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European Journal of Applied Sciences – Vol. 12, No. 5

Publication Date: October 25, 2024

DOI:10.14738/aivp.125.17664.

Salminen-Tuomaala, M. (2024). Supporting the Health, Work Ability and Employability of Unemployed People with Long-term

Illness. European Journal of Applied Sciences, Vol - 12(5). 262-273.

Services for Science and Education – United Kingdom

Supporting the Health, Work Ability and Employability of

Unemployed People with Long-term Illness

Mari Salminen-Tuomaala

School of Health Care and Social Work,

Seinäjoki University of Applied Sciences, Finland

ABSTRACT

The article describes a 3-year project called “Duckboards”, carried out in western

Finland with long-term unemployed people living with long-term illness. The

purpose of the intervention was to test how a multiprofessional team could

support the health, work ability and functioning of 145 unemployed clients with

long-term illness. Of this group, 45 responded to a quantitative survey, whose

purpose was to produce information about how the participants rated the step-by- step intervention and Future Workshop and their encounters with various

experts, and to investigate the meaning of the participation for them. Based on the

client Likert scale ratings, it would seem that the intervention had a greater

positive effect on the participants’ experienced physical and social health and

daily coping, compared to job-seeking skills or career planning, where the

variance was higher. The participants seemed very satisfied with their encounters

and interaction with the project experts.

Keywords: Long-term illness; Long-term unemployment; Work ability, Function, Coping

INTRODUCTION

A considerable proportion of the population in many countries live with one or several long- term illnesses [1]. Impaired health can lead to temporary or prolonged loss of employment

[2]. However, the services for unemployed clients with long-term illness are commonly

fragmented and uncoordinated [3, 4]. This article first discusses long-term illness and its

association with unemployment and other social and health problems globally and in Finland.

Secondly, the article describes a multiprofessional intervention carried out in Finland in order

to support the health, work ability and employability of people with long-term illness. Last,

the article reports and discusses the participant ratings for the success of the project.

BACKGROUND

Long-term illness is here defined as a chronic condition lasting six months or longer, requiring

regular medical care. The prevalence of long-term illness has increased globally, with

cardiovascular diseases, lung diseases, cancer and diabetes among the most common diseases

[5]. These diseases are associated with lifestyle risk factors, including physical inactivity,

unhealthy diet, high alcohol consumption and smoking [6].

Similarly, in Finland, the most prevalent conditions burdening the health care system include

cardiovascular diseases, respiratory diseases, cancer and diabetes. Musculoskeletal and

mental health conditions, however, are currently the two leading conditions associated with

disability pension [7, 8]. Mental health problems and intoxicant addictions are considered a

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Salminen-Tuomaala, M. (2024). Supporting the Health, Work Ability and Employability of Unemployed People with Long-term Illness. European

Journal of Applied Sciences, Vol - 12(5). 262-273.

URL: http://dx.doi.org/10.14738/aivp.125.17664

major challenge for the Finnish population, causing functional decline and unemployment,

and increasing the risk of social exclusion [9]. In the working-aged population of Finland

(total population 5.6 million), 1.9 million people have one or more diseases or disabilities

[10]. Working-aged women seem to be more commonly affected by mental strain and

depression than men in the same age group [11]. Furthermore, a Finnish population gambling

study revealed that up to 11% of the Finns may be at-risk gamblers [12].

Many people with long-term illness are affected by multimorbidity, defined as co-occurrence

of two or more chronic conditions [13]. According to a systematic review covering global data

from 126 peer-reviewed studies, multimorbidity has become increasingly prevalent in the

past two decades. In people with the mean age of approximately 57 years, the prevalence of

multimorbidity was 37.2%, with South America having the highest prevalence, followed by

North America, Europe and Asia. Multimorbidity was found to be more prevalent in females

[1].

In Finland, 31% of men and 44% of women in the age group 18 to 64 have multiple chronic

conditions. Multimorbidity increases with age; in the age group 65 to 85, the rates are 77% for

men and 79 for women in Finland. People with multimorbidity are affected by risks

threatening their daily coping. They are heavy users of healthcare services and are frequently

polymedicated, requiring individual assessment and care planning [14]. Long-term illnesses

are likely to affect individuals’ mental wellbeing and sense of coherence or understanding life

as comprehensible, meaningful, and manageable [15, 16]. Prolonged illness tests people’s

resilience or ability to adapt through mental, emotional, and behavioral flexibility and

adjustment [17], and their ability to see change as a natural part of life, to solve problems and

to look for alternatives [18].

There is a clear association between long-term employment and physical and, especially,

mental health problems [2]. The long-term unemployed have been found to have 1.6-fold

higher mortality and at least a twofold risk of mental disorders, especially depression and

anxiety, compared to the working population. It would seem that unemployment is not just a

consequence of illness, but also contributes to ill health [19]. Besides health problems, a

person’s employability and social participation may be hampered by cumulative disadvantage

[20]. Long term illness is more prevalent in people with a low income and low socioeconomic

status, compared to the more advantaged population [21]. A qualitative study described the

experienced health and wellbeing of unemployed persons. After the initial shock, sometimes

relief, following becoming unemployed, they reported impaired experienced health and

wellbeing, disrupted circadian rhythm, passivity, loss of social contacts, feelings of inferiority

and economic distress [22] The symptoms of the diseases alone frequently contribute to

passivity and withdrawal from social interaction. The person may also avoid seeking help and

services [23].

In the Finnish working-age population, 1.9 million individuals or 55% have one or several

long-term conditions or disabilities [10, 24]. According to a Ministry of Social Affairs and

Health report, the unemployed people with long-term illness are a heterogenous group; One

third of them seem to have had a stable career path, another third have a long history of

unemployment, and the last third live a life of frequent transitions in and out of work [25].

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European Journal of Applied Sciences (EJAS) Vol. 12, Issue 5, October-2024

Many of the unemployed individuals with long-term illness consider themselves to be fit and

willing to work; in Finland the number of these people is estimated to be 65 000 [10].

The services for such clients with multiple needs have been criticised for being fragmented

and uncoordinated, even in countries with accessible and effective systems. The dominant

medical model views the client through the lens of diagnosis and fosters

compartmentalization for administrative and organizational reasons [3]. The services for

complex clients have been criticised in Finland, too. The primary health care, specialized

medical care and social services all operate “in their own silos”, with clients sometimes

randomly referred from one professional to another. The overlapping services are expensive

and the situation is frustrating to both clients and professionals [4, 26]. The situation is

further aggravated by the fact that clients’ needs for multiprofessional services are not always

recognized [27]. In practical client situations, it is difficult for health and social professionals

to identify the clients they share with each other [28]. Any employment efforts are futile

unless adequate care and functional capacity have been reached.

Suggestions for improvement involve basing the work ability assessment practices on a

biopsychosocial health approach instead of a biomedical model, and combining information

on the client’s functioning provided by a multiprofessional network [2]. The Ministry of

Economic Affairs and Employment in Finland recommends that besides the medical

assessment of a person’s work ability and function, the person’s life course and work history

should be examined simultaneously. The assessment of the client’s current functional capacity

is not adequate; it is important to learn why earlier education and employment efforts were

interrupted [29]. The coping of people with long-term illness can be improved through peer

and family support and with help of a resilience-focused approach. In daily life, this approach

could mean increased activity when faced with challenges and willingness to change one’s

actions [18]. An empowering approach that support the person’s life management and self- care can improve their self-efficacy and sense of coherence [30].

This article describes an intervention, whose purpose was to test how a multiprofessional

network could support the health, work ability and functioning of unemployed clients with

long-term illness.

THE INTERVENTION

The project or intervention, named Pitkospuut or “Duckboards” described in this article, took

place in Finland from February 1 in 2021 until December 31 in 2023. The project was funded

by the European Social Fund through the Central Finland Centre for Economic Development,

Transport and the Environment and carried out by experts at Seinäjoki University of Applied

Sciences in the region of South Ostrobothnia. The target group consisted of unemployed job- seekers with multiple long-term illnesses and job-seekers with an immigrant background. The

project mainly targeted the over 50-year-olds, but younger people, who faced difficulty

finding employment due to illness, were also included. The participants were recruited

through social services offices, employment and economic development offices and local

government trials on employment. A few individuals participated out of their own volition. All

the multiprofessional interventions were carried out in the participants’ own domicile. The

total number of participants was 145.