The ‘ticking time-bomb’ of chronic illness

Many employers and workplaces are simply not set up to accommodate the realities of employees having progressive, chronic, terminal or fluctuating health conditions and work. But, as our working population ages, employers will increasingly need to get with the programme, emphasises Jen Remnant.

The UK workforce is ageing, as the age at which UK citizens can access their state pension has increased, and will continue increasing in response to an ageing population more generally.

This has very particular implications for the health of the workforce, as illness, especially long-term conditions such as cancer, type two diabetes and arthritis, are not evenly distributed across age groups. Most experiences of disability and long-term illness are concentrated within the middle and later stages of life so, as the workforce ages, the number of people managing long term conditions in the workplace can be expected to grow.

This represents a huge challenge to employing organisations, and occupational health departments working within them. Firstly, managing illness is expensive. Employees with cancer, for example, take an average of 151 days of sick leave.

After stress-related health issues and back pain, cancer has been identified by employers as one of the main causes of long term sickness absences. Not only does this come at great expense to the employee themselves, but also to their employer and the UK economy more widely. Half the total economic cost of cancer to the UK (approximately £7.6 billion) is due to premature deaths and time off work.

The second key issue relating to long-term ill health in the workplace is the conflict between the physical realities of having a progressive, chronic, terminal or fluctuating condition, and work and welfare systems predicated on an acute, or short-term understanding of illness. Sick leave policies presume that an employee, after a period of being unwell, will return to good health and resume their pre-illness responsibilities.

Lack of protections and provision

Workspaces and tasks are designed with healthy, non-disabled bodies in mind. Though disabled workers, including those with cancer, HIV and multiple sclerosis, are afforded specific workplace protections under the Equality Act (2010) these protections lack efficacy. There is convincing evidence that disabled and ill employees are not provided with adequate support, or protection from harassment and bullying when back in the workplace.

Older workers experiencing ill-health are situated dangerously at the intersection between ableism and ageism and face worrying insecurity and precarity in their work. Especially those whose work is physical.

Research has shown for both disabled employees and older workers that managers and employers deliver positive policy-like rhetoric, but harbour negative views personally about the capacity of those workers.

Two tools used to slim down workforces can be argued to almost exclusively affect older workers and disabled workers – voluntary redundancy and early retirement – leaving people years away from their state pension, and unattractive on the labour market.

Deindustrialisation and organisational restructuring have also been shown to increase the risk of job loss for older workers over recent decades, an issue that is likely to be exacerbated by the continued technologisation of workplaces, and preference for robots over humans. Robots, of course, do not get diabetes.

There are increasing concerns about the standard and nature of employing practices more widely, with employers regularly resorting to zero-hour, fixed term or “self-employed” contracts for their staff.

There is also a persistent resistance from many employers to the universal provision of the living wage. People experiencing long-term ill health experience higher costs in the household than their non-ill counterparts.

Travel to and from medical appointments, higher heating costs and clothing bought to facilitate fluctuating weight (as some examples) add up. They are often stuck between poorly remunerated work and the limited generosity (or indeed flexibility) of the UK state welfare system, should they have recourse to it.

Challenge of accommodating long-term illness

The challenge for occupational health then, is huge. OH is situated in institutions that are not designed to accommodate long-term illness. Similarly, much of their time is be taken up with healthy workforce initiatives and health and safety.

However, it is incumbent on current employing institutions to adapt the workplace and the workforce to facilitate the lengthening working life of their employees. This will involve progress on numerous fronts; policy, interpersonal relationships, working patterns, pay (including sick pay), communication and training.

Utilising advice and guidance from occupational health staff, employers, particularly line managers, will need to find appropriate ways to support people experiencing varied illness trajectories, when on sick leave and when returning to the workplace.

The increasing number of people experiencing long-term ill health in the workplace represents a potential time bomb, with huge social and economic implications for individuals, employers, local communities and the economy more widely.

Focus needs to be redirected toward the positive contributions older and disabled working age people can and do make to labour force, and society in general. It is imperative that employers instigate changes so that the UK labour force reflects the challenges that lie ahead, and do not rely on an outdated, short term model of illness.

References
An Ageing Workforce, Houses of Parliament Postnote No 391, October 2011, https://www.parliament.uk/pagefiles/504/postpn391_Ageing-Workforce.pdf

Age and Cancer Risk, National Cancer Institute, https://www.cancer.gov/about-cancer/causes-prevention/risk/age

Age of Onset for Type 2 Diabetes: Know Your Risk, https://www.healthline.com/health/type-2-diabetes-age-of-onset

Cancer’s Hidden Price Tag: revealing the costs behind the illness, Macmillan Cancer Research, https://www.macmillan.org.uk/_images/Cancers-Hidden-Price-Tag-report-England_tcm9-270862.pdf

Health and wellbeing at work: a survey of employees (RR751), Department for Work and Pensions, July 2011, https://www.gov.uk/government/publications/health-and-well-being-at-work-rr751

Factors that Increase Risk of Getting Arthritis, Centers for Disease Control and Prevention, https://www.cdc.gov/arthritis/basics/risk-factors.htm

Mehnert, A, Employment and work-related issues in cancer survivors, Crit Rev Oncol Hematol. 2011 Feb;77(2):109-30. doi: 10.1016/j.critrevonc.2010.01.004. Epub 2010 Feb 8. Found online at https://www.ncbi.nlm.nih.gov/pubmed/20117019

Changes to the State Pension Age, Age UK, https://www.ageuk.org.uk/information-advice/money-legal/pensions/changes-to-state-pension-age/

Luengo-Fernandez R et al. Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol. 2013 Nov;14(12):1165-74. doi: 10.1016/S1470-2045(13)70442-X. Epub 2013 Oct 14. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/24131614

Conditions automatically treated as a disability – The Equality Act and Cancer, MS and HIV, ACAS, http://www.acas.org.uk/index.aspx?articleid=5847

‘Over Half Of Disabled People Have Been Bullied At Work, Charity Finds: “Not acceptable,” says Scope’, Huffington Post, February 2017, https://www.huffingtonpost.co.uk/entry/over-half-of-disabled-people-have-been-bullied-at-work-charity-finds_uk_58a1f2cce4b03df370d8e0fb?guccounter=1

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Lorretto, W and White, P. Employers’ attitudes, practices and policies towards older workers. Human Resource Management Journal, https://doi.org/10.1111/j.1748-8583.2006.00013.x, https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1748-8583.2006.00013.x

Hutton, M et al. Disability and Job Search Among Older Workers: A Narrative Review. International Journal of Disability Management. Vol 12, December 2012, pp27-34. https://www.cambridge.org/core/journals/international-journal-of-disability-management/article/disability-and-job-search-among-older-workers-a-narrative-review/D8F51641C013657026676C2482B02F08