Workplace Well-being &
Inequality
ADPH Conference May
2010
Dr Steve Boorman
Director CR and Chief Medical Adviser
Royal Mail Group
NHS Workforce HWB- Lead Reviewer
Good Work
 A tale of two post women!!
 By way of context
Marmot Priority Objective C
Create Fair Employment & Good Work For All
 Improve access to good jobs and reduce long-term unemployment across the
social gradient
 Make it easier for people disadvantaged in the labour market to obtain and keep
work
 Improve quality of jobs across the social gradient
Health inequalities and work!
 Health inequalities result from social inequalities in the conditions in which
people are born, grow, live, work and age
 Action taken to reduce health inequalities will have economic benefits in reducing
losses from illness associated with health inequalities. These currently account
for productivity losses (estimated £33bn/year), reduced tax revenue and higher
welfare payments (up to £32bn/yr) and increased treatment costs (£5.5bn/yr).
Work as a harmful myth!
 Work widely perceived as noxious
 Health Risk = smoking 10 packs of cigarettes per day (Ross 1995)
 Suicide in young men > 6 months out of work is increased 40 x
(Wessely, 2004)
 Suicide rate in general increased 6x in longer-term worklessness
(Bartley et al, 2005)
 Health risk and life expectancy greater than many “killer diseases”
(Waddell & Aylward, 2005)
 Greater risk than most dangerous jobs (Construction/North Sea)
 “Long term worklessness is one of the greatest known risks to public
health”
Working For a Healthier Tomorrow
 Dame Carol Black’s appointment and review
 Ill health among working age population has equivalent cost of
running a second NHS
 Work not seen as an important clinical outcome
 Consequences of worklessness on long term health – of individual,
and of family
 Black built on earlier work and Marmot accepts case that
unemployment (particularly long term) impacts on physical and
mental health
 Taken further – Good Work protects health
What is our overall goal?
Healthy engaged workforces in well-managed organisations
• A quality product
• A high-performing resilient workforce
• Enhanced productivity
Contributing to :
• A well- functioning society
• UK plc
Why people are off work in the UK
and many other countries
• Two-thirds of sickness absence
and long-term incapacity is due
to mild and treatable conditions:
• Depression, anxiety, stressrelated mental health
problems (est. cost £28.3 bn
in 2008)
• Musculoskeletal conditions –
mild and often soft tissue
(est.cost £7 bn in 2007)
• Poor retention in the workplace of
those with disabilities or chronic
disease
• Obesity and demographic shift
are significant risk factors to
exacerbate
Mental health: the facts
• 1 in 6 working age adults have symptoms associated with mental
ill-health (e.g. sleep problems, fatigue, etc) which do not meet the
criteria for diagnosis
• A further 1 in 6 working age adults experience diagnosable mental
health problems (e.g. depression, anxiety, etc)
• An estimated 1-2% of the population have severe mental health
problems (e.g. schizophrenia, bipolar disorder, etc)
• 44% of people on long-term health related benefits have a mental
or behavioural disorder as primary conditions
The Royal College of Psychiatrists: Mental Health and Work (2008)
• 11.4 m days lost in 2008/09 due to stress/depression
• Mental illness causes 46% of all sickness absence (average
length of absence 28 days per case)
Mental health and work
• Being in work generally leads to good mental health, selfesteem and well-being
• Being out of work is associated with poor mental health,
increased likelihood of anxiety and depression, and increased
use of medication
• When people return to work their mental health and wellbeing generally improve
• Although work can pose a risk to mental health, the positive
effects far outweigh the risks
• People with mental health problems attach a high priority to
work, and work can be part of the recovery process
• Poor mental health associates with low earnings, social
exclusion, poorer physical health, child poverty, disrupted
education
Unemployment rate by previous
occupation
Long term conditions:
SMR for 3 respiratory diseases
TB
Ca lung
COPD
Long term conditions
are more likely to be
work-limiting in
poorer socioeconomic groups
before retirement
age
300 –
200 –
100 –
1 2 3n 3m 4 5
Ratio
8.9
Unskilled manual:
professional
1 2 3m 3n 4 5
1 2 3m 3n 4 5
4.6
14.2
Source Office for National Statistics
SMR = Standard Mortality Rate
Marmot - Two inter related aims!
 Reduce the adversity of adverse working conditions
 Targeting interventions proportionately towards lower socioeconomic groups
Prioritise active labour market programmes
 Integrate unemployed in to work v passive income support
 Create jobs, offer employers subsidy to offer employment opportunities and
grants for start ups
 Support for retraining and reintegration – improving occupational mobility for
unemployed
 Improving job matching programmes to increase success rate of at risk groups
such as long term unemployed
 Evidence to date is mainly short term but is positive for disadvantaged groups
(especially mental ill health now reflected in New Horizons
What is Good Work?
Marmot highlighted ten key components
 Precariousness – stable, risk of loss, safe
 Individual control – part of decision making
 Work demands – quality and quantity
 Fair employment – earnings and security from
employer
 Opportunities – training, promotion, health, “growth”
 Prevents social isolation, discrimination & violence
 Share information, participate in decision making
collective bargaining, justice if conflicts
 Work/life balance
 Reintegrates sick or disabled wherever possible
 Promotes HWB – psychological needs self efficacy,
self esteem, belonging and meaningfulness
 Both physical and psychosocial environments critical
Creating better work!
 Risk assessment – physical and chemical risk factors
 Shift work & work time factors (eg breaks, working hours, time control, flexibility)
 Improving psychosocial workplace risk factors
 These are largely intuitive and already subject to law
Vital few
 Creating good work
 Psychosocial and physical work environment critical
 Lack of reward and lack of control – stress risk factor and worse for lower socio
economic groups
 Work environment change combined with positive health promotion beneficial in
creating health promoting work
 Preventative and rehabilitation approaches need improvement to create health
promoting work
Leadership and Staff Engagement
Is HWB Important?
Interest in health and wellbeing
50%
45%
40%
35%
30%
My colleagues take a positive interest in my health and
wellbeing
My line manager takes a positive interest in my health
and wellbeing
Senior managers in my organisation take a positive
interest in the health and wellbeing of the employees in
my workplace
My NHS employer takes a positive interest in the health
and wellbeing of all its employees
25%
20%
15%
10%
5%
0%
Strongly disagree
Disagree
Neither disagree nor agree
Agree
Strongly agree
Although 80% of NHS staff felt their HWB impacted on quality of patient care, only
40% believed their employer cared!
We also found over 65% of staff reported coming to work in last month feeling ill
enough to consider taking time off!
HWB and organisational performance
The Case for Change
Correlation between HWB performance and outcomes
LSE Research headlines (Value of Rude
Health - Independent evaluation)
• >£227 mil saving over 3 years, £46mil investment
• Small depot - impact equivalent to 14 extra parcels or
£2700 a day on P&L
• Direct link to Q of S and sales
• Maps our initiatives to our attendance improvement
flight path – ie HWB interventions did reduce SA
• Since savings continued and attendance now 40%
improved on base line
Time periods 2011 - 2015
 Develop Active labour market programmes
 Improve quality of work across social gradient, adhere to legislation and equality
guidance and ensure compliance with stress management and well-being
promotion at work
 Improve security and flexibility of employment via increased flexibility around
retirement age, and encouraging employers to adapt jobs to accommodate
especially lone parents, carers and those with physical and mental health
problems
Time periods 2016-2020
 Widen use of Active labour market programmes to intervene early & decrease
long term unemployment
 Improve implementation of quality of work across social gradient, increase job
security in employment contracts and employers adhering to equality legislation
and extending stress management and active HWB programmes
 Extend security and flexibility of employment via continued flexibility around
retirement age, and continuing efforts for employers to adapt jobs to
accommodate especially lone parents, carers and those with physical and mental
health problems
Time periods beyond 2020
 Use of Active labour market programmes to achieve timely interventions and
reduce long term unemployment
 Improve quality of work across social gradient, building in job security to
employment contracts and monitoring employers adhere to legislation and
equality guidance and monitor compliance with stress management and wellbeing promotion at work
 Continue to achieve flexibility of employment via a tax & benefits system that
promotes flexible working and ensuring jobs are suitable for lone parents, carers
and those with physical and mental health problems
Why Health and Well-being in the NHS?
We tried to articulate a case for change – seeking higher priority for staff health
Healthy workforce essential for the NHS to meet 21st Century challenges and deliver Lord
Darzi’s vision of High Quality Care for All
•Rising demand driven by demographics and increasing expectations
•Imperative to deliver better quality care
•£20bn savings1 can only be delivered by a healthy and productive workforce
•Innovative approaches required to address additional pressures on staff
•Keeping communities well needs prevention as a key workforce skill
NHS Constitution gives legal rights to:
NHS cornerstone of Government response to Dame Carol
Black
•Patients and public –
quality of care
•Staff – rewarding jobs
in a healthy and safe
environment
1 Source:
NHS Chief Executive’s annual report 2008/09
•NHS should be an
exemplar of workplace
health
•Improving staff health
can improve the health of
the general population