Carol Black

National Director for Health & Work

Improving health and work:
changing lives

Health, Work and Well-being

of Working-age People:

The Need for Action

Work and health: The challenges

• The social gradient

• Stress
• Early life
• Social exclusion
•
Work/Unemployment
• Social support
• Addiction
• Food
• Transport
 Relationship Between Work and Health

Galen (129-200) But many people wrongly

Galen (129-200)
Employment is nature’s physician think that
Employment is nature’s
and is essential to human happiness.

physician
Voltaire 1694-1778) • you must be off work to
Work banishes those three great evils recover fully from illness
and is essential to human
– boredom, vice and poverty.
happiness. • health conditions and
William Osler (1849-1919) disabilities are inevitably
To the young it brings hope, to the
middle-aged confidence, to the aged
barriers to employment.
repose – work.
The challenge is to uproot
Theodore Roosevelt (1858-1919) these misconceptions.
Far and away the best prize that life offers is
the chance to work hard at work worth doing.

Waddell and Burton (2006)

Work is generally good for physical and
mental health and well-being
 work needs to be ‘good work’

Good work Better health

Characterised by:
• Job security
• Varied and interesting
• Workers have degree of autonomy, control and
task discretion
• Fair rewards (not just financial) for efforts made
• Supportive social relationships with strong social ties
within the workplace
• Worker engagement essential

Poor relationships and poor work environments can lead to poorer health!
 Most people are off work with
conditions that people in work may have

Mild and treatable conditions:

• Depression, anxiety, stress
related mental health
problems
• Musculoskeletal conditions
• Cardio-respiratory conditions
• Responsible for over two-thirds of
sickness absence and long-term
incapacity
• Inappropriate “medicalisation” -
contact with the workplace is
often lost
 Being out of work long-term is a great
risk to health

Being out of work: Proportion of deviation from perfect

• 2 to 3 times risk of poor health health by work status
• Greater risk than many “killer
diseases”
• Greater risk than most dangerous
jobs (e.g. construction, fishing,
etc)
• 2 to 3 times risk of mental
illness -anxiety and depression
• Loss of worth and self-
confidence
• Loss of fitness and well-being
 Health of unemployed and re-employed
men
Unemployed 18 – 24 months -v- Unemployed >6 months before re-employment

35
Nottingham health profile
30

25 Unemployed
Re-employed
20 Weighted random
population sample
15

10

0
Emotional reaction Social isolation Physical mobility
 It impacts on the next generation too

• 30% of children who have a parent

with a disability or health condition
live in poverty
• Evidence of correlation between
lower parental income and poor
health in children.

• Children in workless households

suffer higher rates of psychiatric
disorders

• Evidence that behavioural/conduct

disorders are more likely where no
parent in the household is working

• Children living in workless households are more likely to

experience worklessness themselves during adult life
 Costs of working age ill-health

• Overall costs of working age ill-health are in excess of

£100billion per year
• Around 172 million working days were lost to sickness
absence in 2007, at a cost to the economy of over
£13 billion (CBI)
• Total costs to the taxpayer, in terms of benefits and forgone
tax revenue, are over £60 billion per year.

• Loss of productivity for those who are ill but still in work likely
to be even greater – estimated cost due to mental ill-health
alone is £15 billion a year (Sainsbury Centre for Mental Health)
 My Review of the health of the working
population: A new vision for health and work
Review commissioned by Secretaries of State for Health and for Work and
Pensions in 2007 to lay the foundations for reform

At the heart of my vision:

• Prevention of illness and promotion of

Working for a health and well-being in the workplace;
Healthier
Tomorrow • Early intervention for those who are
employed but absent with a sick note
• Improvement of the health and well-being
of those within the benefits system
 The challenge of the current economic
climate
There is poor understanding of health and well-being initiatives that
employers can implement:

• Many employers are unaware of the business case for investing in health
and well-being
• Employers often do not have sickness absence policies to enable early and
sustained return to work
• Many employers have no policy on handling mental ill-health
– 60% of line managers underestimate the percentage of the UK
population that experiences mental ill-health
• SMEs struggle to find accessible and affordable sources of support and
advice
• No national standards are available to employers when they purchase
occupational health or well-being services
 Early Intervention to prevent worklessness

A new model –
urrent System - GPs trained on the important links between work
and health ×
o clear pathways of rehabilitation Return to work seen as an indicator of clinical
success ×
Ps not educated in the relationship Electronic Fit Note
between work and health Fit For Work Services
Healthcare professionals work with ×
Ps, OH professionals, & employers do employers and multidisciplinary services
not have close working relationships to achieve a sustained return to work
×
 The central role of healthcare
professionals
All healthcare professionals need to
understand:

• Good work is good for health and

well-being
• A return to functional capacity, and a
sustained return to work where
appropriate, should be key indicators of
clinical success in the treatment of
working-age people
• Work-related issues within the GPs are usually the first
healthcare setting (e.g. Vocational port of call – they issue
Rehabilitation, communication with most sick notes.
employers, etc)
 Involving health professionals

• Ground-breaking Consensus Statement, signed on 5 March 2008 by the

leaders of the healthcare profession, is a pledge to promote the link
between good work and good health

Good clinical care aims for return to functional status

 Mental health and work – a critical
relationship

• We need to tackle the stigma still attached to mental

health conditions

• Employers and GPs need to be better equipped to

detect and respond appropriately to signs of mental
ill-health

• Line managers in particular need to be better trained

both to protect the mental health of their staff and to
recognise and react to the signs of mental ill-health
 The challenge of the current
economic climate

• Employers even less able to sustain unnecessary

costs, such as those from high sickness absence
levels
• Employees experiencing increased concerns over
job and financial security may suffer from greater
levels of stress-related ill-health
• A healthier, more productive workforce which feels
valued will make it easier to secure a sustainable
and profitable future
 Next Steps

• Government accepted my
recommendations
• Government’s response
presented as a Command Paper
to Parliament on 25 November
2008
• Work to implement initiatives
has started
• Mental Health and Employment
Steering Group
– overseeing the creation of a
national strategy on mental
health and employment
– Intention to publish by late
spring/early summer 2009 “ Health is created in places where we
live, love, work and play.”
World Health Organisation