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International Spinal Cord Injury Survey: update two

14 April 2022

In a follow up to last year's article introducing the International Spinal Cord Injury Community Survey, Ian Slater looks at the employment situation of people with spinal cord injury (SCI).

Employment Among People with SCI: results from InSCI [Archives of Physical Medicine and Rehabilitation 2020;101:2157-66]

Okay, confession time, it has taken a while to follow up last year's article, which was the first in the intended series looking at the International Spinal Cord Injury Survey.

By way of a recap, please see the previous article for details of the particular countries and the numbers of individuals within each country.

This second article looks at employment amongst people with SCI in the 22 countries which took part in the survey.

The headline is that worldwide the employment rate was 38%. There were, however, considerable situational differences. Employment rates per continent were highest in Europe (average 51%) and lowest in North America (average 30%). This suggests that system-level infrastructure and policy differences may also play a role in affecting work outcomes.

In fairness, it should be noted that the Study defined employment as being in paid work for at least one hour a week. In total, 9,875 participants of employable age were included in this element of the Study.

The lowest employment rates were in Morocco (10.3%), with the highest in Switzerland (61.4%).

Working hours per week were reported by 70.3% of those employed:

  • 10.3% worked 1 to 10 hours per week
  • 15.8% worked 11 to 20 hours per week
  • 18.4% worked 21 to 30 hours per week
  • 42.3% worked 31 to 40 hours per week
  • 13.3% worked 41 or more hours per week

For Europe, this Study showed considerable differences between higher employment rates (43% to 61.4%) in North West and Middle European samples (Norway, the Netherlands, France, Germany, Switzerland) and lower figures (19.2% to 29.5%) in Southern European samples (Spain, Italy, Greece).

Substantial gaps between the employment rates amongst participants with SCI and the general population were found for all countries, including high income countries such as Germany and South Korea.

If one takes the European countries as previously listed, the difference between observed employment within the SCI participants and the general population was found to be:

  • Norway: -20.9%
  • Netherlands: -25.5%
  • France: -25.5%
  • Germany: -35.5%
  • Switzerland: -19.7%

For females, these differences equated to:

  • Norway: -29.4%
  • Netherlands: -24.8% 
  • France: -15.2%
  • Germany: -31.4%
  • Switzerland: -22.8%

The authors speculated that differences in employment rates between countries could only partly be explained by differences in basic demographic and SCI characteristics. They suggest that income per capita, socio-economic inequality, national labour market policies, healthcare systems, financial incentives and disincentives, and attitudes towards the participation of people with disabilities play a role.

In summary, employment figures amongst people with SCI vary between countries but are well below the general population figures. Whilst this is true, there are, however, a quite significant number of SCI patients who are working more than 20 hours per week.

By way of example only (and before anyone says anything, I know that there are more holes in this than a Swiss cheese) if one looks at France (being the UK's closest geographical neighbour of the countries included within this Study) one can see that employment levels for a male spinal cord injured individual are 25.5% less than the general population. The median age of the French participants within the Study was 48. Using Table 11 (discount rate -0.25%), the multiplier is 19.66. Applying a Table A discounting factor (Level 2 Employed) would produce an overall future earnings multiplier of 16.71. 

Compare that with the SCI individual and assume, perhaps unlikely in itself, that employed status is retained post-injury. The Table B discounting factor (again Level 2 Employed) produces a multiplier of 8.65, which is a 48% reduction in the future employment multiplier as against the 25.5% identified by the Study.

I know it is not that simple and I also appreciate the UK was not a participant in the Study but, as an illustration only, it does raise the question about whether insurers are seeking enough credit for future earning capacity. 

When I use the word 'credit', the automatic implication is financial but perhaps more important than that (and it is always worth remembering that we would anticipate an SCI individual retiring earlier than would be the case for a non-disabled individual) employment is a key indicator of successful rehabilitation and community integration of people with disabilities. 

Participation in paid work is associated with enhanced self-esteem, building social relationships and life satisfaction. It creates a diverse workforce and encourages independence rather than, as we see so often these days, a suffocating care regime that carries with it the implication that the individual is of no value other than as an employer

Further Reading