Healthier workers – carrot vs stick

The politics of workforce health in the UK have, for many years, focused on the depressingly negative themes of ‘incapacity’, welfare dependency and malingering. Yet it is easy to forget that workforce health is a productivity issue too. Over the next 20 years, as our workforce ages, retires later and risks the development of long-term conditions, the pressure to invest more energy and resources in measures to prevent and manage the health and productivity of the UK’s working age population will become more intense.

In the last week we have seen Sir Simon Stevens, CEO of NHS England – in his 5 Year Forward View– urging employers (including the NHS itself) to invest more, even suggesting that incentives from the government might be made available.

Why might the government want employers to do more?

The two biggest health problems experienced by working age people are musculoskeletal disorders (MSDs) and mental illness. To put these into context, days lost to strikes in the ‘winter of discontent’ in 1978/79 were 29.5 million. Over 35 years later we currently lose 31m working days each year to MSDs and 70m more to mental illness. Neither of these conditions are adequately addressed by the NHS among people of working age whose lost productivity may undermine the performance of their employer and increase healthcare costs if their absence becomes long-term. Indeed the total cost of ill health in the UK workforce is about the equivalent of the annual NHS budget.

What are the political risks of using the ‘stick’ rather than the ‘carrot’ approach to doing this?

The uncomfortable truth for politicians who believe that businesses need to be left alone is that greater investment by employers in workplace measures in the next decade – even if work is not the primary cause of ill-health – is very likely to be necessary in the interests of both public health and workforce productivity.

Ministers know very well, as does Sir Simon Stevens, that the workplace is a good - but under-utilised - arena for the delivery of public health messages and interventions. They also know that there is a wider public benefit for society at large, as well as ‘private benefit’ for business, if more employees get access to such interventions through their work.

While government should be in favour of encouraging more employers to increase investment in workplace health interventions it remains a problematic area, for several reasons. First, Public Health feels, to many politicians, like finger-wagging and paternalistic ‘nannying’. If people want to engage in a depraved orgy of self-abuse, the logic goes, then they should be at liberty to do so. Second, in the second least regulated labour market in the OECD, the business lobby has been very successful in pushing for more deregulation and less intervention by government in employment matters.

One of conclusions of the first policy paperproduced this week by The Work Foundation’s new ‘ Health at Work Policy Unit’ - supported by Bupa and NAPP Pharmaceutical Holdings Limited - is that, if government wishes to see the wider societal benefits of the improved workforce health and productivity which result from high quality employer-based interventions – such as the tax breaks suggested by Sir Simon, it must be prepared to invest more in well-targeted measures which improve the incentives for employers to act in their own interests and in the interests of society at large.