Poor working conditions in England pose threat to health, says expert

BMJ 2015; 351 doi: (Published 27 November 2015) Cite this as: BMJ 2015;351:h6445
  1. Matthew Limb
  1. 1London

“Shocking” levels of poverty among working households and rising occupational illness are threatening England’s economic recovery, a leading expert on health inequality has said.

Michael Marmot said that “poor quality jobs” and unacceptably low pay risked increasing levels of harm as more people entered such jobs. He issued the latest “Marmot indicators” for health inequalities on Friday 27 November,1 shortly after the UK government scrapped its planned cuts to working tax credits in its autumn financial statement.

Marmot said that this policy “U turn” meant short term relief for people on low incomes but would not tackle long term problems, such as increasing “segregation” in the labour market between people with good education and well paid, secure jobs and people who could get only poor quality, insecure or part time, low paid jobs.

Marmot, who is director of the Institute of Health Equity at University College London, said that insecure contracts and poor working conditions could increase risks to physical and mental health. “Getting people off unemployment benefits and into low paid, insecure, and health damaging work threatens the economic recovery, because it means higher staff turnover and lower productivity and spending power,” he said.

The 2015 Marmot indicators measured inequalities in health and life expectancy in every local authority in England. They were set up to measure progress against six policy recommendations made in the 2010 government commissioned review “Fair Society, Healthy Lives,” which he chaired.2

Marmot said that the latest indicators provided “good news” in some of the categories when they were compared with the previous set of results. He cited improvements in life expectancy, levels of wellbeing, and children’s readiness for school at age 5, alongside falling levels of unemployment and fewer people aged 19-24 who were not in employment, education, or training (“NEETs”).

However, England’s south east bucked the trend to improvement on three indicators: recording rising numbers of NEETs, people in “fuel poverty,” and people not earning enough for a healthy life. Marmot said that in these respects the “advantage of the south east has diminished” over the past year when compared with the north of England.

Some indicators have worsened across England. These included the number of years people could expect to spend in ill health, the number of years spent with a disability, and raised levels of work related ill health.

In 2012-13 just under a quarter (24.4%) of all households in England did not have enough income to reach an “acceptable minimum” standard, up from 23% in 2011-12. Marmot said, “What’s really shocking is that over half of all poverty is now found in working households.”

The positive downward trend in work related illness seen between 2009-10 and 2011-12 reversed in 2013-14. In 2013-14 4000 people in every 100 000 of workers reported a work related illness, around 10% higher than the 3640 in 2011-12.

Levels of self reported illness related to work rose between 2011-12 and 2013-14 in all English regions apart from London, the north east, and the south east, where there were reductions.

Marmot said that falling unemployment was “not quite as good as it sounds.” He said, “Being in work is good for health and wellbeing if it provides people with enough money to live a healthy life. If you are in insecure, part-time work that’s associated with stress, depression, and anxiety, it’s not a recipe for a healthy alternative.”

Marmot said that there were positive—though as yet unexplained—signs that some local authorities were succeeding in breaking the link between poverty and its adverse effect on health and education. In 2013-14 deprived boroughs such as Tower Hamlets in London had substantially narrowed the gap in attainment in the GCSE examinations between pupils who were eligible for free school meals and all pupils.

“I think we really need to look into this,” Marmot said. “What’s going on in the more deprived areas that is reducing the disadvantage of being in poverty?”


Cite this as: BMJ 2015;351:h6445


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