The record 2.5 million people out of work due to long-term sickness have forced policymakers to realise the importance of the health of the workforce. The March Budget and a recent flurry of thinktank reports underline health is an asset that enables people to thrive, supports the NHS and drives the economy. But the current crisis in workforce health is not a sudden change – it has been growing for the past decade and requires a long-term approach, investing now to prevent ill health in future. This involves rebuilding the relationship between employers, workers and health, and driving long-term action at national and local level.
The big shock to health caused by the pandemic revealed the vulnerable underlying health of the UK population and the lack of resilience in the health system. More working age people are living with one or more physical or mental health problems, and if they need a GP or hospital treatment they now face longer waits – a growing problem before the pandemic that has since reached a tipping point. We have seen relative underinvestment in the NHS and social care compared with peer countries and we know that a decade of decay will take another 10 years to recover from.
But the NHS was never meant to go it alone. It was supposed to be part of a wider system supporting people from cradle to grave; with decent jobs, pay, homes and education – the building blocks of good health. Many of these building blocks have been weakened but repairing them is key to sustainable growth, solving the productivity puzzle and levelling up.
The Health Foundation and others are drawing parallels with climate change as another complex, systemic issue requiring a long-term approach that goes well beyond the span of a single parliament, and encompasses action across society. We have shown that housing, food, clean air and green jobs provide opportunities for improving both health and the environment, but they need whole-government coordination. Although some policy mechanisms were put forward – and the government announced a levelling up health mission last year – a lack of political drive has slowed any progress. New proposals from the IPPR for a Health and Prosperity Bill could ensure a stronger framework based on the approach in the Climate Change Act. Translating this into impact on health requires having the right targets, identifying the local building blocks of health and making sure there is cross-sector buy in.
Estimates of the economic cost of ill health vary (usually because they try to capture different elements) but they all run into the tens of billions – previous government estimates put the economic cost of long-term sickness and absence at £100bn. Health is also a driver of regional inequality and key to levelling up, with an association between lower life expectancy and lower productivity.
With so many aspects of our lives influencing our health it cuts across many different agendas. It is fast becoming a core consideration in employment policy circles given the tangled relationship between work and health. We know from Health Foundation-funded research that the local relationship between health and work is complex. While health is an important factor in work and productivity, local labour market circumstances are also an important determinant – over and above health status. This reflects deep and persistent geographical inequalities in investment, job opportunities and work quality, as well as health. Having a secure job, with autonomy over working patterns, can be a boost to health but bad-quality work – such as low pay or irregular hours – can make people sick. We need to address local economic development to break a cycle of poor health, low participation and bad work.
Employers increasingly recognise that restoring the health of the workforce can help businesses grow as more people are able to work, take less time off and can produce more. Some are ahead of the game. The Business In The Community campaign, for instance, last week called for investment by employers starting with action on negative workplace culture as the biggest opportunity for improvement in wellbeing. The latest Budget also acknowledged the need for investment in worker health, and offered some support for the long-term sick to return to work, although it spent more on retaining early retirees.
More needs to be done to build our understanding of the health impact of the changing nature of work, and the work implications of demographic change and increasing mental illness among younger workers. We need to build an accepted economic case and define what works for local economies and individual employers. Long-term change requires consensus and to start building this, the Health Foundation is bringing together business leaders, unions, experts and policymakers in a new Commission that we will launch later this year. Supported by a programme of research and deliberative public engagement, the commission will set out a new deal between government, employers and people to invest in our health and build a thriving society.
Please see our vacancies for roles in the Work and Health Commission secretariat.
Joe Farrington-Douglas (@joefd) is an Interim Senior Policy Fellow at the Health Foundation.