Nick Pahl, CEO Society of Occupational Medicine (Supporting occupational health and wellbeing professionals)
Professor Brendan Burchell, Department of Sociology, Fellow, Magdalene College University of Cambridge.
There is a paradox in Britain today. We know that paid work is good for mental and physical wellbeing, but we have an increasing number of people who are out of paid work because of ill health. It is like being too ill to take the medicine, and like most paradoxes, if we think about it differently, we should be able to see a way of making more sense of it.
Let’s start with the premise that employment is good for health. Statistically, this is easy to demonstrate; numerous trials have followed individuals in and out of jobs and find that mental and physical health improves when people move from being workless into a job, and health deteriorates when people lose their jobs and become unemployed or ‘economically inactive.’ This is particularly true of ‘good jobs’ – rewarding and worthwhile jobs that enhance our life, social interaction, appreciation from others, a feeling of achievement, and self-esteem.
The one caveat is that it is true on average, but not for all jobs. There are some jobs, fortunately a small minority in the UK, which are bad ones, would then people would be better off without them. There has been a long-term ambition to improve jobs (as in an EU mantra ‘More and better jobs’), but unfortunately that has not been a priority for governments over the last 14 years.
There are lots of ways we can improve jobs. Sometimes it comes through legislation, for instance the European Working Time Directive, or rights over unfair dismissal, and sometimes it can be brought about by threats of legal action – for instance, where an employer does not seriously take a culture of misogyny, racism, or bullying. Health and safety legislation has done a good job of dealing with poor physical environments at work that can lead to respiratory illnesses or muscular-skeletal problems. It also comes from support at work. Occupational physicians can advise employers both on the impact of jobs generally and the specific impact on vulnerable individuals who may be, for instance, be more vulnerable to stressors at work.
We also need to consider whether many people who are currently excluded from work would be able to return to work if conditions were right. The previous government tended to interpret this situation as meaning that if we put enough pressure on them, for instance by reducing or withdrawing benefits, or making it more difficult to register as ill, then we could force them back into work and shift them from benefit claimants to taxpayers. But there is another way to consider this.
There are many people in our society who would be healthier and happier if they had a job, but it would have to be a job that would make it easier for them to combine caring for themselves or caring for others, in particular children or older people, with being in paid work. There are some things that we could do to make a lot of these high quality, health-giving jobs more widely available. Two specific examples are hybrid working and the four-day week. Working from home can be life-changing for some people with disabilities, particularly if they have limited mobility or need to combine employment with care responsibilities. And the trials of four-day-week working, where employees are given a 20% reduction in working hours, have been welcomed by many individuals with disabilities and organisations that support individuals with disabilities. Working four days and having a three-day weekend is far more manageable for people with certain health issues than working five days with only a two-day break.
Changing the labour market so we have better work-life balance for everyone is a great place to start, but there is also a vital place for considering the match between the person and the job. In many cases, simple modifications to a job can allow employees with health problems to remain in the workplace or permit others to make the transition into employment.
A combination of better jobs for everyone and modifying jobs for people who would otherwise struggle to work would seem to make us a more inclusive and a more equal society; a powerful way to increase social inclusion is through inclusion in the workforce.
The potential for win-win solutions is massive here – a virtuous cycle between good health and economic prosperity. That is why the Society of Occupational Medicine’s Manifesto 2024 called for universal access to occupational health. This would boost the UK’s economy as it would reduce the number of people who are not in work due to ill health (which has spiked by over 400k to over 2.8M since the pandemic). This measure should be accompanied but a
national Occupational Health strategy that would cover:
Investment to support people stay in and return to work, linking primary care with community assets, and work and pensions including Job Centre Plus staff and occupational health in a tiered framework
A local work and health strategy to strategically support people living with ill health return to work and stay in work
Reform of the fit note to support people quickly back to work through case note reviews and rapid access
A workforce plan that builds a multidisciplinary occupational health workforce that can deliver occupational health advice across all workplaces.
A National Director for Work and Health
Investment in NHS occupational health to enable health and social care professionals to access the support they need
There should be a requirement for larger organisations to invest in workplace health, including occupational health and investment in research with a National Centre for Work and Health for evidence generation to inform employers.
If we aim for a society that prioritises good jobs, that understands that good work is good for you, and that if you are sick then you will be supported to return to work; then we can solve the paradox of stick note Britain and see many more people in work and healthier for it.
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