Work and health: international comparisons with the UK

Blog posts

10 Feb 2025

Zofia Bajorek, Senior Research Fellow
Jonny Gifford, Principal Research Fellow

When the government published its Get Britain Working White Paper at the end of last year, it included the message that ‘to get Britain going again, we’ve got to get Britain working again’. One area the government recognised as a challenge to improving economic activity and productivity was that the health of the working-age population is in decline, and as a result, many individuals with long-term health conditions often find themselves excluded from the labour market.

It is for this reason The Health Foundation set up the Commission for Healthier Working Lives. The Commission aims to gain a better understanding of health trends and inequalities and build a consensus on the actions needed to address this decline in working-age ill health to aid individuals, employers and the economy. Interim findings from the Commission highlight the extent of the challenge in the UK:

• In 2023, almost 2 in 5 people aged 16-64 years reported having a long-term health condition.
• Half of this group is limited in their ability to work as a result. This is 20% of the working-age population, or over 8 million people. It is up 15% from a decade ago. Mental health conditions have especially increased.
• Working-age ill-health affects recruitment and retention. Each year, about 300,000 people move from being in employment to being economically inactive with a work-limiting condition. Once out of work, returning becomes more challenging: fewer than 4% of people with long-term work-limiting health conditions move from economic inactivity back to employment.

The UK is not alone in facing these challenges. Research by the OECD (2022) highlights that economic inactivity due to ill health is a persistent challenge faced by many countries that generally needs stronger policy action. However, there are significant variations in how countries have approached these challenges, and how well they have recovered since the COVID-19 pandemic.

As part of the Commission for Healthier Working Lives, the Institute for Employment Studies analysed how the UK compares with 14 EU countries in long-term ill health and employment. The results indicate that relative to most European peers, the UK adults with long-term health conditions fare poorly in employment outcomes. For example:

• Among healthy adults, the UK has a good rate of employment, but the same is not true of the chronically ill. Thus, the ‘employment gap’ between those with and without health limitations in the UK is among the highest in the EU15.
• Among older UK workers, the employment chances of those with health limitations are declining, whereas in other European countries they are improving. We are clearly headed in the wrong direction.
• The situation for young adults is even more concerning. In 2022, those with chronic ill-health aged 16-24 were twice as likely to be out of work than they were pre-pandemic.

IES’ research also reviewed policy from overseas that the UK might learn from to promote healthy work and help people stay in work and get into work. Our findings highlight that it does not have to be this way in the UK.

What policy approaches might the UK consider? One of the key differences lies in how workplace health policies are integrated, and how responsibilities for employers and other actors are defined. Compared to a number of countries – including France, the Netherlands, Poland, Finland, Japan, Italy and Germany – the UK leaves much more to individual responsibility and markets, and its legislation is more split across different systems. Changing this would be a long road but it is something that can be worked towards.

There are also more specific policies that the UK could emulate. One promising approach to promoting healthier work is industry-focused initiatives to share good practice. Options to help people with ill health stay in work include increasing occupational health coverage, linking statutory sick pay to people’s wages, and more structured support with rehabilitation and workplace adjustments. Policy to help people move out of economic inactivity is trickier, in part because early interventions work best: once people have fallen out of the labour market, it is hard to get them back in. The evidence on some measures – such as employment quotas and incentives for employers – is mixed, but again, well designed support for workplace adjustments can make a real difference.

Before advocating a raft of new measures, we should think about their longevity. At the webinar launch of our report, Christopher Prinz, who leads the OECD’s analysis on links between ill health and employment, gave a robust challenge to the UK. He noted that the UK holds a privileged position in having an unusual amount of research and insight into health and employment policy. Indeed, it provides an important reference internationally, with other countries actively drawing on the UK's work. But, he argued, the UK doesn't properly implement its own recommendations, or it does so fleetingly. For example, the Fit Note proposed in the 2008 Black Review held promise but has not been implemented by most GPs. Elsewhere, changing and renaming interventions means that employers, employees and those out of work must navigate an unstable and confusing set of policies. 

Compared to our peers, the UK could be doing a great deal better to improve the employment prospects of those with ill health. The recent launch of the government’s new review ‘Keep Britain Working’ presents a great opportunity. Through an evidence-based approach, we should be able to find a combination of support and incentives that weakens the link between ill health and economic inactivity. We need to play a long game, both in thinking beyond individual initiatives to how systems hold together, and to ensure that positive changes are sustained. Policy options are there on the table, if the political will and consensus can be found. 

Subscribe to blog posts

Any views expressed are those of the author and not necessarily those of the Institute as a whole.