Health:Unemployment and Employment :
The Links Between Health and Work
Dr Nerys Williams
Principal Occupational Physician
Department for Work and Pensions
London, June 2008.
Outline
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The Big Picture
How people become unemployed
Health effects of unemployment
Benefits (and harms) of employment
The Big Picture
• Working age population = 36 m
• Unemployed population = 800,000
• Incapacity benefit claimants = 2.7 m
7.5% of the working age population is on an incapacity
benefit and 2.5% are unemployed. Nearly 10% are
economically inactive.
How people become unemployed
• Voluntary exit (health or non health related)
• Redundancy ( individual or company)
• Disciplinary procedures e.g. poor attendance, poor
sickness record,
• Health procedures, e.g. ill health retirement or medical
severance
• Never worked due to childhood illness, poor education,
no skills
The health effects of unemployment
Well documented
Unemployment if one of the most significant contributors
to social and health inequalities
Leads to increased :
• consumption of tobacco (Wilson and Walker 1993)
• alcohol, (Janlert and Hammerstrom 1992)
• sexual risk taking (Hammerstrom and Janlert 1997)
• GP services (Jin et al 1995)
• Use of medication (Studnicka et al 1991)
• Admissions to psychiatric hospital (Agerbo et al 1998)
The health effects of unemployment
Unemployed people have
• Twice the rate of depression and three times the rate
of anxiety than the general population (Ytterdahl et al
2000)
• Increased rates of obesity (Morris et al 1992)
• Reduced rates of activity (Underlid 1996)
• Increased cardiovascular morbidity and mortality
(Brenner 2001)
More links between health and work…
• Unemployed people show worsening mental and
physical health with time
• Workers in companies where redundancies are likely
to occur have worse health even if they eventually
keep their jobs
• Workers in companies which are changing show more
sickness absence and hospital admissions
• The higher the socio-economic status of the person ,
the lower probability of illness and mortality, holding
age and sex constant (Brenner 2001)
More links between health and work…the
added difficulties
• Unemployed people show worsening mental and
physical health with time
• Unemployed people suffer a loss of self esteem which
influences their chances of re-employment (Wates and
Moore 2004)
• Debt increases the risk of mental and physical ill health
(White 1991)
• Unemployed people find it harder to be successful at
health interventions e.g. smoking cessation (Lee et al
1991)
Summary of Evidence on Benefits of Work for
the Majority of People
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“Is Work Good For Your Health and Wellbeing ?”
By G Waddell and K Burton
Published by The Stationary Office 2006
Review looks at impact of :
– Work on health
– Unemployment on health
– Moving from unemployment to employment
– Moving off benefits and into employment
Benefits of work
Work benefits (from the work of Jahoda 1973)
• Financial
• Social
• Status
• Discipline/routine
• Opportunity
Health Benefits of Work
• Reduction in psychological distress (for return to both
long term but also temporary work (Bjarnason and
Sigurdardottir 2003)
• Fall in distress levels when unemployed re enter
employment (Murphy et al 1999)
• Reduction in cardiovascular morbidity and mortality
(Brenner 2001)
• Enhanced socio economic status
• For some, more opportunity to access health
promoting services and schemes
Example of Benefits of Being an Employee:
A Midlands NHS Trust
Access to:
smoking cessation courses
counselling services
physiotherapy
Health club (weight
management)
discounted childcare in
designated facilities
Financial and Training
tax relief cycle purchase
subsidised computer purchase
lower rate loans
subsidised bus travel
ECDL/Managing stress
Presentation skills
(London and South East
keyworker housing scheme)
So why don’t people return to work?
Simplistically
• Medical label (“crumbling spine”)
• Beliefs ( “it will make it worse” “work caused my
problem”)
• Attitudes (“I don’t like pain killers”)
• Waiting for a “cure”(“I can only go back to work when
my pain has completely gone”)
Many of these beliefs/attitudes are influenced by health
care practitioners
The potential negative effects of work
• 2.2 m people feel that their ill health is either caused
by or aggravated by, their work
(LFS)
• 40 m days lost due to work related ill health of which
just under 30 m are due to ill health (HSE)
• Whitehall Study: negative effects of high job demands
and low control
(Marmot et al)
• Interheart Study: work stress is one of 4 psychosocial
stressors which increase the risk of a first heart attack
More links between health and/at work….
• People also suffer ill health and are at work
• Impacts such as sickness absence (short and long
term) are important
• 4-6 times as much time is lost from non work related
as from work related ill health
• “Presenteeism” or “work impairment” also affects
productivity and is important for the UK economy
• General health status and perceived health impacts on
sickness absence, risk of injury and subjective work
impairment
Health and Productivity in Employment
• “for all chronic conditions, the costs associated with
health related work impairment or “presenteeism”
greatly exceeded the combined costs of absenteeism
and medical treatment”
• Biggest work impairment came from depression,
back/neck pain and breathing disorders
• For Dow, costs for work impairment per employee
were 10 times those for absenteeism.
“Effect of chronic health conditions on work performance and
absence and total economic impact for employers”.
Collins et al. JOEM 2005
Benefits of Work
Work benefits (adapted from the work of Jahoda 1973)
• Health (for the right type of work, the right job for the
right person)
• Financial
• Social
• Status
• Discipline/routine
• Opportunity
What we need to do….
We need to do more to:
• Prevent work damaging health
• Promote health of those at work
• Promote work for those with health problems
Healthcare practitioners are crucial to achieving these
goals