Policy Research Units - Working Age Research Specification
This research specification was used in the 2018 competition to fund NIHR Policy Research Units. A unit on developing the evidence base for policy aimed at improving health and wellbeing, and reducing health inequalities, for people of working age was not commissioned.
This document is provided to inform discussions around the scope of a new NIHR Policy Research Programme funding call on research to improve health for people of working age. This is to ensure that the new funding call is focusing on priority areas and asking appropriate questions, such as Does it look to be addressing the most relevant themes? How would it need to change to become a new NIHR call?
Section 1: Summary of main strands/themes for research
A new Working Age Policy Research Unit (PRU) will develop the evidence base for policy aimed at improving health and wellbeing and reducing health inequalities for people of working age. As employment is one of the key determinants of health, the initial focus of this unit will be on the relationship between health and work. The PRU’s work will involve a mixture of long-term work to inform design, development or evaluation of policy and strategy measures, and short-term rapid analysis and advice.
Strands/themes may include:
- Identifying and informing the design and implementation of effective, and cost-effective, measures to promote employee physical and mental health
- Identifying mechansims through which work may have positive and negative impacts on health, e.g. status, social interaction, acute and chronic stress
- How the health and employment systems can work together to improve the work opportunities of those with health conditions and/or a disability
- Reducing the risk of falling out of work for people with, or at risk of developing, long-term conditions and/or disabilities
- Supporting return to work after short-term and long-term absence, particularly for people with common mental and musculoskeletal health conditions
- Transitions in and out of ill-health and employment, and identifying the best intervention points to promote work retention
- Evaluating the health impacts, and effects on health inequalities, of interventions
- Building the business case for future investment in interventions, e.g. by measuring or estimating the impact on economic output
- Influencing key stakeholders (e.g. employers, healthcare professionals, welfare employees)
- Impact on health of emerging forms of employment, and unpaid work, e.g. volunteering, informal care
- Opportunities and risks presented by technological advancements
- Health benefits and risks of extending working life, and how workplace interventions for older employees impact on health inequalities
- Understanding and improving outcomes for different groups of individuals. These include people with characteristics protected under the Equality Act 2010 (particularly older people and disabled people) and groups with different labour market experiences or conditions of employment, including part-time workers, shift workers, specific occupations and socio-economic groups.
Section 2: Details of policy context and background
The Work and Health Unit is jointly sponsored by the Department of Health and the Department for Work and Pensions, working closely with NHS-England, Public Health England and the Department for Communities and Local Government. The Work and Health unit’s aim is to improve the health and employment outcomes for working age people by improving the health and wellbeing of people in work; supporting more people with health conditions or disabilities to stay in employment wherever possible; and increasing the number of people with long-term health conditions or disabilities entering work. There is particular interest in mental health and employment, as demonstrated through the recently commissioned Independent Review.
Recently, Improving lives :Work, health and disability green paper explored a range of options to transform employment opportunities for disabled people, setting out a 10-year strategy of reform to:
- develop improved and more joined-up health, welfare and employment systems, so that people get the best support available
- invest in innovation through a funding pipeline and collaborating with key stakeholders to test new approaches.
- work across Government and wider society to continue building consensus, understand how to facilitate engagement and action so that all Government Departments are playing their part, and to further develop and drive our programme of work.
The Green Paper sets out the need for early action to build the evidence base on what works in this area.
An independent review into the impact on employment outcomes of drug or alcohol addiction, and obesity (2016) also recommended measures within the treatment, support and benefits systems that could improve employment outcomes.
Consideration of health inequalities is integral to this policy agenda. Worklessness and poor working conditions are key drivers of health inequalities, and worklessness is often experienced together with other social disadvantages. The PRU should take a broad view of equality and equity considerations in relation to employment, including groups who share protected characteristics defined by the Equality Act 2010 (including subgroups of disabled people) as well as socio-economic differences.
Section 3: Justification for research topics
The Green Paper outlines short and long-term actions to join up work, health and welfare systems.
Work can be good for health, and being out of work can have a detrimental effect on health. The longer a person is out of work the more their health and well-being deteriorates. Better integration of the health and welfare systems may improve the work opportunities of those with disability or health conditions. Understanding what works in this area may contribute to improvements in population health.
There is evidence that good work may bring health and wellbeing benefits. IIl health also affects ability to gain and retain employment, and to attend work while employed. In the UK, on average, 1.8 million employees have a long-term sickness absence of 4 weeks or more in a year. Overall, an estimated 137.3 million working days were lost due to sickness or injury in the UK in 2016.
However, aspects of work can also have a negative effect on health,and there is evidence that adverse conditions are more prevalent amongst more disadvantaged social economic groups, ethnic minorities and disabled people. Conversely, the workplace can provide opportunities to promote and support healthy lifestyles. The role of the employer is therefore an important element of this agenda, both in supporting individuals to remain and return to work and in changing attitudes towards people with disabilities and long term health conditions in the workplace. It is important that health care professions and others ensure an individual can access health services which consider their employment needs.
Work is one of the most common sources of stress. Chronic stress can have negative effects on physical and mental health, including, for example, reduced immune response, stomach problems, weight gain, musculoskeletal disorders, raised blood pressure, heart attack, stroke, anxiety and depression. Interventions may reduce levels of work-related stress, for example, by changing employee and manager behaviour, and organisational culture.
There have been some successes from interventions in these areas, but there is more to do. As evidence does not always translate into effective integrated action on the ground, it is important to build our evidence base on what works.
The Work and Health Unit has a particular focus on improving health and work outcomes for people with common mental health conditions or musculoskeletal conditions as these are the most common mild to moderate, chronic health conditions in the UK working age population. At the same time, work is needed to inform interventions for different groups, including people with other common health conditions, and smaller groups with specific needs. The work will have benefits across government, as increased employment and improved working conditions have the potential to generate cost savings for health and social services. This is a wide-reaching cross-government agenda in a post-Brexit labour market and the PRU would help us to understand various components involved in promoting good health at various stages in working life.
The work of the PRU will support the policy aims of improving health and reducing health inequalities by supporting more people to gain and remain in employment, improving working conditions and promoting health in the workplace, by investing in building our evidence base so that we know what works, for whom, why and at what cost.
Section 4: Other related research activity of which the Unit will need to be aware
The PRU should be aware of relevant cross-governmental programmes and research, including work led by the Department for Work and Pensions, and the Department for Communities and Local Government, for example the Troubled Families Programme. Furthermore, the Work and Health Unit has already commissioned or is planning a number of trials to fill key evidence gaps, as outlined in the Green Paper.
The PRU will be expected to develop links with other NIHR commissioned PRUs, relevant research and intelligence teams at arms length bodies, including Public Health England, NHS England, the Health and Safety Executive, the Government Office for Science and the Office for National Statistics, to ensure mutual awareness of relevant research and analysis plans, and to share learning both in terms of findings and methodologies.
The PRU will be expected to respond to guidance on research priorities from NICE and NIHR where these relate to topics within the scope of the PRU’s work.
A number of third-sector organisations also conduct research and develop research tools in the area of health and work, and the PRU is expected to be aware of these organisations, develop links with them, and keep abreast of their work in this area.