Health matters: health and work

Content from Public Health England


Being in good work is better for your health than being out of work. ‘Good work’ is defined as having a safe and secure job with good working hours and conditions, supportive management and opportunities for training and development.

There is clear evidence that good work improves health and wellbeing across people’s lives and protects against social exclusion. Conversely, unemployment is bad for health and wellbeing, as it is associated with an increased risk of mortality and morbidity.

For many individuals, in particular those with long-term conditions such as mental health problems, musculoskeletal (MSK) conditions and disabilities, health issues can be a barrier to gaining and retaining employment.

Combined costs from worklessness and sickness absence amount to around £100 billion annually, so there is also a strong economic case for action. Addressing and removing health-related barriers requires collaborative work between partners from across the private, public and third sectors at both national and local level.

Scale of the problem

Why employment matters to health

As adults in employment spend a large proportion of their time in work, our jobs and our workplaces can have a big impact on our health and wellbeing. In fact, employment can impact both directly and indirectly on the individual, their families and communities. Therefore, work and health-related worklessness are important public health issues, both at local and national level.

There is clear evidence that good work improves health and wellbeing across people’s lives, not only from an economic standpoint but also in terms of quality of life. ‘Good work’ means having not only a work environment that is safe, but also having a sense of security, autonomy, good line management and communication within an organisation.

There is also evidence that shows that good quality work protects against social exclusion through the provision of:

  • income
  • social interaction
  • a core role
  • identity and purpose

Conversely, there is also clear evidence that unemployment is bad for your health as it is associated with an increased risk of mortality and morbidity, including:

  • limiting long-term illness
  • cardiovascular disease
  • poor mental health
  • suicide
  • health-harming behaviours

Just as unemployment can be a risk factor for various health conditions, long-term health conditions including MSK conditions such as back pain can also be the cause of unemployment. This is known as ‘health-related worklessness’.

The cost of ill health

From an employer perspective, the benefits of a healthy workforce are clear. Healthy staff are more productive, take less time off sick and do not necessarily need to retire early.

An unhealthy workforce negatively impacts our economy and society due to:

  • lost productivity
  • a reduction in income tax receipts
  • increases in long-term sickness
  • increased informal caregiving
  • increased healthcare costs

Looking at the wider economy, combined costs from worklessness and sickness absence amount to approximately £100 billion annually, so there’s a strong economic case for action. The costs of ill health to the UK government is estimated to be around £50 billion a year, as a result of benefit payments, additional health costs, taxes and national Insurance.

A healthy and productive workforce

Enabling people with health issues to obtain or retain work, and be productive within the workplace, is a crucial part of the economic success and wellbeing of every community and industry.

Therefore, it is important that people are supported to gain employment and maintain economic independence for themselves and their families, especially as they age. This is of particular importance for individuals with long-term conditions and disabilities, due to the barriers they face in gaining employment and retaining a job.

Collaborative work between partners from across the private, public and third sector is essential for creating pathways to good jobs. Local government plays an important role in bringing these partners together, as well as leading by example within their workforce. The call to action section below expands on the actions local authorities can take in the health and work agenda.

Health of the working age population

As of September 2018, in the UK there were an estimated:

  • 32.4 million people in work, with the employment rate for 16 to 64 year olds who were in work being 75.7%
  • 1.38 million unemployed people (people not in work but seeking work and available to work), with the unemployment rate estimated at 4.1%
  • 8.74 million people aged from 16 to 64 years who were economically inactive (not working and not seeking nor available to work), with the economic inactivity rate estimated at 21.2%

Around 12.8 million (31%) of working age people in the UK have a long-term health condition. One in 4 UK employees reported having a physical health condition, and 1 in 5 of those employees with physical health conditions also reported having a mental health condition. People with one health condition have an employment rate of 61%, while those with 5 or more have an employment rate of 23%.

Of the 5.3 million people with a non-disabling long-term health condition in the UK, 81.6% are in employment compared with 81.2% of the 28.4 million people with no long-term health conditions. This suggests that the existence of a health condition does not in itself affect the likelihood of people being in work, but whether it is perceived to limit a person’s day-to-day activities.

Employment rates are lowest among disabled people, with only 51.3% in work, meaning there is a substantial employment rate gap in the UK between disabled and non-disabled people (81.4% in employment). Among these working age disabled people in the UK, 54% have a mental health or MSK condition as their main health condition.

Almost 9 in 10 disabled people that are out of work are economically inactive.

As the population of the UK ages, there will be an increase in the number of people with one or multiple long-term conditions and limiting long-term conditions. It also means that people are likely to be working for longer, with over 9 million people aged 50 to 64 in the UK who are employed, an increase of more than 2 million since 2008.

In 2017, the UK government published Improving lives: the future of work, health and disability. This sets out the actions that are being taken across 3 settings (welfare, the workplace, and the health system) to transform employment prospects for disabled people and people living with long-term health conditions. It also includes the government’s commitment to see 1 million more disabled people in work over the next 10 years.

The UK government also published the Industrial Strategy in 2017. This sets a path to improved productivity while keeping employment high, with the objectives of raising living standards, providing funds to support public service, and improving the quality of life for all citizens. The strategy strengthens the 5 foundations of productivity: ideas, people, infrastructure, business environment and places. Furthermore, it sets out 4 ‘grand challenges’, one of which is meeting the needs of an ageing society, which is of great importance for the work and health agenda.

Creating healthy workplaces

Creating healthy workplaces entails supporting disabled people and people with long-term health conditions. It is also important to ensure the health and wellbeing of healthy employees who do not have existing health conditions is maintained, as work and the workplace also play a pivotal role in this.

Jobs need to be sustainable and offer a minimum level of quality, which should include:

  • a decent living wage
  • opportunities for in-work development
  • flexibility to enable people to balance work and family life
  • protection from adverse working conditions that can damage health

Mental health and MSK conditions remain 2 of the leading causes of sickness absence. The following sections outline the burden these conditions place on individuals of working age and their employers.

MSK and work

The pain and disability of poor MSK health limits independence and the ability to participate in family, social and working life. It is estimated that 17.8 million people live with an MSK condition in the UK, and according to Arthritis Research UK, only 59.4% of people of working age with an MSK condition are in work. Furthermore, around 1 in 5 people with arthritis have depression.

In 2017, MSK problems were the second most common cause of sickness absence, accounting for 28.2 million days lost in work (17.7% of total sickness absences). The most common cause of sickness absence was acute illnesses such as cough and colds, which accounted for 34.3 million days lost.

You can read more in productive healthy ageing and MSK health edition of Health matters.

Mental health in the workplace

1 in 6 employees in the UK reported having a mental health condition, and stress, depression and anxiety are leading causes of sickness absence. In 2017, these conditions accounted for 14.3 million working days lost per year (7.6% of sickness absence). The estimated cost to UK employers of mental health-related absence is £7.9 billion.

People with mental health problems are also often over-represented in high-turnover, low-paid and often part-time or temporary work.

Being in good employment reduces the risk of mental health conditions such as depression and psychological distress but, for some people, can also be a cause of stress and common mental health problems.

The NHS is on track to support up to 20,000 people with severe mental illness to find and retain employment by 2020 to 2021. Employers also have an important role to play in supporting their staff to stay well and in work. The government has published a framework to help employers record and voluntarily report information on disability, mental health and wellbeing in the workplace.

The 2017 independent Stevenson/Farmer review of mental health and employers makes a number of recommendations for the public sector, government and employers on managing mental health at work. The Public Health England (PHE) and Business in the Community (BITC) Mental health toolkit for employers is well reflected in the report and provides a strong road map for the steps to achieving the changes that the review proposes.

You can read more about mental health conditions and employment in reducing health inequalities in mental illness edition of Health matters.

How PHE can support you

PHE has multiple tools to support the health and work agenda, which can be used to start the conversation at local level to shape local action.

Fingertips data tool

PHE’s Fingertips Wider Determinants of Health data tool provides public health professionals with intelligence regarding the wider determinants of health – to help improve population health and reduce health inequalities.

The tool includes data on the following topics for each area:

  • employment rate, economic inactivity rate, and unemployment rate
  • employment rate trend
  • long-term Jobseeker’s Allowance claimants
  • learning disabilities employment gap
  • long-term conditions employment gap
  • mental health conditions employment gap
  • MSK conditions
  • employment issues and over 50 year olds
  • local spotlight on young people
  • local spotlight on sickness absence

These profiles are a rich source of indicators across a range of health and wellbeing themes that have been designed to support Joint Strategic Needs Assessment (JSNA) and commissioning to improve health and wellbeing, and reduce inequalities.

With these profiles you can:

  • browse indicators at different geographical levels
  • benchmark against the regional or England average
  • export data to use locally

Return on investment tool

PHE’s interactive return on investment (ROI) tool, Movement into employment: estimation of benefits from moving individuals into employment, can be used by local decision-makers to assess the health and financial benefits (for individuals, the economy and wider society) of helping people in their area back into work.

The ROI tool focuses specifically on the impact on mental health of moving from unemployment to employment. The results can be used by local authorities, clinical commissioning groups (CCGs), Jobcentre Plus and national policymakers to make the case for greater investment in health and work interventions.

Workplace health tools and employer toolkits

A health-needs assessment is a simple way to gather anonymous information about the health of a company’s workforce and provides a baseline of data to track progress against. It helps employers to understand areas to invest in within staff health and wellbeing, especially beyond the basic legal health and safety requirements.

PHE and Healthy Working Future’s Workplace health needs assessment document provides practical advice on workplace health and a tool for carrying out workplace health needs assessments for employers of all types and sizes.

PHE has also developed multiple employer toolkits, in partnership with BITC, to help employers support their workforce to be productive and have good health and wellbeing.

These toolkits include: