It is estimated that by 2030, four out of ten working age people will have at least one chronic health condition, and some will have several. The most common symptom is pain with the mental and physical effects of pain. Further, in many individuals symptoms fluctuate, often unpredictably. This presents a challenge, to those who are affected, to their health professional advisers and especially to their employers.
I shall consider the effects of painful conditions on the lives of people of working age and ways in which those effects can be ameliorated.
First, the evidence is consistent and fairly strong that for most people, work – good work – is good for their physical health, their mental health and their overall wellbeing. And it is certainly true that good work can enable people to live lives that are fulfilling personally, socially and economically – helping to ensure their wellbeing.
This is no less the case for most people who are not wholly well or fit. Indeed, most people with long term health conditions, many of which are painful, do in fact work.
What are the effects of painful conditions on the lives of people of working age and how can those effects can be ameliorated and their wellbeing restored?
Except where there are obvious features such as deformity, altered posture or gait, or difficulty in movement or undertaking physical tasks the symptoms are subjective and their effects often difficult for employers and co-workers to fully understand.
Neither, of course, is pain solely a physical problem; always there are psychological and emotional elements. Anything one does might influence pain and the experience of that pain, and the consequences. Pain will trouble us to varying degrees depending on our mental state. Moreover, pain can influence that mental state.
The circumstances of working life and the personal and employment needs that must be met bring particular considerations into play.
Effective approaches to bring pain under control, make it tolerable, to enable the fullest possible working life depend on the attitudes and actions of many participants, first on skilled clinicians, in a range of specialties. But this aim cannot be achieved by clinicians alone. It requires close and sensitive collaboration with patients themselves. Without their keen, committed, informed participation the results will fall short. Often there must be acceptance of pain, importantly with the recognition that enhanced physical activity is not something to be endured but rather an essential part of coming to terms and rejecting unnecessary curtailment of activity that can still be rewarding and enjoyed.
The challenge is not just for any single part of our health and work system. If affected people are to have fulfilling working lives then facilitating entry to work, job retention and return to work after sickness absence must also be a concern of the welfare system and, crucially, of employing organisations.
There is compelling evidence that the conditions of work are themselves important and sometimes decisive factors in influencing both mental and physical health and overall wellbeing of working people. Further, there is a growing recognition among employers of the importance of employee health and wellbeing to the performance and reputation of their organisations, and a keen awareness of the costs when employee wellbeing is neglected.
However, for many the onus for self-managing a painful condition at work weighs too heavily, often at great cost to their personal lives at home, and their social lives. The effort to stay in work can compromise their physical health.
Recent research has revealed more fully the tension between wanting to continue to work, in the face of a struggle to manage the painful condition successfully. Being in work as a condition of effective self-management is often undermined as individuals seek to self-manage in that context. The report Self-management of chronic musculoskeletal disorders and employment captured the barriers that people with chronic musculoskeletal face in the workplace.
A central finding of the study was confirmation that work itself should be considered as a form of self-management. Individuals interviewed for the report found that partaking in work was an important way in which they managed several (often psychological) aspects of living with their painful condition.
Individuals also described how the invisible nature of pain meant that other people found it harder to understand their condition, and that they often were not offered support when they needed it. Some even described feigning alternative, more understandable, symptoms in order to communicate to others that they were unwell. Such experience raises the crucial, yet often overlooked relationships between employees and their line-managers, and also with their immediate colleagues.
Progress in these matters turns on such fundamental matters as workplace culture, senior leadership and line management skills. There is growing evidence of better understanding amongst employers, employees and health professionals of the benefits of good work on health. This heralds a wider culture change in attitudes to health and work. Among health professionals, for example, maintaining or returning to work is widely accepted as a desirable health outcome.
Dame Carol Black
Expert Advisor on Health and Work to the Department of Health & Principal of Newnham College Cambridge