A presentation I gave to the Vocational Rehabilitation Association Annual Conference in June 2018.

1. Policy in Action - The Changing
Nature of Health & Work
DrJustinVarney
NationalStrategicAdvisoronHealthandWork
Justin.varney@phe.gov.uk

2. Work, Worklessness & Health
2
Health Survey of
Male Civil
Servants
(1967-77)
London Transport
Workers Study
(1947-52)
Over 74% of people are in employment. On average, we
spend 60% of waking hours in work.
Safe and health supporting work is good for health, being
unemployed or in dangerous work is harmful to health.
Health remains a significant barrier to accessing and
retaining employment, particularly in relation to mental
health issues, musculoskeletal health and disabilities.
To improve adult health, we need to engage employers
and ensure workplaces are safe and health promoting, as
well as work with health and public services to support
individuals to reach their employment potential.

3. National Policy Context
Work, worklessness and health
issues are embedded across
multiple different interconnecting
national and sub-national policies.
This reflects the matrix of action
that is required at both national
and local level to effect a whole
system approach to enabling
individuals with health issues to
work.
3
Industrial Strategy
Improving Lives Green
Paper
NHS Five Year Forward
View
Devolution Agreements
Economic Development
Plans

4. 4 Waddle G, Burton A K (2006) Is Work Good for your Health and Well-Being?
Health
and
wellbeing
Economic
resources
Psychosocial
needs
Identity / role
/ status
Physical
health
Mental
health
Benefits of Health & work (individual level)

5. 5 Suhrcke et al. (2005) The Contribution of Health to the Economy in the European Union.
Benefits of Health & economy (societal level)
Capital
outcomes
Lifestyle
Age, gender,
ethnicity
Education
& skills
Employment
Income
& status
Housing
Health care
Environment
ECONOMIC
OUTCOMES
Education
Labour
supply
Productivity
Health

6. Safe & Good Work
Health improving
workplaces
Health enabling
employment
Health as a
barrier to
employment
Unemployment
impact on health
6
5 Core
Themes of
Health, Work
&
Worklessness

7. Underlying principles
7
Everybody should be supported to achieve their employment potential so
that health is not a barrier
The employment gap for people with health issues and disabilities is a
reflection of how society and the public health system lacks the appropriate
enablement and support for individuals.
Most adults are in work, and most spend a large proportion of their waking
hours in the workplace so it is a key space for improving adult health and
wellbeing
Work can cause ill health if it is dangerous, poorly managed, insecure, but
‘good work’ can be good for health and a protective factor
The wealth of the nation is directly connected to the health of the nation

8. Supporting action in the
workplace to enable people with
health issues to access, retain
or return to employment.

9. Taking a holistic approach to health in the
workplace
Although different employers
are often be motivated to start
taking action on a specific
aspect of health and wellbeing
such as mental health.
This can be developed to take
a holistic approach based on
the WHO definitions of health.
9
Health is a state of complete
physical, mental and social well-
being and not merely the absence
of disease or infirmity.
The enjoyment of the highest
attainable standard of health is one
of the fundamental rights of every
human being without distinction of
race, religion, political belief,
economic or social condition.
World Health Organisation
Definition of Health

10. Effectiveness of employer actions
Sources: BUPA (2009) Healthy Work: Evidence into Action ; Social Science Research Unit, UCL Institute of Education
(2016) Do evidence-informed, employer-led, workplace health programmes work?; GMPHN (2015) Ageing Well in
Work.
10
Workplace health interventions can return 1:2-34 (i.e. £2 to £34
for every £1 spent) to employers
Effective workplace health interventions are:
• supported by organisational policy
• focus on specific health issues
• engage employees
Benefits for employers on healthy ageing actions include:
• workplace skills retention
• lower levels of sickness absence
• reduced staff turnover and associated costs
• wider recruitment pool
Sources: BUPA (2009) Healthy Work: Evidence into Action ; Social Science Research Unit, UCL Institute of Education
(2016) Do evidence-informed, employer-led, workplace health programmes work?; GMPHN (2015) Ageing Well in
Work.

11. Physical
MentalSocial
11
PROTECTION IMPROVEMENT
RESPONSE, SUPPORT & ADJUSTMENT
Taking a whole system approach

12. BITC / PHE interconnected toolkit suite for employers
• Mental health is a common thread
across all the toolkits
• Consolidates best evidence along
with best employer practice
aligned with freely available
resources
• Take a whole person, whole
system approach to embedding
wellbeing into organisational
culture
12

13. Enabling people with health
issues to achieve their
employment potential.

14. Cross-government vision for enabling individuals
in relation to work and health
14

15. Opportunities to influence the relationship
between health and work
Healthcare pathway &
healthcare professional
advice & support
Patient narratives about
health condition & work
Enablement support to
individuals to
adapt/adjust
Suitable employment
opportunities
15
Enablement
Empowerment
Opportunity

16. Work as a clinical outcome project
16
Undergraduate
education
Post-
graduate
education
Continuing
professional
development
16/17
• Develop pilot of peer to peer clinical champion
education initiative with Royal College of
Occupational Therapy.
• Map undergraduate teaching on health
and work across healthcare professional
education.
17/18 in Partnership with Joint Unit
• Develop and expand peer to peer clinical
champion pilot.
• Undertake research to better understanding of
healthcare professionals attitudes to health and
work.
• Develop e-learning modules on health and work
on e-learning for health.
• Developing with Medical Royal Colleges an
action consensus on health and work.

17. Developing the national and
local understanding of the
connection between population
health and economic
productivity/sustainability

18. Developing the national narrative on
population health and economic
productivity
Some of the examples of resources that have
been developed to support the health and wealth
narrative:
PHE & IHE reports on increasing employment opportunities
PHE Health and work, worklessness and economic growth:
LEP briefing
PHE LGA Joint Briefing Health, work and health related
Worklessness: A guide for local authorities
PHE & Work Foundation Infographics on Work and Health
PHE Blogs on Work & Health Issues
18

19. PHE Wider Determinants Fingertips Tool
The wider determinants fingertips tool presents local data on a range of
indicators. Wider determinants, also known as social determinants, are a
diverse range of social, economic and environmental factors which
impact on people’s health. Such factors are influenced by the local,
national and international distribution of power and resources which
shape the conditions of daily life. They determine the extent to which
different individuals have the physical, social and personal resources to
identify and achieve goals, meet their needs and deal with changes to
their circumstances.
The work and the labour market indicator suite includes indicators on:
• Disability employment gap
• Economic inactivity
• Long term job seeker allowance claimants
• Sickness absence
19

20. 20

21. England East of
England
Suffolk
74.4% 77.2% 77.0%
21.8% 19.7% 19.5%
4.8% 3.8% 3.5%
Employment, economic inactivity and
unemployment
Employment rate
Economic inactivity rate
Unemployment rate
16-64 yrs
(2016/17)
16-64 yrs
(2016/17)
16+ yrs
(2016)
2

22. Long-term conditions employment gap
The gap between the
employment rate for those
with a long-term condition
and the overall employment
rate is a good reflection on
how well the local system is
enabling people with long-
term conditions to achieve
their employment potential.
Enabling people with long-
term conditions to access
work that supports their
needs is fundamental to
supporting people to have
independence and
autonomy in their lives.
Focusing on the
employment gap for people
with long-term conditions
provides an opportunity to
reflect on how well the
health system is working
with local partners,
including employers, to
support employment.
Percentage
point gap in the
employment
rate between
those with a
long-term health
condition and
the overall
employment
rate (2016/17)
England East of
England
Suffolk
** statistically worse than
England
2x
A national survey of adult health in
Great Britain found that unemployed
people were more than twice as likely
as employed people to report having a
limiting long-term condition (2013)
2 60% 2
Nationally, having a long-term condition
is associated with unemployment and
worklessness. People with a long-term
condition have an employment rate of
only 60% (2014)

23. Long-term conditions employment gap
Discussion and reflection points to explore the local context and
response to the issue
• How does the health and wellbeing board, joint strategic needs assessment
and local strategy reflect the health related employment gap?
• How do local healthcare professionals talk about work in the context of
holistic patient care?
• How are local employers being supported to offer employment opportunities
for people with long-term conditions?
• How are local health employers creating job opportunities, especially for
people with health issues?
National resources to support local action
• PHE is working in partnership to develop a national programme for clinical
staff to better support work as part of holistic patient care. This includes free
e-learning on health and face to face peer education through the Royal
College of Occupational Therapists Clinical Champion programme.
• There is support via and schemes for
employers.
Access2Work Disability Confident

24. Musculoskeletal (MSK) conditions
Musculoskeletal
conditions remain one of
the most significant
barriers to employment
and highest causes of
sickness absence.
Although there is a broad
spectrum of
musculoskeletal issues
that affect work, back
pain remains one of the
most common causes of
sickness absence.
Focusing on the burden
on the welfare system
created by MSK provides
an opportunity to reflect
on how well the health
and welfare system are
working with employers
to prevent MSK
conditions and intervene
early to provide support.
England East of
England
Suffolk
Total number of
Employment
Support
Allowance
claimants where
MSK conditions
are primary
health cause
identified (2017)
Percentage of
Employment
Support
Allowance
claimants where
MSK conditions
are primary
health cause
identified (2017)
A study of adults in Great Britain found
that 1 in 10 of the working age population
reported having an MSK condition
507,000
workers suffering from work-related
musculoskeletal disorders (new or
long-standing) in 2016/17
8.9 million
working days lost due to work-related
musculoskeletal disorders in 2016/17
Nationally, in Great Britain
2
2

25. Musculoskeletal (MSK) conditions
Discussion and reflection points to explore the local context and
response to the issue
• How well do local MSK pathways and strategic plans reflect employment
issues and opportunities for supporting patients to remain economically
active through vocational rehab?
• How well established is the narrative around early identification, self-care
and management of MSK, especially back pain?
• How are local employers being supported to offer employment opportunities
for people with MSK conditions?
• How are local health employers demonstrating how to reduce the burden of
MSK in the workplace?
National resources to support local action
• There is support via and schemes for
employers and PHE produced a for employers on MSK
issues with BITC.
• The has extensive resources and materials to
support action on back pain in the workplace.
Access2Work Disability Confident
specific toolkit
Health and Safety Executive

26. Economic Benefit Modelling Tools
In 2017/18 PHE published a economic modelling tool to support local areas
understand the economic benefits, particularly to the health system, of
supporting an individual into employment.
This interactive tool helps local decision-makers assess the health and financial
benefits for individuals, the exchequer and wider society of helping people in
their area back into work.
We are currently scoping a further tool to model the economic benefits of
reducing the burden of mental health and musculoskeletal disease to both the
business sector and the public sector.
26

27. Support the public sector to be
an exemplar of health and
wellbeing in the workplace

28. The Public Sector Workforce (Sept 17 data)
Total UK public sector employment in September 2017 was 5.492 million, up
19,000 on the previous quarter and up 21,000 on the previous year.
Of all people in work, 17.1% were employed in the public sector, an increase of
0.1 percentage points over the quarter.
The NHS accounts for 1.629 million jobs and it is the highest level since
comparable records began and accounts for 30% of total public sector
employment (PSE).
28

29. Our Approach
Working with the Civil Service and NHS Staff Health and Wellbeing
groups, trade unions and relevant professional bodies, to embed
evidence based approaches to improving the health of the workforce
into delivery plans and strategies.
As PHE to work to become an exemplar organisation for employee
health and wellbeing.
Work with public sector employers to explore innovation and develop
transferrable learning on employee health and wellbeing.
29

30. Looking Ahead

31. Looking ahead
31
Life expectancy continues to expand
but so does the proportion of life lived
with disease and disability.
Fertility rates remain relatively constant
and although migration patterns may
change the overall picture is of
population growth.
Increasing shift to city based living
aligned with mobilisation of sustainable
tech harmonised living.
More people are remaining in work into
later life for economic and personal
reasons.
Estimated and projected total population, UK, year
ending mid-1971 to year ending mid-2089 (ONS 2015)
Percentage change in the size of the usual resident
population in urban and rural areas 2001 to 2011 (ONS)

32. Emerging contextual shifts
• 1 in 3 girls and 1 in 5 boys aged 5yrs today will
reach their 100th birthday which will influence
work patterns and types of work across the life
course.
• Climate change and ecological stability will have
an influence on the patterns of work.
• Evolution of types of industry and impact of
technology especially on ‘low skilled work’
opportunities.
• Globalised multi-nationals working with ‘crowd
sourced’ businesses and growth of ‘gig’
economy.
• Potential for increasing inequalities and social
division
32

33. Potential Opportunities
• Integration of health and work into routine patient care
and conversations - paradox of low hanging fruit
• Complex challenges of multiple employers might
generate more of a concept of self care, possibly linked
to increased uptake of personal health insurance
• Changing landscape of employment and increasing
cohort effect of the digital natives will drive self-care and
patient led care
33

34. Investing in prevention is key at an
individual level to being able to enjoy
life, remain economically active and
independent into later life.
For the business sector, ensuring
individuals are active across the life
course and investing in their own health
is essential to the economic viability of
local communities and the sustainability
of businesses.
At a national level, reducing inequalities
in access and uptake of safe and good
work is imperative to improving the
health, and wealth, of the nation.
34

35. Policy in Action - The Changing
Nature of Health & Work
DrJustinVarney
NationalStrategicAdvisoronHealthandWork
Justin.varney@phe.gov.uk