The Challenge

All enterprises depend on managers who are able to manage changes in the labour market but also in their company environment and in that of their employees.
One of the main challenges of the last decades is that the number of employees with chronic conditions is increasing, and the ability of these employees to participate in working life is often not recognized among employers. Chronic Diseases (CDs) also affect managers: absence from work, issues connected to employability, costs of retaining or replacing workers, and internal company policies are aspects that are crucial for hiring as well as re-integrating persons with CDs.

The Answer

The CHRODIS PLUS Training Tool has been developed to help employers understand the benefits of the inclusion, integration, stay at work and reintegration of people suffering from chronic diseases and will train managers to evaluate inclusiveness and work ability of their teams so as to create facilitating environments for reaching desirable organizational outcomes: productivity, job satisfaction of all employees, and organizational commitment.

1. To whom is this training directed?

The training tool is directed to managers of small, medium and large organizations:
  • Human resource department
  • Top management
  • Employers
  • Stakeholders (e.g. occupational health care service providers)
  • Health and work safety officers

2. Why managers need this training?

Good management includes taking care of the most important resource of the organization: the employees. A manager should be competent in the team’s business and this is related also to the health and wellbeing of employees. At the workplace there is often a lack of information regarding the abilities and capacities of people with chronic conditions to continue working, resulting sometimes in stigma and in inappropriate disclosure of their condition, lack of support when returning to work after sick leave, or even difficulties after a long-term absence as well as more difficulties obtaining training opportunities and promotion. This lack of knowledge and of information about employees’ health and wellbeing is impacting on leadership and the increase of ageing employees with chronic conditions could be an element that deserves to be known and handled by managers.

Chronic diseases, or non-communicable diseases (NCDs), are broadly defined as diseases of long duration and generally slow progression that are not passed from person to person (e.g. type 2 diabetes and cardiovascular diseases).

While chronic diseases are the main causes of longstanding health problems in the working-age population, existing national policies, in most cases, do not address chronic illnesses specifically, nor the specific needs of patients with highly cyclic conditions where periods of normal life (e.g. during remission) and periods of frailty (e.g. during treatment cycles) alternate.
People with a well-managed chronic disease are able to work normal hours and, if reasonable accommodation in terms for example of flexibility of working times or of workplace adaptation is enabled, they can often stay at work, return to work or maintain a work. The ability in the employment sector, to manage complex and chronic conditions brings important returns to individuals, employers and indeed society as a whole. For example, retaining the experience and knowledge of a worker with a chronic illness is essential to the business outcomes of a company and the overall economic productivity of a country.
This is the scope of this TRAINING TOOL FOR MANAGERS.

3. How was the tool developed?

This training tool was developed within the European Joint Action CHRODIS Plus, a 3-year project in which 42 partners, representing 21 European countries, collaborate to implement good practices in the working lives of those with chronic diseases. The tool draws on international research and on best practices related to inclusion in the work sector and to the health assessment of organizations. It was developed with the advice and support of a large group of international experts, including policy-makers, practitioners, unions, researchers, patient associations, other relevant stakeholders and representatives of various international agencies. It is built upon the work of the EU Pathways project (, of international reports and recommendations and on scientific reviews aiming at identifying existing training tools for employers [1].

4. What are the expected benefits?

Implementing this training tool in enterprises will have numerous benefits both for employees and the organizations as a whole, concerning inclusion, stay at work and return to work. Work participation will be the broad expected outcome that will benefit all, so that discrimination and stigma are avoided and inclusiveness for all is promoted. The Training tool does not pretend to provide ready-made solutions for every type of employee for every specific kind of workplace. Instead, it claims to generate a new and stimulating discussion and new questions in European workplaces on the issue of employment, chronic diseases, inclusion and work ability, suggesting possible ways of evaluating the present workplace situation and consequent ways of intervention for empowerment. The hope is that the dissemination of the Training Tool will give space to increase consciousness and knowledge on such issues, defeating stigma and discrimination and giving way to the creation of new feasible measures to cope with this challenge. Engaging this Training Tool is the first step towards a change.

4.1 Top Benefits for Employees

Promoting inclusion, stay at work and return to work programs in any enterprise communicates care and concern. It also shows employees that their well-being is appreciated and that, in the case of sick leave, efforts are made to get them back to work as soon as possible. This benefit employees in the following ways:

  • Retaining full earning capacity
  • Maintaining a productive mind-set
  • Staying on a regular work schedule
  • Avoiding dependence on a disability scheme
  • Having a sense of security and stability

4.2 Top Benefits for the Organization

Employers, in turn, benefit from preserving their employees’ capacity to work and work for instance by retaining their staff actively on the job reducing the associated cost of health insurance and maintaining the productivity of their workforce. For employers, the benefits of being inclusive, meaning having the capacity of hiring and retaining employees with chronic conditions or any kind of decrement in functioning due

to health conditions, are multiple. It shows that the
employer values diversity and inclusion, which is a part of a well-functioning company; it results in higher
motivation, commitment and productivity of the employees and better productivity and it ensures that the company retains skilled staff and spares the additional costs of recruitment and training. In particular by:

  • Avoiding stigma in the workplace and promoting inclusiveness
  • Reducing the financial impact of workplace injuries as well as that of sick leave
  • Providing a proactive approach to cost containment
  • Having experienced employees continue working, resulting in less time and money spent on recruiting and hiring.

How to use this training?

This Training Tool for Managers is composed of 3 Sections and an Appendix that includes examples and case vignettes and informative sheets on some of the most frequent chronic diseases in the workplace.

Fight discrimination and stigma in the workplace: promote inclusion for all

Discrimination occurs when one person is treated less favorably than another is, has been, or would be treated in a comparable situation, based on a particular characteristic they hold or when an apparently neutral provision, criterion, or practice would put one person at a particular disadvantage compared with other persons. Stigma occurs when certain differences (or imagined differences) are labelled or pointed out and given negative associations. Because of negative perceptions, people with chronic conditions may not disclose their condition or may not ask for the necessary adaptations. Disclosing the illness is often sensitive for people with chronic conditions as there is stigma attached to chronic conditions and lack of awareness that people with chronic conditions can continue to work. In the context of mental health, in particular, the fact of not disclosing can also lead to the mental health problem getting much worse and may eventually lead to a longer sick-leave absence as well, to the detriment of as well the employee and the employer. The workplace should allow for a climate where ill health status can be discussed in a safe environment.

[1] Lamore K, Dubois T, Rothe U, Leonardi M, Girard I, Manuwald U, Nazarov S, Silvaggi F, Guastafierro E, Scaratti C, Breton T & Foucaud J. Return to Work Interventions for Cancer Survivors: A Systematic Review and a Methodological Critique, Int. J. Environ. Res. Public Health 2019, 16(8), 1343;
– Silvaggi F, Leonardi M, Guastafierro E, Quintas R, Toppo C, Foucaud J, Lamore K, Rothe U & Scaratti C, Chronic Diseases & Employment: An Overview of Existing Training Tools for Employers, International Journal of Environmental Research and Public Health, 2019, 16(5), 781
– Nazarov S, Manuwald U, Leonardi M, Silvaggi F, Foucaud J, Lamore K, Guastafierro E, Scaratti C, Lindström J, Rothe U, Chronic Diseases and Employment: Which Interventions Support the Maintenance of Work and Return to Work among Workers with Chronic Illnesses? A Systematic Review, Int. J. Environ. Res. Public Health 2019, 16(10), 1864

Chronic diseases and employment: some facts

FACT 1: If there are at least 4 employees, ONE of them suffers from one or more health conditions

Employment and Chronic diseases: an emerging issue

The number of people living with one or more chronic diseases (CDs) has dramatically increased in recent decades and this has significant social and economic implications for the employment sector. The rising prevalence of chronic conditions is probably due to several reasons.
  • Firstly, life expectancy has increased which is leading to a higher prevalence of age-related health conditions
  • Secondly, the prevalence of unhealthy lifestyles such as smoking, heavy consumption of alcohol, drug use, poor diet and lack of exercise have increased in the European general population
  • Finally, people with a chronic health condition are more likely to come down with other chronic health conditions

This comorbidity might be due to the same pathophysiological pattern that some of these health conditions share and also because living with a chronic health condition has an impact on daily functioning which makes people more vulnerable to experience further health conditions.
Individuals with CDs have demonstrated to have poorer employment prospects. This means for instance fewer possibilities to become employed, difficulties in obtaining training opportunities and advancing in one’s career, and early retirement. All these factors have the potential to reduce income and increase the risk of poverty among these individuals, as well as their families. In the workplace, there may be insufficient awareness of the potential of employees with CDs to continue working, and lack of knowledge of practical means to enable this to happen. If this is the case, there is a risk of inappropriate exclusion from working life of qualified and skillful professionals.

FACT 2: Workplaces play a key role in improving employees’ health

Supporting employees with CDs to keep working

Working for as long as possible for people affected by a chronic disease can provide not only a daily routine, but can represent a protective factor for improving the quality of life and wellbeing. Therefore, if the job has not a direct impact on the progression of the disease, people may choose to continue working. In order to promote an inclusive labor markets for all, is fundamental to redesign the role of the workplace, addressing not only the physical working environment but also the social working environment. Often for people with chronic conditions there is stigma attached to the conditions and lack of awareness that people with chronic conditions can continue to work. Chronic conditions may also sometimes be considered as a private matter by people with chronic conditions or/and employers.

FACT 3: Planning Stay at work and Return to work of skilled employees is a benefit both for the person and the enterprise.

Supporting return to work after sick leave

When employees experience illness or injury, it often impacts their ability to perform their jobs, especially in occupations that are more intensive. As soon as an employee is able, it is in everyone’s best interest to return him or her to work in some capacity. Often, this is done through formalized Return to Work (RTW) programs that are plans established by a workplace to help reintegrate injured or sick employees into the workplace, after a period of sick leave. The goal is to return employees to the workplace as soon as they are medically able. A well-run RTW program offers benefits to both employers and their employees. For employers, a RTW program offers the following advantages: retain experienced employees, reduce turnover, allow better employee’s relations, better productivity, reduced costs. Return to work requires careful coordination and consideration of the needs of the various players; it is in fact a complex process where many actors play a relevant role, not only the affected persons.

Maintaining people with chronic diseases at work and reasonable accommodations

Maintaining people with chronic diseases at work involves a number of adaptations, or reasonable accommodations, that can be made to the working environment. Reasonable accommodations should be provided to enable qualified employees with a chronic disease to perform the essential functions of their job, in order to guarantee the fruition and exercise of human rights. These may include for example changes or adjustments to the physical work environment such as access to lunchrooms, to meetings, to social events, etc. Others might require training of colleagues on the situation. Some of the changes can be scheduled in advance, while others are the result of negotiations that always stem from a certain problem that makes it difficult for the person to perform the given task. An approach able to act on the environment as well as on the person will allow better results for all.