Since the introduction of the Health and Safety at Work Act 1974 in the UK, we have seen a significant reduction in physical work-related injury, with fatal injuries to employees falling by 83%.
This has been attributed to more awareness of workplace health and safety and changes in the organisation of work, moving away from heavy industry to office-based work.
Although this fall is very welcome, there has at the same time been a significant rise in the total number of cases of stress, anxiety and depression, which accounted for 15.2 million workdays lost in 2014 according to the Office for National Statistics.
As the nature of work has changed, the risks it poses to our health have also changed. More and more attention is being given to the threats arising from adverse psychosocial work environments and the implications for our – particularly mental – health and wellbeing.
A notable example is Michael Marmot’s 2010 review of health inequalities in the UK which argued strongly for the improvement of the psychosocial work conditions.
The campaign for ‘good’ work
At the Work Foundation we have long-campaigned for increased access to and provision of ‘good’ work and recognise the significant impact that the psychosocial quality of work has on an employee’s health and wellbeing.
While we recognise that – generally speaking – being out of work is bad and being in work is good for people’s physical and mental health and wellbeing, there is compelling evidence that poor quality work can have negative impact that, in some cases, is comparable to or even worse than unemployment.
But how do we determine whether work is good or bad?
There is no strict definition, but there is an emerging consensus that good work:
- Enables the worker to exert some control through participatory decision-making
- Places appropriate high demands on the worker
- Provides adequate support at work
- Provides sufficient job security
- Offers opportunities for both professional and personal development
- Aims to reconcile work and extra-work/family demands (work-life balance/long working hours)
- Offers job satisfaction
This is not an exhaustive list and other aspects of the psychosocial work environment will have an impact on employee health and wellbeing.
There is a vast body of evidence in the academic literature showing strong relationships between the presence or absence of these factors and corresponding effects on mental and physical health.
For example, a recently published meta-analysis in the academic journal BMC Public Health found that employees facing significant demands at work with little control over it – who are said to be suffering from ‘job strain’ – are at risk of developing mental health problems, particularly depression.
Work characterised by unrealistic demands and a lack of control can undermine beliefs of mastery over work, reduce self-esteem, and devalue people’s feelings of self-worth.
Furthermore, the same review highlights evidence showing an association between job insecurity and depression; the fear of losing one’s job may prompt feelings of helplessness and, if chronic, lead to depression.
Similarly, a poor work-life balance and exposure to long working hours (generally 48 hours or more) promotes unhealthy behaviours, e.g. exercising too little or drinking too much alcohol, which in turn can lead to the development of depressive symptoms.
Although they are few and far between, studies of workplace interventions to improve the psychosocial quality of work, e.g. increasing employees’ control or providing them with more social support at work, have been shown to improve employees’ health – particularly their mental health – and reduce symptoms of anxiety and depression. These studies can be found in this systematic review.
Can ‘good’ work help address depression?
The evidence presented here shows that good work can help prevent the development of depressive symptoms, which is much-needed given the recent rise in the number of sick days lost to stress, depression and anxiety in the UK.
Indeed, recently published data from the Health and Safety Executive show that the most common causative factors at work are excessive demands and a lack of support and control.
Work should always be protective of employees’ health and wellbeing – ensuring it is ‘good’ work represents one way of doing this. Preventing people from falling out of work is crucial because once they leave the workforce for health reasons it can be difficult to find it again.
Depression as a barrier to employment
As our recent report shows, symptoms of depression can often act as a barrier to employment. The report highlights several areas where change is needed to ensure people with depressive symptoms are not unfairly excluded from employment – or subject to work that is not suitable for them.
Amongst other things it calls for more joined-up working across government, promoting the concept of work as a health outcome throughout the health system and better recognition of and support for mental health conditions in the workplace.
Encouragingly, since the publication of the report in 2015, progress has been made in this area.
For example, the Joint Work and Health Unit (spanning the Department of Health and the Department for Work and Pensions) published its response to the ‘work, health and disability’ 2016 green paper consultation at the end of last year.
It has committed to advancing healthcare professionals’ understanding of the relationship between work and health, first conducting a baseline survey of their attitudes on this issue.
In addition to this, the 2017 Stevenson/Farmer review of mental health and employers calls for the need to develop mental health awareness among employees and encourage open conversations about mental health and the support available when employees are struggling.
Findings from Business in the Community’s Mental Health at Work Report 2017 suggest we are moving in the right direction, with more employees (compared to last year) reporting that they feel comfortable talking about mental health issues like depression at work.
Complementary to this is the recently convened Heads Together Workplace Wellbeing steering group, which we sit on and is chaired by Mind, which will produce a gateway for employers to access reliable and clear information on managing employees’ mental health.
So, it is clear that progress is being made in this area but we still have a long way to go.
About James Chandler
Dr James Chandler has experience using both qualitative and quantitative research methods and an understanding of the social determinants of health, particularly the role of work and how the psychosocial work environment impacts on employees’ mental and physical health and wellbeing. He joined the Work Foundation in November 2016 as a Policy Analyst. In his role at the Work Foundation, he is, primarily, focused on developing evidence-based policy recommendations relating to the health and wellbeing at work agenda.