Health:Unemployment and Employment : The Links Between Health and Work

1. Health:Unemployment and Employment :The Links Between Health and Work Dr Nerys Williams Principal Occupational Physician Department for Work and Pensions London, June 2008.

2. Outline • The Big Picture • How people become unemployed • Health effects of unemployment • Benefits (and harms) of employment

3. 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.

4. 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

5. 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)

6. 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)

7. 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)

8. 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)

9. Summary of Evidence on Benefits of Work for the Majority of People • “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

10. Benefits of work Work benefits (from the work of Jahoda 1973) • Financial • Social • Status • Discipline/routine • Opportunity

11. 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

12. 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) Example of Benefits of Being an Employee:A Midlands NHS Trust

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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