For centuries we have come to expect that we will live healthier, longer lives than our parents’ generation. But research led by Sir Michael Marmot, Professor of Epidemiology and Public Health at University College London and Director of The UCL Institute of Health Equity, shows the extent to which the health and wellbeing of UK citizens has, for many cohorts within society, gone into reverse.
In 2010 Marmot published a report ‘Fair Society, Healthy Lives’ which spelled out the public health challenges facing the UK and proposed solutions to them. So influential was this report, which argued for strong policy interventions from government, that a Royal Society for Public Health survey of its members cited the review alongside the smoking ban and the sugar levy as the three major UK public health achievements of the 21st century
A decade later, Marmot and his team have published Health Equity in England: The Marmot Review 10 Years On, which highlights severe health and wellbeing failings across the populace.
For workplace benefits professionals, the report underlines many of the key challenges facing employers in keeping their staff healthy, happy, engaged and productive. It also flags up big changes that employers will need to make as our workforce ages.
“For part of the decade 2010-2020 life expectancy actually fell in the most deprived communities outside London for women and in some regions for men. For men and women everywhere the time spent in poor health is increasing,” says Marmot.
“The damage to the nation’s health need not have happened. When, in 2015–16, statistics from the Office for National Statistics and Public Health England first showed that the increase in life expectancy had nearly ground to a halt, we at the UCL Institute of Health Equity were cautious, in the usual academic fashion. We were reluctant to attribute the slowdown in health improvement to years of austerity because of difficulty in establishing cause and effect – we cannot repeat years without austerity just to test a hypothesis. The fact that austerity was followed by failure of health to improve and widening health inequalities does not prove that the one caused the other. That said, the link is entirely plausible, given what has happened to the determinants of health.”
Whether or not you blame austerity for the current state of affairs will be down to individuals’ political beliefs. But the reality for employers is that if current trends continue they can expect to have to deal with increasing numbers of staff with disabilities. Employees, meanwhile, should come to terms with the idea that they may not be able to work because their physical condition may stop them from being able to do so.
So what does Marmot see as the core challenge for employers looking to improve the health and wellbeing of their staff?
“An important question to ask is what is work about? It is about getting money, personal development, social interaction, status, self-esteem. Work forms different functions and so we need to look at the changing nature of work. All of these impact on health – the amount of money you have, self-development, social interaction, self- advancement,” he says.
So what does Marmot make of the proliferation of apps, wearables and other solutions that claim to be able to change behaviour and improve wellbeing?
“By and large health inequalities are not primarily about individual behaviours. They are about the conditions in which people are born, grow, live, work and age. Within that, clearly behaviours make a difference. But we know that most of the behaviours that are beneficial to health are less frequent as you go down the social hierarchy. Not because people can’t be bothered or don’t care about their health. We know from the report that 30 per cent of single parents in work are in poverty,” he says.
“Do you say to a working single mother ‘I’m going to give you a Fitbit’? Give me a break. I work full time, I am in poverty, I am trying to get through the month and you are asking me whether I’d like a Fitbit to chart how many steps I have done. That is not going to do much to change health inequalities,” he says.
Someone who already has a gym may cancel one and switch to another on the basis of an incentive, he agrees, but by and large deeper interventions are needed.
One of the key findings of the report is that around most people will spend some of their working life with a disability. In the bottom 70 to 80 per cent of neighbourhoods, workers can expect to suffer from health conditions before they reach state pension age.
“What’s more, the likelihood of you being disabled at work increases the further down the social hierarchy you are. So you are either forced out of the workplace or you need an employer who can make the arrangements so you can work. And it also means your likelihood of enjoying a pension is reduced,” says Marmot.
Marmot’s data-driven approach flags up particular groups where health and wellbeing are severely impacted, and consequently where greater improvements can be achieved. One key group is working single parents.
“Families with children have been particularly hard-hit. In 2017–18, 66 per cent of children living in working families with one or more parents in part time work, were growing up in poverty. In-work poverty for working-age families after housing costs rose from 16 percent in 2010 to 18 percent in 2018,” he says.
So what can employers do for that single parent who is in a distressed situation?
“Number one is pay them a living wage. And then number two, recognise the importance of the work-life balance, to understand what it means to be a working single parent,” says Marmot.
The concept of inequality runs through both Marmot’s reports – the idea that the increasing divisions in society, both hierarchical and financial, translate through to shorter, less healthy lives for the worse off, is a constant theme. HR directors are not in the business of setting government policy, but a key takeaway from the report is that the impact of health and wellbeing solutions is most needed amongst lower income groups. Asked what single intervention can most help low income workers improve their health and wellbeing, Marmot’s answer is succinct: “Pay them more.”
And what does he make of the financial wellbeing strategies being adopted by some employers and providers?
“If you are poor life is a lot more complicated than if you are rich. If you are rich you have to decide whether you go to Wimbledon or Glyndebourne. If you are poor you have to think how do I feed the children, how do I pay the heating bill and the rent. Not having enough resources is very complex. There is clear evidence that being under financial pressures is bad for people’s health.”
Marmot’s report shows that around 70 per cent of people will have a disability by the time they reach state pension age, which is a wake-up call to the nation.
Does he think there is a postcode lottery when it comes to access to healthcare around the UK?
“Our NHS is pretty good when it comes to access. Our healthcare system has more equitable access than any other country. There is no difference in accessing care between those below and above average income.”
Another concern of Marmot is the poor provision for the health and wellbeing of gig economy workers.
“Last year we published a report on health inequality in the Americas. Informal work throughout the Americas is very high. There is nobody to care for health and wellbeing in these areas, they are own- account workers or family businesses, working in the grey economy,” he says.
“There are no occupational health standards and no benevolent employer. And this has become more of an issue at the bottom end of the employment market in the UK.” Marmot believes the economic pain caused by the coronavirus crisis is only going to worsen workers’ health and wellbeing.
“It is not difficult to predict that when the country gets poorer the problems of the poor become exacerbated. Coronavirus is going to make the country poorer. And then we are on course to crash out of the EU without a deal, which most sensible economists say will make the country poorer. So with these two things coming at the same time we know people will suffer. So these economic effects will have bigger health effects for those further down the income scale.”