Public health: encouraging employers to take responsibility

Dame Carol Black, a leading public health figure, discusses an initiative that aims to make significant improvements to the wellbeing of the UK workforce.

Black, expert adviser to the Department of Health and long-time advocate for improving health and wellbeing at work, argues that public health is everyone’s responsibility – employers included. She challenges companies and all organisations to consider the very real long-term gains that good employee health brings for all, and not to see it as a burden.

Dame Carol Black
Dame Carol Black, expert adviser to the Department of Health and chair of the Health at Work Network.

Black is chair of the Government’s Public Health Responsibility Deal Health at Work Network, one of five networks working collaboratively with business and other organisations to improve public health voluntarily. Occupational Health magazine invited her to answer some questions about this innovative work and her mission to encourage employers, big or small, to sign up to the Responsibility Deal.

In a nutshell, describe what the Public Health Responsibility Deal is all about

It’s about the Government harnessing the largely untapped potential of industry, business and other organisations to improve public health through their influence over alcohol, food, health at work and physical activity. It means accepting that public health is everyone’s responsibility and that the Government alone cannot solve the major public health challenges we face. Of course, individuals must take primary responsibility for their health, but the way we work together in shaping the environment and influencing decision-making and behaviour is key to helping people lead healthier lives.

The Responsibility Deal, launched in March last year, is about collaboration. We believe that working voluntarily in partnership with all organisations can enable us to achieve far more, quicker than would be possible with a narrow regulatory approach. Organisations sign up to a commitment to take action to improve public health. This action is expressed as a pledge that covers one of the following areas: alcohol, food, health at work or physical activity. To become a Responsibility Deal partner, an organisation has to sign up to the principles of the deal along with at least one of the pledges, but ideally as many as they feel able to commit.

The deal is just one part of the Government’s public health strategy, one that engages with industry and others to deliver real public health improvements.

Is the Public Health Responsibility Deal specific to any particular sector or business?

We are asking all employers – no matter how big or small, no matter what sector or type of business – to give careful consideration to signing up to the deal.

Around 340 organisations have already become partners and new organisations are signing up every week. We have some of the UK’s largest companies – among them Asda, the Co-op, BP, British Airways, EDF Energy, GlaxoSmithKline, Kraft Foods, McDonald’s, Mars, Unilever, Heineken UK, Marks and Spencer and the Royal Bank of Scotland. They are joined by a diverse range of organisations, including universities, NHS foundation trusts, charities and many smaller companies. So it’s open and appropriate for all employers that wish to demonstrate their commitment to helping improve the health of their employees.

To date, there are 21 collective pledges developed by the networks, and this number looks set to increase. For example, in the Health at Work Network, we are looking at the future workforce. We need to ensure that young people starting work for the first time have a healthy work experience.

Organisations may choose to design their own individual pledge and some companies have already gone down this route.

All the pledges, and a list of the partners that have signed up, are available on the Responsibility Deal website.

What has public health got to do with employers? Surely it is the responsibility of individuals, the local authority and the NHS?

Of course, it is up to individuals to look after their health. It is now well known that too many of us are eating too much, drinking too much and not doing enough physical activity. However, I do think that it is not up to individuals alone and would argue that we all have responsibilities in this endeavour.

quotemarksA fitter, healthier workforce performs more efficiently and more productively.”

Simply from a business perspective, there is much sense in investing in your employees’ health and wellbeing. A fitter, healthier workforce performs more efficiently and more productively.

In 2009/10, 23.4 million days were lost by British industry due to work-related ill health. The annual economic cost of sickness absence and worklessness associated with working-age ill health is estimated to be more than £100 billion.

Clearly this is wasteful, for individual companies and other organisations, and for the wider economy. There are many good examples from the UK where investment in staff health and wellbeing has led to improved productivity.

But it isn’t just about productivity. Companies that are committed to improving staff health can benefit in other ways. Their commitment sends a positive message about their work culture, enhancing their reputation and helping to attract good candidates, as well as helping to retain valued employees. It also sends positive messages to customers, clients and the wider community.

Furthermore, whatever the economic climate, it is both morally right and economically prudent to do all we can to improve employee health and wellbeing. Dr Steve Boorman’s review of the health of the NHS workforce, the largest employer in Europe, reported that a 30% reduction in NHS sickness absence rates would lead to an estimated annual direct cost saving of £555 million.

How can the workplace influence public health? Aren’t keeping fit, eating sensibly, and so on things that people need to do themselves, outside of work?

Of course, individuals must take primary responsibility for their health, but the way we work together in shaping the environment and influencing decision-making and behaviour are key to helping people lead healthier lives. The Responsibility Deal aims to tap into the potential for business and other organisations to help create the right environment to support and encourage people to make balanced and better choices to lead healthier lives. The workplace is a critical environment that has a huge role to play – it can, and does, have a real impact on our health and wellbeing.

There are 27 million people that go to work every day. Many spend more time working than doing anything else. Reaching people and helping them to understand the basics of healthier living is not easy, but the workplace offers a major opportunity to do this. How employers can encourage and support their staff will of course vary according to the type of workplace, size of the organisation, whether or not it has a canteen and so on.

But I believe that we have developed a number of flexible and pragmatic “health at work pledges” that employers can sign up to. It is unlikely that all of the pledges will be suitable for every organisation, but each should be able to commit to at least one of them.

What are the key things that managers and HR staff should consider to help improve the health of their staff?

One of the pledges recognises the importance for each organisation to measure and publish sickness absence rates. But the pledge also encourages the inclusion in annual reports and/or on websites of a dedicated section on the health and wellbeing of employees.

quotemarksOccupational health shouldn’t only be about supporting staff who have declared health problems, it should also be about safeguarding and promoting the health and wellbeing of all staff.”

Let us not forget that presenteeism – being at work but not being able to function to maximum capacity, whether due, for example, to the work environment, poor managerial relations or an unsupported health issue – is often a greater problem than sickness absence. Occupational health shouldn’t only be about supporting staff who have declared health problems, it should also be about safeguarding and promoting the health and wellbeing of all staff.

Therefore we have developed another pledge, which is specifically about bought-in occupational health services. This pledge asks employers to use only occupational health service providers that meet the occupational health standards developed by the Faculty of Occupational Medicine, and that are accredited or are in the process of being accredited. If an occupational health service is provided in-house, employers can ensure that they formally apply for accreditation under the Safe Effective Quality Occupational Health Service (SEQOHS) accreditation scheme.

Traditionally, occupational health has been largely restricted to helping those who become ill while in employment, rather than preventing them from becoming ill in the first place. In the 21st century, we must reach further and strengthen the preventive function of occupational health.

Another issue is ensuring that line managers are well supported, so that they know how to help and support any staff with health issues, including mental ill health. Mental wellbeing is a leading cause of sickness absence. It’s therefore vital that managers are aware of mental health issues – especially the risk of stigma when these are declared. The network is currently developing a pledge looking at support and adjustments for staff returning to the workplace, with a particular focus on those with a mental health condition.

What other Responsibility Deal pledges have been developed that are appropriate for employers, managers and HR personnel to consider?

My role, in the Health at Work Network, has been to develop pledges that are appropriate for employers, managers and HR staff to consider signing up to. But the other networks in the deal have a wider scope and range of pledges concerning alcohol, food and physical activity. So employers should also consider all the other pledges to see what wider commitments they could make.

One of the Health at Work pledges sets out to encourage employers to implement some basic measures for encouraging staff to eat more healthily at work. We are asking employers to look at providing healthier food and drinks in staff canteens, vending outlets and buffets for their staff. But if the company is, for example, a food manufacturer or a catering outlet, then they should also consider the specific food pledges. For example, Unilever has signed up to some of the food pledges, as well as the Health at Work pledges. Any employer should consider how they can encourage their staff to be physically active – so, again, all employers could also sign up to some of the physical activity pledges.

We are particularly keen to ensure that employers do all they can to encourage staff to stop smoking. One of the pledges is about helping staff do this by facilitating on-site smoking cessation services or by encouraging them to attend local services during working time without loss of pay.

quotemarksPrioritising employee health makes sound business sense, but also reminds us of the moral obligation of all employers.”

We are also asking organisations to sign up to a pledge that commits to offering staff health checks, for example, NHS LifeCheck. In addition, businesses should also encourage eligible employees to participate in the NHS Health Check for vascular disease and other NHS screening programmes, such as breast or bowel cancer.

What are the challenges facing employers, occupational health and HR personnel in relation to staff health?

We have seen, and will continue to see, a steady rise in the number of employees with long-term health conditions, such as obesity, diabetes, cancers that have been treated and heart disease. This presents a major challenge for the health support of the future workforce and means that employers will need to gain experience in the workplace management of employees with such conditions.

The very first pledge addressed this issue and we have developed two guides that provide advice to employers and employees in managing long-term medical conditions at work. They recommend a common sense approach that reflects the least to be expected in a trusting and respectful line manager-employee relationship. The guides are designed to help keep people in work and help those on long-term sickness absence to return to work. Although chronic medical conditions last many years, in most instances work can actually help to reduce their long-term impact.

The specific pledge is about embedding the principles of these guides within HR procedures, to ensure that employees with chronic conditions at work are managed in the best way possible, with reasonable flexibilities and workplace adjustments. The principles in these guides can supplement existing HR practices and provide employees and their line managers with practical solutions that can benefit both.

All Responsibility Deal pledges are related to keeping people healthy, fitter, in work, productive and engaged. Any employer or HR person would find that particularly attractive. Therefore, I urge all employers to seriously consider just what occupational health means today, what effect having a healthier workforce can have, as well as what it means to have an employer that looks after staff wellbeing – what that means for productivity, business and prosperity. More than ever, in this current economic climate, prioritising employee health makes sound business sense, but also reminds us of the moral obligation of all employers.

For general queries, email the Responsibility Deal programme team at or call on 020 7972 4549 or 020 7972 4858. Additional information on the Responsibility Deal and its pledges, as well as how to sign up, can be found on the Responsibility Deal website.

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