Book Reviews |
Is Work Good for Your Health and Well-Being?
Gordon Waddell and A Kim Burton. Published by The Stationery Office, 2006. ISBN 0-11-703694-3. Price: £25. 246 pp.Is work good for you? This review attempts to answer that by collating and evaluating the evidence on the question ‘Is Work Good for Your Health and Well-Being?’ It is funded by the Department of Work and Pensions (DWP) and forms part of the evidence base for the DWP's ‘Health, Work and Well-Being’ strategy published in October 2005. The authors are well known to occupational physicians having collaborated on the evidence-based guidelines for the management of low back pain among other documents.
The answer to the question is ‘Yes’ provided you have a good job which in many ways is a no-brainer. It is also qualified by a ‘generally’ but the review finds ‘strong evidence’ to support the benefits of work which are not simply a selection effect. Of more practical relevance to occupational physicians (and indeed the government as the population ages) is the answer to the question, is work good for someone who doesn't want to work any more? Possibly not, as strong evidence is found to state that the beneficial effects of re-employment depend mainly on the security of the new job and also on the individual's motivation, desires and satisfaction. Additionally ‘unsatisfactory’ jobs may be little better than unemployment and currently it is not possible to predict which older workers will benefit from re-employment and whether it is better than other alternatives (retirement).
The document references >350 publications in arriving at its conclusions. It focuses on common health problems that now account for two-thirds of sickness absence, long-term incapacity and ill-health retirement. These are the usual suspects of mild/moderate mental health problems, musculoskeletal disorder and cardio-respiratory conditions, conditions which ‘have high prevalence rates, are essentially subjective and have limited evidence of objective disease or impairment’. While the authors do not deny the reality of the symptoms or their impact, they state that those affected are ‘essentially whole people, their health conditions are potentially remediable and long-term incapacity is not inevitable’. The section on mental health highlights the fundamental difficulty of the circularity of the stimulus–response definitions. Stressors are any job demands associated with adverse stress responses while stress responses are any adverse health effects attributed to stressors. Not surprisingly, the review calls for more rigorous research into the whole area of work-related ‘stress’.
The evidence that sick and disabled people should remain in work or return to work is more variable. The review states that there is little actual evidence of benefit but feels that ‘valid consensus’ can be established on other grounds. This means (expert) opinions from disability groups, trade unions and insurers among others. However, in the section on musculoskeletal disorders ‘strong evidence’ is found for activity-based rehabilitation and early return or remaining at work.
Overall, this is an interesting read with many sensible and thought-provoking comments. The introduction, methods, findings and discussion are <40 pages with the bulk of the review being taken up with evidence tables so it is doable in a fairly short space of time and definitely worth looking at if you can borrow a copy. Reminding ourselves and others that work is good for you is a favourite pastime of occupational physicians and this review provides substantial weight to that argument. However, it has not quantified the size of the effect and to some extent it appears to depend on having a good job that you find satisfying so we may be persuading some people of the benefits of work for some time to come.
(Borrow from the library)
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