Local authorities have both direct and indirect impacts on employment and training, employing about 2.5 million people directly but supporting many others indirectly through procurement (Office for National Statistics 2013). They are also responsible for regulating and supporting employment locally.
Injuries and stress endured in the workplace can be bad for health, but being unemployed can lead to poor physical and mental health, across all age groups, with major impacts for the individual concerned, their spouse and family. Getting back into work improves people’s health, as long as it is decent work.
How can employment improve health?
- Young people who are not in education, employment or training (NEET) for a substantial period are less likely to find work later in life, and more likely to experience poor long-term health (Audit Commission 2010). More than 900,000 young people aged 16–24 fell into this category across England in early 2013 – a 25 per cent increase over the past 10 years (Department for Education 2013b).
- Unemployment increases the risk of fatal or non-fatal cardiovascular disease and events, and all-cause mortality, by between 1.5 and 2.5 times (Siegrist et al 2010).
- One in seven men develop clinical depression within six months of losing their job (Royal College of Psychiatrists 2013), and prolonged unemployment increases the incidence of psychological problems from 16 per cent to 34 per cent (Paul and Moser 2009), with major impacts on the individual’s spouse (Marcus 2012).
- More than half of people with a long-term condition say their health is a barrier to the type or amount of work they can do (Department of Health 2012).
- Poor mental health is a leading cause of worklessness and sickness absence in the United Kingdom. People living with mental illness have employment rates of between just 16 per cent and 35 per cent (London Mental Health and Employment Partnership 2012).
- Getting back into employment increases the likelihood of reporting improved health (from poor to good) almost threefold, and boosts quality of life almost twofold (Carlier et al 2013).
- Around 1.8 million people report suffering from an illness they believe was caused or made worse by work; 80 per cent of new cases were musculoskeletal disorders or related to stress, depression or anxiety (Health and Safety Executive 2012).
- Stress arising from work causes employers to lose 13 million working days a year. Job stress, job insecurity and lack of job control are strongly related to poorer long-term physical and mental health outcomes, increasing the risk of cardiovascular disease (Siegrist et al 2010), hypertension, diabetes, and unhealthy behaviours, and significantly increasing the risk of depression.
What are the possible priority actions for local authorities?
Local authorities can influence people’s employment opportunities in many ways, from adopting good employment practices for their own employees, to using the Social Value Act across their commissioning. It can also commission Fit for Work and other return-to-work schemes, and work with employers in the private and independent sectors to ensure that the jobs they offer are of high quality and do not harm employees’ physical or mental health.
To improve their own employees’ health and adapt commissioned services to deliver social value, local authorities can:
- use the Social Value Act to maximise equitable employment opportunities, focusing on people classed as NEET and those least likely to be able to access the jobs market. Waltham Forest, for example, re-tendered its special educational needs transport services on the basis of social value resulting in the long-term unemployed getting back to work (Social Enterprise UK 2012)
- improve the health of their direct employees through:
- actively promoting health-enhancing work cultures, and adopting supportive, person-centred management styles
- developing systems that rapidly recognise and manage ill health
- implementing effective health promotion initiatives and encouraging employees to make healthy choices (National Institute for Health and Clinical Excellence 2009)
- champion and improve the take-up of ‘supported employment’ and job retention schemes (Centre for Mental Health 2013b). Supported employment is significantly more effective in helping people with severe mental health illness into employment than prevocational training (34 per cent compared with 12 per cent) (Crowther et al 2001).
To improve health through employment more broadly, local authorities can:
- champion employment issues within health and wellbeing boards
- help more people to be ‘fit for work’ by incorporating lessons learned from the national pilot of Fit for Work Services into local services and commissioning
- support and challenge local businesses, through Business in the Community and other schemes, to implement National Institute for Health and Care Excellence (NICE) evidence on healthy workplaces
- support and challenge local businesses to do more to help employees lead healthier lives by signing up to the Responsibility Deal’s health at work network – specifically its collective pledges on chronic conditions, mental health at work, occupational health, healthier food and behaviours, health checks, and young people in the workplace (Department of Health 2013b).
The business case for different interventions
Workplace injuries and ill health cost society an estimated £13.8 billion in 2010/11 (excluding cancer) (Health and Safety Executive 2012); sickness absence and worklessness cost the British economy £100 billion a year (Black 2008), and 300,000 people every year fall out of work onto health-related state benefits (Black and Frost 2011).
Evidence shows that getting people back into work and helping them ‘be well’ in work can help to reduce this huge economic burden (McDaid et al 2008). For example, Business in the Community has estimated that its programme of getting disadvantaged groups ‘Ready for Work’ provides more than £3 in benefits to society for every £1 spent over five years (Business in the Community 2012). This creates savings for central and local government, mainly through reduced costs associated with homelessness, crime, benefits, and health care. Employee wellness programmes have also been found to return between £2 and £10 for every £1 spent (PricewaterhouseCoopers 2008).
Further resources and case studies
- The Department for Education produces annual benchmarking data on the number and proportion of 16–18 year olds not in education, employment or training (NEET) across local authorities (Department for Education 2013a).
- The NHS Confederation has published a briefing on employment for people with a mental health condition (NHS Confederation 2010). NICE has produced guidance on promoting wellbeing at work, with evidence-based and practical advice for all employers, including local authorities (National Institute for Health and Clinical Excellence 2009).
- The Centre for Mental Health has a range of resources with advice on how to help people with mental health problems back into work, including resources for ‘mindful employers’ (Centre for Mental Health 2013a, 2013b, 2007).
- The website of the Responsibility Deal’s health at work network sets out the collective pledges partners can commit to, and includes case studies of how local authorities are delivering on the alcohol, food, health at work and physical activity pledges (Department of Health 2013a). The Business in the Community website also has tools and resources on how employers can manage employees’ emotional wellbeing (Business in the Community 2013).
- The Institution of Occupational Safety and Health (IOSH) has produced guidance on promoting health and wellbeing at work, with case studies from East Sussex and Burnley about how they reduced sickness absence levels and delivered cost savings (Institute of Occupational Safety and Health 2012).
- The National Council for Voluntary Organisations (NCVO) has produced seven case studies of voluntary organisations that provide public services which demonstrate social value, including schemes to get people with disabilities into employment, and to help ex-prisoners find full-time employment (National Council for Voluntary Organisations 2013).
For references please see Improving the public's health: references appendix
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