ADPH Presidential blog: Sickness in the workforce – how to reverse “alarming trend”

Jim McManus, President, Association of Directors of Public Health 

Figures from the ONS released earlier this month revealed that unemployment due to long-term sickness has reached record levels, more than trebling in the last year. Moreover, according to government figures, a staggering 131 million working days are lost every year due to ill health while 1 in 3 employees with a long-term health condition have never discussed it with their employers. On this measure alone, a healthy workforce is clearly vital for a healthy economy.

This data paints a very worrying picture, and not just for the individual – being employed, or not, has a knock-on effect for both families and communities which makes sickness in the workforce, and its increase, an important issue for those of us in public health, both locally and nationally.

Being in employment is intrinsically good for our health. As well as the obvious benefit of providing an income, working also has less tangible benefits including providing us with a role, identity and purpose and much needed social interaction, all of which are vital components of mental health. The reverse is also true, with unemployment carrying an increased risk of poor mental health, mortality and morbidity.

Across all the reports and statistics, mental health is cited as one of the biggest causes of workplace illness with an estimated 14.3 million working days lost per year, costing UK employers in the region of £7.9 billion. In 2017, one in every six employees in the UK reported having a mental health condition – a figure that has undoubtedly risen as a result of the pandemic. When looking to the next generation of workers, mental health is also a grave, and growing, concern, with a large proportion of NEETs suffering from mental health problems. 

So, with an ageing population, an increasingly older retirement age and rising numbers of mental health problems in young people, the numbers of long-term sick look set to continue rising unless we take action, but what should action look like?

Recruitment and retainment

According to the 2018 CMO report for England, half of people on incapacity benefits had a mental health problem. Even if supported into work however, people experiencing mental health problems are often over-represented in high-turnover, low-paid and part-time jobs, which provide an unstable, inconsistent environment that carries with it a danger of further feeding into a cycle of unemployment causing a deterioration in health, making it harder to get into, and stay in, work.

There are many excellent initiatives encouraging people with a whole range of health problems into work – all of which are, of course, vitally important. However, what we also need are programmes specifically focussed on helping people stay in their jobs when faced with ill-health.

Occupational health has a role to play and colleagues in the profession do an enormous amount to support with rehabilitation and absence management as well as with health promotion and prevention. Indeed, workplace health and wellbeing schemes are key to supporting a healthy workforce and there are excellent examples of employers leading the way with this work. However, occupational health, although an important piece, isn’t the whole picture.

Good work

The pandemic, along with all its lessons, has focused the minds of millions and forced people to think about the trade-off between health and work. Many who had struggled while working before, especially those whose conditions were exacerbated by their job, found themselves to be healthier and happier on furlough. It will be interesting to see how this section of the population decide to move forward; some of them may well be in that health-related inactivity bracket although clearly the current economic pressures may cause a shift back to work for some.

Others may have joined the gig economy which, although offers seeming freedoms not afforded by employment, is a growing concern for public health, with a lack of the normal protections and safeguards associated with good work. 

We need good work. It’s for another time to talk in more detail about what that is but this report from Public Health Scotland makes some important points about what good work looks like, how it can build better health, and how it benefits the economy.

Put simply, ‘good work’ – having a safe and secure job, good hours, good conditions, supportive managers and opportunity for training and development – should be considered important by employers both in terms of job creation and when it comes to adapting existing roles. After all, once someone becomes sick, the longer they are off work, the harder it becomes to make the return to work.  Ultimately, employers need to be able to create a working environment that makes it easier for people to maintain good health throughout their employment.

An asset for the economy

It is, after all, in an employer’s interest to have employees who are in good health and able to work more productively for longer. Having a healthy workforce isn’t just good for individual businesses though. If all work is ‘good work’ then the whole nation has a healthier, more present and productive workforce and economic growth will necessarily follow with more people employed, more business being done, and more profit being made.

Therefore, with combined costs from worklessness and sickness absence totalling around £100billion every year, it simply makes good economic sense to put our efforts into having a healthy workforce – not only will we save money, we will make money too! 

Closing the gap

Unfortunately, as with nearly all public health issues, there is a huge disparity between rich and poor when it comes to workforce health and the sobering difference between healthy life expectancies not only has implications for the workforce, but for the NHS and social care – and this is true across all four nations of the UK.

Research shows that individuals born in our affluent areas, will not only be better educated and live longer, but will only spend a seventh of their longer life in poor health, with its onset often after retirement.  Conversely, individuals born in our poorest areas can expect to live a third of their, already shorter life, in a state of poor health with its onset towards the end of middle age, which crucially for business means while still within their economically productive years. 

Meanwhile, the 2018 CMO report clearly identified that health and economic outcomes drive each other, with strong links between poor educational attainment and poor health then impacting on an individual’s ability to work which can further impact living standards and health. 

How then do we turn this vicious cycle into a virtuous circle?

The IFS concluded that it is highly likely that an integrated approach to dealing with health, education, economic productivity and poverty will work better than approaching each in isolation – a position local Directors of Public Health take in all their work and see on a day to day basis locally but one we must start adopting nationally.

There needs to be more incentives for employers to recruit people furthest from the labour market as well as more support for voluntary and community sector organisations who work with individuals who want to work, but who have been unwell and are struggling to get into, or stay in, work.

There needs to be a wider appreciation for the hidden barriers to employment – like fully accessible public transport while local health risk reduction and promotion services need to be readily accessible to employers along with closer ties being forged between Job Centres, business and local health services.

However, it isn’t just a case of employers being more flexible and making sure everyone has the appropriate equipment or access to counselling and occupational health and it’s not just a case of more training to use the wide range of employer toolkits out there.

Rather, it’s a case of doing all of these things and more – from good work design to policy which sees health as an asset to economic growth - in a joined up, preventative way that puts health at the centre of policy so that the population are as healthy – and as able to work – as possible.

Fortunately, there is much being done and DsPH are in a unique position to be able to help bridge the gap between the health and economic agenda and support the work being done by chambers, employers federations across the UK, economic development bodies like Scottish Regional Enterprise Partnerships and English local economic partnerships with local authorities and the NHS to promote ‘good work’.

As local leaders for the nation’s health, we are able to bring people from different departments and sectors together, to encourage more partnership working, develop joint approaches and co-commission programmes to promote this agenda with the backing of both council and clinical leadership. However, we also need our local approach to be replicated nationally so that the numbers come down and the alarming trend we are seeing is reversed for good.

Read our policy position on Living and Working Well