Work and Wellbeing

Professor Ewan Macdonald OBE University of Glasgow

But what is Work?But what is Work? Its not only being in a paid job with 6 months full Its not only being in a paid job with 6 months full

pay and 6 months half paypay and 6 months half pay

Paid employment Self Employment Voluntary work Carer Homemaker Child rearing Full time/ part-time Community activities, clubs, church Etc

ALL OF THE ABOVE ARE BENEFICIAL TO SOCIETY AND THE INDIVIDUAL PROVIDED THEY HAVE ENOUGH MONEY

Jimmy - Road Worker case studyJimmy - Road Worker case study

Jimmy – a 45 year old Jimmy – a 45 year old distribution worker distribution worker

Contractor Minimal health and

safety No eye protection No ear muffs Early noise induced

hearing loss Vibration white finger Several Eye injuries

in past

Irritant dermatitis

Back injury in past

Osteoarthritis of spine,shoulders , elbows and knees

6 visits to accident and emergency

One hand fracture

Getting a bit past it

JimmyJimmy

Average housing

Poor diet, not much fruit, veg or fish

4 pints of beer a night (occas drink at lunchtime)

20cigs a day

No leisure exercise

Left school with no qualifications

Jobs on building sites Frequently does overtime Sometimes in informal

economy Few of his employers

have occ health and safety resource

JimmyJimmy Separated lives with

partner and two stepchildren

Two children by first wife

Financial problems Child care issues

Has been on courses to use power tools

No other education Reads paper

occasionally Has home

computer-on internet

JimmyJimmy He has an accident – pipe rolled on leg fracture of right

tibia and fibula Taken to hospital – transferred to orthopaedics –

surgery, plated , discharged on crutches after two days (superb treatment)

No record of job in the hospital notes No physiotherapy Gets Fit note “unfit” No guidance about rehabilitation

JimmyJimmy Rests at home, watches TV (gets depressed) Progresses to walking with a stick Wasting of quadriceps (50%) and reduction in power both

legs, pain at fracture site After six weeks starts physiotherapy – once per week for

six weeks Pain and weakness still a problem, Family doctor advises

job will be too much for him Follow up hospital appointment – no discussion about

work

Jimmy - OptionsJimmy - Options

Probably dismissed within 4 weeks

Friendly with the boss – given job driving the dump truck

Goes on to long term Health Benefit (ESA) after six months

Sickness Related Benefits Growth 1979 - Sickness Related Benefits Growth 1979 -

20052005

Facts about Incapacity Benefit in Facts about Incapacity Benefit in Scotland Scotland (Brown, Hanlon, Macdonald et al, J. Pub.Health 2008)(Brown, Hanlon, Macdonald et al, J. Pub.Health 2008)

2.5% of Working age population go on to IB each year (3.5% in Glasgow)

55-59 yr old males – 18% on IB (35% in Glasgow, 60% in districts)

Mental Health problems cause 50% of IB

10 years ago main cause was musculoskeletal

Rate of Rate of IB receipt IB receipt

by MSP by MSP ConstituencyConstituency

20082008

Scottish Observatory Scottish Observatory for Work & Healthfor Work & Health

http://www.gla.ac.uk/departments/hwlgroupdepartments/hwlgroup//

Age standardised mortality (Men) Age standardised mortality (Men) per 100,000 per 100,000

Relationship between mortality (age/sex standardised rates Relationship between mortality (age/sex standardised rates per 100,000 population) and deprivation (as measured by the per 100,000 population) and deprivation (as measured by the

Scottish Index of Multiple Deprivation) Scottish Index of Multiple Deprivation)

Work and InequalityWork and Inequality Your status is determined by having

a job and the level of that job Your job (or jobless) level determines

your life expectancy Your job (or jobless) level determines

how long you will survive the same medical condition

Work is good for youWork is good for you

“Overall the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long-term unemployment or prolonged sickness absence. Work is generally good for health and well-being”

Waddell and Burton 2006

What else do we know about What else do we know about being out of work?being out of work?

Unemployment is bad for you:

– Loss of Income¹

– Destructive on self-respect¹

– Risks of ill-health²

– The “psychosocial scar” persists³

– Trans-generational effects

1. Winkelmann and Winkelmann 1996

2. Clark, Georgellis, Samfey 2001

3. Clark and Oswald 1996

4. Aylward 2006

Long-term worklessness is one of the Long-term worklessness is one of the greatest known risks to public healthgreatest known risks to public health

Health Risk = smoking 10 packs of cigarettes per day (Ross 1995)Health Risk = smoking 10 packs of cigarettes per day (Ross 1995) Suicide in young men > 6 months out of work is increased 40 x Suicide in young men > 6 months out of work is increased 40 x

(Wessely, 2004)(Wessely, 2004) Suicide rate in general increased 6x in longer-term worklessness Suicide rate in general increased 6x in longer-term worklessness

(Bartley et al, 2005)(Bartley et al, 2005) Health risk greater and life expectancy worse than many “killer Health risk greater and life expectancy worse than many “killer

diseases” (Waddell & Aylward, 2005)diseases” (Waddell & Aylward, 2005) Greater risk than most dangerous jobs (construction/North Sea)Greater risk than most dangerous jobs (construction/North Sea)

The Scottish Healthy Working Lives The Scottish Healthy Working Lives

paradigmparadigm 20032003 (Macdonald E, Docherty G. 2007)(Macdonald E, Docherty G. 2007)

“A healthy working life is one that continuously provides working age people with the opportunity ability support and encouragement to work in ways and in an environment which allows them to sustain and improve their health and well being. It means that individuals are empowered and enabled to do as much as possible, for as long as possible, or as long as they want, in both their working and non working lives”

Self Reported Health from British Household Panel Survey

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Employed Workless Incapacity Benefit

Scottish Observatory for Work and Health, University of Glasgow(Data Source: BHPS)

Self-Reported Health by Economic Group in Scotland

Excellent/Good Less than Good

BHPS Study0

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Self-R

eport

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ealth (

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Employed Workless Incapacity Benefit

Self-Reported Health by Economic Group

Excellent Good FairPoor Very Poor

Scottish Health Survey StudyEmployment status and education, SHS 2003

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30

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Employed Unemployed Economically Inactive

Economic Group

% o

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Degree or higher No qualifications

In ScotlandIn ScotlandWorklessness is the single Worklessness is the single

most important cause of health most important cause of health inequality, social exclusion, inequality, social exclusion, deprivation , and mortalitydeprivation , and mortality