Dame Carol Black National Director for Health and Work

CBI Employee Health and Absence Conference

15 June 2010

Employee Health and Well-Being: Challenges

and Opportunities

What is our overall goal?

Healthy, engaged workforces

• A high-performing, resilient workforce

• Enhanced productivity

Contributing to:

• A flourishing society

• Better economic performance

Well-managed organisations

Near and future challenges and opportunities

The need to address:

• very different and difficult economic times

• workforce health, well-being, engagement, productivity and performance

• the prevention paradigm and the workplace

• Occupational Health professionals, fit for 21st century purpose

• demographics – increased life expectancy, the need to extend working life

• long-term conditions (LTCs) and capability to work

• association of lowest socio-economic groups with poor fitness and physically-demanding jobs

• common Mental Health problems – now the chief problem of working age

• early-life building for a resilient future workforce

• working together: secure alignment of all partners in developing a new culture of health and wellness

The economic challenge

“ I guess the biggest challenge is the economic one – so productivity and efficiency of the workforce are high up there.

But there is an increasing policy gap between employers needing to cut costs and potentially deliver more with fewer workers (especially in public services) and the push to get more people into work.

One of my offices gave a very stark message recently – the improved attendance without more revenue available simply means that we don’t need so many staff on our books.

Previous staffing levels reflected higher expected sickness absence and being ready for extra revenues that we now do not get.”

Corporate Medical Director, June 2010

The economic challenge

“ 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

Workplace Wellness Programs Can Generate Savings

“ There is growing interest in workplace disease-prevention and wellness programs to improve health and reduce costs. In a critical meta-analysis of the literature on costs and savings associated with such programs, we found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent.

Although further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes. “

Katherine Baicker, David Cutler and Zirui Song, Health Affairs 29(2), 2010

First US National Health and Productivity Summit

Attended by corporate leaders from 40 national organisations, Nov. 2008.

One of the Consensus Statements:

“The impact of a healthier, more productive workforce is quantifiable; when combined with other business measures it helps determine the overall economic value of an enterprise.

The business community, ranging from financial analysts to investors, should develop and institutionalise additional accounting and valuation methods that include health and productivity metrics to determine more accurately the business value of workforce health assets in a company”

ACOEM, IBI and US Preventive Medicine - convened working group to develop outline strategies to bring health and productivity to the corporate balance sheet.

Employee Benefits Summit, June 2010

58 significant companies present (many of them global) responding to a key-pad questionnaire.

Do you have :

• Health and Wellbeing Programmes in place? 26 %

• Programmes planned 34 %

• Would like a programme 25 %

• No plans for a programme 15 %

Prevention

John Snow (1813-1858) prevented cholera by removing a water pump handle (1853).

“ In the 19th century John Snow recognised the epidemiology of risk, and prevented cholera by removing the pump handle.

In the 20th century Occupational Health focussed on many hazardous workplace issues.

In the 21st century our main workplace productivity impacts are MSDs and mental health problems, and our primary prevention – the modern pump handle – is pretty poor for these, with a focus on medical models of downstream treatment.

We need to be much more inventive in moving upstream on the prevention agenda.” S. Boorman, 2010

Are we ready for this approach?

Occupational Health USAA Healthy Workforce and the Health Economy

“ The workforce is the engine that drives the economy and supports the financial underpinning of the healthcare system. The working-age population is therefore the key to assuring the future availability of healthcare in the US.

Fiscal soundness can be advanced through strategic investment in the health and productivity of the working-age population through a new prevention-based paradigm centred in the workplace.

ACOEM is committed to supporting a national agenda for system reform that begins with protecting and strengthening the social and economic engine of the economy – the nation’s workforce.”American College of Occupational and Environmental Medicine Guidance Statement 2009

Occupational Health in the UK

• Occupational Health (OH) services reflect historical view of ‘industrial medicine’ as a benefit to employers which should be financed by them.

• BUT 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

– 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)

Occupational Health: opinions

“I am afraid standing back I think we are more at risk than we were before, as the opportunity is there like it never has been before, but I’m not sure how many of the OH medics recognise this and are really up for it.”

“ The truth is the OH profession may well have lost its way, and not be fit for purpose on its own to drive the cultural and societal changes necessary to communicate the value of work, and the value of engagement and happiness at work for productivity and business performance.

Evolving HR may not be up to the task either.”OH physicians, 2010

Opportunities for the OH community

• Working with Government

Responsibility Deal 2 : Working with businesses to improve public health. A position paper by Andrew Lansley, now Secretary of State for Health, when a shadow minister.

• Closer working with Public Health

“The new administration’s desire to reorganise Public Health is a huge opportunity for this revised approach also to contain OH – i.e. bring it on to an official footing and in from the cold at last. That said, the OH community may lack the cohesion, foresight and leadership to position and develop this.”

OH physician, June 2010

Extending working life

• Life expectancy increasing – 77 years for men and 81 for women at birth – over-65s will soon outnumber under-16s– ratio workers/pensioners, 3.3 in 2007, is expected to

decrease to 2.9 in 2032.

• But corresponding increase in – working life expectancy will be difficult to achieve without– improvements in healthy life expectancy (together with skills

matched to labour demand).

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

so as to increase participation in work and extend working life. • People need to be economically active for longer.

Expectancy figures

Expectancies at age 16 in 1998 and 2004 in England (figures in years). Males Females

1998 2004 1998 2004

Life expectancy 59.7 61.5 64.5 65.7

Disease-free life expectancy 29.4 29.6 28.3 28.5 Disability-free life expectancy 44.4 46.1 46.1 47.0

Years spent with disease 30.3 31.9 36.2 37.2 Years spent with disability 15.3 15.4 18.4 18.7

Current patterns of working-age health

• Patterns of working-age health and ill-health, and their longer-term consequences, reflect

– underlying complex biosocial-economic factors (including health inequalities examined by Marmot) which can only be changed slowly, and

– current healthcare and employment attitudes and practices, which can be influenced now.

• When illness supervenes, prompt intervention with optimal treatment and rehabilitation measures offers– improvement or restoration of function– remaining in or prompt return to work– though evidence tenuous) possible increased working life

expectancy.

Common long-term conditions

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

• Require: – good clinical care and Vocational Rehabilitation– flexibility and adaptation in the workplace.

• Workplace response emphasised in policies now taking root.• 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.

The shape of things to come

BMI-related diseases: predicted rates per 100,000 in 20-year intervalsSource: National Heart Forum

2006 2030 2050

Arthritis 603 649 695Breast cancer 792 827 823 Colorectal cancer 275 349 375 Diabetes 2869 4908 7072Coronary heart disease 1944 2471 3139 Hypertension 5510 6851 7877Stroke 792 887 1050

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

Obesity trends by social class

Source: Foresight Tackling Obesities: Future Choices – Modelling Future Trends in Obesity and Their Impact on Health

Action taken to reduce health inequalities will have economic benefits in reducing losses from illness associated with health inequalities. These currently are productivity losses (estimated £33bn/year), reduced tax revenue and higher welfare payments (up to £32bn/yr) and increased treatment costs (£5.5bn/yr).

(Marmot Review, February 2010)

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.

Common Mental Health problems

• The chief health problem of working age - and at any age

• mental health symptoms/conditions may compound physical disorders.

• Prevalence of mental health conditions requiring treatment increased• 4.1% of the adult population 1993 • 6.4% of the adult population 2007 (ONS survey)

• Mental health problems were cited by 40% of claimants for Incapacity Benefit in 2006 compared to 26% in 1996.

• People with mental health problems do not have to be entirely free of symptoms to remain in or return to work successfully, but there are barriers to be overcome.

• Evidence on the effectiveness of health and employment interventions is currently weak, and we depend on reinforcing accepted best practice to promote mental wellbeing and restore working life.

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.”

Inactive and young

• In 2006, just as in 1997, almost a fifth of those aged 16 to 24 were not in employment, education or training – currently this is 1.4 million young inactive.

• Male joblessness and single motherhood correlate strikingly. In Liverpool male unemployment rose from 12% in 1971 to 30% in 2001; over the same three decades the proportion of families headed by a single parent rose from 11% to 45%.

“The taxpayer has become the father” - one in four UK mothers is single.“The men have no role. The State has helped create a class of jobless serial boyfriends who prey on single mothers on benefits.”“Those men need a chance, not a benefits system that undermines them.” Camilla Cavendish, Opinion, The Times, 28 May 2010

Final thoughts

“As captains of industry and government, as employees, as parents, as influencers, and teachers, we can all choose to rally behind a clear strategy to revitalise the nation, that is based on a desire to all pull together for a greater good. We need to continue to build a strategy with belief that healthy high-performing businesses need healthy high-performing leaders who need healthy high-performing employees – and that fundamentally requires cultural change.”

Businessman, 2010