Dame Carol Black UK National Director for Health and Work

1. Promoting health in ageing New York 27 September 2011 Work, Health and Active Ageing Dame Carol Black UK National Director for Health and Work

2. Work, Health and Active Ageing • The fullest possible working life benefits individuals and society. It is necessary to maintaining prosperity, health and wellbeing. • People who are not working depend on the support of those who are in work. • Being sufficiently healthy is a condition for work, and maximising healthy life as a proportion of total life is therefore a desirable goal for individuals and society.

3. Work, health and active ageing Society needs the maximum number of productive years from as many of the population as possible. We need the ratio of earners and wealth-generators to dependants (children, pensioners, unemployed) to be as high as possible. Childhood Working life Retirement In April 2011 it became illegal in the UK, without special justification, for an employer to require workers to retire at a fixed age. On current predictions, the future population will be composed of longer survivors, with more long-term health conditions. This is a challenge in many countries of the world.

4. Typical wealth trends during life Consumption Income Wealth £ Increase wealth - accumulate housing, pension wealth and savings Start Work Spending exceeds income Retire Income falls. Use wealth to compensate End life Exhausted Wealth Saving Dis-saving Dis-saving Time

5. What prevents us from working? As well reported in many countries: common mental health problems musculo-skeletal problems chronic diseases – mental and physical organisation of work, quality of line management, lack of leadership, inflexibility of the workplace, changing nature of work lack of education and/or skills deprivation, poverty, unavailability of employment. Solutions depend on collaboration, understanding and action involving employees, employers, healthcare professionals, trade unions, and local and national governments.

6. The American workforce • The American workforce is ageing, and it is projected that between 2006 and 2016 the number of workers aged 55 to 64 will increase by 36%, while the number of workers aged 65 and over will rise by 80%. • By 2015 one in every five workers will be 55 or older. • Older workers typically suffer from chronic health conditions and have multiple health risks. • Chronic conditions common at greater age often require more care, are more disabling, and are more difficult and costly to treat, than the chronic conditions more common in the young. From P. Hymel et al, JOEM 53 (6), June 2011

7. Work injuries and age: California Data analysis from the University of California at Berkeley (F.Neuhauser et al 2010) Risk of occupational injury or illness, relative to overall average risk Female • risk declines steadily with age for men, rises for women • sudden decline for both after age 64 is thought to be due to underreporting, connected with impending switch to Medicare • average duration of disability rises with age, but is slightly longer for men than women with similar diagnosis Male Data from Current Population Survey, Workers’ Compensation Information System etc, controlled for job type, hours worked etc. Age Overall impact of ageing workforce on frequency, duration and total cost is expected to be modest: frequency and duration trends offset, and workers over 55 will remain a minority (12% of workforce in 2000, 23% in 2030).

8. The UK workforce • Every day the average lifespan of British citizens increases by between five and six hours. • The proportion of people in the UK over 65 is expected to increase from 16% in 2004 to 23% in 2031. • By 2020 almost a third of the workforce will be over the age of 50. • In 2010, total employment in Britain went up by 218,000, of which 104,000 went to those over 65 • thus nearly half of all new jobs went to a sector representing just 3% of the labour force. • Next year, the European working-age population will begin to shrink, while the over-60 population will continue to increase by at least 2 million per year.

9. ASDA (a supermarket chain) and Older Workers Currently employs over 20,000 older workers (19% of workforce) Business benefits include • Mirrors the business's customer base more closely, thus providing better customer service • Professional and life experience shared with colleagues • Continuity of staff and experience • Extra flexibility • Improved customer satisfaction survey results and staff satisfaction. ASDA supports older workers • One week unpaid leave for grandparent or carer duties • ‘Benidorm Leave’ – up to three months unpaid leave • ‘Seasonal squad’ – choose to work only during 10 busiest weeks of the year (Christmas, Easter) Absenteeism has reduced to levels that are a third lower than the national average for this industry. WANTED ASDA is looking for workers in the 50-plus age group.

10. Increasing working life expectancy • Increase in working life expectancy is difficult to achieve without accompanying improvements in healthy life expectancy (together with skills matched to labour demand). • The Health Survey for England and the General Household Survey for 1998 and 2004 show that the additional years of life are usually spent with co-morbidities rather than a single disease – these may be non-limiting diseases. • The first challenge is to minimise ill-health and to mitigate its effects on function, enabling increased participation in work and extended working life.

11. The ‘elephant in the room’ - obesity It is likely that by 2025 40% of adults will be obese, and the number of people living and working with chronic conditions will rise steadily, affecting morale, competitiveness, and profitability. In an increasingly competitive global economy, only the healthiest businesses will prosper. Companies that invest to support employees’ health will be fitter to survive.

12. Obesity and chronic disease The latest Health Survey for England (HSE) data shows us that nearly 1 in 4 adults, and over 1 in 10 children aged 2-10, are obese. In 2007, the Government-commissioned Foresight report predicted that, if no action was taken, 60% of men, 50% of women and 25% of children would be obese by 2050.

13. Chronic conditions and extending working life • Common chronic conditions e.g. cardiovascular and respiratory conditions, diabetes, rheumatic diseases, treated cancers do not deny the possibility of fulfilling work or an extended working life. • Previously fatal diseases are also becoming chronic, after improved medical treatment. Obesity may promote earlier onset of chronic conditions. • Chronic conditions require: • good clinical care, Vocational Rehabilitation, well- informed work-conscious healthcare professionals • flexibility & adaptation in a health-promoting workplace. • If managed effectively and proactively, disability can be minimised and disease progress delayed - extending working life and reducing healthcare costs.

14. Extending working lives – the social factors • In the UK, labour participation rates drop significantly after age 50. • Those with longest working life expectancy at 50 are more educated, are home owners, are married or co-habiting, and are in reasonable health. • Besides poor health, the reasons for ceasing economic activity at age 50+ include limited skills and increased caring responsibilities. • Reversing these factors will depend on more than healthcare interventions alone. Marmot Review 2010

15. Workplace illness costs: USA and UK Apply only in US 30% Medical care and pharmaceutical costs Met by NHS (from taxes) in UK 70% Health-related Productivity Costs Absenteeism Overtime Turnover Temporary Staffing Administrative Costs Replacement Training Off-Site Travel for Care Customer Dissatisfaction Variable Product Quality Apply in UK also (adapted from R. Loeppke, US National Business Group for Health, Philadelphia 2009)

16. The workplace – its potential • There is increasing emphasis on the role of the workplace in influencing and providing the conditions necessary for healthy and fulfilling working lives … • … with persuasive evidence that the health and well-being of employees are significant determinants of the success of business enterprises and services.

17. Older Workers at Lafarge Construction - background • The largest diversified supplier of construction materials in the U.S. and Canada, employing approximately 13,000 people at over 900 locations. • Workforce mainly male, older and of long tenure (often 20 to 25 years) Challenge: • Medical, dental and pharmacy costs increased 13% annually 2001 to 2006. • Many high-cost claimants with chronic conditions. • Before 2005, long-term disability claims were more than twice expected, causing significant premium increase. Research: • Showed that costs could be reduced by $30 million within 3 years by early diagnosis and treatment and improving medication adherence for asthma, diabetes and heart disease.

18. Older Workers at Lafarge Construction – the initiatives Initiatives included: • rigorous use of data to monitor and manage results against a 2005 baseline • communication/education effort for employees, family members, senior management and operations managers (all education material sent directly to employees’ homes). • health and productivity culture premised on the existing safety culture • evidence-based identification of the need for, and encouragement of, medication compliance • financial incentives to reward program participation, clinical screening • on-site health screenings • integrating all clinical resources and benefits through a dedicated cross-functional team. Locally, several plants were encouraged to partner with local hospitals to - provide sleep apnea tests, - create counselling sessions to train on prevention of low back injuries - bring nutritionists to the workplace to promote healthier eating.

19. Older Workers at Lafarge Construction - results • 97% of the 5500 benefit-eligible employees in the U.S. workforce now participate in the Lafarge Health risk assessment • In 2010, 2800 employees participated in onsite health education programs. • Medical/pharmacy cost trend is now 4.7% compared to 13.0% in 2001 – 06 • Claims in excess of $50,000 are at the lowest level in the past five years. • Medical costs for diabetics and asthmatics are down 25% and 38%, largely due to reduction in hospital and emergency room visits • 7,102 employees now participate in the disease management programme (159% increase) • Lafarge received the 2010 IBI/NBCH Healthy Workforce Productivity Award for leadership in health and productivity. Integrated Benefits Institute, Dec 2010

20. Supporting the employment of older workers Provides good practice case studies, FAQs, guidance on fixed retirement age and research into extended working lives www.dwp.gov.uk/age-positive Provides guidance for employers on employing older workers, including recruitment, flexible working, training and development, and retirement www.businesslink.gov.uk Co-financed by the European Regional Development Fund, the Silver Academy encourages the over 50s in engaging with new enterprises and SMEs, and runs practical workshops www.peopleproject.eu

21. Barriers to employment and social participation for older people Participation rates in selected activities Participation generally declines with age, quite steeply beyond 65 when arguably people have more free time Over 1 in 4 of people have experienced age discrimination. Of people refused a job, 23% gave age as a reason. Almost half of people aged 50+ would carry on working in their present job beyond 65, if permitted. From Department of Work and Pensions

22. Extending working lives: steps to be taken • Build on current policies for health and work to strengthen concerted action, across clinical medicine, occupational health and employment practice, to minimise the impact of ill-health and ageing on capability for work. • Develop and promote fuller understanding of : - the role of healthcare in maintaining and restoring function at working age, - the role of employers in enabling people not wholly well, or ageing, to undertake fulfilling work, - the natural history of common disorders in relation to function, emphasising prevention and delaying onset, - the interplay of psychosocial, economic and medical factors in relation to functioning and work. • Strengthen the evidence base on the clinical and cost effectiveness of interventions in relation to disability and extended working life • Ensure that the workforce has the skills required to maintain and extend working life • Put in place the practical arrangements and interdisciplinary practices necessary to realise these aims.

23. Final thought “ In the end, it’s not the years in your life that count. It’s the life in your years.” Abraham Lincoln