Charlotte Wu, Senior Consultant, Rocket Science, and Matt Towner, Portfolio Manager, Guy's and St Thomas' Charity
Sep 18, 2019
As part of our multiple long-term conditions programme, we are exploring the potential role that work can play in slowing people’s progression from one long-term condition to many.
The relationship between employment and health is well established. Not only does having a low or no income contribute to poor health outcomes, but work has been found to meet important psychosocial needs in societies where employment is the norm and is central to social roles and status.
However, we know less about what interventions work. This is why, over the summer we commissioned research into existing interventions that we could learn from.
The changing relationship between work and health is gaining increasing visibility and emphasis nationwide. In 2017, the government published its Work, health and disability green paper, pledging to halve the employment gap for people with disabilities and long-term conditions. While around 15 million people in England currently have a long-term condition, only 8% of employers reported that they had recruited a person with a disability or long-term condition in the previous year.
As life expectancy increases (with the retirement age set to rise to 68 by 2037), the workforce is ageing along with society. Long-term conditions are, moreover, increasingly understood to not only affect older people. In Lambeth and Southwark, around a third of people with multiple long-term conditions are diagnosed under the age of 65.
All of this means that employees will increasingly be dealing with health issues while at work, and employers will need to respond to these changes, adapting to support their workforce to manage (potentially multiple) chronic conditions, as well as investing in preventative measures.
Over the summer, we sought to understand how work-related activities can be used to boost confidence and motivation, supporting people living with long-term conditions to increase their resilience and ability to proactively manage their conditions.
Our research partner, Rocket Science, helped us to review over 100 interventions to further understand how purposeful activities can support people living with long-term conditions to potentially delay their progression to multiple long-term conditions.
We found that improving self-management can be a ‘gateway outcome’ to build people’s confidence and motivation needed to both manage their conditions better but also move closer to the labour market.
We also found that, while work and health are positively correlated, some forms of work can also have a negative impact on a person’s health outcomes. In Lambeth and Southwark, inner-city boroughs with high levels of deprivation, many residents are employed in low-paid sectors. Jobs which are low-paid, precarious or insecure can in fact exacerbate the development of health conditions. For example, construction workers experience high rates of risk and injury, often leading to chronic pain, musculoskeletal disorders (MSK) such as back pain and substance misuse. There is an opportunity for employers to provide support for health management at the workplace itself, which can be tailored to specific industries and conditions, and help promote prevention and early intervention.
The overall approach that employers take to recruitment and working culture and behaviours is fundamental to whether a person with a long-term condition is able to access or remain in work. A workplace environment that encourages staff to be open about their health, and where employers respond with appropriate adjustments, can play a huge role in preventing them from entering unemployment or even long-term worklessness. Similarly, the working culture could be substantially improved for people with long-term conditions by improving access to guidance and support for managers to create good working environments that reduce the incidence of ill-health and overcome stigma or unconscious bias.
The findings from this work offer an important guide and we hope to explore all this potential with a group of Lambeth and Southwark employers, offering a place-based intervention that will support residents’ health, autonomy and resilience.
Our ambition over the coming years is to drive change and build the evidence base around the impact and opportunities of purposeful activity in tackling progression to multiple long-term conditions. As the Charity funds and learns from initiatives to create workplaces that promote health and help people at risk of developing multiple and creating their own innovative and successful interventions.
23 April, 2020
As a funder, our priority is to support our partners and the communities most affected by COVID-19. Our Portfolio Director, Louise Mousseau, sets out the actions we've taken to date and how we're adapting our work in response to a changing environment.
25 February, 2020
Our Programme Director for multiple long-term conditions, Barbara Reichwein, reflects on persisting health inequalities ten years on from the Marmot Review.