Work and ill-health

The article by Henderson et al. ¹ regarding work and common psychiatric disorders raises awareness of this important issue. Complex, interwoven strands of environment, occupational influences and factors individual to the employee contributing to ‘worklessness’ are discussed at length.

In this era of ‘Austerity Britain’ however, with public sector spending cuts and high unemployment rates, ² I would like to have seen discussion/comment on the effects of unemployment on our patients; examining the problem from the opposite angle: that the losing of a job by an individual in itself undermines their health (including mental) and welfare.

There is much in the literature regarding this: Fryers ³ discussed the contribution of work to a person's identity, while Bartley ⁴ attempted to understand the relationship between unemployment and ill-health.

Work can boost self-esteem and helps to mould an individual's identity; take that away and, understandably, it follows that he/she suffers. From our own practice, as well as from the literature, we have known for a long time that consultation rates in primary care are higher in the unemployed. ⁵ But which is ‘chicken’ and which ‘egg’? Are redundancy and consultation rates higher because of ill-health or vice versa? Beale studied just this, and found that GP consultation rates increased significantly after a group of factory workers were made redundant, and that those workers with worse prospects for future job-tenure continued to attend at a higher rate even years later, while those that had better job prospects gradually attended their GP less over time.

In the murky waters of unemployment, ill-health, benefit-seeking, et cetera, one thing, to me, seems clear: keeping people in work helps not only their own health and finances, but those of society as a whole.

Henderson et al. cited an aim to stimulate debate; I hope to have added some fuel to this fire.