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)physician Employment is nature’s and is essential to is nature’s Employment human happiness. Voltaire 1694-1778) physician Work banishes those three great evils and is essential to human – boredom, vice and poverty. happiness.
William Osler (1849-1919)
To the young it brings hope, to the middle-aged confidence, to the aged repose – work.

Galen (129-200)

But many people wrongly think that • you must be off work to recover fully from illness • health conditions and disabilities are inevitably barriers to employment. The challenge is to uproot these misconceptions.

Theodore Roosevelt (1858-1919)
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
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!

Better 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: • 2 to 3 times risk of poor health
• Greater risk than many “killer diseases” • Greater risk than most dangerous jobs (e.g. construction, fishing, etc)
Proportion of deviation from perfect health by work status

• 2 to 3 times risk of mental illness -anxiety and depression • Loss of worth and selfconfidence • Loss of fitness and well-being

Health of unemployed and re-employed men
Unemployed 18 – 24 months
35 30 25 20 15 10 5 0


Unemployed >6 months before re-employment

Nottingham health profile
Unemployed Re-employed Weighted random population sample

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 health and well-being in the workplace; • 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

Working for a Healthier Tomorrow

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

urrent System o clear pathways of rehabilitation Ps not educated in the relationship between work and health Ps, OH professionals, & employers do not have close working relationships

A new model – GPs trained on the important links between work and health × Return to work seen as an indicator of clinical success × Electronic Fit Note Fit For Work Services Healthcare professionals work with × employers and multidisciplinary services 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 healthcare setting (e.g. Vocational Rehabilitation, communication with employers, etc) GPs are usually the first port of call – they issue most sick notes.

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