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Work and Wellbeing. Professor Ewan Macdonald OBE University of Glasgow. But what is Work? Its not only being in a paid job with 6 months full pay and 6 months half pay. Paid employment Self Employment Voluntary work Carer Homemaker Child rearing Full time/ part-time

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Work and Wellbeing

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work and wellbeing

Work and Wellbeing

Professor Ewan Macdonald OBE University of Glasgow

but what is work its not only being in a paid job with 6 months full pay and 6 months half pay
But what is Work?Its not only being in a paid job with 6 months full pay and 6 months half pay
  • Paid employment
  • Self Employment
  • Voluntary work
  • Carer
  • Homemaker
  • Child rearing
  • Full time/ part-time
  • Community activities, clubs, church
  • Etc


jimmy a 45 year old distribution worker

Minimal health and safety

No eye protection

No ear muffs

Early noise induced hearing loss

Vibration white finger

Several Eye injuries in past

Irritant dermatitis

Back injury in past

Osteoarthritis of spine,shoulders , elbows and knees

6 visits to accident and emergency

One hand fracture

Getting a bit past it

Jimmy – a 45 year old distribution worker
Average housing

Poor diet, not much fruit, veg or fish

4 pints of beer a night (occas drink at lunchtime)

20cigs a day

No leisure exercise

Left school with no qualifications

Jobs on building sites

Frequently does overtime

Sometimes in informal economy

Few of his employers have occ health and safety resource

Separated lives with partner and two stepchildren

Two children by first wife

Financial problems

Child care issues

Has been on courses to use power tools

No other education

Reads paper occasionally

Has home computer-on internet

  • He has an accident – pipe rolled on leg fracture of right tibia and fibula
  • Taken to hospital – transferred to orthopaedics – surgery, plated , discharged on crutches after two days (superb treatment)
  • No record of job in the hospital notes
  • No physiotherapy
  • Gets Fit note “unfit”
  • No guidance about rehabilitation
  • Rests at home, watches TV (gets depressed)
  • Progresses to walking with a stick
  • Wasting of quadriceps (50%) and reduction in power both legs, pain at fracture site
  • After six weeks starts physiotherapy – once per week for six weeks
  • Pain and weakness still a problem, Family doctor advises job will be too much for him
  • Follow up hospital appointment – no discussion about work
jimmy options
Jimmy - Options
  • Probably dismissed within 4 weeks
  • Friendly with the boss – given job driving the dump truck
  • Goes on to long term Health Benefit (ESA) after six months
facts about incapacity benefit in scotland brown hanlon macdonald et al j pub health 2008
Facts about Incapacity Benefit in Scotland (Brown, Hanlon, Macdonald et al, J. Pub.Health 2008)
  • 2.5% of Working age population go on to IB each year (3.5% in Glasgow)
  • 55-59 yr old males – 18% on IB (35% in Glasgow, 60% in districts)
  • Mental Health problems cause 50% of IB
  • 10 years ago main cause was musculoskeletal
Rate of IB receipt by MSP Constituency2008Scottish Observatory for Work & Health

Relationship between mortality (age/sex standardised rates per 100,000 population) and deprivation (as measured by the Scottish Index of Multiple Deprivation)

work and inequality
Work and Inequality
  • Your status is determined by having a job and the level of that job
  • Your job (or jobless) level determines your life expectancy
  • Your job (or jobless) level determines how long you will survive the same medical condition
work is good for you
Work is good for you
  • “Overall the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long-term unemployment or prolonged sickness absence. Work is generally good for health and well-being”
  • Waddell and Burton 2006
what else do we know about being out of work
What else do we know about being out of work?
  • Unemployment is bad for you:
    • Loss of Income¹
    • Destructive on self-respect¹
    • Risks of ill-health²
    • The “psychosocial scar” persists³
    • Trans-generational effects
  • Winkelmann and Winkelmann 1996
  • Clark, Georgellis, Samfey 2001
  • Clark and Oswald 1996
  • Aylward 2006
long term worklessness is one of the greatest known risks to public health
Long-term worklessness is one of the greatest known risks to public health
  • Health Risk = smoking 10 packs of cigarettes per day (Ross 1995)
  • Suicide in young men > 6 months out of work is increased 40 x (Wessely, 2004)
  • Suicide rate in general increased 6x in longer-term worklessness (Bartley et al, 2005)
  • Health risk greater and life expectancy worse than many “killer diseases” (Waddell & Aylward, 2005)
  • Greater risk than most dangerous jobs (construction/North Sea)
the scottish healthy working lives paradigm 2003 macdonald e docherty g 2007
The Scottish Healthy Working Lives paradigm2003(Macdonald E, Docherty G. 2007)
  • “A healthy working life is one thatcontinuously provides working age people with the opportunity ability support and encouragement to work in ways and in an environment which allows them to sustain and improve their health and well being. It means that individuals are empowered and enabled to do as much as possible, for as long as possible, or as long as they want, in both their working and non working lives”
In ScotlandWorklessness is the single most important cause of health inequality, social exclusion, deprivation , and mortality