Belgian experts are warning that public and political discourse around long-term sick leave is becoming increasingly stigmatising, as the Federal Government pushes ahead with measures aimed at getting more people back into work.
The Chronic Diseases Observatory criticised the government’s approach to long-term incapacity for work, arguing that too much emphasis is being placed on sanctions, controls and reintegration, while prevention and the conditions for a sustainable return to work receive too little attention.
"The public and political discourse surrounding long-term incapacity for work is increasingly characterised by stigmatisation and mistrust," the experts warn, according to La Libre Belgique.
€15 billion
More than 570,000 people were considered long-term sick in Belgium at the end of 2025, excluding civil servants. The issue has become a major political and financial concern, with the cost of disability benefits expected to rise from just over €15 billion currently to around €19 billion by 2029.
The Chronic Diseases Observatory, part of the scientific council of Belgium’s National Institute for Health and Disability Insurance (INAMI), does not dispute the need for a system based on rights and obligations. However, it warns that a predominantly punitive approach could have the opposite effect to the one intended.
"An approach that primarily relies on sanctions carries risks for recovery and sustainable reintegration," the experts argue, before adding that people suffering from chronic illnesses are often already in medically, socially and financially vulnerable situations.
Additional stress, uncertainty and fear can make recovery more difficult and potentially increase their distance from the labour market.
Focus on prevention
According to the Observatory, recent reforms have focused heavily on assessing people’s ability to work and bringing them back into employment, while prevention has remained largely overlooked.
The experts argue that preventing people from becoming too ill to work in the first place should be given greater priority. This means addressing working conditions themselves, including psychosocial risks, workload, sustainable employment and workplace well-being.
“We must not only look at the individual worker, but also at the organisation and culture of work themselves,” the Observatory says.
The body is also calling for clearer rules and a better division of responsibilities between the different professionals involved in reintegration, including GPs, medical advisers, occupational physicians and return-to-work coordinators.
Administrative procedures should also be simplified, while sanctions that risk pushing vulnerable patients into poverty should be avoided, the experts say.
Returning to work is “a process”
One of the Observatory’s main concerns is that political ambitions to increase labour-market participation do not always match the reality faced by people with chronic illnesses. "Returning to work is a process, not a one-off event," the experts stress.
A successful reintegration should therefore focus on finding sustainable, quality employment rather than simply closing a case as quickly as possible. Returning someone to the same working conditions that contributed to their illness could also increase the risk of relapse, according to the Observatory.
The pace and conditions of a return should instead take into account factors including the person’s illness, age, type of work and personal circumstances.
The experts also highlight a gap between a person’s theoretical "work potential" and their actual chances of finding a suitable job. "Even when a person has sufficient capacity to return to work, this does not automatically mean that a suitable job is available," they argue.
The Observatory therefore believes that the availability and flexibility of the labour market should play a greater role in the political debate around long-term incapacity for work. The warning comes as the Federal Government continues to tighten its approach to long-term sick leave, with stricter checks, more assessments and measures aimed at accelerating reintegration.
