Reducing health-related job loss among older workers

Blog posts

14 Jul 2023

Stephen Bevan, Principal Associate

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Working age Britons with long-term health conditions have caused considerable head-scratching in the last two years. Why have so many chosen to leave the labour market early? The number of working age people who can’t work because of long-term sickness has been increasing since before the pandemic. It rose from 2 million at the start of 2019 to 2.5 million as of early 2023. Since the pandemic started in early 2020, this number has increased by around 400,000, although the numbers have recently started to decline as the labour market ‘cools’ slightly. 

According to new analysis published by the Office of Budget Responsibility (OBR) this week, inactivity had contributed to the UK’s sluggish economic growth: ‘The increase in working-age inactivity due to long-term sickness since the pandemic (alongside rising ill-health among those in work) has already added £6.8 billion to the annual welfare bill, cost £8.9 billion in foregone tax receipts, and therefore added £15.7 billion (0.6 per cent of GDP) to annual borrowing.’ Apart from the impact of this outflow of people on the supply of labour and on the productive capacity of the economy, for thousands of mainly older workers the impact of so-called ‘health-related job loss’ (HRJL) on their finances, their self-esteem and their wider wellbeing is incalculable.

While there is a bigger labour market and public health story to be told here (and a debate about whether ill-health is the only explanation for the rise in inactivity), I have both a professional and personal interest in understanding at a more granular level what has been going on and what government, employers and healthcare professionals might do to reduce the chances of HRJL ‘hollowing out’ the future economic contribution of a knowledge-rich and experienced age cohort. In this blog, I’ll take a look at what we know are the main causes of HRJL among older workers in the UK; and try to identify what can be done by employers to predict and mitigate the risk of the problem getting worse.

In recognition of the health, societal and economic impact of long-term health conditions, the government has just completed a consultation as part of its ‘major conditions strategy’. We know that there are six major health conditions (cancer, cardiovascular diseases - including stroke and diabetes, chronic respiratory diseases, dementia, mental ill health and musculoskeletal disorders) which affect millions of people in England with data showing that 25 per cent live with two or more of these major long-term conditions. Increasingly, these conditions affect both the quality of life and employment prospects of people of working age (exacerbated, in some cases, by long-Covid and lengthy NHS waiting lists). For many, the risk of premature and permanent withdrawal from the labour market through HRJL rises rapidly as they age, especially if the physical or psychological demands of their jobs are intense.

Let’s look first at what we know about HRJL and its causes among older workers. There are two sources with which I’ve become familiar in recent years which provide very sound analysis. In Australia, the work of Professor Deborah Schofield and colleagues at Sydney University’s Clinical Trials Unit has looked at risks of leaving the labour market among 45-64 year olds with long-term health conditions (compared with healthy working adults in the same age cohort). Those with heart disease, for example, were 4.21 times more likely not to be working because of their health. This rises to 6.71 among those with depression and mood disorders. Among those with cancer, job loss was 3.66 times more likely compared with healthy workers and among those with back pain the odds of being workless were 3.59 times higher.

Closer to home, the Health and Employment After Fifty (HEAF) study at Southampton University has been studying HRJL among more than 8000 over-50’s in the UK for several years. Among the findings from this work, we learn that:

• Men with good self-reported health but who are dissatisfied with their work have a sixfold increased risk of HRJL compared with healthy men who are satisfied with their jobs.
• There are several demographic and lifestyle factors which elevate the risk of HRJL. Among older men these include those struggling financially and those taking very little or no physical activity. Among older women, living with overweight or obesity and smoking are significant risk factors for HRJL.
• Other clinical risk factors associated with HRJL include inflammatory arthritis, sleep disorders, depression, anxiety and musculoskeletal pain. In addition, for women, widespread pain (eg Fibromyalgia) and lower limb osteoarthritis are strong risk factors. Among men, hypertension and cardiovascular disease (CVD) were most significant;
• Frailty and pre-frailty are very powerful predictors of HRJL among older workers. The chances of HRJL are thirty times higher for workers exhibiting signs of frailty (including poor grip strength, walking slowly etc) compared with those in the same age cohort with no signs of frailty. Frailty also predicts a reduction in working hours, with frail older workers 17 times more likely to cut their hours.

I and my colleagues have studied the impact of many chronic conditions on labour market participation over the last 20 years. This work has included cancer, multiple sclerosis, schizophrenia, inflammatory bowel disease, psoriasis, heart disease, depression, rheumatoid arthritis and epilepsy. There is a range of common experiences that working age people living with these conditions report which help us to understand some of the drivers of HRJL, pointing the way to steps that might be taken to improve job retention. These include:

• Chronic pain. We know that workers of all ages can experience pain which can be work-limiting and, in extremis, career-ending. Pain is not well understood by employers, not least because it has a strong link with mental ill-health and can be associated with HRJL.
• Fatigue. With conditions such as rheumatoid arthritis, MS and cancer, chronic fatigue (e.g. tiredness not resolved by sleep) can be the dominant and most debilitating symptom and the one which can be the most difficult for managers and co-workers to comprehend and accommodate through workplace adjustments.
• Fluctuations. With many long-term conditions the severity of symptoms vary considerably and unpredictably. This can undermine the confidence with which an employee can guarantee that they can attend and perform at work. This can, in turn, reinforce the fear that, as someone living with a chronic illness, you may be a burden on your colleagues.
• Comorbidity. Among EU workers, the employment rate for older workers with two or more health conditions is 52 per cent. For many older workers with physical ill-health (e.g. cancer, pain or MS) the risk of developing depression or anxiety increases and this, in turn, can complicate efforts to stay in or return to work.
• Stigma and Disclosure. It remains the case that, despite greater emphasis by many employers on inclusivity, workers with disabilities or chronic ill-health fear both stigma and discrimination if they disclose their condition to managers and co-workers. Recent studies suggest that up to 50 per cent of workers do not disclose details of their health nor how it might affect their ability to carry out their work. Of course, non-disclosure means that many workers do not get access to workplace support, job crafting, occupational health (OH) or vocational rehabilitation (VR) expertise which might help them avoid HRJL.
• Performance expectations. Many workers living with a chronic illness will have concerns that they will not be able to sustain the high levels of job performance expected of their co-workers. This can reinforce stigma and a feeling that the team is ‘carrying’ workers whose performance may be impaired by their health. They can fear that they are perceived as lazy, unmotivated or incompetent. In some cases, this can lead individuals to consider reducing their hours or even leaving work altogether.
• Line manager & co-worker support. Some studies show that the support offered to employees with chronic illness and disability can make a difference to the social and psychological support offered. This can make access to workplace adjustments and empathetic OH interventions easier and help reduce stigma and anxiety – and reduce the risk of HRJL.

These are just some of the consequences of living with a long-term illness which can elevate the risk of leaving work prematurely. As we have seen, low levels of job satisfaction and engagement can only serve to accelerate this process if individual workers do not feel that their needs are understood and if they are not made to feel valued or supported.

So, what is to be done? There are some excellent studies and resources which focus on job retention and return to work programmes which focus on the needs of older workers living with multiple chronic illnesses. They include the Centre for Ageing Better, with whom IES has worked on several occasions. NIACE has carried out excellent work to test and refine mid-life career reviews which can help older workers plan the last stages of their careers, either with or without a health challenge. The OECD has an active programme of research and analysis looking at policies and practices which support older workers to play an active and productive part in the labour market. In Canada the NTAR Leadership Center has produced practical and evidence-based guidance about the actions which employers and policy makers can adopt to prevent work loss and promote job retention. The Work Foundation has produced research and policy papers looking at the support that older workers with chronic illness need to stay active in the labour market. The European Occupational Safety and Health Agency (EU-OSHA) has also collated many examples of employers taking innovative steps to promote wellbeing and job retention among older workers.

Several research groups have also carried out work to develop ‘work instability’ measures which help to identify the early signs of reduced function which could aid the adjustment of work tasks and the working environment which will guide proactive OH or VR interventions which can prevent long-term sick-leave or HRJL. Tools focused on mental illness, rheumatoid arthritis, manual work, upper extremity disorders, ankylosing spondylitis and nursing work. Looking at work instability, as well as conducting risk assessments focusing on the physical and psychosocial demands of the work typically carried out by older workers are ‘upstream’ and preventative approaches which allow the risk of HRJL to be identified and mitigated early on. Both OH and VR professionals are equipped to carry out this kind of analysis and to implement measures which support job retention. However, too few OH and VR specialists are commissioned or tasked to do this work if their contracts are focused mainly on sickness absence management and preparing assessments and medical reports. This will need to change if we are serious about promoting job retention for older workers with health conditions and functional/cognitive limitations.

I would contest that we already know quite a bit about both the causes of HRJL and what measures employers can take to prevent premature withdrawal from the labour market through prevention, early intervention, creative use of workplace adjustments and the commissioning of evidence-based OH and VR expertise. On the policy front, much more can be done to re-focus employment support services, job coaching and Access to Work towards the needs of older workers at the margins of the labour market. These will be issues which are examined in more detail by the Commission on the Future of Employment Support, with IES fulfilling the role as secretariat for the Commission.

What is very clear is that a partnership between employers, specialist healthcare professionals and policy makers is needed to make sure we have a joined-up approach to tackling the challenge of health-related inactivity among older workers. This means making use of the wealth of evidence which already exists and prioritising efforts which help keep more older workers with long-term health conditions who want to work as actively connected to fulfilling and engaging work for as long as possible.