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Health, work & well-being
Gordon Waddell
Centre for Psychosocial & Disability Research,
University of Cardiff
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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
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Definitions
Work(lessness) (Un)Employment
Health Well-being
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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
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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 one’s quality of life
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Work and health
Possible causal pathways between health, work and well-being
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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
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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?
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Review Methodology
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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
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Review Findings
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The generally accepted theoretical framework about work and well-being is based on extensive background evidence:
Work
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Work
Work provides income: material well-being and participation in today’s 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
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Work
Work provides income: material well-being and participation in today’s 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
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Unemployment
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.
There is strong evidence that (long-term) unemployment is associated with:
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Re-employment
Improves physical & general health and well-being Improves mental health Magnitude of improvement comparable
to the harmful effects of losing a job.
First comprehensive review of 53 longitudinal studies
There is strong evidence that re-employment:
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Re-employment
Improves physical & general health and well-being Improves mental health Magnitude of improvement comparable
to the harmful effects of losing a job.
First comprehensive review of 53 longitudinal studies
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
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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 -
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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 disability
and long-term incapacity Reduces poverty and social exclusion Improves quality of life and well-being
Work for sick & disabled people:
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Work for people withcommon health problems:
Common mental health problems Musculoskeletal conditions Cardio-respiratory conditions
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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.
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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.
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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
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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
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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.
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Some Implications
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Hazard Worker Harm
Objective,assessable
Passive(susceptible)
Medically diagnosable
Trauma Injury / disease
Proof of causal relationship
Occupational health paradigm
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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)
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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)
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Work & Health
Jobdemands &rewards
Workerstrengths &vulnerabilities
+/-
Harm
+veBenefits Health &
well-being
Ill-health-ve
+ve
-ve
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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
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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
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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
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Therapy
Treating symptoms
Restoring function
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Rehabilitation
Principles of rehab integrated intoclinical and occupational management
Every health professional has a responsibility for rehabilitation
Treat symptoms AND restore function Address bio–psycho–social obstacles to
recovery and return to work All players onside: communication Focus on occupational outcomes
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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
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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
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Culture:The collective attitudes, beliefs and behaviours that characterise a particular social group over time
Changing the culture of work & health
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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 absence
therefore therefore
Advice to stay off / sickness absence / sick certification ‘protects’ from work
Advice and support to remain in or (early) return to work
Shifting attitudes to work & health
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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
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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.