Health Inequalities and the Workplace Why should you care?

1. Health Inequalities and the WorkplaceWhy should you care? Jim McManus, CPsychol, CSci, AFBPsS, FFPH, FRSPH, MCIPD Director of Public Health

2. I will cover Health inequalities Why you should care What can we do about it?

4. 1. Health Inequalities

6. And Hertfordshire shows the same pattern!

7. The Problem • Increasing non-communicable disease • Smoking, obesity • Increasing mental ill health • Increasing sickness absence • Increasing loss to business productivity and performance from sick pay • Avoidable cost of managing and replacing sick and absent staff

8. Hertfordshire • 2,200 early and avoidable deaths per annum • Most of them preventable • Problems start in working age life with sickness absence • Common causes: inactivity, MSK problems, diet, alcohol, smoking • Significant avoidable stress and mental health costs • The human side of resource depreciation because it isn’t looked after • WE REALLY MUST DO SOMETHING! BUT WHAT?

9. Premature death in Hertfordshire • The causes of premature mortality can be grouped into four main conditions which account for around 80% of premature deaths. These are: • cancer • heart disease and stroke • lung disease • liver disease

17. Mental Health • Biggest single cause of sickness absence • Mostly avoidable or remediable at early stages • Significant cause of ET claims and workplace disputes • Area most employers feel least prepared for • 1 in 4 of population have in lifetime • 1 in 3 of workforce report sickness absence around it

18. Hertfordshire percentage projected population change 2010 to 2035

19. 2. Why should you care?

20. Because it’s costing you • Sickness absence • Productivity Established relationship between lifestyle related risk factors (smoking, inactivity, obesity) and productivity absenteeism and health claims. • (Buron et al,2005, Wellsource, 2006 & University of Michigan, 2006)

21. Doing nothing is not an option The do-nothing strategy of waiting for sickness and then paying for treatment isn’t cost neutral – it costs you Lifestyle related risk factors and behaviours of employees as well as unhealthy work environments and practices drive costs. High risk employees incur high costs whatever the outcome measure: pharmaceutical, absenteeism, compensation costs or productivity. Now I’m going to prove it….

22. What is the root issue? • There is a flow from low risk to high risk to disease for the working age population • This leads to: • Diseases of lifestyle • More risk, more absence • Compound risk, compound absence • Low productivity

23. What does this mean for you as employers? • Chronic disease related deaths account for 56% of all deaths in the working-age population in the world (World Health Organization). • High prevalence of major modifiable health risks contributes to the epidemic of chronic disease. • Elevated BMI (BMI ≥25kg/m2) Obesity (BMI ≥ 30 kg/m2) • Inactivity Smoking • Stress Elevated blood pressure • Elevated cholesterol High blood sugar • Alcohol • Places an increasing burden on employers: decreased productivity, increased absenteeism, increased health and workers’ compensation claims.

24. Productivity Decreases with Number of Health Risks Excess Productivity Loss Productivity Loss (%) Base Cost Number of Health Risks (Journal of Occupational and Environmental Medicine 2005;47:769-77 (n = 28,375))

25. Absenteeism Increases with Number of Health Risks Number of Health Risks (Journal of Occupational and Environmental Medicine 2005;47:769-77 (n = 28,375)) work loss days/yr Excess Work Loss days/yr Base work loss days/yr

26. Example: Smoking costs in Herts • total annual cost in Hertfordshire £45,972,899 • NHS Treatment and Care costs: £32,429,375 • Costs to businesses (productivity losses): £12,931,914 • Passive smoking costs: £598,947 (adults: £425,607; children: £173,340) Work done for Herts by economists at

27. Root causes One of the root causes of unsustainable increases in costs is natural flow of individuals from low risk → high risk →disease →higher employer costs natural flow estimated at 2% - 4% per year. • (Edington et al, 2009).

28. 3. What are we doing about it? Helping you build workplace wellness through the workplace offer

29. What can be done • An effective Workplace Wellness strategy is to stop migration of people to higher risk and keep low risk people at low risk. • Employers costs go up as people age, regardless of their health risk status and as health risk status gets worse, costs go up regardless of age.

30. NICE Business Case 1: Gross Savings • Worked example - for a company with 300 employees earning average £8.20/hr On average, sickness absence costs employers 8.4 working days per employee per year (Chartered Institute of Personal Development 2007a). Physical activity programmes at work have been found to reduce absenteeism by up to 20%; physically active workers take 27% fewer sick days (Health, Work and Wellbeing Programme 2008).

31. Nice Business Case 2: Interventions Total Cost £50,300

32. NICE Business Case 3: Net Savings

33. Interventions with Gold Standard Evidence (Systematic Reviews) • Musculoskeletal disorders • education about stress management, principles of ergonomics, anatomy, musculoskeletal disorders, and the importance of physical activity. • 'pause gymnastics', how to use a relaxed work posture, proper positioning, the importance of rest breaks, and strategies to improve relaxation. • some studies also included how to modify work tasks, work load, working techniques, working positions, and working hours. • adjustments and recommended alternatives to the existing furniture and equipment at the workplace.

34. Interventions with Gold Standard Evidence (Systematic Reviews) • Standing workers and vein problems • Flexible working interventions that increase worker control and choice (such as self-scheduling or gradual/partial retirement) are likely to have a positive effect on health outcomes • Smoking Cessation • Healthy weight management • Stopping movement from low – high risk - disease

35. Healthy Herts • County Council Programme • Reduced Sickness Absence • Increased Health Offer including smoking cessation, gym, physical activity, emotional wellbeing, roll out of alternatives to Lifts • Nominated for two awards • Will be rolled out further

36. Our workplace offer • Hertfordshire workplace health offer for employers • Online tools for behaviour change and mental wellbeing • First six Herts major commercial Employers already engaged • Working closely with Business in the Community as key partner

37. Thank you! Jim.McManus@hertfordshire.gov.uk

38. Paul WinterChief Executive www.ibs.co.uk @IpswichBuildSoc

39. Business Action on Public Health What we have been doing in the East of England • Met with 200 employers across the region • Worked to engage the statutory and voluntary sector • Spoken at regional platforms, presence at ACAS and Public Health England events • BAOPH pages on BITC website consistently most visited pages in the region, providing case studies, signposting and employee survey tools

40. BAOPH: Engagement Leadership team a good reflection of employers in East of England 167 employees in the network have completed mental health first aid lite training (MHFA accredited), with 59 employees completing full two day training Practitioner network events engage employers in wellbeing agenda – BITC has run 22 events with over 230 employees having attended

41. The bigger picture Organisations with a high level of employee engagement outperform their peers on measures of operating income, net income growth and earnings per share Physically active employees take 27% less time off than their colleagues Wider public health impact

42. Obesity 1: National Audit Office (2001) 2: Department of Health, Policy ‘Reducing Obesity and Improving Diet’ 3: Williams NR, Malik N (2005). “Obesity and work: perceptions of a sample of patients attending an NHS obesity clinic”

43. Alcohol misuse 1: Institute of Alcohol Studies, IAS Factsheet, Alcohol in the Workplace (August 2013) 2: John Woodhouse and Philip Ward (March 2013), 'A minimum price for alcohol?', House of Commons Library, p. 11, from Home Office (November 2012), 'Impact Assessment on a minimum unit price for alcohol', p. 5 3: National Institute for Health and Clinical Excellence (June 2010), 'Business case: Alcohol-use disorders: preventing harmful drinking', p. 13

44. Tobacco related illnesses 1: Clive Bates, Action on Smoking and Health 2: NHS Report ‘Stop Smoking Wales’

45. Stress, anxiety & depression 1.HSE Labour Force Survey 2012/13 2.Centre for Mental Health

46. Issue for employers Employers pay £9bn per year in sick pay and associated costs, plus the indirect costs of managing business whilst people are absent A third of managers have no support in place to help deal with employees experiencing depression A recent YouGov survey for the TUC found that one in three employees are not engaged in their work

47. British Heart Foundation • 20% of workers do not take a lunchbreak • 49% feel stressed on a daily basis • Over two thirds believe their employer should take general responsibility for their health at work

48. Our story Leadership team need to set the example We can spend up to 60% of our day at work – much of this time spent physically inactive, stressed and reliant on caffeine and sugar

49. Our approach Staff investment • Health and wellbeing programme including reward scheme • Volunteering • Work-Life balance • Flexible working patterns • Development and training Resulting in high engagement, low sickness and turnover plus impact on the bottom line

50. Paul WinterChief Executive www.ibs.co.uk @IpswichBuildSoc