1. www.hertsdirect.org Health Inequalities and the Workplace Why should you care? Jim McManus, CPsychol, CSci, AFBPsS, FFPH, FRSPH, MCIPD Director of Public Health

2. www.hertsdirect.org I will cover Health inequalities Why you should care What can we do about it?

3. www.hertsdirect.org

4. 1. Health Inequalities

5. www.hertsdirect.org

6. And Hertfordshire shows the same pattern!

7. www.hertsdirect.org The Problem Increasing non-communicable disease –Smoking, obesity Increasing mental ill health Increasing sickness absence Increasing loss to business productivity and performance from sick pay Avoidable cost of managing and replacing sick and absent staff

8. www.hertsdirect.org Hertfordshire 2,200 early and avoidable deaths per annum Most of them preventable Problems start in working age life with sickness absence Common causes: inactivity, MSK problems, diet, alcohol, smoking Significant avoidable stress and mental health costs The human side of resource depreciation because it isn’t looked after WE REALLY MUST DO SOMETHING! BUT WHAT?

9. www.hertsdirect.org Premature death in Hertfordshire The causes of premature mortality can be grouped into four main conditions which account for around 80% of premature deaths. These are: cancer heart disease and stroke lung disease liver disease

10. www.hertsdirect.org

17. Mental Health Biggest single cause of sickness absence Mostly avoidable or remediable at early stages Significant cause of ET claims and workplace disputes Area most employers feel least prepared for 1 in 4 of population have in lifetime 1 in 3 of workforce report sickness absence around it

18. www.hertsdirect.org Hertfordshire percentage projected population change 2010 to 2035

19. www.hertsdirect.org 2. Why should you care?

20. www.hertsdirect.org Because it’s costing you Sickness absence Productivity Established relationship between lifestyle related risk factors (smoking, inactivity, obesity) and productivity absenteeism and health claims. (Buron et al,2005, Wellsource, 2006 & University of Michigan, 2006)

21. www.hertsdirect.org Doing nothing is not an option The do-nothing strategy of waiting for sickness and then paying for treatment isn’t cost neutral – it costs you Lifestyle related risk factors and behaviours of employees as well as unhealthy work environments and practices drive costs. High risk employees incur high costs whatever the outcome measure: pharmaceutical, absenteeism, compensation costs or productivity. Now I’m going to prove it….

22. www.hertsdirect.org What is the root issue? There is a flow from low risk to high risk to disease for the working age population This leads to: Diseases of lifestyle More risk, more absence Compound risk, compound absence Low productivity

23. www.hertsdirect.org What does this mean for you as employers? Chronic disease related deaths account for 56% of all deaths in the working-age population in the world (World Health Organization). High prevalence of major modifiable health risks contributes to the epidemic of chronic disease. – Elevated BMI (BMI ≥25kg/m 2 )Obesity (BMI ≥ 30 kg/m 2 ) –InactivitySmoking –StressElevated blood pressure –Elevated cholesterolHigh blood sugar –Alcohol Places an increasing burden on employers: decreased productivity, increased absenteeism, increased health and workers’ compensation claims.

24. www.hertsdirect.org Productivity Decreases with Number of Health Risks Excess Productivity Loss Productivity Loss (%) Base Cost Number of Health Risks (Journal of Occupational and Environmental Medicine 2005;47:769-77 (n = 28,375))

25. www.hertsdirect.org Absenteeism Increases with Number of Health Risks Number of Health Risks (Journal of Occupational and Environmental Medicine 2005;47:769-77 (n = 28,375)) Base work loss days/yr Excess Work Loss days/yr work loss days/yr

26. www.hertsdirect.org Work done for Herts by economists at Example: Smoking costs in Herts total annual cost in Hertfordshire £45,972,899 –NHS Treatment and Care costs: £32,429,375 –Costs to businesses (productivity losses): £12,931,914 –Passive smoking costs: £598,947 (adults: £425,607; children: £173,340)

27. www.hertsdirect.org Root causes One of the root causes of unsustainable increases in costs is natural flow of individuals from low risk → high risk →disease →higher employer costs natural flow estimated at 2% - 4% per year. (Edington et al, 2009).

28. www.hertsdirect.org 3. What are we doing about it? Helping you build workplace wellness through the workplace offer

29. www.hertsdirect.org What can be done An effective Workplace Wellness strategy is to stop migration of people to higher risk and keep low risk people at low risk. Employers costs go up as people age, regardless of their health risk status and as health risk status gets worse, costs go up regardless of age.

30. www.hertsdirect.org NICE Business Case 1: Gross Savings Worked example - for a company with 300 employees earning average £8.20/hr Average no. of days sickness absence Total no. of days sickness absenceHours per day Total annual cost £ % reduction in sickness absence Total annual savings £ 8.425207.5 154,98020%-30,996 On average, sickness absence costs employers 8.4 working days per employee per year (Chartered Institute of Personal Development 2007a). Physical activity programmes at work have been found to reduce absenteeism by up to 20%; physically active workers take 27% fewer sick days (Health, Work and Wellbeing Programme 2008).

31. www.hertsdirect.org Nice Business Case 2: Interventions Examples of Interventions Cost per employee £ % of employees taking part Total Cost £ Health champion/coordinator NA100% 3,000 Health check 35100% 10,500 Pedometer challenge 2050% 3,000 Lunchtime walks 1050% 1,500 Workplace travel plans 10100% 3,000 Activity classes 5030% 4,500 Social events 10030% 9,000 Discounted local gym membership 10030% 9,000 Team days - estimated 20100% 6,000 Signs and posters NA100% 200 Booklets, leaflets and promotional material 2100% 600 Total Cost £50,300

32. www.hertsdirect.org NICE Business Case 3: Net Savings Total quantifiable benefits-45,024 Total costs 50,300 Total costs 5,277

33. www.hertsdirect.org Interventions with Gold Standard Evidence (Systematic Reviews) Musculoskeletal disorders –education about stress management, principles of ergonomics, anatomy, musculoskeletal disorders, and the importance of physical activity. –'pause gymnastics', how to use a relaxed work posture, proper positioning, the importance of rest breaks, and strategies to improve relaxation. –some studies also included how to modify work tasks, work load, working techniques, working positions, and working hours. –adjustments and recommended alternatives to the existing furniture and equipment at the workplace.

34. www.hertsdirect.org Interventions with Gold Standard Evidence (Systematic Reviews) Standing workers and vein problems Flexible working interventions that increase worker control and choice (such as self-scheduling or gradual/partial retirement) are likely to have a positive effect on health outcomes Smoking Cessation Healthy weight management Stopping movement from low – high risk - disease

35. www.hertsdirect.org Healthy Herts County Council Programme Reduced Sickness Absence Increased Health Offer including smoking cessation, gym, physical activity, emotional wellbeing, roll out of alternatives to Lifts Nominated for two awards Will be rolled out further

36. www.hertsdirect.org Our workplace offer Hertfordshire workplace health offer for employers Online tools for behaviour change and mental wellbeing First six Herts major commercial Employers already engaged Working closely with Business in the Community as key partner

37. www.hertsdirect.org Thank you! Jim.McManus@hertfordshire.gov.uk

38. Paul Winter Chief Executive www.ibs.co.uk @IpswichBuildSoc

39. Business Action on Public Health What we have been doing in the East of England Met with 200 employers across the region Worked to engage the statutory and voluntary sector Spoken at regional platforms, presence at ACAS and Public Health England events BAOPH pages on BITC website consistently most visited pages in the region, providing case studies, signposting and employee survey tools

40. BAOPH: Engagement Leadership team a good reflection of employers in East of England 167 employees in the network have completed mental health first aid lite training (MHFA accredited), with 59 employees completing full two day training Practitioner network events engage employers in wellbeing agenda – BITC has run 22 events with over 230 employees having attended

41. Organisations with a high level of employee engagement outperform their peers on measures of operating income, net income growth and earnings per share Physically active employees take 27% less time off than their colleagues Wider public health impact The bigger picture

42. Obesity 1: National Audit Office (2001) 2: Department of Health, Policy ‘Reducing Obesity and Improving Diet’ 3: Williams NR, Malik N (2005). “Obesity and work: perceptions of a sample of patients attending an NHS obesity clinic”

43. Alcohol misuse 1: Institute of Alcohol Studies, IAS Factsheet, Alcohol in the Workplace (August 2013) 2: John Woodhouse and Philip Ward (March 2013), 'A minimum price for alcohol?', House of Commons Library, p. 11, from Home Office (November 2012), 'Impact Assessment on a minimum unit price for alcohol', p. 5 3: National Institute for Health and Clinical Excellence (June 2010), 'Business case: Alcohol-use disorders: preventing harmful drinking', p. 13

44. Tobacco related illnesses 1: Clive Bates, Action on Smoking and Health 2: NHS Report ‘Stop Smoking Wales’

45. Stress, anxiety & depression 1.HSE Labour Force Survey 2012/13 2.Centre for Mental Health

46. Issue for employers Employers pay £9bn per year in sick pay and associated costs, plus the indirect costs of managing business whilst people are absent A third of managers have no support in place to help deal with employees experiencing depression A recent YouGov survey for the TUC found that one in three employees are not engaged in their work

47. British Heart Foundation 20% of workers do not take a lunchbreak 49% feel stressed on a daily basis Over two thirds believe their employer should take general responsibility for their health at work

48. Leadership team need to set the example We can spend up to 60% of our day at work – much of this time spent physically inactive, stressed and reliant on caffeine and sugar Our story

49. Our approach Staff investment Health and wellbeing programme including reward scheme Volunteering Work-Life balance Flexible working patterns Development and training Resulting in high engagement, low sickness and turnover plus impact on the bottom line

50. Paul Winter Chief Executive www.ibs.co.uk @IpswichBuildSoc

51. www.hertsdirect.org Listening to Hertfordshire Workplaces The 2013-2014 Pilot Jim McManus, CPsychol, CSci, AFBPsS, FFPH, FRSPH, MCIPD Director of Public Health

52. www.hertsdirect.org Some of our partners

53. www.hertsdirect.org What have we done? Worked with Business in the Community on a pilot project 21 employers

54. www.hertsdirect.org Agree % 98 4 2 95 Disagree % Workplace health & well-being  Improving workplace health is seen as strong contributor to business success (2 in 5 strongly agree)  95% believe it is more important in tough economic climate

55. www.hertsdirect.org Employers’ reasons for focusing on workplace health are around staff engagement, motivation and absence...

56. www.hertsdirect.org However public health focus is on improving productivity & reducing presenteeism when employers are focusing more on employee motivation and engagement (NB small base) Businesses Public health

57. www.hertsdirect.org We’ve built our workplace offer around what employers have told us

58. www.hertsdirect.org You said….we did

59. www.hertsdirect.org You said….we did

60. www.hertsdirect.org Our Offer 1. Workplace health champions (North Herts College) 2. Mental Health First Aid (Bourne Leisure) 3. Health Checks and Mini-MOTs (HCC) 4. Physical Activity (ServiceLine) 5. Weight Management 6. Stop Smoking 7. Alcohol and Drugs 8. Active Travel

61. 61 RES PRESENTER NAME – BARRY THOMPSON – SENIOR GROUP HEALTH & SAFETY ADVISOR BSc (Hons) OSHE, CMIOSH, MIIRSM Hertfordshire Public Health and Business in the Community Improving Employee Wellbeing at RES – 26/03/14

62. 62 Energy storage Advisory Services Transmission lines Solar PV Offshore Wind Onshore Wind RES are the largest Independent Renewable Energy System provider in the UK

63. 63 Our Growth 1981-91 1992 2001 2003 2005 2006 2007 2008 2009 2010 2012 2013 Over 8,200MW of renewable energy capacity in its global portfolio. A further 1,700MW under construction and thousands of megawatts in development 1GW 5GW 8.2GW Our projects are meeting the needs of the industrial, public and commercial sectors

64. 64 Working across the globe to develop, construct & operate a range of projects & services, contributing to the goal of creating a low carbon future Renewable Energy in 5 Continents 14 UK offices Sweden, Norway and Finland North America & Canada ChileAustralia Japan South Africa France, Germany, Italy, Portugal Turkey

65. 65 Business: Positioning the company for continued growth combining long term thinking with exceptional short term performance Social: Providing a safe and stimulating work environment and working with our stakeholders to provide mutual benefits Environment: Managing our activities and impacts in order to maximise the environmental benefit we create through our projects Reputation: Being a thought leader and trusted partner, leaving a lasting and positive legacy for our stakeholders We are basing our Sustainability on four principles – Business, Social, Environment and Reputation. This means: Applying Sustainability – 2013 onwards

66. 66 Why Wellbeing is important to RES We have recognised that our employees are our most valuable asset to sustaining the company at the forefront of Renewable Energy We take health and safety seriously – supported from the Senior Management Health to us is a 24/7 consideration – Home and work We have been introducing employee health and wellbeing gradually as part of a long term programme and have run quarterly health & safety campaigns from the end of 2012

67. 67 How we support Employee Wellbeing at RES Dedicated pages on company intranet – running, climbing, cycling, curry and book reading clubs. Even had a knitting club All employees undertake a health questionnaire when joining company. And for certain tasks have yearly medicals / ECG’s We have a dedicated Occupational Health Assistant – DSE, Provision of equipment – AED’s training We provide showers, lockers for kit, drying rooms – where possible We have an employee forum – WB raised as a subject. Also introducing a intranet forum page We support community projects – everyone can go on these events, paid Numerous sports events are planned – summer solstice ride, Frisbee throwing, inter-departmental football, cricket Annual Company / H&S questionnaire to employees – independent results – state of the business Charity events – dress down days, food days, office challenges – even had a flash dance (France) & Cross Ski challenge (Sweden). 2012 Cycle event from KL to Avignon office (5 days) Training on Safety leadership/behaviour/wellbeing

68. Why RES got involved in the workplace pilot on Employee Wellbeing 68 The demographics of our workforce indicate that we have a relatively young workforce. Around 50% of the employees are under the age of 35 and 78% are under 45 years old (KL). We are constantly trying to get worker engagement into everything we do and we felt that we needed to do more on the wellbeing side. We hope to engender good health practices within the business, recognising the benefits it brings in all areas of a persons home and working life. The offerings that BITC and HPH were offering fit within the wellbeing framework that we are planning over the next 2 years and what has been provided so far has generated employee awareness of their wellbeing and how it can be supported within RES.

69. 69 What RES have done in conjunction with BITC & HPH We have put 5 people through the Workplace Champions Offering We have provided 9 employees with Mental Health Lite Awareness training We have taken the opportunity of having mini MOT’s provided to staff – 25 employees We promoted the workplace challenge / portal within the business – over 40 registered and 46 employees did the pedometer challenge - in total we had over 70 employees engaged in some form of physical activity – approximately 20 – 22% of office staff We have also signed on to the Governments, Health at Work element of the Public Health Responsibility Deal

70. 70 What are our Champions doing Our Champions are made up from HR / H&S / Office Managers Meeting monthly Planning – 2 year cycle, using occupational health and wellbeing planner Looking at workplace demographics in planning Attending wellbeing events – i.e: Health & Wellbeing @ work – NEC Obtaining resources from organisations Looking at what additional clubs can be promoted Already in planning Mental Health Awareness Campaign (End of May) – 1 week of information on intranet, posters, notice boards and Friday forum Alcohol & Drugs Awareness Campaign (End of November) – same approach as above We are inviting members of the charity committee to work with us

71. 71 Mental Health This is one of the biggest challenges in RES - Awareness 9 employees (line Managers / HSQE / HR) went through the Mental Health Lite offering – good to gauge their reaction to the information Firstly, this was a start – helped in providing feedback Has helped provide information for campaign in May to whole workforce Enables us to look at the budget and training requirements for the rest of the line managers for the next financial budget setting (30- 40 line managers + senior staff) It has shown to us the need for further training – misconception of what MH is and how to manage it (benefits, resilience etc)

72. 72 How do our staff respond? All RES employees are constantly encouraged to provide feedback on their learning outcomes. Annual questionnaire – state of the business Forum sessions – (new intranet forum pages being developed) Training feedback – all training Providing recommendations for topics Involvement in community campaigns Taking up company offerings – cycle schemes, etc Talking about the issues openly within the working environment At management monthly / quarterly updates Challenge any new ideas / introduced elements – effectiveness / need

73. 73 The RES Wellbeing future RES are putting wellbeing within its long term planning to make sure its supported by: resources finance materials communication The process is to develop a 2 year rolling plan looking at: learning from feedback Items / issues raised by employees for consideration Lessons from the community / other organisations best practices Any legislation requirements Expanding on BITC / HPH offerings Changes to business / business needs

74. 74 Any Questions HSQE

75. Suzanna Giera Group Occupational Health Assistant Alan Songhurst Group Health & Safety Advisor Barry Thompson Senior Group Health & Safety Advisor 75 Julian Hubbard Group HSQE Manager

76. 76

77. www.hertsdirect.org Break Out Sessions Mental Wellbeing Musculoskeletal Physical Activity Workplace Health Champions Based on the four big issues

78. Mental health first aid Sue Hazleton Luton Borough Council

79. ilot Experience in the private, voluntary and public sectors Led on workplace health in Camden for Public Health – identified need for more support around mental health issues Trained as an MHFA trainer – part of a national accredited programme – evidence based Now working in Public Health in Luton and rolling out programme within Luton’s workplaces Sue Hazleton – my background

80. What is a mental health problem? “It seemed to me the basic definition of mental illness, this persistent, painful inability to simply be with someone else. It might be lifelong, or it might descend like a sudden catastrophe, this blankness between ourselves and the rest of the world. The blankness might not even be obvious to others. But on our side of that severed connection, it was hell, a life lived behind glass. The only difference between mild depression and severe schizophrenia was the amount of sound and air that seeped in”. – Anon “And of course you are mad, if by a madman we mean a mind that questions and rejects every civilized norm”. – Stephen Fry, Revenge

81. Impact of mental health Mental health problems cover a wide range of issues They affect someone’s ability to get on with their daily life 1 in 4 British adults experience at least one diagnosable problem in any year* Almost 9% of people in Britain meet the criteria for diagnosis of mixed anxiety and depression* * The Office for National Statistics Psychiatric Morbidity report (2001)

82. Mental health and work – is it an issue? One in five workers report their job to be very or extremely stressful One in six workers are likely to experience anxiety, depression or stress-related problems at any one time Anxiety, stress and depression were responsible for the most UK sick days from 2001-2008 In 2007/08, an estimated 442,000 people in Britain believed they experienced work-related stress at a level that was making them ill Self-reported work related stress, depression or anxiety accounted for an estimated 13.5m lost working days in Britain in 2007/08

83. Mental health and work – the costs The overall cost of mental health problems in England stands at £105.2 billion a year, (taking into account care costs, sickness absence and unemployment)* Stress, anxiety and depression are responsible for 70 million days sick leave every year* In 2003 research by the Sainsbury’s Centre for Mental Health showed that staff with mental illness not being supported cost UK businesses a total of £26bn per year – equivalent to £1,035 for every employee in the UK workforce For 2009/10 updated figures estimate that the cost to UK businesses is now £30.3 billion a year – equivalent to £1206 per employee *The Centre for Mental Health (2010)

84. What can you do to help? Early intervention can help slow down or stop a mental health problem and lead to a faster recovery However, most of us know very little about mental health We often don’t spot the signs that someone else – or ourselves – maybe struggling until very late

85. An MHFA course will teach you to: Define mental health and some mental health problems Reduce the stigma and discrimination of mental health problems Spot the early signs of a mental health problem Relate to other people’s experience Guide someone towards the right support Look after your own mental health and wellbeing What will an MHFA course teach you?

86. Quotes We receive compulsory resuscitation training annually, which I have never put into practice. This is the first mental health training for the vast majority of our officers, and yet they are meeting people with mental health difficulties almost daily I believe that my awareness of mental health issues has been improved and I feel I will be able to use the knowledge gained every day and in one-off situations Helped me pick up on the warning signs and refer people at an early stage to occupational health for advice/support

87. Mental Health issues are one of the top two issues for the workplace Over 150 employees have attended the MHFA Lite training sessions All 5 core employers took up the training on their own sites plus an additional 4 ‘open sessions’ were run to support employer requests “The course seemed to touch a nerve with all the leaders in the room. There are not many opportunities to take 3 hours out to focus on yourself, to ask yourself how am I really doing? Am I looking after my mental health? And then question how well you really support and perceive your team if/when they have mental health concerns.” – see the Bourne Leisure case study in the workplace brochure Feedback from the Herts Pilot

88. Perceived Benefits: – Opens the door very effectively to talk about these issues and get mental wellbeing on the agenda – Seen as a fantastic offering for all line managers – RES say it is so successful they are now looking to build it into management training and have not done anything like this on mental health before Feedback from the Herts Pilot

89. Change lives “Mental Health is everyone’s responsibility, something MHFA England strongly believes in. They create positive change in people by focusing on individuals’ capacity, ability, skills, knowledge, passion, interest, connections and on their potential to do things and make a difference for themselves. I believe that organisations such as MHFA England are a vital community resource and are leading the way in community engagement and creating networks that enable individuals, families and neighbourhoods to all play a crucial role to change people's lives for the better.” Lord Kamlesh Patel, March 2011, MHFA Patron.

90. Next steps – attend an MHFA Lite course Mental Health First Aid Lite Training – 24th April 2014 FREE to Hertfordshire based workplaces, funded by Public Health Hertfordshire Target audience Available to Hertfordshire workplaces, aimed at Line Managers, Health & Safety and HR professionals Course details Venue: Beales Hotel, Hatfield Date/Time: 24th April 2014 - 9.30am – 12.30pm For more information or book your place please email: Debbie.Longhurst@bitc.org.uk

91. www.hertsdirect.org The way forward We need your help in recruiting more workplaces to join in with this Will you pledge today to be a champion? –Tell and recruit other workplaces for us? –Get this offer to other businesses, especially commercial and independent sectors? –Phone one employer you think could benefit and get this to them?

92. www.hertsdirect.org Many thanks to our breakout presenters No such thing as a free lunch! Please complete evaluation forms and hand to a member of BITC staff who will then allow you to have your lunch! Thank you and enjoy your networking lunch...