Abstract
Over the past decade there has been considerable progress made in our understanding of the importance of workplace health – not just for the individual, but for business and wider society. With medical advances resulting in an increase in life expectancy, an ageing workforce, and later retirement, it is estimated that by 2030 more than 40% of the working-age population will be living with at least one work-limiting long-term health condition. While it is to be celebrated that many more organisations have started to implement health and wellbeing interventions in an attempt to prevent sickness absence and improve productivity, the majority are still focusing their efforts on nutrition, exercise and other lifestyle factors, rather than more evidence-based interventions. The latter may be less eye-catching, but they make more difference to health, wellbeing and productivity. In this piece, we ask what lies behind the ‘fruit and pilates’ evangelism that dominates so much of corporate health promotion, and argue that embedding the principles of ‘good work’ in HR practice is much more likely to deliver sustainable improvements in health and productivity at work.
What’s new
In her 2008 review of the health of the UK workforce, Working for a healthier tomorrow, Carol Black made a strong economic and moral case for why workplace health should be taken more seriously. Improved workforce wellbeing, she argued, makes sound business sense and could generate the UK government savings of more than £60 billion – the equivalent of nearly two-thirds of the NHS budget. The report argued that a shift in attitude was needed to understand the importance of prevention of ill health in working-age individuals, and the part that the workplace can play in promoting health and wellbeing.
The review is now more than 10 years old. It’s frequently cited, but has it been a catalyst for employers, policymakers and practitioners to consider health and wellbeing initiatives at work?
It’s important to recognise how much progress Black's report has stimulated. Compared with 2008 many more employers are engaged in workplace health. And government policy and clinical practice by healthcare professionals are much more joined up in their efforts to support workers living with health problems to remain active, fulfilled and productive at work.
However, a stubbornly consistent one in five UK employers still say that – aside from compliance with health and safety regulations – they have no intention of doing more to promote employee wellbeing, because this is beyond their remit and should be the personal responsibility of workers and something that the NHS alone should pick up.
So we may have reached an inflection point at which we must find answers to a number of questions and challenges. For example, how do we get healthcare professionals to play a more active part in helping those patients who want to work (considering, for example, that work might be a desirable and therapeutic clinical outcome for many patients).
Another challenge remains that of de-stigmatising mental illness. Again big strides have been taken, but many employers and sadly still too many HR professionals still believe that a history of mental illness is an insurmountable barrier to career progression and additional responsibility.
But the challenge we want to focus on here is this: do employers recognise that good-quality jobs that offer autonomy and control, supportive line managers, opportunities for personal growth, and discretion over working time and work/life balance, deliver better health outcomes than measures that focus on nutrition and exercise alone?
Key findings
At many health and wellbeing conferences, the common rhetorical assertion that ‘people are our most valuable resource’ is still used by HR managers when they are discussing what their organisation is currently doing to improve the wellbeing of its employees. In one way they are right; as a healthy workforce is more likely to be resourceful, productive, innovative, motivated, loyal and have improved attendance. There is also evidence that organisations are implementing interventions that, at least on the face of it, could plausibly improve wellbeing.
The box below represents quite a shopping list of interventions. But, amid such choice, there is very little to guide employers about where to invest their time and resources to best effect. Our experience is that employers who provide some of these interventions as part of a compensation and benefits package are often doing so for different reasons than those who have more of an occupational health (OH) or vocational rehabilitation (VR) focus. It’s perhaps true that to remain competitive in a tight labour market employers must offer attractive benefits such as gym memberships and good private health cover. These also tend to be the employers who measure the success of these benefits only by whether they are taken up by employees rather than whether they improve health in any tangible way.
It’s a legitimate approach, but it shouldn’t be dressed up as a set of health interventions. Those employers going down an OH or VR route are more likely to target interventions where there is highest risk, to prioritise early referral and to offer personalised return-to-work support. They are also more likely to look at both physical and psychosocial risk factors in the work environment, promote preventative action and measure health, attendance and productivity outcomes. Of the two approaches, our experience is that the OH and VR model is more likely to recognise that so-called ‘good work’ is likely to lie at the core of healthy organisations.
The health benefits of good work
The term ‘good work’ was propelled into the policy arena last year when Matthew Taylor released Good Work: The Taylor Review of Modern Working Practices, with the overriding ambition that 'all work in the UK economy should be fair and decent with realistic scope for development and fulfilment'. However, the idea that work is a factor in fulfilling human and psychological needs (other than a need for income) has a long history.
In the 1960s the Quality of Working Life movement was centred around the idea that work, organisation and the design of industrial processes need to take into account how employees gain fulfilment and satisfaction from the work they do. Some of the essential elements of the movement included: the idea that learning is good, high levels of skill are preferred to low levels, autonomy is preferable to dependence, and a high degree of self-investment in work is good (with the provision that it offers opportunities for growth).
The roots of our current discussions about job quality and good work can be found in moral philosophy. For example, back in the 18th century Kant intimated in his writings that work has the power to animate us, and has an important role in our lives, even though the work that we do may be constrained or hindered by our position in the labour market and the role and actions of our bosses.
Increasingly analyses of workplace practices are indicating that to engage employees, and to ensure they are fully committed and motivated in their role, it is important to understand the meaning and purpose of their work and how it connects to and identifies with the wider aims of the organisation (Parker and Bevan, 2011). Consequently, instead of just focusing on those practices that aim to improve satisfaction, maybe attention needs to shift to interventions that pay more systematic attention to the ‘intrinsic quality’ of the work that employees do.
The connection between employee health and good-quality work is becoming a lot clearer. In their landmark report Gordon Waddell and Kim Burton (2006) asked the question: ‘Is work good for your health and wellbeing?’ The evidence reviewed clearly highlighted a link; that ‘work is generally good for physical and mental health and wellbeing…work can be therapeutic and can reverse the adverse health effects of unemployment…' It also found that: 'The provisos are that account must be taken for the nature and quality of the work and its social context; jobs should be safe and accommodating.’
Similarly Michael Marmot, in books such as Status Syndrome: How Your Place on the Social Gradient Directly Affects Your Health, also provided compelling evidence of the links between quality of work and health and wellbeing. He reported that employees in lower-status work had reduced health and lower life expectancy than those in higher-status roles. Lower-status workers experienced more stressors, which had implications including increasing the risk of mental illness, coronary heart disease and gastro-intestinal conditions. Marmot’s idea of the so-called ‘social gradient’ in health applies in organisations as well as wider society, with a clear correlation identified in his research on civil servants between job control and the incidence of coronary heart disease.
From research to reality
It is clear that interest in job quality is now intensifying.The follow-up to Taylor’s 2017 report, Measuring Good Work (September 2018), notes that despite employment rates currently at a record high, the quality rather than just the quantity of work is now being given greater priority by policymakers, with levels of in-work poverty and fears of increasing job insecurity (i.e. through the gig economy) and job inequality all remaining high.
We believe that the focus must now go beyond just creating jobs, instead ensuring that work is fair, fulfilling and provides opportunities for development, growth and progression (which should, in turn, reduce the associated risks to health and wellbeing). This also needs to be harnessed in the UK’s battle to improve on its dismal record on labour productivity.
The Measuring Good Work report aimed to develop a metric for this, as ‘it is only by determining the different aspects of ‘good work’ and tracking progress on these issues in a robust and credible way that we can understand whether improvements in the quality of work are being achieved or not'.
A number of recommended measures were made, which fit closely the measures of ‘good work’ discussed in the Parker and Bevan (2011) report, such as pay and benefits (reward), social support and cohesion, voice and representation, job design and the nature of work (control, use of skills, progression), terms of employment, health, safety and wellbeing and work/life balance.
So where do we go from here?It is clear that for most of us work is more than an economic activity; there is a clear social dimension and it is now reasonable to expect that work should be designed – as far as possible – to be good for health and wellbeing. The focus on this now in the policy realm is a good start. But it is important that this can be transformed into action among employers.
For those employers who have fallen into the self-congratulatory trap of thinking ‘fruit and pilates’ are enough by themselves, there is a simple message: nutrition and exercise are both really important, but they are insufficient to deliver long-term success.
Promoting and supporting better lifestyle habits can only ever be one, relatively minor, element of a more holistic, preventative, culturally-challenging and sustainable approach to delivering physically and psychologically healthy workplaces where employees can thrive and give full expression to both their creative energy and talents. This is why good work has to be woven more delicately and permanently into the fabric of the way we manage modern organisations.
Stephen Bevan is director of employer research and consultancy at the Institute for Employment Studies (IES). Zofia Bajorek is a research fellow at the IES