Is 'good work' the ultimate workplace health intervention?
19 Jul 2017
The recent Taylor Review has, understandably, attracted a lot of attention for its analysis of trends in the so-called 'gig' economy and proposals to offer more protections for people in 'precarious' or 'contingent' work. But one aspect which has received less attention is the recommendation that the UK should 'develop a more proactive approach to workplace health.' While this recommendation is based on the correct assessment that job quality and health are often strongly linked, the Review is clear neither on the detail of the evidence-base it uses to reach this conclusion nor on what a 'proactive approach' would look like. So, while the government looks at the Review over the summer to consider its response, it may be worth reminding ourselves why the link between 'good work' and worker health is so important and why the noble aspiration to be 'proactive' must not fall foul of some common misconceptions and pitfalls.
The idea that the work might fulfil a human and psychological need (beyond the need for income) has a long history. The concept of 'good work' was popularised over a decade ago by colleagues at The Work Foundation and the Good Work Commission. It is now increasingly part of the analysis which tells us that enjoyment, meaning, and purpose at work can be an important way of engaging employees and connecting them to the wider aims of their employer in a way that unlocks their motivation and commitment. Considerable attention is being paid to clinical or public health-related interventions at work which can help promote physical and psychological wellbeing. However, perhaps the most sustained impact on health at work can be achieved by paying more systemic attention to the intrinsic quality of the work we give people to do.
At its best, work has the power to animate us. To get philosophical for a moment, what makes work so humanly important is that, through it, life can take on a wider purpose. Indeed, according to Immanuel Kant, we have an existential need for work, even though the choices many of us are able to make about work may be constrained (sometimes very seriously) by our position in the labour market and the enlightenment of our leaders in the workplace. These ideas were certainly not mainstream in the early days of industrialisation. Henry Ford, according to one account, was not a proponent. At Ford's River Rouge plant in Michigan in the 1930's and 40's, David Collinson reports the following incident:
'In 1940 John Gallo was sacked because he was 'caught in the act of smiling', after having committed an earlier breach of 'laughing with the other fellows', and 'slowing down the line maybe half a minute'.'
This tight managerial discipline reflected the overall philosophy of Henry Ford himself, who, according to Collinson, stated that:
'When we are at work we ought to be at work. When we are at play we ought to be at play. There is no use trying to mix the two.'
Despite the enlightenment journey that we have witnessed since Henry Ford, however, awareness of the connection between 'good work' and employee health and wellbeing has taken longer to establish itself. It is to be celebrated that the Taylor Review, though a little late to the party, has recognised this too. However, the imperatives to act quickly and at scale are significant.
In the context of an ageing workforce, with young workers now likely to have to work for fifty years or more before they can retire, and a growing burden of chronic illness forecast to affect over 40 per cent of the UK workforce by 2030, it is no surprise that the health of working-age people has become a challenge attracting considerable interest from policymakers and employers. The UK currently loses close to 140 million working days a year to sickness absence, with significant economic and social costs. Employer responses have traditionally focused on improving attendance management through better information systems, return-to-work interviews and focusing more senior management attention on the problem. All of this is sensible and necessary but all too often treats the symptoms rather than the causes.
When we start to think about what some of these causes might be, it is clear that – in some cases – we might have been guilty of over-medicalising the problem. The publication of Status Syndrome by Professor Sir Michael Marmot in 2006, presented compelling evidence that workers in lower status jobs experience worse health and lower life expectancy than workers in higher status jobs. This is described by Marmot as the 'social gradient' in health. The argument can be summarised quite simply: workers in lower status jobs are exposed to more stressors than their more highly paid and highly qualified colleagues which, in turn, increase the risk of mental illness, gastro-intestinal conditions and coronary heart disease. Looking at why such a clear relationship between status and mortality existed, Marmot unearthed a clear strong association between the amount of job control reported by employees and the incidence of coronary heart disease – again with low control associated with poorer health outcomes.
Interest in job quality has also intensified as awareness of the burden of mental ill-health in the UK workforce has grown. This has forced policymakers, employers, and clinicians to recognise that Indeed, the psychosocial quality of work has received attention from those researching the impact of welfare policies aimed at encouraging the unemployed to find work, with evidence from both the UK and Australia suggesting that the health impact of jobs of poor psychosocial job quality may be equal to, or worse than, being unemployed.
When we look at what all this means for employers, the challenge is that most of the very well-intentioned things many are currently doing to improve workplace health are having little or no effect and have only weak evidence to support them. Thus, pedometer challenges, fruit bowls, subsidised gym membership, and fancy smartphone apps have far less support in the academic literature than job redesign; early intervention and timely referral to occupational health, physiotherapy or psychological support; and, above all, supportive and empathetic line management. The 'proactive' steps which Taylor calls for, therefore, need to be carefully targeted if they are to have an enduring impact.
Since John Gallo lost his job for being 'caught in the act of smiling' in 1940, we have witnessed a revolution in the way we think about the role work plays in people's lives and how we need to manage people at work. What Taylor reminds us is that work is a social act as well as an economic one. Workplaces are where we seek fulfilment, social connectivity, a sense of purpose, opportunities for personal growth, and a sense of identity. In addition, as well as the basic expectation that work should not cause us physical or emotional harm, it is now reasonable to expect that – as far as possible – work should be good for our health and wellbeing. Of course, we need more data and practical evidence about which interventions work best and have the most sustained positive impact. But we also need other changes to both policy and practice to embed the notion that it is only Good Work that is good for our health and for the productivity and inclusiveness of the UK economy.
 Vaughan-Jones H, Barham L (2010). Healthy work: Evidence into action. Bupa and The Oxford Health Alliance: The Work Foundation and RAND Europe
Any views expressed are those of the author and not necessarily those of the Institute as a whole.