Context

There is strong evidence to show that work is generally good for people's physical and mental health and wellbeing (Is work good for your health and well-being? Department for Work and Pensions; Annual report of the Chief Medical Officer surveillance volume, 2012 Department of Health).

It meets important psychosocial needs in societies in which employment is the norm and is central to someone's identity, social role and status ('Is work good for your health and well‑being?'). Work can also reverse the ill‑health effects of unemployment.

However, these benefits do depend on the type of work involved (Good work and our times Good Work Commission). There is also a positive association between wellbeing, job satisfaction and an employee's job performance. Many studies have also shown a relationship between supportive supervision and job satisfaction. These findings provide a strong case for employers to consider investing in the wellbeing of their employees on the basis of likely performance benefits (Does worker wellbeing affect workplace performance, Department for Business, Innovation & Skills).

During 2013/14, 1.2 million working people had a work‑related illness. Half a million of these were new illnesses (Health and Safety Statistics Annual report for Great Britain 2013/14 Health and Safety Executive). Work‑related illness and workplace injury led to the loss of an estimated 28.2 million working days in 2013/14. Injuries and new cases of ill health resulting largely from current working conditions cost society an estimated £14.2 billion in 2012/13 (based on 2012 prices).

People's health can be damaged at work by, for example:

  • physical hazards

  • physically demanding or dangerous tasks

  • long or irregular working hours or shift work

  • tasks that encourage a poor posture or repetitive injury

  • tasks that mean someone is sedentary for prolonged periods of time.

Lack of control over the work (including a lack of opportunity to take part in decision‑making), conflicts in workplace hierarchies, and covert or overt discrimination can also affect health.

All these factors are most prevalent among people who are in jobs that are low paid, unsafe and insecure (Fair society, healthy lives The Marmot review). On the other hand, the Good Work Commission in 'Good work and our times', noted that 'employees and employers alike recognise that these days guaranteeing job security is unrealistic'. It also pointed out that employers have a role in ensuring people are equipped with transferable skills that will be an asset in the future.

The World Health Organization has highlighted the importance of ensuring the culture of an organisation promotes health and wellbeing (Healthy workplaces: a model for action). A 'healthy' culture, for example, would include having fully implemented policies on:

  • dignity and respect

  • preventing harassment and bullying

  • preventing gender discrimination

  • tolerance for ethnic or religious diversity

  • encouraging healthy behaviours.

Good line management has also been linked with good health, wellbeing and improved performance (Working for a healthier tomorrow Department for Work and Pensions).

Poor‑quality leadership, on the other hand, has been linked with stress, burnout and depression (Mental capital and wellbeing: making the most of ourselves in the 21st century Government Office for Science). It can also affect how well employees relate to the organisation, their stress levels and the amount of time they spend on sick leave (Preventing stress: promoting positive manager behaviour phase 4: How do organisations implement the findings in practice? Chartered Institute of Personnel and Development; Westerlund et al.[1]).

A Confederation of British Industry (CBI) report highlighted the importance of providing adequate training for line managers to help them support employees with a health condition to remain at work (Getting better: workplace health as a business issue). Furthermore, the Workplace Wellbeing Charter (which provides an opportunity for employers to demonstrate their commitment to the health and wellbeing of their workforce) recognises the importance of line managers in their standards.

Evidence suggests that people going to work while they are sick ('presenteeism') is a more costly problem for employers than absenteeism (Mental health at work: developing the business case. Policy paper 8 Sainsbury Centre for Mental Health). This is partly because it is more likely to occur among higher‑paid employees.

'Presenteeism' may be caused by the culture of an organisation or the nature of the work – or both (people may come to work when they are unwell because they don't want to let their team members down). It leads to poorer longer‑term health outcomes (Working while ill as a risk factor for serious coronary events: the Whitehall II study Kivimäki et al. 2005; The future of health and wellbeing in the workplace Advisory, Conciliation and Arbitration Service). A study examining the prevalence of presenteeism in the UK found that nearly 60% of the sample reported presenteeism during a 3‑month period[2]. The majority of participants (67%) indicated that the primary pressure to go to work while sick came from themselves. A substantial minority (20%) also indicated that their manager was a source of pressure.

Older employees

The number of employed people aged 65 or over in the UK has more than doubled over the past 2 decades, from 425,000 in 1994 to almost 1.17 million in 2015. Furthermore, nearly 8.2 million people aged 50–64 were also in employment in 2015 (Labour Market Statistics, June 2015 Office for National Statistics). The proportion of older employees is similar across all sectors (HSE horizon scanning intelligence group demographic study Health and Safety Executive).

By 2020, it is predicted that older people will account for almost a third (32%) of the working‑age population and half of the adult population (National Population Projections, 2012-based projections Office for National Statistics). Increases in the state pension age may mean the proportion of this group continuing in employment increases further.

Older people who earn less tend to retire earlier than their middle‑income peers, due to ill health and disability (Living in the 21st century: older people in England ELSA 2006 [Wave 3] Institute for Fiscal Studies). They are more likely to have long‑term health problems, some of which are attributable to lifestyle behaviours. They also have higher rates of non‑work related stress and mental health problems.

If people in this group are to work until 68, action is needed to raise their general level of health, reduce health inequalities ('Fair society, healthy lives') and offer a broader range of employment opportunities.

Over the next 10 years it is predicted that there will not be enough young people to fill the jobs available. So employers will become more reliant on older people (Managing a healthy ageing workforce: a national business imperative Chartered Institute of Personnel and Development).

More information

You can also see this guideline in the NICE pathway on workplace health: policy and management practices.

To find out what NICE has said on topics related to this guideline, see our web page on workplaces.

See also the evidence reviews and information about how the guideline was developed, including details of the committee.



[1] Westerlund H, Nyberg A, Bernin P et al. (2010) Managerial leadership is associated with employee stress, health, and sickness absence independently of the demand-control-support model. Work 37: 71–9.

[2] Robertson IT, Leach D, Doerner N et al. (2012) Poor health but not absent: Prevalence, predictors and outcomes of presenteeism. Journal of Occupational and Environmental Medicine 54: 1344–9.

  • National Institute for Health and Care Excellence (NICE)