Variations in the size of the population receiving disability payments across countries cannot be explained by simple differences in health. Rather, the process to disability is shaped by both social and medical factors. When governments ignore this reality, a policy generated disability epidemic is possible. This paper compares disability policies in The Netherlands, Sweden, Germany, and the United States. It argues that the extraordinary increase in Dutch disability rolls in the 1970s was caused by a general government policy to reduce official unemployment. And that by the end of the 1980s, this policy had left Holland with a hidden unemployment rate that was twice its official rate and three times the unemployment rates in the United States and Germany
