157 A time for reflection: international work disability policy challenges and directions

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IntroductionSince the 1990’s, there has been a move across international jurisdictions to policies and programs that focus on work ability, not disability, and on strategies that encourage employment integration of people with temporary and permanent impairments. Almost 30 years later, we are at a point where we can reflect on those programs: their ideals, what worked, and what did not work and why.MethodTop work disability researchers from 14 jurisdictions assembled in Toronto in 2017 to share knowledge about work disability conditions, policies and practical social, economic and political realities of work integration. Each addressed work disability policies in their country, current practices, and avenues for change. Issues raised were compared and contrasted and then summarised in using thematic analysis approaches.ResultsAcross jurisdictions, rising levels of disability claimants were a concern, together with increasing work absence due to mental illness, work disability in ageing populations, and limited social protection for self-employed workers. Many systems have been redesigned in recent years to address these and other issues using strategies including program coordination, tightened timelines, eligibility restrictions, and reduced income and health care support for sick listed workers. Employer activation, management of non-severe impairment, and when to begin work activation were locations of developing and disparate policies.ConclusionA relationship between reduced number of people on disability benefits and increased employment is not always clear. More tracking is needed of employment outcomes for people who receive or are declined support. Strategies for successfully engaging employers and health care providers in work integration are still developing. Areas of emergent concern are effects of quality of the claimant encounter with providers and approaches to support the growing self-employment economy.

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