Health and work strategy: review report

6 Fair and Healthy Work For All

The Review proposes a vision (figure 5) for Fair and Healthy Work in Scotland that seeks to capture the critical relationship that exists between Health and Work, Fair Work and the Economy. Of particular importance is the framing of the agenda as being about 'Fair and Healthy Work,' a framing that makes explicit the improved integration that the Review considers is required between the policy areas of Health and Work, and Fair Work, indeed a number of the Review's recommendations identify opportunities for making this integration happen in practice.

For everyone of working age in Scotland to be able to enjoy Fair and Healthy Work that enables their full economic participation and personal fulfilment and that underpins successful private public and social enterprise in a vibrant productive inclusive and sustainable economy.

Figure 5 Vision for Fair and Healthy Work for All

Underlying Principles for Fair and Healthy Work for All

The Review identified seven underlying principles that should underpin the Scottish Government's approach to Fair and Healthy Work.

Healthy Working Lives

The Review embraces the definition of a Healthy Working Life established in the Scottish Government's original Healthy Working Lives Action Plan^[3]. Fifteen years on this remains a valid expression of the outcome required at individual level to achieve Fair and Healthy Work for All.

"A Healthy Working Life is one that continuously provides working-age people with the opportunity, ability, support and encouragement that works in ways and in an environment which allows them to sustain and improve their health and wellbeing. 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."

Fair Work

The Review endorses the approach taken by the Scottish Government to Fair Work^[10]and its five dimensions of Effective Voice, Opportunity, Security, Fulfilment and Respect. The dimensions have a clear read across to Good Work and reflect the conditions necessary to enable Fair and Healthy Work for All. Importantly, Fair Work also articulates the need for a balance between the rights and responsibilities of employers and workers, and that outcomes include benefits for individuals, organisations and society. More details of the dimensions of Fair Work can be found at Appendix V.

Work as a Human Right

Article 23.1 of the Universal Declaration of Human Rights states that " Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment^[51]". Human Rights therefore underpin the requirement for Fair and Healthy Work for All, with disability and long-term conditions, particularly in relation to mental health^[52] continuing to be identified as an area in which particular work is needed to deliver Scotland's Human Rights obligations.

Prevention

The Public Health Reform agenda and the Public Health Priorities for Scotland are explicit about the importance of "prioritising preventative measures to reduce demand and lessen inequalities^[13]," underlining the adage that prevention is better than cure.

Tackling Inequalities

In their joint introduction to the Public Health Priorities for Scotland, the Minister for Public Health and COSLA's Health and Wellbeing Spokesman call "for Scotland to be a place where everyone thrives^[13]," and these means tackling the health and social inequalities that continue to blight our communities. The priorities go on to highlight the importance of having a sustainable and inclusive economy with "inclusive growth" at its heart.

Professor Sir Michael Marmot^[29], identified "Good Work"', within which he defined ten dimensions (Appendix IV), to be fundamental to tackling health inequalities. Good Work "provides a decent income, widens social networks and gives people a purpose" with the benefits of good work extending beyond working-age adults to their children^[25]".

Good work is good for health.

Good work is good for health, however, not all work is good for health. "Up to one-third of jobs fail to lift families out of poverty and can increase worker's risk of illness, injury or poor mental health. For some people, working in these jobs maybe no better for their health than being unemployed^[53]."

Work is not always an appropriate outcome

Whilst the policy ambition is rightly about enabling everyone of working age in Scotland to enjoy Fair and Healthy Work, it is also important to recognise that the nature of some health conditions and disabilities means that work, paid or otherwise, is not an appropriate outcome for everyone. For some people, this may be at certain times in their lives, though for others this may be for the whole of their lives. For individuals for whom this is the case it is essential to ensure dignity and social and economic inclusion. The Review, therefore, welcomes the ambition of the Scottish Government to build a new social security system founded on dignity and respect and that considers 'social security is a human right, essential to the realisation of other human rights^[54]'.

Policy Objectives

The Review proposes four policy objectives to deliver Fair and Healthy Work for All.

1. Access to Fair and Healthy Work

To enable and support everyone with a health condition or disability to access fair and healthy work that is sustainable and accommodating of their individual needs (and where this is not possible to ensure dignity and social and economic inclusion).

2. Availability of Fair and Healthy Work

To maximise the availability of Fair and Healthy Work for all that protects and improves health and which balances personal, societal and business needs, and which enables an individual to work, with support and adaptation where required, for as long as they wish to.

3. Retention of Fair and Healthy Work

To support individuals with a disability or health condition, including long-term life limiting conditions such as cancer, where appropriate to their needs, to remain in work, return to quickly in the event of an absence, and where necessary access alternative work.

4. Underpinning/Cross-Cutting Actions to enable Fair and Healthy Work for All

A number of the recommendations that emerged are applicable to more than one of the principle policy objectives and are therefore captured here. In addition, there are a number of recommendations that are in effect underpinning of those within the first three areas.

Measuring Success

The National Performance Framework^[55]sets out a vision for national wellbeing and includes measures of a "Fair and Equitable working society," and the proposal within the Fair Work Action Plan (2019)^[12] to develop and adopt a set of indicators to measure progress in delivering a 'Fair Work Nation' will provide a helpful addition to this, though it would be strengthened by the inclusion of explicit health metrics.

At the level of intervention, there already exists a significant body of international and domestic data and evidence to demonstrate the costs of poor health at work and the positive impact and cost benefit of measures to improve health at work. Employers do not cite a lack of evidence as being a barrier to investment, indeed the Review has heard from some of our largest employers, who have the metrics available, whose commitment to health at work is because they understand it makes business sense to do the right thing by their employees. The issue, rather, is knowing what to do and where to find the right support.

Whilst continuing to build the evidence base, including evaluating new programmes to ensure they are impactful remains important, measuring the level of engagement by employers in Fair and Healthy Work needs to be the focus.