1 Public health need and practice

1 Public health need and practice

It is widely recognised that being employed can help improve a person's health and wellbeing and help reduce health inequalities (Department for Work and Pensions 2005a; DH 2004; Health, Work and Wellbeing Programme 2008; Waddell and Burton 2006). Conversely, unemployment is linked to higher levels of mortality and psychological morbidity (Mclean et al. 2005). However, being employed in some jobs may still have a worse impact on health than having no job at all. For example, poor quality, low paid and insecure employment (such as temporary casual work and unregulated work) may be no better for health than unemployment (Bartley and Ferrie 2001; Benach et al. 2002; Broom et al. 2006).

The quality and accuracy of data on absence and sickness absence is variable (Barham and Begum 2005; Barham and Leonard 2002). In 2007, UK employees were absent for an average 3.5% (about 8 working days) of the time they were due to spend working. Sixty six per cent of absences involved 7 days or less, 16% involved between 8 days and 4 weeks, and 20% lasted for 4 weeks (20 working days) or longer (Chartered Institute of Personnel Development 2008). The 2008 Confederation of British Industry survey shows that 95% of absences last less than 20 days, but the remaining 5% account for 40% of all lost time (Confederation of British Industry 2008).

In 2006, an estimated 175 million working days were lost in Britain due to sickness absence (Health, Work and Wellbeing Programme 2008). The review of the health of Britain's working-age population by Dame Carol Black estimated that the annual costs of sickness absence and worklessness associated with working-age ill health were over £100 billion. This is greater than the annual budget of the NHS (Health, Work and Wellbeing Programme 2008).

The most common causes of long-term sickness absence among manual workers (across all sectors in the UK) are acute medical conditions followed by back pain, musculoskeletal injuries, stress and mental health problems. Among non-manual workers (across all sectors) the most common causes are stress, acute medical conditions, mental health problems (such as depression and anxiety), musculoskeletal injuries and back pain (Chartered Institute of Personnel and Development 2008). In Scandinavian countries musculoskeletal problems are the most common cause (Shiels et al. 2004).

Sickness absence rates vary by gender, age, occupation, sector, region and the size of the workplace (Barham and Begum 2005; Chartered Institute of Personnel and Development 2008).

Individuals who are out of work for long periods of time due to sickness experience a drop in incomes which can result in poverty and social exclusion. In addition, the longer someone is not working the less likely they are to return to work (DH 2004; Ministerial Task Force for Health, Safety and Productivity 2004). Someone who has been off sick for 6 months or longer has an 80% chance of being off work for 5 years (Waddell and Burton 2006).

Government action

Government benefits available when a worker falls ill include incapacity benefit, employment and support allowance (ESA) and statutory sick pay (SSP).

About 2.7 million people receive incapacity benefit (Department for Work and Pensions 2005a; 2005b; 2006a; 2006b). Those claiming this benefit for 12 months will, on average, continue to claim for 8 years. After 2 years they are more likely to die or retire than return to work (HM Government 2005b).

A number of national policies, strategies and initiatives have been implemented to help people aged over 16 remain in – or return to – work after sickness absence or after receiving incapacity benefit. (For details see: Department for Work and Pensions 2003; 2004; 2005b; 2006a; 2006b; DH 2008a; 2008b; Health and Safety Commission 2003; HM Government 2005b; 2007; HM Treasury 2004; House of Commons Work and Pensions Committee 2006; Office of the Deputy Prime Minister and Social Exclusion Unit 2004.)

For example, in 2007 the government set a target to reduce the number of people claiming incapacity benefit by one million over the next decade. The government also has targets to increase the proportion of the working population who are in work, reduce health inequalities and eradicate child poverty. Helping people who are off sick and on incapacity benefit to resume work and draw a full salary will help achieve these targets (Department for Work and Pensions 2007). More recently, the review of Britain's working-age population made a number of proposals to help achieve these targets (Health, Work and Wellbeing Programme 2008). In addition, they are supported by a recent review of vocational rehabilitation interventions (Waddell et al. 2008).

  • National Institute for Health and Care Excellence (NICE)