Dame Carol Black National Director for Health and Work

Fit for Work Summit

London

2 November 2010

Health and Work in 2011

Future direction: challenges and opportunities

• Maintaining progress, and measuring it

• Public Health Responsibility Deal

• Public Health White Paper

• Welfare Reform

• pressing economic issues - inter-relation with other goals

• Health, well-being, engagement, productivity

• Occupational Health: encourage prevention, promotion, concern for population not just individuals

• increased life expectancy and work - changing nature of work

• long-term conditions (LTCs) and common Mental Health problems

• early-life building for a resilient future workforce

• socio-economic status, poor fitness and physically-demanding jobs

Some of the essential steps to maintain progress

• Health Issues:

- spread the message that Work is generally good for Health

- create services that deal with the common symptoms, which are often bio-psycho-social

- do not medicalise unless necessary - recognise the burden of chronic diseases: prevent where possible, control,

stop progression, enable people to work - educate and train professionals.

• Public Sector and Private Businesses:

- make the business case for investing in Health, Work and Well-being,

show what works, spread good practice – make HWWB a productivity issue - enable SMEs to be engaged – get the Trade Unions on board.

Health Work and Wellbeing - Interrelations with other government goals

• Improving public health– Health improving behaviours– Public Health Responsibility Deal– Reducing impact on health and social care– Reduce health inequalities

• Improving economic performance – Creating the conditions for business success

• Explore how economic and social objectives can be met through adopting good workplace practices

– The changing role of management • Reduce dependency; restore self-esteem, dignity, aspiration - 21st Century Welfare

• Strengthen the foundations of childhood development and family life. - A positive fulfilling work environment protects employees and also affects

their families. By investing in the health of our workplaces we are investing in our future. - Every Child Matters

Welfare Reform and the Health and Well-being agenda: the Challenge

If we are to achieve further opportunities for employment and reduce child poverty, no discussion on welfare reform can now take place without considering:

• how best to promote health and well-being in the workplace and protect the health of those in work; and

• how best to support those with health conditions to stay in work or return to work.

Health and well-being must be seen as the first pillar of a 21st-century welfare state, and the first line of defence against worklessness.

Public Health Responsibility Deal

• An initiative of the Secretary of State for Health, the business community, the voluntary sector and NGOs, working together to:

• recognise their vital role in improving people’s health

• encourage and enable people to adopt a healthier diet

• foster a culture of responsible drinking

• encourage and assist people to be more physically active

• actively support our workforce to lead healthier lives.

• Delivered through five networks:– Food– Alcohol– Health at work– Physical activity– Behaviour change

The economic challenge and the workplace

“ The truth is that we are in very different economic times, and the future for the health, well-being, productivity and performance of our working population is not sustainable unless we are all able to work radically and pull together in times of austerity to create a better whole for us all.

We have to create the right political and business environment that will allow entrepreneurial spirit and value wealth-generation by businesses – but through the untapped potential of the large numbers of now-partly-disengaged but potentially-actually-working population.”

Head of productivity and wellness, Large corporation, June 2010

Macleod Review: Engaging for Success 2009

Organisations with engaged employees tend to:

• Have employees who have a real sense of where they are trying to get to

• Have managers engaged at the front line; managers who offer clarity about what’s expected and give lots of appreciation

• Have well organised work – it is hard to be engaged if work is badly organised

• Have congruity between values and actions

Increasing productivity: the public sector

Case Study: York Hospitals NHS Trust

Previously, absence rates sat at 5.13%, costing £3.7 m yearly

• Trust invested £100k in a team – specialist nurse, physiotherapist, counsellors, clinical psychologist, HR manager – operating in partnership with hospital managers, to help staff return to work.

• Number of staff off for 4 weeks plus reduced by 42% (99 to 57 staff)• Number of staff off for 3 months plus reduced by 46% (52 to 28)

• Estimated saving of £200k with this pilot project

• Trust has dedicated resources for the coming year.

Occupational Health in the UK

• Occupational Health services reflect the historical view of ‘industrial medicine’ as a benefit to employers which should be financed by them. (However, currently only 30% of employees have access to OH via their employer.)

• A new model has to be put in place to reflect the current profile of employment in Britain.

• It requires new partnerships and new ways of working across traditional boundaries. Occupational Health must make a greater contribution to the health of the national economy.

“ If we are to change fundamentally the way we support the health of working age people, then we have to address a number of challenges which face Occupational Health as it is currently configured.”

Working for a healthier tomorrow (2008)

Why Occupational and Environmental Medicine?

• The profession of OEM is positioned at the crossroads of the employer-employee-healthcare interface, making it a logical advocate for health-system reform through workplace initiatives.

• OEM physicians have unique training, expertise and perspective to understand the link between health and productivity, as well as how to help injured, ill and aging workers remain at work and productive.

• OEM has a high concentration of physicians trained in public health, whose focus on population-based health issues is critically important to system reform.

• OEM physicians have a distinct and logical role in advocating prevention-oriented programs that protect and assure the health of employed and productive citizens.

American College of Occupational and Environmental Medicine Guidance Document 2009

Population trends and working life

For a flourishing society we need the maximum number of productive years from as many of the population as possible.

We need the ratio of earners and wealth-generators to dependants (children, pensioners, unemployed) to be as high as possible.

Childhood Working life Retirement

On current predictions, the future population will be composed of longer survivors, with more long term conditions.

Extending working life

Life expectancy is increasing:

• now 77 for men and 81 for women (at birth)

• over-65s will soon outnumber under-16s

• the ratio workers/pensioners, 3.3 in 2007, is expected to decrease to 2.9 in 2032.

But a corresponding increase in working life expectancy will be difficult to achieve without improvements in healthy life expectancy.

The challenges are:• minimise ill-health• mitigate effects of age on function.

People need to be economically active for longer.

Common long-term conditions

Common chronic disorders – rheumatic diseases, cardiovascular and respiratory conditions, diabetes, treated cancers – do not deny the possibility of fulfilling work or an extended working life.

They require:

• good clinical care and Vocational Rehabilitation

• flexibility and adaptation in the workplace.

Increasing prevalence of chronic disorders appears inevitable with an ageing population and ‘lifestyle factors’.

If managed effectively, disability can be minimised and disease progress delayed - thus extending working life and reducing the load on health and care services.

Impact of Lifestyle on Health and Work

100%

0%

HE

ALT

H

0 10 20 30 40 50 60 70 80 90

AGE

Ideal Lifeline

Typical Lifeline

Optimal Health

Declining Health

Poor Health

Progressive and chronic disability

What is healthy aging in the 21st century? Westendorp RGJ Am J Clin Nut, Vol. 83, No. 2, 404S-409 (2006)

February 11, 2010

Retire at 68? Three-quarters of us will be too ill to even work that long...

Lifestyle trends

It is likely that by 2025 40% of adults will be obese, and the number of people living and working with chronic conditions will rise steadily, affecting morale, competitiveness, profitability.

In an increasingly competitive global economy, only the healthiest businesses will prosper. Companies that invest to support employees’ health will be fitter to survive.

The UK epidemic of obesity: BMI-related diseases

2006 2030 2050

Arthritis 603 649 695

Breast cancer 792 827 823

Colorectal cancer 275 349 375

Diabetes 2869 4908 7072

Coronary heart disease 1944 2471 3139

Hypertension 5510 6851 7877

Stroke 792 887 1050

Predicted UK rates per 100,000 (National Heart Forum):

The risk factors, of poor diet, physical inactivity, high alcohol consumption and smoking, provide a clear focus for action for all.

Labour participation rates

UK Labour Force survey:

Of the 36.3m people aged 20-64, 79% are economically active

Of the remaining 7.8m, 40% are disabled by DDA criteria (30% in the age-group 25-47, rising to 50% in the 48-64 cohort).

Labour participation rates drop significantly after age 50 (for reasons including poor health and increased caring responsibilities).

Those with longest working life expectancy at 50 are more educated, are home owners, married or co-habiting, and in reasonable health.

Reversal of these factors will depend on more than healthcare interventions alone – the Marmot agenda.

Unemployment rate by previous occupation

Managers

Skilled Trades

Unskilled

Marmot Review:Health Inequalities

• Create fair employment and decent work for all

• Improve access to good jobs and reduce long-term

unemployment across the social gradient.• Make it easier for people who are disadvantaged in

the labour market to obtain and keep work.

• Improve quality of jobs across the social gradient

Getting people into work is of critical importance for reducing health inequalities.

Policy objectives of Marmot :

Early life : building resilience

for our future workforce To increase the life chances of young people :

• Improve support in education

• Encourage supportive parenting and relationships

• Provide early and co-ordinated intervention

Four recent Reports address this: Foresight, Mental Capital and Wellbeing; the Black Review Working for a Healthier Tomorrow; Working our way to better mental health: a framework for action; and the Marmot Review.

“In order to give every child and young person the best possible chance to thrive, families carers and health and education systems must act together to promote wellbeing and foster skills for resilience.”

Work is changing

• Continued growth at the top end in the professions and managerial work,

• but much low-paid employment remains in areas such as personal services, cleaning, retail, wholesaling (15% of workforce), hotels, restaurants – often in poor conditions.

• Fewer low-skill jobs, more customer-service jobs,• Fewer permanent ‘core’ staff due to out-sourcing• More women in the workforce; importance of work-home balance

• Concept of ‘good work’; relationship security – well-being• Flexibility, upskilling, lifelong education and training – transferable

skills essential• Work-anywhere culture• Consumer expectations

Cross-Government collaboration

Cross-government collaboration will be essential to safeguard and improve health and wellbeing in the context of work, to achieve more fulfilling and productive lives and to reduce health inequalities.

A recent successful cross-government Workshop will help DWP to set out strategy on the health and well-being of the working-age population over the next five years, commanding wide support and with consistent policies between departments, encouraging collaboration.

Cross-Government collaboration strategy should give attention to: • role of the workplace in protecting and promoting health, as part of the

public health endeavour • the major problems surrounding mental health, • the support of people with long term disorders in the workplace, • roles of health professionals in bringing about the required shifts in

health related behaviours; and • the need to strengthen the evidence base to guide policy and business

and healthcare practice.