4DefinitionsWork : application of physical and mental knowledge & skills; commitment over time; effort, labour & exertionEmployment : contract of employment for pay; set of specific tasks, located in specific physical/social contextHealthWell-being
5Definitions Work Employment Health : usually operationalized in terms of absence of physical and mental symptoms, illness and morbidityWell-being : the subjective state of being healthy, happy, contented, comfortable and satisfied with one’s quality of life
6Work and healthPossible causal pathways between health, work and well-being
7Common health problems Less severe medical conditionsResponsible for 2/3 of absence and long-term incapacityCommon mental health problemsMusculoskeletal conditionsCardio-respiratory conditions
8Common health problems Common featuresHigh prevalence in working age populationLargely subjective - little or no disease or impairmentMultifactorial causation – work usually only one contributory factorMost episodes settle rapidly – though often persistent or recurrentMost people remain at work or return to work quite quicklyEssentially whole people, with what should be manageable health conditionsIs work beneficial for people with common health problems?
10Structure of review Health effects of work Health effects of unemploymentHealth effects of re-employmentoriginal studiesWork for sick and disabled peopleImpact of work on people withmental health conditionsmusculoskeletal conditionscardio-respiratory conditionsHealth effects of moving off social security benefitsoriginal studies + reviews
12WorkThe generally accepted theoretical framework about work and well-being is based on extensive background evidence:
13WorkWork provides income: material well-being and participation in today’s societyWork meets important psychosocial needs in societies where employment is the normWork is central to individual identity, social roles and social statusEmployment and socio-economic status are the main drivers of social gradients in health
14WorkWork provides income: material well-being and participation in today’s societyWork meets important psychosocial needs in societies where employment is the normWork is central to individual identity, social roles and social statusEmployment and socio-economic status are the main drivers of social gradients in healthAt the same time, various aspects of work can be a hazard and pose a risk to health
15UnemploymentThere is strong evidence that (long-term) unemployment is associated with:Higher mortalityPoorer general health, somatic complaints, long-standing illness, limiting longstanding illnessPoorer mental health; more psychological distress; minor psychological/psychiatric morbidity, suicideHigher medical consultation, medication consumption and hospital admission rates.
16Re-employment There is strong evidence that re-employment: First comprehensive review of 53 longitudinal studiesImproves physical & general health and well-beingImproves mental healthMagnitude of improvement comparable to the harmful effects of losing a job.There is strong evidence that re-employment:
17Re-employment There is strong evidence that re-employment: However: First comprehensive review of 53 longitudinal studiesImproves physical & general health and well-beingImproves mental healthMagnitude 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-employmentThere is a persisting risk of poor employment patterns and further unemployment
18Work 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 -
19Work for sick & disabled people: Is (generally) therapeuticHelps to promote recovery and rehabilitationLeads to better health outcomesMinimises the harmful physical, mental and social effects of long-term sickness absenceReduces the risk of chronic disability and long-term incapacityReduces poverty and social exclusionImproves quality of life and well-being
20Work for people with common health problems: Common mental health problemsMusculoskeletal conditionsCardio-respiratory conditions
21Moving 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.
22Is work good for your health? Theoretical frameworkUnemployment is bad for physical and mental health and mortality (c.f. work)Re-employment reverses the ill effectsClinical management of common health problemsBenefit leavers – health benefits depend on re-entering work.
23Is work good for your health? Theoretical frameworkUnemployment is bad for physical and mental health and mortality (c.f. work)Re-employment reverses the ill effectsClinical management of common health problemsBenefit leavers – health benefits depend on re-entering work.Strong case that work is good for health
24ConclusionsEmployment is generally good for physical and mental health and well-beingUnemployment and unnecessarily prolonged sickness absence are generally bad for physical and mental health and well-beingThat is true for healthy people of working age, for many disabled people, for most people with common health problems, and for social security recipients
25ProvisosThese 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 workAccount must be taken of the social context, particularly social inequalities in health and regional deprivation.
27Occupational health paradigm TraumaInjury / diseaseHazardWorkerHarmObjective, assessablePassive (susceptible)Medically diagnosableProof of causal relationship
28Health & SafetySafety: identify, assess and control hazards & risks - primary prevention of injury & diseaseA 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)
29Work & Health Distinguish health and safety Beneficial and harmful health effectsInteractions between worker and workCommon health problems usually not a simple consequence of work – multifactorial + contextPerceptions – the more subjective the condition, the more central the role of psychosocial factorsMust consider the worker, their health problem and their (work) environment (A biopsychosocial model)
31ImplicationsClinical management Information & advice Sick certification RehabilitationHealth at work ‘Risk’ assessment & control Sickness absence management Return to work processSocial policy Employment / ‘Good jobs’ Health & Safety Social security
32Information and advice Avoid false attribution to workAdvice on staying active and continuing ordinary activities as normally as possible – including workTalk about their job & dutiesHelp plan return to work processOccupational outcomes
33Sick certificationSick certification is a major therapeutic interventionIs 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
35RehabilitationPrinciples of rehab integrated into clinical and occupational managementEvery health professional has a responsibility for rehabilitationTreat symptoms AND restore functionAddress bio–psycho–social obstacles to recovery and return to workAll players onside: communicationFocus on occupational outcomes
36Good jobs Possible characteristics: As safe as reasonably practicable Fair paySocial gradients in healthJob securityPersonal development & fulfilment: investing in human capitalAccommodating, supportive, non-discriminatoryControl/autonomyJob satisfactionGood communication
37Social context Worklessness Poverty Social exclusion Social gradients in healthRegional deprivationLocal unemployment rateSickness, disability and incapacityMultiple disadvantages% ‘poor health% on benefits
38Changing the culture of work & health Culture: The collective attitudes, beliefs and behaviours that characterise a particular social group over timeBenefits culture – e.g. South Wales valleys where 2 and even 3 generations of family not worked
39Shifting attitudes to work & health Current:Shift to:Work is a ‘risk’ and (potentially) harmful to physical and mental health.Work is healthy, therapeutic & the best form of rehab.vs.Risks of long-term sickness absencethereforeAdvice to stay off / sickness absence / sick certification ‘protects’ from workAdvice and support to remain in or (early) return to workThe key idea is that work is therapeutic and the best form of rehabilitation
40Long-term worklessness is one of the greatest risks to health Loss of fitness2-3X risk of poor healthDepression, 2-3X risk mental illness20% excess deathsGreater risk than many “killer diseases”Greater risk than most dangerous jobs e.g. construction, North SeaTrapped on benefits to retirement ageSocial exclusion, poverty
41Health, 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.