The person may be spending less time working, working at a less skilled job, or earning less money. This information can be obtained from survey questions (see Figure 5), but often with relatively little qualifications as to what this means. What is less often addressed is that for many people with disabilities working may mean forgoing opportunities to participate in other areas of life. Just going to work may, for example, exhaust all reserves of energy or require time-consuming preparations. There is a fine line between what might be considered a satisfactory accommodation and an unsatisfactory compromise or necessity, and different people will value this trade-off differently.
The problem with all the approaches to work disability, as indicated by our discussion of conceptual frameworks, is that there is unlikely to be a one-to-one relationship between the presence of health conditions, impairments, functional limitations, or activity restrictions and disability in employment. There is a pervasive assumption that work disability relates to the person’s degree of functional limitation and activity restriction. This is reflected in the concern about assessment, where the focus is very much on the individual’s performance. Lip service is paid to the environment, particularly in the context of work disability and vocational rehabilitation. As we have tried to show, a full understanding of work disability needs to take into account the individual’s circumstances and the social and physical environments of the workplace.
The research challenge is to apply the insights provided by the models of disablement to come to a common understanding of work disability and to understand the relationships and the dynamics of the pathway between health conditions and work disability. Researchers need to find ways to incorporate an understanding of the external factors that influence the development of work disability into its measurements.
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