Work, Health and Wellbeing

Abstract

During the past decade we have become more aware of important relationships between health and work. There is a persuasive body of evidence. This was brought together in an important review by Waddell and Burton [1] - Is work good for your health and well-being? - which examined the evidence on that question. The review formed part of the evidence base for the UK Government's Health, Work and Well-Being Strategy [2] published in October 2005. There are economic, social and moral arguments that, in general, good work is the most effective way to improve the wellbeing of individuals, their families and their communities. Moreover, there is strong evidence that prolonged loss of work, whatever the cause, can harm physical and mental health. For all these reasons supporting people into work is a key element of the UK Government's aims for both public health and welfare reform. Similar responses are being made in many other countries across the world. I was appointed to the new post of National Director for Health and Work to initiate a national debate in taking forward the strategy and to secure widespread recognition of the benefits of work to health and well-being. My report, Working for a healthier tomorrow [3], made recommendations designed to protect and improve the health and well-being of working age people and to enable them to remain in or return to work with minimal delay when illness, injury or disability threatens their capability to work. Not only is working life important in maintaining the health and wellbeing of individuals and their families and it is also evident that a healthy workforce brings financial and productivity benefits to employing organisations. Conversely when employees are sick and absent from work, or remain at work but do not perform well - a phenomenon called presenteeism - the performance of the organisation falls. Employers from a range of organisations - small, medium and large, public and private, including healthcare organisations such as those of the British National Health Service [4] - can show that close attention to workplace well-being improves productivity, staff retention and engagement, and morale. A critical question is how do we move from analysis of the relations between ill health and work to a programme of interventions to deliver the strategy? The success of the strategy depends on preventive, therapeutic and rehabilitative interventions alongside those that strengthen motivation and confidence. An important step in the UK has been introduction of the Statement of Fitness for Work [5] (the Fit note) which has now replaced the previous Medical Statement or 'sick note' made by the patient's doctor. It has encouraged important changes in understanding and behaviour. Most sickness absence and inactivity follows common health conditions which, with the right support, are compatible with work - although sometimes it means a different kind of work. The statement enables the doctor to give advice that an employee's condition does not necessarily stop them from returning to work but that return may be possible if the employer and employee together could find suitable adjustments. The Fit note also brings new opportunities and enhanced responsibilities to business. It signals, in a formal way, the growing recognition that for most people of working age the right work is good for health and well-being. It is well known that the longer a patient is on sickness absence from work the likelihood of yet more prolonged absence and of permanent worklessness increase rapidly. In some instances, of course, this is a natural consequence of the severity of illness or disability, but in many cases it is a result of inadequate overall sickness management in the face of relatively non-disabling conditions that are compatible with work. Provided the necessary clinical and psychosocial interventions are made promptly, and confidence restored, with employer support in making any necessary work adaptations, most patients should be able to return to work without delay. Out of this understanding came the recommendation that there should be a 'Fit for Work Service' [3]. This would provide early intervention, case-managed, multi-disciplinary support for individuals, making access to work-related health support more widely available. Pilots have been set up and following evaluation the results will help show how healthcare professionals, employment services, employers and employees can best work together on the health and work agenda [6]. A further recommendation of my review was that building on a commitment made by leaders of the healthcare professions, the general practitioners and other healthcare professionals should be supported through education and training to adapt the advice they give, doing all they can to maintain the capability of people to enter, remain in or return to work. It is step to enhancing the occupational health function. An initial emphasis on reducing the risk of sickness absence or worklessness because of illness or injury has broadened. It now includes action in the workplace to safeguard and improve the physical and mental health and wellbeing of employees and to promote collaboration between employing and health care organisations to ensure that individuals receive the range of support and health interventions they need to enable them to work when capability is threatened by illness, injury or disability. These aims have been given a new additional focus in the UK through the Government's Public Health Responsibility Deal [7]. The Public Health Responsibility Deal aims to tap into the potential for businesses and other influential organisations to make a significant contribution to improving public health through their responsibilities as employers, as well as through their commercial actions and their community activities. It embodies the Government's ambition for a more collaborative approach to tackling the challenges to physical and mental health and wellbeing that permeate developed societies. This unified approach has brought new, strong partnership between government departments. It has brought together leaders of industry and key stakeholders from across the public and private sectors; and it has promoted new thinking among health professionals.