Analysis: Many chronic conditions are invisible to colleagues and managers, creating a disclosure dilemma for thousands of workers
When workers receive a diagnosis of a chronic illness, the immediate concerns are medical: treatment options, prognosis, and symptom management. But workplace questions follow quickly: Should I tell my employer? Will colleagues treat me differently? How will this affect my job and career? For hundreds of thousands of Irish workers living with chronic conditions, these calculations aren't abstract. They're ongoing decisions about who to tell, when to disclose, and what it might cost professionally.
According to the CSO, Census 2022 showed more than one in five people in Ireland reported having a disability, representing over 1.1 million people experiencing a long-lasting condition or difficulty.
The most common conditions include chronic pain, breathing difficulties, problems with basic physical activities, and visual impairment. However, many chronic conditions remain invisible to colleagues and managers: autoimmune diseases like lupus and rheumatoid arthritis, neurological conditions such as multiple sclerosis, digestive disorders, chronic fatigue syndrome, fibromyalgia, mental health conditions, and cognitive difficulties with learning, remembering or concentrating.
This invisibility creates a disclosure dilemma. Unlike workers whose disabilities are immediately apparent, those with invisible conditions must actively choose whether to reveal their health status. Of those aged 15 and over experiencing a long-lasting condition or difficulty, only 34% were at work in 2022. Among those experiencing conditions to a great extent, the unemployment rate was 22%, compared to the overall unemployment rate of 8%. Workers face a difficult calculation: disclosure may secure necessary accommodations but could also trigger the discrimination that contributes to these employment disparities.
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From RTÉ Radio 1's Liveline, Saoirse and Amy talk about how tough it can be to work with a disability.
The disclosure decision
When diagnosed with a chronic illness, workers must weigh the benefits of revealing this against concealment. In other words, they are "damned if they do, damned if they don't" as disclosure risks stigmatisation and discrimination, whilst non-disclosure may threaten both physical and emotional wellbeing.
Research on American workers with chronic conditions identified three primary disclosure motivations: facilitating continued employment, enacting personal values, or explaining absences and symptoms. Workers who disclosed proactively often reported better workplace relationships but worried about long-term promotion prospects. Those who minimised disclosure avoided immediate stigma but risked symptoms being misinterpreted as job performance issues.
The economic reality of worker health
Worker health matters to organisations for practical reasons. Unlike work effort, which employees can immediately increase or decrease, health cannot be manipulated at will. A worker's health affects how much they can deliver: someone in poor health will be less productive than when in good health, regardless of their desire to contribute.
Managing a chronic condition also involves substantial hidden work that many must perform simply to remain employed: symptom management, medical appointments, medication regimes, and energy rationing. For workers with chronic conditions, how they think about their illness matters as much as medical severity. Workers with autoimmune diseases who perceive more serious consequences from their illness show higher levels of concern about their career sustainability, whilst those with stronger beliefs in controlling their illness experience less anxiety. Critically, these beliefs operate independently of actual disease severity.
Given these realities, organisations have strong economic incentives to support workers with chronic conditions. Organisations that invest in worker health see reduced absenteeism, lower turnover, and improved productivity. Retaining experienced workers through reasonable accommodations costs far less than replacement and retraining.
The gap between economics and practice
Yet despite these economic incentives, workplace culture often undermines chronically ill workers. Most workplace cultures expect consistent, uninterrupted performance from all employees. Workers whose health fluctuates face constant tension between managing their conditions and meeting these expectations.
Research on workers with invisible chronic conditions documents various challenges following health disclosure in the workplace. Workers report being passed over for high-visibility projects, facing increased scrutiny of their work performance, and experiencing subtle forms of marginalisation. Whilst such treatment rarely constitutes overt legal discrimination, it effectively limits career progression and creates hostile work environments.
The Employment Equality Act protects against discrimination based on disability and obliges employers to provide reasonable accommodation for employees with disabilities. The legislation requires employers to take "appropriate measures" as a proactive duty, rather than placing the onus on employees. Yet many employers struggle to translate these legal requirements into practical support. Recent cases demonstrate this gap; last year the Workplace Relations Commission ordered one employer to pay €64,000 for failing to consider reasonable accommodations for an employee with lupus. Most workplaces lack specific frameworks for health disclosure decisions, creating situations where career sustainability depends on individual managers rather than systematic support.
Closing the gap between economic incentives and workplace practice requires concrete action. Evidence-based approaches that organisations can adopt include:
- Develop Clear Disclosure Frameworks: Provide explicit guidance on disclosure processes, potential accommodations, and privacy protections. Workers need to understand what disclosure means practically before making irreversible decisions.
- Train Managers in Supportive Responses: Supervisor support significantly affects outcomes for workers with chronic conditions. When supervisors build relationships based on trust and possess sufficient communication skills, workers are more likely to disclose chronic conditions and access needed support.
- Implement Practical Accommodations: Irish law requires employers to provide reasonable accommodations unless doing so creates a disproportionate burden. Many effective accommodations involve minimal cost: flexible working hours, remote work options, adjusted workloads during symptom flare-ups, and regular breaks. Normalising such flexibility benefits all workers whilst removing the disclosure burden.
- Focus on Outcomes Rather Than Presence: Performance evaluation emphasising work quality rather than physical presence accommodates chronic illness whilst maintaining standards. Presenteeism, particularly working whilst ill, creates costs for both workers and organisations without delivering meaningful productivity gains.
Strategies for workers
Whilst organisations should provide systematic support, workers with chronic conditions can adopt strategies that improve their employment outcomes. Workers who understand their limitations whilst recognising continued capability are more likely to maintain employment. Effective approaches include prioritising essential tasks, scheduling demanding work during optimal energy periods, and communicating clearly about needs.
Support programmes work best when they address health management and workplace challenges together rather than separately. For disclosure decisions, workers may find it helpful to consider selective approaches rather than all-or-nothing choices. Building relationships with colleagues who value what you accomplish rather than constant attendance, and choosing carefully whom to confide in, are practical considerations when navigating disclosure decisions.
The bottom line
These individual strategies help, but workplace experiences of workers with chronic illnesses ultimately reflect organisational cultures, manager responses, and workers' own illness perceptions. Crucially, all three are changeable.
The disclosure dilemma presents a clear opportunity: Irish workplaces that embrace decent work principles for workers with chronic conditions stand to gain economically and ethically. Systematic support structures recognising human variation as normal rather than exceptional would serve both workers and employers far better than forcing hundreds of thousands of people to calculate the professional cost of honesty about their health.
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The views expressed here are those of the author and do not represent or reflect the views of RTÉ
