and the evaluation of natural policy experiments. By studying a small number of countries in great depth, we gained greater understanding of the policies and interventions that have been tried in these countries to help chronically ill and disabled people into work, against the backdrop of the wider labour market and macro-economic trends in those countries. We then integrated evidence from the wider policy context into the findings of systematic reviews of effectiveness of interventions, to advance interpretation of the natural policy experiments that have been implemented in these countries…..”



Preface: What the study adds to knowledge

1. Executive summary

2. Introduction

2.1. Political and public health significance

2.2. The need for natural policy experiments

2.3 Why select these five countries?

3. Purpose of the study

4. Design and methods

4.1. A note on concepts and terminology

4.2. Study design

4.3 The policy review and analysis

4.4 Observational studies

4.5 Synthesis of evidence on impact of focused interventions

5. Main findings

5.1. Policy context: making sense of interventions in different countries

5.1.1. Natural policy experiments

5.1.2. Typology of policy responses

5.1.3. Conceptual framework of policy entry points

5.2. Some key findings for cross-country empirical analyses

5.2.1. How do chronically ill and disabled people fare under  different labour market contexts

5.2.2. How could the results be interpreted in the light of opposing hypotheses?

5.3. Review of evidence on effectiveness of focussed interventions

5.3.1. Interventions to reform the employment environment

5.3.2. Interventions focused on strengthening individuals

5.3.3. Lessons from the review of focused interventions

6. Contribution to Consortium themes

7. Conclusions and considerations

7.1. The project’s contribution to knowledge

7.2. The added value of international collaboration

7.3. Outcome of pilot attachment of Public Health Specialist Trainees

7.4. Further Research

8. Dissemination/Outputs

9. General references


Appendix 1: Summary of evaluation of public health trainee attachment

Appendix 2: Datasets an variables

Appendix 3: Search strategies for reviews

Appendix 4: Critical appraisal, summary tables and full citations for review studies


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