It is well known that many disabled people are out of work and living in poverty. But little is understood about the process of becoming disabled: who is most at risk, how it affects their income, and the impact on the rest of the family. This study, by Tania Burchardt of the London School of Economics, seeks to unpick the relationship between the onset of disability and social exclusion for people of working age. It finds that:
- The majority of disabled people experience the onset of their health problem or impairment during adulthood.
- People in the poorest fifth of the income distribution are two-and-a-half times more likely to become disabled during a year than those in the top fifth. There is a steep gradient in risk of onset according to other indicators of disadvantage, for example educational qualifications or occupational group.
- This means the average fall in income associated with becoming disabled is less than might be expected, because many are already on a low income. For people not initially in employment, greater benefit entitlement can result in a small overall increase in income: an average of £17 per week for couples (2003 prices).
- The effect on employment status varies widely by severity of impairment. Eighty-four per cent of people with the least complex impairments retain their employment, while just over half of those with multiple impairments do so.
- Someone becoming disabled also affects other members of the household. In single-earner couples, even where it is not the earner who becomes disabled, one in five leave employment. In some cases this is to take on new caring responsibilities.
- The researcher concludes that three policy areas could be enhanced: the health inequalities agenda, to reduce the risk of becoming disabled among the worst off; job retention schemes, to reduce the risk of leaving employment among those who become disabled; and benefits for carers, to give greater recognition to the contribution made by the families of individuals who become disabled.
This study is concerned with the process of becoming disabled during working life and the impact on the individual and his or her family. It focuses on changes in activity - paid employment, caring, and leisure pursuits - and on changes in income. Becoming disabled is understood to be the onset of a health problem or impairment, from which various limitations in activity may arise due to the physical, social and economic environment in which the individual finds him or herself.
At present, policy emphasis is on getting disabled people into work, through the New Deal and other programmes. Less attention is paid to helping people to retain their jobs when they become disabled, or to preventing the impairment or health condition occurring in the first place. In the past, social insurance benefits provided protection against a sudden drop in living standards, but their role is now less clear. For the families of people who become disabled, social security offers very limited assistance.
Little previous research has been done in this area. However, one important study, by Stephen Jenkins and John Rigg, can be read in conjunction with the one reported here. See details under 'Further information', below.
Who becomes disabled?
The majority of disabled people experience the onset of their health problem or impairment during adulthood. (According to the Family Resources Survey Disability Follow-Up (in 1996/7), 78 per cent of disabled adults of working age became disabled at the age of sixteen or older).
On average, two per cent of people of working age become disabled each year (according to the definitions used in this study). Of these:
- 15 per cent have had an accident in the previous year;
- 44 per cent have experienced the sudden onset of a health problem;
- 41 per cent have had intermittent, chronic or unspecified conditions which got worse.
Acquiring an impairment or developing a serious health problem is often thought of as a random occurrence, but examining patterns of onset of disability suggests this is far from the case. People with lower educational qualifications are at higher risk of becoming disabled than those with higher qualifications (see Figure 1). This relationship holds within each age group.
The risk of becoming disabled is also higher for individuals who:
- are not in employment;
- are in a low-status occupational group (such as plant and machine operatives, sales, or personal and protective services); or
- live on a low household income.
These factors are not independent of each other, but all indicate that the risk of becoming disabled has a strong gradient according to the individual's socio-economic circumstances.
Risks of entering poverty
Because many individuals who become disabled are already on a low income before the onset of their health problem or impairment, the overall average change in household income after onset is relatively small (minus £13 per week in 2003 prices). However, this summary statistic hides considerable variation.
- Single adults who were previously employed lose on average £22 per week.
- Couples where the sole earner becomes disabled lose on average £20 per week.
- Couples where neither person was previously employed gain on average £17 per week.
People who experience an unexpected deterioration in their health, or who have an accident, have larger falls in household income than those whose condition develops gradually.
The study examined the transitions individuals make into and out of poverty (see Table 1). It compared individuals in households in which someone becomes disabled, and other individuals. Three-quarters of individuals in households in which someone becomes disabled are above the poverty line before onset of disability, and the majority remain so even after onset of disability. However, 14 per cent enter poverty. This is twice the rate of transition to poverty among individuals in unaffected households.
|Individuals in households in which someone becomes disabled||Individuals in households in which no-one becomes disabled|
|Not initially in poverty|
|of whom...||% remain non-poor||86||93|
|% enter poverty||14||7|
|Initially in poverty|
|of whom...||% exit poverty||31||39|
|% remain in poverty||69||61|
Note: poverty defined as less than 60% median household income for individuals of working age
One-quarter of individuals in affected households are already in poverty before onset of disability. This compares to one in six individuals in unaffected households. Although an increase in income can occur as a result of someone becoming disabled (for example due to increases in benefit entitlement), it does not result in as many households leaving poverty as is achieved in unaffected households by other means.
Changes in paid and unpaid work
Changes in employment status and earnings depend greatly on initial circumstances. For some, existing disadvantage - low earnings or lack of employment - is compounded by becoming disabled. The chance of gaining employment falls and earnings rise less quickly than for non-disabled counterparts. For others, a relatively comfortable employment position is disrupted, and a significant fall in earnings occurs.
Within a year of becoming disabled, 35 per cent of single adults who were in employment have left employment, as have 22 per cent of individuals in two-adult households. These are much higher rates of exit than are observed for those who do not become disabled.
In couples, one partner becoming disabled can have an impact on the other partner's employment too:
- Of individuals initially in no-earner couples, nearly all remain in that position when one of the partners becomes disabled.
- By contrast, among individuals in no-earner couples unaffected by the onset of disability, 24 per cent gain some employment over the course of a year.
- Among single-earner couples, even if the earner is not the one who becomes disabled, one in five leaves employment, and the couple becomes a no-earner couple. This may be related to taking on new or increased caring responsibilities.
Ten per cent of individuals whose spouse becomes disabled report that they have taken on caring responsibilities at that time, and many more continue with pre-existing arrangements. Just under one in four of these carers report that they spend 100 hours or more per week caring - an enormous commitment of time, which is almost certain to rule out paid employment.
Decisions about paid and unpaid work interact, so it is important to consider the impact on the household as a whole, not just the person directly affected.
Being and becoming: disability and social exclusion
The study draws attention to the two-way relationship between disability and social exclusion. Someone who is socially excluded is at greater risk of becoming disabled, and someone who becomes disabled is at greater risk of being socially excluded.
Policy interventions that could be targeted to break these links include:
- reinvigorating the health inequalities agenda, to reduce the steep socio-economic gradient in the risk of becoming disabled;
- directing more resources at job retention schemes, rather than waiting until someone has been out of work for six or twelve months;
- giving greater recognition to the contribution made by partners of those who become disabled, through improved benefits for carers.
Becoming disabled is a major life-event. The researcher concludes that the financial hardship, and exclusion from participation in society which often occurs as a result, is an additional and unnecessary burden. She argues that to achieve stated policy objectives, and to meet the demands of social justice, policymakers should give these issues their urgent attention.
About the project
The research was based on analysis of data from the first eight years (1991 to 1998) of the British Household Panel Survey (BHPS). The BHPS re-interviews a nationally representative sample of approximately 10,000 adults every year.
Onset of disability was defined as reporting limitation in activities of daily living at at least two consecutive interviews. During the eight-year period, 702 sample members experienced onset of disability.