1. Opportunities for reducing health inequalities by making good quality work more available Dr Angela Donkin

2. BACKGROUND

3. Health, Work-force, Pensions Costs and productivity

4. Unemployment and low paid, low skilled work increase the risk of poor health.

5. Unemployment and health inequalities Social gradient in unemployment Unemployed people at greater risk of poor health than those in employment: –Increased risk of mortality for all socioeconomic groups, limiting illness, cardiovascular disease, poor mental health, suicide, health- damaging behaviours such as smoking Those who experience long-term unemployment have the greatest health-adverse effects Unemployment causes the loss of a regular income and can cause additional psychological stressors related to status and self-esteem, identity and the loss of a core role in life.

6. Working conditions and health inequalities Psychosocial working conditions (organisational culture) contribute to the social gradient in health. Lower paid workers with fewer skills or qualifications are more likely to experience poor working conditions and worse health. Evidence suggests the following work conditions are more prevalent in lower occupational groups, and cause stress and poor health, particularly if the employee has no alternative choice in the labour market: –High demand, low control –Effort reward imbalance –Organisational injustice –Job insecurity (e.g. temporary or 0-hour contracts) –Long or irregular hours or shift work

7. Policy Objectives: The Social Determinants of Health A.Give every child the best start in life B.Enable all children, young people and adults to maximise their capabilities and have control over their lives. C.Create fair employment and good work for all D.Ensure a healthy standard of living for all E.Create and develop healthy and sustainable places and communities F.Strengthen the role and impact of ill-health prevention

8. Recent IHE work in this area Increasing employment opportunities and improving workplace health, PHE Evidence Review 5, Sept 2014 And associated briefings on: Workplace interventions to improve health and well-being Working with local employers to promote good quality work Increasing employment opportunities and retention for people with a long term disability Increasing employment opportunities and retention for older people Promoting good quality jobs to reduce health inequalities. To be published later this month as a PHE evidence review (Sept 2015) Social Determinants of Health and the Working Age Population: Global Challenges and Priorities for Action. Contemporary Occupational Health Psychology. 2014. Chapter 1, Ed L. Stavroula and RR. Sinclair. Wiley Blackwell Work, employment and unemployment. Chapter 3.7 in Review of social determinants and the health divide in the WHO European Region: final report.

9. CURRENT SITUATION

10. Scope of the problem Unemployment rose during recession– recovering An ageing population means more older people in work. However, crisis has particularly affected young adults.

11. … Has economic recovery led to lower quality work? Proportion of employees on temporary contracts increased from 6.0% to 6.4% between Q1 2010 and 2014. The proportion of these that could not find a permanent job rose 17%. More than double the number on zero-hour contracts in 2013 GB compared to 2008. Skills and Employment survey suggests more employees worried about job loss and unfair treatment at work. 1 million more workers want to work more hours in 2012 compared to 2008. More jobs (77%) created in 2010-13 were in low pay sectors. Number of workers earning less than living wage increased from 3.4 million (2009) to 4.8 million (April 2012).

12. WHAT CAN BE DONE?

13. Key factors of success for improving workplace health and wellbeing 1.Increase employee control and autonomy over their work 2.Greater employee participation in decision-making 3.Line management training 4.Effective leadership and good relationships between leaders and employees 5.Employee engagement, ensuring commitment to organisation’s goals 6.Provide staff with in-work training and development 7.Greater flexibility within a role for a greater sense of control and work-life balance 8.Interventions to reduce stress and improve mental health at work 9.Address the effort-reward imbalance

14. How to engage employers to encourage, incentivise and enforce good quality work 1.Promote guidance e.g. NICE guidelines on promoting wellbeing at work, HSE guidelines on stress management 2.Ensure employers abide by legal obligations, particularly around health and safety and non-discrimination 3.Use contractual levers of procurement, e.g. through the Social Value Act 2012 4.Programmes to incentivise employers through: –Support and advice around how to implement effective policies and interventions, facilitating partnership working and promoting best practice –Provision of funding –Accreditation and rewards, providing the organisation with reputational benefits

15. Employment for people with a disability or long-term condition Disabled people have a far lower employment rate than the general population; there has been a considerable rise in numbers on ‘inactive’ health benefits in past 35 years Key messages on effective local intervention: –Local govt can raise employer awareness of national measures –Preventing people from leaving work due to health problems –Personalised, tailored support is important –A ‘health first’ approach may help people move into work –Supported employment programmes can be effective for those with complex needs

16. Employment for older people 36% working population over 50 by 2020. Employment benefits older people for financial, health and social reasons. Interviews with a sample of people aged 50-69 found those who were retired had greater falls in physical, mental and self-assessed health compared to those still in work. Older people in more disadvantaged social positions are more likely to have difficulty finding and keeping a job.

17. Key features of success in increasing employment opportunities and retention for older people 1.Improvements to the physical and psychosocial work environment 2.Fair recruitment practices that encourage applications from older people 3.Encouraging training opportunities and making them accessible for workers of all ages 4.Flexible working 5.Phasing retirement and flexible retirement options 6.Performance discussions for employees of all ages 7.Succession management 8.Training for managers on issues of age 9.Regularly seeking workforce feedback 10.Risk assessment for workers with health or mobility needs

18. The scale of the problem In Q4 2013, 14% of 16- 24 year olds were NEET in England - almost 900,000 Globally, young people suffering worst effects of unemployment – 73.4m (12.6%) unemployed in 2013, up 3.5m since 2007

19. Detrimental health effects across the life course MENTAL HEALTH - Young men who are NEET found to be 3 times more likely to suffer depression than their peers; depression as a result of unemployment is amplified for young people. UNHEALTHY BEHAVIOURS – in one survey, 11% of 16-25 year olds who had been unemployed said they had “turned to drugs or alcohol” as a result of their unemployment. SCARRING EFFECT – spending time unemployed under the age of 23 lowers life satisfaction, health status, job satisfaction and wages more than 20 years later. OFFENDING – young men who are NEET are five times more likely to have a criminal record than their peers; documented links with civil unrest. EDUCATION/ QUALIFICATIONS - more time spent in education, and higher qualifications, tend to improve physical and mental health – e.g. four more years of schooling (in total, up to age 25) on average relates to 16% reduction in mortality rates, and reduces risk of heart disease and diabetes.

20. What can be done? Early intervention Tackle the barriers that young people face to move into employment, training or education Work across organisational and geographic boundaries Engage local employers Track people, monitor progress and programme evaluation Best practice examples

21. NEET levels in Wales, Swansea and Wrexham, 2005 - 2012.

22. 6.7 million of the 13 million people in poverty are in working households, UK 2011/12 (JRF 2013 using DWP data)

23. Living on a low income is bad for health Greater risk of limiting illness and poor mental health including sleep deprivation and maternal depression. Children in poverty are more likely to be born early and small, suffer chronic diseases such as asthma, and face greater risk of mortality in early and later life. Why? –Material needs – good food, decent housing, heating, cost effectiveness of work, social participation –Psychosocial factors – stress, low self-esteem, poor mental wellbeing, ‘status anxiety’ –Unhealthy behaviours – on low incomes, health and longer term outcomes are not as critical as shorter term outcomes and can be overlooked.

24. What can be done by local authorities to increase the adoption of a living wage? Lead by example as a major employer (27.5% LAs adopted so far) Use innovative approaches for implementing in procurement, e.g. Social Value Act Maintain on-going discussions with local employers Ensure strong leadership and buy-in from LA Use existing or create new partnerships to develop wider support Clearly communicate and promote the living wage Plan ahead regarding the best time to implement Establish systems to monitor compliance and ensure sustainability

25. Thank you. Contact details a.donkin@ucl.ac.uk http://www.instituteofhealthequity.org/