Memorandum submitted by Professor Richard
Everyone knows that disabled people are less
likely to have a job than non-disabled people. But what is it
that distinguishes between disabled people in and out of work?
This submission is motivated by a contrast:
between the intensity of the policy interest in the economic position
of disabled people, and the lack of detailed understanding of
the relationship between disability and employment. It is based
on research which will be published by the DWP next month. The
full report is attached, in advance of publication, with the kind
permission of the Department. The submission does not comment
directly either on incapacity related benefits or on Pathways
to Work, except in so far as an understanding of the variations
in disabled people's employment prospects contributes to the principles
on which policies should be based.
The new research, and this submission, are based
on the Health and Disability Survey (HDS), a detailed survey
of disabled (and non-disabled) people undertaken by the then Department
of Social Security in 1996-97. The information is not very up
to date, but it is the latest available at this level of detail.
Other sources suggest that the situation has not changed greatly
It is common to quote a single overall average
for the proportion of disabled people (of working age) who have
a job. A first point is that the overall average of 50% used by
the DWP for its Public Service Agreement targets (and quoted by
the Committee in announcing this enquiry) is highly misleading.
That figure is based on the Labour Force Survey definition of
disability which is far too loose (ie it includes many people
with minor health problems and high employment rates). A more
realistic figure for the overall employment rate of disabled people
But the main message is that any estimate of
the overall average employment rate of disabled people can be
misleading. It encourages analysts and policy makers to think
of disability as a single condition, with little variation in
prospects between disabled people. Such a monolithic view leads
to assumptions about the position of "most" disabled
people. And it diverts attention way from disability itself towards
other characteristics of disabled people such as their employment
history, their educational level or the benefit regime they encounter.
These are all important issues, for disabled as well as non-disabled
people. But the single most important influence on their employment
is their disability.
The research shows that three sets of disability
characteristics are important:
Conditionthat is the
type of disease or body-part affected. Musculo-skeletal conditions
are easily the most common, but mental illnesses have the most
adverse effect on employment.
Type of impairmentthat
is, the normal tasks that people are restricted in performing.
Note that in general it is not possible to assume that any particular
condition leads to any particular type of impairment. Locomotor
impairments are both the most common, and have the worst influence
on job prospects.
Severitythat is, how
serious is the restriction on performance of normal tasks. Again,
severity cannot be inferred directly from the conditions people
report. In general, the more severe the impairment, the less likely
people are to have a job.
These three packages of variables make a significant
contribution to an explanation of employment probabilities across
the working-age population as a whole, and especially to an explanation
of variations within the disabled group. In the latter case, variations
by disability characteristics are more important than any other
sources of variation identified by the survey.
The personal model of disability would interpret
these findings to mean that people with certain conditions and
impairments cannot work. The social model would interpret them
to mean that employers will not offer them a job. Adherents of
the social model often distrust analysis which distinguishes between
disabled people according to the nature of their impairments.
But it seems likely that employers' willingness to offer a job
will vary by disability characteristics. Given that impairment
is a necessary precondition for disablement, the social model
lacks a framework to account for variations in outcomes between
people with different types and severities of impairment.
The fact that disability characteristics affect
variations in employment rates among disabled people does not
mean that other characteristics are irrelevant. The analysis has
shown that the demographic (especially family) characteristics
which so strongly affect everyone's employment prospects affect
disabled people too. It has also shown that economic characteristics
(especially education) affect disabled and non-disabled people
alike. The economic influences measured by the analysis are relatively
weak, though it seems likely that they would have seemed stronger
if better data about economic characteristics had been available.
Indeed, economic influences seem to be more relevant to severely
disabled people than to the rest of the populationa severely
disabled person with adverse conditions and impairments is much
less disadvantaged by his or her impairments if s/he had a good
education and lives in a prosperous area, than if s/he had minimal
education and lives in a depressed area. This finding discourages
too literal an interpretation of the idea of that many individuals
are made "incapable" of work simply by their impairments.
Of course, each disabled person either has a
job, or does not. But we can use a "logistic regression equation"
to identify groups of people with favourable characteristics and
a high probability of employment; and conversely groups with unfavourable
characteristics and a low probability.
The average employment probability of non-disabled
people is 76%. (This average is the same as saying that 76% of
non-disabled people have a job.) Because disabled people tend
to have some unfavourable demographic and economic characteristics
(older, less-educated), the average employment probability of
disabled people would be only 69%seven percentage points
lowereven if they were not disabled. But the actual average
among disabled people, including consideration of their disability
characteristics, is only 29%. We could say that the "employment
disadvantage" associated with disabilitythe reduction
in their job chancesis 40 percentage points.
DISTRIBUTION OF ESTIMATED EMPLOYMENT PROBABILITIES:
The averages for non-disabled and disabled people
conceal wide variations in job-prospects.
The thin grey line in Figure A shows
that the great majority of non-disabled people have characteristics
which give them a high chance of employmentmost of them
in the 80 or 90% regionthough there is a tail of disadvantaged
non-disabled people with very poor job prospects.
The dotted black line in Figure A
plots the probability of having a job calculated for disabled
people if their demographic and economic characteristics are taken
into account, but their disability characteristics ignored. This
is equivalent to estimating what their chances would be if they
were not disabled. Because more of them have disadvantaging characteristics,
the number who would have very good prospects is smaller than
among the non-disabled group, and the number with poor prospects
is larger. But the shapes of the two distributions are not hugely
different from each other.
The solid black line in the figure
plots the actual distribution of employment probabilities among
disabled people, including the effect of their disability characteristics.
The shape is completely different. Very few are so mildly disabled
as to have good job prospects. Many are so severely disabled as
to have minimal job prospects. A substantial proportion of disabled
people's chances are so low as to be close to zero. Half of them
for example, have a probability of less than 22%.
Figure A illustrates the width of the gap between
disabled people's experience and what they might have expected
if disability had not been a source of disadvantage. It is this
gap which can be labelled the employment disadvantage associated
with disability. The "logistic regression" formula allows
us to calculate the disadvantage faced by each individual, and
the distribution is plotted in Figure B. The average reduction
in employment rates (always comparing disabled people with their
own alternative prospects) is 40 percentage points. The range
of variation is quite wide, with a small number of disabled people
even appearing to enjoy a small gain in their probability, and
a small number having their chances virtually wiped out by their
disadvantage. It would be appropriate to describe those at the
right hand end of the distribution as "those who can work"
and those at the left hand end as "those who cannot".
But the most striking characteristic of the distribution is the
smoothness of the "hill", with its central peak and
DISTRIBUTION OF EMPLOYMENT DISADVANTAGE ASSOCIATED
Much policy discussion is based on a set of
assumptions about the profile of impairments experienced by IB
claimants. The Pathways report, for example, said that "the
large majority do not have severe conditions". But it is
very difficult to reach conclusions about the experience of "most"
claimants. The analysis of employment probabilities shows a wide
range of employment disadvantages. There is no bulge in the distribution
which could be used to argue that "most" disabled people
are at the less-severe end of the spectrum; nor a bulge at the
opposite end which would suggest that "most" of them
are "incapable of work". Still less is there a pair
of bulges which could conveniently be used to distinguish "those
who can work" from "those who cannot". All we can
say is that "most" disabled people face a significant
disadvantage; that there are some who are less disadvantaged,
and others who are even more disadvantaged.
A weakness of the disability survey, based on
a single set of interviews, was that it provided hardly any information
about the process of transition at the entry to disability. Most
of the analysis had to be based on an assumption that disability
is a source of economic disadvantage. But there are also clear
signs that economic disadvantage is a source of disability. The
economic characteristics (years of education and local labour
demand) which help to predict whether people have a job, also
help to predict whether people are disabled, and even how severe
their impairments are. Some of the apparent association between
disability and losing one's job may really be an association between
not having a job and becoming disabled.
The survey showed that the great majority of
disabled people not in work report that they are "permanently
disabled" when asked to record their economic position. But
the proportion of non-working disabled people who said they were
permanently unable to work rose substantially between 1985 and
1996-97. There is a clear sign here of the growth of disability
as an economic identity; the acceptance of "I am disabled"
as an appropriate economic role by the disabled person, his or
her personal community (family and friends), and perhaps the broader
public community (including employers, doctors and benefit administrators).
(Just as "I am a housewife" was accepted as an economic
identity 30 years ago.)
These "dynamic" questions about the
process of becoming disabled and leaving the labour market are
clearly an important part of the overall story, even though they
are poorly described by the data-set used for this paper. But
recent policy discussion has perhaps overemphasised the dynamics
of the process, and played down the underlying relationship between
impairments and employment probabilities. One of the conclusions
of this analysis has been that impairment is an important part
of the overall story, too.
None of this analysis invalidates the Pathways
approach, which aims to reduce employment disadvantage through
a combination of rehabilitation, labour market engagement and
financial incentives, and which is already showing some clear
signs of success. The objective might be expressed in terms of
countering the growth of disability as a long-term "economic
identity" (as discussed above). Perhaps, though, the analysis
should encourage government to adopt rather less ambitious targets,
at least in the short run. If it was thought that "most"
IB claimants had minor impairments, it might have been hoped that
"most" of their employment disadvantage could be eliminated,
and that the majority of claimants could return to work. Reducing
employment disadvantage seems a more realistic objective, which
would result in "many" more claimants returning to work.
Professor Richard Berthoud