Fit for Purpose? - Disability Legislation and Missionary Health

by Dr Adele Pilkington
Posted on 1st May 2009

Any organisation sending staff to work or travel abroad has a duty of care for those individuals. Whilst the Health and Safety at Work Act and its Regulations do not apply outside Britain, an international dimension is relevant when considering the duty of reasonable adjustment under the Disability Discrimination Act (DDA) 1995.

The DDA makes it unlawful to discriminate against disabled people in recruitment, and employment, access to goods and services including education and related services. Amendments in 2004 made the Act applicable to all organisations regardless of size, and also broadened the scope of mental health impairments covered by the Act. Disability is defined under the Act as 'a physical or mental impairment which has a substantial and long term adverse effect on a person's ability to carry out normal day-to-day activities'.

Disability is defined under the Act as 'a physical or mental impairment which has a substantial and long term adverse effect on a person's ability to carry out normal day-to-day activities'

Mission work is essentially occupation in particularly demanding contexts, and so the application of occupational health principles are essential to good missionary health. In recent years there has been a rise in the reported incidence of common mental health problems in the general population, with further rises anticipated by the World Health Organisation. A number of factors are cited for this including social isolation and difficulties adapting to societal change. These factors are equally relevant to mission work in addition to culture and re-entry shock, unforeseen events, and limited access to mental health services overseas. Research suggests that at least a third of regular business travellers report anxiety related to aspects of travel, and these concerns are compounded in remote locations, with basic living and health care facilities.

Research also suggests that at least two thirds of travellers experience at least one physical health related problem during a 12 month abroad. A significant percentage of these problems arise as a result of pre-existing health problems. In many cases this illness burden can be largely preventable by effective pre-travel health screening and travel health advice. Early return home is just one of the costs and consequences of ill-health abroad. Individuals can often experience longer term health consequences, and the impact of 'failed' mission can be considerable for both individuals and their families.

Health screening is often dismissed on the basis of cost or for fear of 'opening a can of worms'. There is also the misapprehension that compliance with the DDA will require costly adjustments. The costs of health screening are generally far outweighed by the costs of early repatriation, and research shows that the cost of most adjustments is likely to be negligible, and many disabled people do not require any adjustments to carry out their work effectively. Health screening does however provide the opportunity to effectively assess the potential risks of an individual working abroad with a pre-existing health condition and does allow the opportunity to provide advice aimed at risk reduction. On occasions it may not be possible to reduce the risk to an acceptable level, and in these circumstances the appropriate and legitimate outcome is to inform the individual and mission agency that work abroad is inadvisable. The need for effective health screening becomes even more imperative with the growth of 'DIY Mission'.

Mission agencies and mission workers can both benefit from access to expert travel and occupational health services, and reduce the organisational and personal costs associated with ill-health abroad. The DDA should be seen as a protective Act for both the individual and their sending organisation. Complying with the DDA will ensure that you do not discriminate against individuals on the grounds of disability and recruit the right person for a job. It will also help you to foster good relations within the organisation and demonstrate your commitment to equal opportunities for all.

Dr Adele Pilkington, MB, BS, MSc, MRCGP, DCH DRCOG, FFOM has been a Consultant Occupational Physician with HealthLink360 since 2005. She provides medical services for a variety of heavy and light industry and is part-time Executive Director of the remote learning programme for Occupational Health at Manchester University. For further details visit