Health, work

1
Health, work well-being

• Gordon Waddell
• Centre for Psychosocial Disability Research,
• University of Cardiff

2
Aims of Review

• To collate and evaluate the scientific evidence
  on the question
• Is work good for your health and well-being?
• Does the scientific evidence support promotion of
  work and RTW?

www.health-and-work.gov.uk
3
Definitions

• Work(lessness)
• (Un)Employment
• Health
• Well-being

4
Definitions

• Work application of physical and mental
  knowledge skills commitment over time effort,
  labour exertion
• Employment contract of employment for pay set
  of specific tasks, located in specific
  physical/social context
• Health
• Well-being

5
Definitions

• Work
• Employment
• Health usually operationalized in terms of
  absence of physical and mental symptoms, illness
  and morbidity
• Well-being the subjective state of being
  healthy, happy, contented, comfortable and
  satisfied with ones quality of life

6
Work and health
Possible causal pathways between health, work and
well-being
7
Common health problems

• Less severe medical conditions
• Responsible for 2/3 of absence and long-term
  incapacity
• Common mental health problems
• Musculoskeletal conditions
• Cardio-respiratory conditions

8
Common health problems

• Common features
• High prevalence in working age population
• Largely subjective - little or no disease or
  impairment
• Multifactorial causation work usually only one
  contributory factor
• Most episodes settle rapidly though often
  persistent or recurrent
• Most people remain at work or return to work
  quite quickly
• Essentially whole people, with what should be
  manageable health conditions
• Is work beneficial for people with common health
  problems?

9
Review Methodology
10
Structure of review

• Health effects of work
• Health effects of unemployment
• Health effects of re-employment
• original studies
• Work for sick and disabled people
• Impact of work on people with
• mental health conditions
• musculoskeletal conditions
• cardio-respiratory conditions
• Health effects of moving off social security
  benefits
• original studies reviews

11
Review Findings
12
Work

• The generally accepted theoretical framework
  about work and well-being is based on extensive
  background evidence

13
Work

• Work provides income material well-being and
  participation in todays society
• Work meets important psychosocial needs in
  societies where employment is the norm
• Work is central to individual identity, social
  roles and social status
• Employment and socio-economic status are the main
  drivers of social gradients in health

14
Work

• Work provides income material well-being and
  participation in todays society
• Work meets important psychosocial needs in
  societies where employment is the norm
• Work is central to individual identity, social
  roles and social status
• Employment and socio-economic status are the main
  drivers of social gradients in health
• At the same time, various aspects of work can be
  a hazard and pose a risk to health

15
Unemployment

• There is strong evidence that (long-term)
  unemployment is associated with

• Higher mortality
• Poorer general health, somatic complaints,
  long-standing illness, limiting longstanding
  illness
• Poorer mental health more psychological
  distress minor psychological/psychiatric
  morbidity, suicide
• Higher medical consultation, medication
  consumption and hospital admission rates.

16
Re-employment
First comprehensive review of 53 longitudinal
studies

• Improves physical general health and well-being
• Improves mental health
• Magnitude of improvement comparable to the
  harmful effects of losing a job.

• There is strong evidence that re-employment

17
Re-employment
First comprehensive review of 53 longitudinal
studies

• Improves physical general health and well-being
• Improves mental health
• Magnitude of improvement comparable to the
  harmful effects of losing a job.

• There is strong evidence that re-employment

• However
• That depends on the quality and security
  of re-employment
• There is a persisting risk of poor employment
  patterns and further unemployment

18
Work for sick disabled people
There is a broad consensus across multiple
disciplines, disability groups, employers,
unions, insurers and all political parties, based
on extensive clinical experience AND on
principles of fairness and social justice When
their health condition permits, sick and disabled
people should remain in or re-enter work as soon
as possible, because -
19
Work for sick disabled people

• Is (generally) therapeutic
• Helps to promote recovery and rehabilitation
• Leads to better health outcomes
• Minimises the harmful physical, mental and social
  effects of long-term sickness absence
• Reduces the risk of chronic disabilityand
  long-term incapacity
• Reduces poverty and social exclusion
• Improves quality of life and well-being

20
Work for people withcommon health problems

• Common mental health problems
• Musculoskeletal conditions
• Cardio-respiratory conditions

21
Moving off social security benefits

• Claimants who move off benefits and (re)-enter
  work generally experience improvements in income,
  socio-economic status, mental and general health,
  and well-being.
• Claimants who move off benefits but do not enter
  work are more likely to report deterioration in
  health and well-being.

22
Is work good for your health?

• Theoretical framework
• Unemployment is bad for physical and mental
  health and mortality (c.f. work)
• Re-employment reverses the ill effects
• Clinical management of common health problems
• Benefit leavers health benefits depend on
  re-entering work.

23
Is work good for your health?

• Theoretical framework
• Unemployment is bad for physical and mental
  health and mortality (c.f. work)
• Re-employment reverses the ill effects
• Clinical management of common health problems
• Benefit leavers health benefits depend on
  re-entering work.

Strong case that work is good for health
24
Conclusions

• Employment is generally good for physical and
  mental health and well-being
• Unemployment and unnecessarily prolonged sickness
  absence are generally bad for physical and mental
  health and well-being
• That is true for healthy people of working age,
  for many disabled people, for most people with
  common health problems, and for social security
  recipients

25
Provisos

• These findings are about average or group effects
  and should apply to most people to a greater or
  lesser extent however, a minority of people may
  experience contrary health effects from
  work(lessness)
• Beneficial health effects depend on the nature
  and quality of work
• Account must be taken of the social context,
  particularly social inequalities in health and
  regional deprivation.

26
Some Implications
27
Occupational health paradigm
28
Health Safety

• Safety identify, assess and control hazards
  risks - primary prevention of injury disease
• A healthy working life is
• one that continuously provides working-age
  people with the opportunity, ability, support and
  encouragement to work in ways and in an
  environment which allows them to sustain and
  improve their health and well-being
  (Scottish Executive 2004)
• Work should be comfortable when we are well and
  accommodating when we are ill (Hadler 1997)

29
Work Health

• Distinguish health and safety
• Beneficial and harmful health effects
• Interactions between worker and work
• Common health problems usually not a simple
  consequence of work multifactorial context
• Perceptions the more subjective the condition,
  the more central the role of psychosocial factors
• Must consider the worker, their health problem
  and their (work) environment (A biopsychosocial
  model)

30
Work Health
31
Implications

• Clinical management - Information
  advice - Sick certification -
  Rehabilitation
• Health at work - Risk assessment
  control - Sickness absence management
  - Return to work process
• Social policy - Employment / Good jobs
  - Health Safety - Social
  security

32
Information and advice

• Avoid false attribution to work
• Advice on staying active and continuing ordinary
  activities as normally as possible including
  work
• Talk about their job duties
• Help plan return to work process
• Occupational outcomes

33
Sick certification

• Sick certification is a major therapeutic
  intervention
• Is sickness absence really necessary?
• Are there any other (better) options?
• What are the risks and do they outweigh the
  benefits?
• For how long? - The longer someone is off work,
  the lower the chances of returning.
• Have you thought about how/when they will get
  back to work? - before you issue the certificate

34
Therapy
Treating symptoms
Restoring function
35
Rehabilitation

• Principles of rehab integrated intoclinical and
  occupational management
• Every health professional has a responsibility
  for rehabilitation
• Treat symptoms AND restore function
• Address biopsychosocial obstacles to recovery
  and return to work
• All players onside communication
• Focus on occupational outcomes

36
Good jobs

• Possible characteristics
• As safe as reasonably practicable
• Fair pay
• Social gradients in health
• Job security
• Personal development fulfilment investing
  in human capital
• Accommodating, supportive, non-discriminatory
• Control/autonomy
• Job satisfaction
• Good communication

37
Social context

• Worklessness
• Poverty
• Social exclusion
• Social gradients in health
• Regional deprivation
• Local unemployment rate
• Sickness, disability and incapacity
• Multiple disadvantages

poor health
on benefits
38
Changing the culture of work health

• CultureThe collective attitudes, beliefs and
  behaviours that characterise a particular social
  group over time

39
Shifting attitudes to work health
40
Long-term worklessness is one of the greatest
risks to health

• Loss of fitness
• 2-3X risk of poor health
• Depression, 2-3X risk mental illness
• 20 excess deaths
• Greater risk than many killer diseases
• Greater risk than most dangerous jobs e.g.
  construction, North Sea
• Trapped on benefits to retirement age
• Social exclusion, poverty

41
Health, work well-being
The beneficial effects of work on physical and
mental health and well-being generally outweigh
the risks of work and the harmful effects of
worklessness.