1. Work and Wellbeing Professor Ewan Macdonald OBE University of Glasgow

2. But what is Work? Its not only being in a paid job with 6 months full pay and 6 months half pay n Paid employment n Self Employment n Voluntary work n Carer n Homemaker n Child rearing n Full time/ part-time n Community activities, clubs, church n Etc ALL OF THE ABOVE ARE BENEFICIAL TO SOCIETY AND THE INDIVIDUAL PROVIDED THEY HAVE ENOUGH MONEY

3. Jimmy - Road Worker case study

4. Jimmy – a 45 year old distribution worker n Contractor n Minimal health and safety n No eye protection n No ear muffs n Early noise induced hearing loss n Vibration white finger n Several Eye injuries in past n Irritant dermatitis n Back injury in past n Osteoarthritis of spine,shoulders, elbows and knees n 6 visits to accident and emergency n One hand fracture n Getting a bit past it

5. Jimmy n Average housing n Poor diet, not much fruit, veg or fish n 4 pints of beer a night (occas drink at lunchtime) n 20cigs a day n No leisure exercise n Left school with no qualifications n Jobs on building sites n Frequently does overtime n Sometimes in informal economy n Few of his employers have occ health and safety resource

6. Jimmy n Separated lives with partner and two stepchildren n Two children by first wife n Financial problems n Child care issues n Has been on courses to use power tools n No other education n Reads paper occasionally n Has home computer-on internet

7. Jimmy n He has an accident – pipe rolled on leg fracture of right tibia and fibula n Taken to hospital – transferred to orthopaedics – surgery, plated, discharged on crutches after two days (superb treatment) n No record of job in the hospital notes n No physiotherapy n Gets Fit note “unfit” n No guidance about rehabilitation

8. Jimmy n Rests at home, watches TV (gets depressed) n Progresses to walking with a stick n Wasting of quadriceps (50%) and reduction in power both legs, pain at fracture site n After six weeks starts physiotherapy – once per week for six weeks n Pain and weakness still a problem, Family doctor advises job will be too much for him n Follow up hospital appointment – no discussion about work

9. Jimmy - Options n Probably dismissed within 4 weeks n Friendly with the boss – given job driving the dump truck n Goes on to long term Health Benefit (ESA) after six months

10. Sickness Related Benefits Growth 1979 - 2005

11. Facts about Incapacity Benefit in Scotland (Brown, Hanlon, Macdonald et al, J. Pub.Health 2008) n 2.5% of Working age population go on to IB each year (3.5% in Glasgow) n 55-59 yr old males – 18% on IB (35% in Glasgow, 60% in districts) n Mental Health problems cause 50% of IB n 10 years ago main cause was musculoskeletal

12. Rate of IB receipt by MSP Constituency 2008 Scottish Observatory for Work & Health http://www.gla.ac.uk/ departments/hwlgroup / http://www.gla.ac.uk/

14. Age standardised mortality (Men) per 100,000

16. Relationship between mortality (age/sex standardised rates per 100,000 population) and deprivation (as measured by the Scottish Index of Multiple Deprivation)

17. Work and Inequality n Your status is determined by having a job and the level of that job n Your job (or jobless) level determines your life expectancy n Your job (or jobless) level determines how long you will survive the same medical condition

18. Work is good for you n “Overall the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long- term unemployment or prolonged sickness absence. Work is generally good for health and well-being” n Waddell and Burton 2006

19. What else do we know about being out of work? n Unemployment is bad for you: –Loss of Income¹ –Destructive on self-respect¹ –Risks of ill-health² –The “psychosocial scar” persists³ –Trans-generational effects 1.Winkelmann and Winkelmann 1996 2.Clark, Georgellis, Samfey 2001 3.Clark and Oswald 1996 4.Aylward 2006

20. Long-term worklessness is one of the greatest known risks to public health n Health Risk = smoking 10 packs of cigarettes per day (Ross 1995) n Suicide in young men > 6 months out of work is increased 40 x (Wessely, 2004) n Suicide rate in general increased 6x in longer-term worklessness (Bartley et al, 2005) n Health risk greater and life expectancy worse than many “killer diseases” (Waddell & Aylward, 2005) n Greater risk than most dangerous jobs (construction/North Sea)

21. The Scottish Healthy Working Lives paradigm 2003 (Macdonald E, Docherty G. 2007) n “ 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. It means that individuals are empowered and enabled to do as much as possible, for as long as possible, or as long as they want, in both their working and non working lives”

22. Self Reported Health from British Household Panel Survey

23. BHPS Study

24. Scottish Health Survey Study

25. In Scotland Worklessness is the single most important cause of health inequality, social exclusion, deprivation, and mortality