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Yin N and Heiland F

An active literature is devoted to estimating the impact of disability reform on
behaviors such as labor force participation and program application (e.g., Gruber, 2000;
Mullen and Staubli, 2016; Wise, 2017). We argue that there is an important pathway
through which disability policy may influence individuals that has been largely
overlooked: individuals’ perceptions regarding what constitutes a work disability. In
this paper, we provide a comparative analysis of disability policy in the U.S. and seven
European countries and investigate whether cross-country differences in disability
policies are linked to different views held by the public on work limitations.
We hypothesize that long-standing institutional differences (e.g., coverage and
benefit generosity) between the public disability insurance systems in Europe
and the U.S. affect residents’ perceptions of work limitations, and in turn shape
beliefs regarding disability. For instance, since many European disability programs
differentiate by severity (offering partial benefits) while the U.S. only recognizes those
with the most severe work limitations as disabled (offering full support), Americans
may consider a person with a health condition that limits but does not prevent work
as not work-disabled while Europeans may describe him or her as moderately work-
disabled. As another example, in countries with better accessibility, it is more common
for people to see disabled individuals on a daily basis performing regular activities
whereas in other countries the disabled individuals might not be able to leave their
houses as often, which might affect public views on disability. 1
To further conceptualize the relationship between disability institutions and
individuals’ perception of work disability, we invoke the concept of cultural beliefs.
Culture attracts researchers in many fields, but there has not been a universal
definition that applies across disciplines (Bachrach, 2013; Bisin and Thierry, 2010;
Giuliano, 2007). When we refer to (disability) culture here, we follow literature in
economics (e.g., Guiso, Sapienza and Zingales, 2006) and anthropology (e.g., Boyd
and Richerson, 2005) that define culture as “decision-making heuristics or rules of
thumb that have evolved to serve our need to make decisions in complex and uncertain
environments … manifest[ing] themselves as values, beliefs, or social norms” (Alesina
and Giuliano, 2013, p. 5).
Cultural beliefs have been linked to the institutional environment: People internalize
social norms that emerge and develop in specific institutional settings (Alesina and
Giuliano, 2013). As a result, differences in policy can affect the prevalence of various
types of social norms. (For example, Alesina and Glaeser (2004) while examining the
bi-directional relationship between institutions and culture, show that the different
attitudes between Americans and Europeans toward the poor can be explained by the
relative generosity of the respective welfare states.) Adopting the same conceptual
framework, we hypothesize that the disability institutional arrangements in a country
will play a role in shaping the social norms about work disabilities, as reflected in the
way people assess work limitations.
Previous research has documented substantial variations across countries in disability
assessments that cannot be explained by demographic and health characteristics
(e.g., Angelini, Cavapozzi and Paccagnella, 2012; Bagod’Uva, O’Donnell and van
Doorslaer, 2008; Grol-Prokopczyk, Freese and Hauser, 2011; Kapteyn, Smith and
van Soest, 2007; 2009; Murray et al., 2003; Sadana et al., 2002). However, to date,
systematic analyses of the potential mechanisms underlying those cross-country
differences has been lacking. We seek to fill this void by conducting a comparative
analysis of disability policy, investigating how the different components of the
disability systems in the U.S. and Europe influence individuals’ perceptions of what
constitutes work limitations.
To study individuals’ perceptions, we look at how differently people characterize a
given level of work disability across countries (disability reporting style). Measures
of self-assessed disability status, which are commonly available in survey data, are
insufficient to conduct this type of analysis because they will reflect both the true

1. We thank an anonymous referee for making this point.
International Journal of Population Studies 2017, Volume 3, Issue 1 43