Economic activity and health inequalities: how labour market experiences sustain health inequalities
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Summary
Good work can be a key ingredient of a healthy life. It provides the income to support material well-being, and plays an important role in supporting mental and physical wellbeing too. Yet there is much more to be done to improve the relationship between work and health. Too many people face insecure or exploitative conditions at work, are denied the support they need by inflexible employers, or find themselves trapped outside of employment altogether. In each case, there is a risk that their health will suffer as a result. The impact of these harms fall unequally across society, both reflecting and deepening wider inequalities.
This report explores the complex relationship between work and health through the stories of some of the people Citizens Advice supports. We show how the issues they face at work can be detrimental to their health, and how poor health and disability can put barriers in the way of finding work. We also highlight the opportunities for policies that can lift these barriers and help to close a widening gap in health outcomes.
Work itself can be a source of both physical and mental ill health, particularly when it is insecure, unsupportive or exploitative. When people experience ill health in the workplace, it is crucial that they are supported by their employers. But our data shows that the rate at which people come to talk to us about health-related discrimination is increasing year on year, with a 14% increase between 2022 and 2024, even as numbers of overall employment cases remained flat. This highlights that there is still significant variation in what employers are willing to do to help people keep working, with the provision of legally mandated reasonable adjustments being highly uneven and poorly enforced. This can affect people’s health in work, and keep others trapped out of work for reasons that could be overcome with more support.
The government has made an encouraging start to improving the landscape of work for disabled people and people with long-term health conditions, but their work in these areas is at an early stage, with the Keep Britain Working review still ongoing. Ensuring that the world of work is welcoming and supportive for everyone is a crucial first step before other policies can be put in place to increase the rate of employment for disabled people and those with long-term health conditions. Otherwise, too many people will be set up for failure by pushing them into a workplace that is not ready. Unfortunately, as the government's recent reversal of changes to disability benefits shows, this is a lesson that they have been slow in learning.
A good job should mean an income that is enough to cover essentials and provide security. But too many people, both in and out of work, struggle to make ends meet. The stress of this alone can be damaging to people’s health. Low incomes also mean that, when people experience ill health, they have less of a safety net to support them. Magnifying these problems is an uneven system of sick pay and benefits, with analysis of our data presented in this report to show that people in the more economically deprived areas are the least likely to have additional safety nets beyond statutory sick pay when they fall ill. This means that those with the least capacity to manage a period of ill health face a threadbare and inconsistent landscape of support.
More support is needed for people who fall ill at work, particularly for those who have to rely on statutory sick pay. Recent reforms, whilst welcome, do not go far enough, and it is only by increasing the support given to people when they are ill that the lowest-paid in society will no longer face impossible choices between paying the bills or doing what is best for their health. Increasing the basic rate of sick pay would be a vital first step to making sure short-term periods of ill health didn’t lead to longer term financial problems.
The most urgent task facing the government is to rethink their reforms to the system of health-related benefits. Postponing changes to PIP, pending a review, will go some way to ensuring that its proposals of greater support for people seeking to get back to work are not undermined by needless cuts. But legislation will still have a significant impact on far too many disabled people and people with long-term health conditions if planned cuts to Universal Credit health are taken forward. And this risk remains that thousands more will find themselves pushed into poverty if cuts to PIP are later reintroduced.
We already help nearly 23,000 people a year with issues relating to benefit conditionality, and of these 57% are disabled or have a long-term health condition. With the removal of the Universal Credit health element, and ongoing uncertainty about the future of PIP assessments, there is a risk that more people already struggling with their health will face the risk of sanction. A greater burden of conditionality for people who are already struggling with their health risks undoing the benefit of any additional employment support, unless it is accompanied by wider reaching reform of the work coach system.
Based on the findings of this report and our research, we recommend action in the following areas to help improve the relationship between health and work, and in doing so reduce health inequalities:
Protect disadvantaged workers with a well-resourced Fair Work Agency able to proactively address labour issues that lead to poor health outcomes.
The government should support employers and model best practice when it comes to providing reasonable adjustments for disabled workers and workers with long-term health conditions.
Increase the rate of statutory sick pay, to ensure that fewer people face poverty when they fall ill.
Provide access to quality assured employment support and advice, either from work coaches or other providers, tailored to reflect people’s individual circumstances and the places they live.
Fully withdraw proposals for disability benefit cuts; we welcome the decision to review changes to the Personal Independence Payment, and believe that change to the Universal Credit health element should also be paused to allow their impact on employment and living standards for disabled people and people with long-term health conditions to be properly assessed.
This report is authored by Edward Pemberton and Emily Lynn. It is part of a larger project on health inequalities funded by the Health Foundation.