In the U.S. and most of the developed world “the law is on your side”; enforcement is another matter and personal-information security yet another. Both the choices and the responsibility are primarily yours.
Like depression, which we discussed in a recent post, diabetes (of any type) is largely invisible to others. Unlike clinical depression, there are conclusive ways to diagnose and measure its progress—or, ideally, for people with type-2 diabetes regress.
This makes for complications in the world of work for people who have either (or both). But because diabetes is a matter of physiological rather than mental health, the fact that more is known about your diabetes poses more imposing questions about what to do with and about that information—in particular, what you do.
Among the stigmas to be dealt with is that of the person with diabetes. Increasingly, people who have diabetes and manage it don’t consider it a disability. But in the important area of labor law, it is regarded as an “unseen” disability. Accordingly, its protections fall under the Americans with Disabilities Act (ADA) in the US and the Equality Act in the UK.
Appreciate them while we have them. These protections are under siege everywhere.
As with depression, the variables are as numerous as the individuals who have diabetes. Taking that into account, there is a remarkable number of knowables and knowns. The most recent and most recently updated summary is “Diabetes and Employment Discrimination,” from thediabetescouncil.com, a site whose self-described purpose is “providing up-to-date, emerging and reliable information for those suffering from Type 2 diabetes (Diabetes mellitus) and Prediabetes.”
The post divides the considerations into two categories: legal considerations and practical issues.
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The post speaks plainly (verbatim):
“When applying for a job, legislation is clear; employers have no right to ask about your health status and neither are you under any obligation to offer the information. ... If an employer inquires about your health you are entitled to ask if the position is exempt from discrimination legislation in respect of diabetes.”
There could hardly be a definitive statement that more draws attention to the law, the enforcement of the law, and ways around the law (for both employer and applicant). In what few cases would “ask[ing] if the position is exempt from discrimination legislation in respect of diabetes” not be effectively disclosing diabetes status?
As a matter of “disability discrimination” the law applies equally to the US, the UK, and most other developed nations.
In a subsection on “Diabetes and the Economic Burden on Employers,” the post looks at the ramifications of a fact it reports, about US business. “Excluding direct medical costs it was estimated that in 2012 decreased productivity as a result of diabetes cost employers in the US $69 billion. Despite legislation being in place to both prevent and deter discrimination, in the real world diabetics are faced with employers who they are aware, will consider their condition and the possible implications when interviewing candidates for positions.”
The discrimination laws hold after an applicant is employed. “Once you are in employment then disability discrimination law protects you in ensuring that employers are obliged to make small, or reasonable, amendments to your work environment or schedule if they are necessary.”
Further, “More serious employment situations can arise if the employee is considered, due to their illness, to be what is known as a ‘direct threat.’ In the US this can be a defense an employer will use against any accusation of discrimination. However the direct threat defense cannot be used without employers first proving that they have made reasonable accommodation for an employee. They must also prove that they have undertaken a risk assessment in respect of the individual concerned.”
And, “Essentially, not telling your employer formally at any point means that you waive any rights, not only to reasonable accommodation, but to any future disability discrimination issues which might arise.”
A place where the legal and personal considerations intersect is stated succinctly: “Your employer can only provide reasonable accommodation if he is aware you have a disability. If he does not, then obviously such changes cannot be enforced. Neither can your employer be accused of being discriminatory if he was not made aware you had a disability in the first place.”
From the above it is clear that the personal decision is when—and whether—to tell a potential employer/employer that you have diabetes. “Most people,” the post says, “opt not to discuss issues relating to their condition at least until they have secured a position.”
One thing to keep in mind is that your medical records and insurance records are "out there" somewhere, and any employer serious about seeing them will find few impediments.
Being realistic, not discouraging, the writer adds that “the permutations are endless. … It may be that you discover the work environment engages in security checks on staff and visitors to the building. Being embarrassed at work for carrying syringes and medication, which might initially be misconstrued, is not something everyone would feel comfortable with. Depending on the nature of the work and the environment it might also be necessary to establish if there is an area available to check glucose levels or take medication.”
Other personal concerns include informing work colleagues so that, in the event of a hypoglycemic attack, they know what is happening and respond accordingly. There is also the issue of the impact of any progression of the diabetes on job suitability, which could mandate a change of job or workplaces circumstances.
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A delicate balance
Like your blood-sugar levels, the circumstances of present and future employment ask both employees and employers to maintain a delicate balance. Throughout the post, evidence abounds that job discrimination on the grounds of diabetes is real. Being naïve about that is merely impractical.
But the matter is now sufficiently out in the open that employers, particularly of large work forces, also have to reckon with it realistically. Because type-2 diabetes is treatable and therefore manageable, employers increasingly see that the right person is more important than the desirable medical for a job to be done well and in a way that benefits the company.
“Additionally,” the author(s) write, “the rising incidence of people with diabetes means that most employers will have to deal with both candidates and employees who suffer from the condition on a regular basis.
“In 2012 it was claimed that over 29.1 million people were suffering from diabetes in the US alone, which is approximately 9.3 per cent of the total population. The clear indicators are that employers are not only regularly interviewing large numbers of candidates with diabetes, but also that they make up a large proportion of the workforce.”
What does this mean for the employee/job applicant with diabetes?
At the empowerment level, it means that a great deal of it is “your call.” That, in turns, makes making informed, deliberate choices first, if not primarily or solely, your responsibility.
People of a certain age will recall when they (and countless others) stayed in a job that was not necessarily giving their lives meaning or fulfillment because of the “benefits.” The benefit “package” had variable contents, but what most people meant by “the benefits” was “the health insurance.”
In the U.S. at least, fewer things could be more uncertain at the moment than work-related medical insurance. Far more employers are no longer required by law to provide it, and many of the ones who are hire people on a “temp-to-perm” or “on-call” basis that precludes them from getting a complete benefit package, health insurance, paid medical leave, and paid vacations being the first benefits to go.
Some say that the stigma about diabetes as regards employers now is less about the likelihood of costly medical accidents on the job and more to do with the make-up of the sub-populations of people with type-2 diabetes.
Statistically, it’s clear that people from lower economic backgrounds, people of color, and overweight people—three groups chronically faced with discrimination and stigma regardless of their health status—are more likely to have type-2 diabetes. So at some level it's “logical,” if unfair, for employers to assume that people from those sub-populations are less likely to afford, or practice, full medical care for their diabetes.
The vicissitudes of economies also cut both ways. The fact that people are working longer, and coming out of retirement to work low-paying jobs to meet basic living needs, points to a economies where people have less choice about employment or its terms.
At the same time, as flexibility about work, and particularly work situations, becomes more a part of shifting definitions of “work” and “jobs,” new possibilities present themselves to people with diabetes. Working at or from home naturally expands the opportunity to meet personal health and self-care requirements. And the creation of smaller entities that are the "new" businesses opens opportunities for people with diabetes to work in situations where having diabetes, properly managed, isn’t in itself an issue.
Attitudes may seem to evolve all too slowly, but increasingly there’s a collective of awareness that: