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

1
HealthUnemployment 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.

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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

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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)

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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)

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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)

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More links between health and workthe 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)

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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

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Benefits of work

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

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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

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Example of Benefits of Being an EmployeeA
Midlands NHS Trust

• 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)

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So why dont people return to work?

• Simplistically
• Medical label (crumbling spine)
• Beliefs ( it will make it worse work caused my
  problem)
• Attitudes (I dont 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

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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

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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

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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

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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

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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