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Thomas Carlyle once said that
"work is the grand cure of all maladies and miseries that ever beset mankind".
How right he was. Work, or, more specifically, getting a job, maintaining a job, and, most important of all, deriving a sense of personal fulfilment and satisfaction from that job, is the key to good health. Men's health outcomes, in particular, owe much to the type of work that they do and the amount of time and energy that they devote to it. It defines who they are and their place in the world. Even today, men spend far more time in the workplace during their lives than women do. Not only are there more men employed than women—some 1.5 million more, in fact—but there are twice as many men in full-time work as women. Men also work much more overtime than women, and 30 per cent. of men work more than 45 hours a week, compared with 10 per cent. of women. Furthermore, because of the traditional differential in the retirement age, men still tend to work to a greater age than women.
When we consider the extent to which work continues to dominate the lives of men, it is little wonder that they make much less use of primary health care provision than women. The fact that access to most primary care services is still predicated on where people live, rather than on where they work, means that it is much more difficult for men to gain access to help when they need it. That is not the only reason we have this gender gap, as there is a whole range of cultural and psycho-social reasons why take-up is lower among men, but the difficulty men face in simply getting to a GP practice is undoubtedly part of the problem.
There is good evidence to show that if we provide health services in environments that are more accessible to men, such as in the workplace, men do take advantage of them. For example, Royal Mail, 85 per cent. of whose work force is male, introduced a health awareness programme in 2004 as part of a wider scheme to reduce employee absenteeism. The scheme succeeded in reducing employee absenteeism from 7 per cent. to 5 per cent. between January 2004 and May 2007—equivalent to putting an extra 3,600 employees in work. A report by the London School of Economics calculated that if the 13 sectors of the economy with the highest absence rates followed Royal Mail's lead, the resultant reduction in absenteeism would be worth £1.45 billion to the UK economy.
The Work Fit programme developed by BT is another example of an effective workplace-based health initiative aimed at men. BT, 75 per cent. of whose employees are male, commissioned the Men's Health Forum to develop a lifestyle improvement programme that would appeal particularly to men. The resulting Work Fit programme was a 16-week scheme delivered mostly online, which focused on nutrition and physical activity. More than 16,000 staff, three quarters of whom were male, registered to participate in the scheme, and 6,000 were successfully tracked over the course of that 16-week programme. Each participant lost an average of 2.3 kg during the programme and a six-month follow-up found that most had managed to sustain the progress they had made.
The success of those initiatives underlines the value of workplace-based health schemes. The NHS needs to work closely alongside employers, unions and industry associations to ensure that such schemes are more widely disseminated across the country. There is no reason why many of the services provided in traditional NHS settings could not be delivered just as well in workplace settings. Basic health checks, screening services and some routine GP appointments are among the services that could easily be provided in the workplace.
Not only do workplace-based schemes produce tangible results in terms of improved health and higher productivity, they also help the NHS to meet its obligation under the gender Equality Act 2006 to ensure that services are delivered more equitably between men and women. The value of gender-sensitive approaches in enhancing the effectiveness of workplace-based health initiatives is also acknowledged in Dame Carol Black's review of the health of the working-age population, "Working for a healthier tomorrow".
It is clear from the Department of Health's willingness to give its backing to last year's national men's health week, which looked at health in the workplace, that the Government appreciate the vital importance of this issue. The mini-manual produced for men at work that was funded by the Government is evidence of that, but we need to do more. The Men's Health Forum is organising, with Department of Health support, an expert symposium on
The centre for men's health at Leeds Metropolitan university has already identified a need for research to look at what we know, what we do not know and what we need to know regarding the promotion of men's health in the workplace. I would like the Department of Health to work closely with the Men's Health Forum, which I am pleased to see is now a strategic partner, on developing this agenda.
I would like to move on to the importance of good work for a man. I have focused so far on the role of the workplace as a means of helping men to gain better access to health services and information, but I want to return now to the issue I started with—namely, the relationship between work itself and the health outcomes of men.
We know now that the quality of employment has a direct and quantifiable impact on people's health, life expectancy and life chances. Arguably, that applies even more to men than women, given the residual importance our culture continues to attach to the role of the man as a successful breadwinner. Yet while it is clear that unemployment has a particularly corrosive effect on the physical and mental health of men, there is now equally strong evidence to show that having a good job is considerably better than having a bad job as far as men's health is concerned.
Poor-quality work among men is associated with low levels of well-being, a higher incidence of physical or mental illness, low levels of self-esteem and a sense of powerlessness. In the Greek myth, Sisyphus was punished by the gods for his deceit by being condemned to work without purpose. His punishment was to roll a large boulder up the same hill, without purpose or object, for eternity. Every time he reached the top, the boulder rolled back down the hill and he had to start all over again. As Albert Camus said, the gods
"had thought with some reason that there is no more dreadful punishment than futile and hopeless labour."
As humans we need purpose and meaning in our lives, and work, along with family, is the primary vehicle through which meaning is created. To quote Kant:
"If a man has done much he is more contented after his labours than if he had done nothing whatever; for by work he has set his powers in motion".
We are much better off—socially, physically and spiritually—when we have work that offers us a chance to find an outlet for our creative spark and also provides us with a degree of stability and rootedness.
The famous Whitehall study of British civil servants, carried out by Michael Marmot, emphasised that point. He found that people in those grades that do the most routine work experience the most rapid clogging of the arteries. Between the ages of 40 and 64, those in the bottom grade were four times more likely to die than those at the top.
In a recent book, "The Craftsman", Richard Sennett, the sociologist, underlined the importance of "craftsmanship" in human society. The craft process, whereby we select our materials and then manipulate them, using our skill and experience to create something of tangible value, is a necessary human experience, and without it we are lost. The craft process lies at the heart of all "good work".
What do I mean when I talk about "good work"? According to a recent Work Foundation publication by David Coats and Rohit Lekhi, "good work" can be said to embrace the following features: employment security; work that is not characterised by monotony and repetition; autonomy, control and task discretion; a balance between the efforts that workers make and the rewards that they receive; whether the workers have the skills they need to cope with the demands pressure; observance of the basic principles of procedural justice; and strong workplace relationships.
In some of those areas, we have made very good progress over the past 12 years. Nevertheless, it is clear that we still lag behind many of our European neighbours in a number of areas. Take the measure of job quality, for instance: according to a recent Eurobarometer study, the UK has marginally more low-quality employment than France and Germany, and significantly more than the Nordic countries.
Nearly 70 per cent. of jobs in Denmark are deemed to be of high quality, compared with only 42 per cent. in the UK. The Danish experience shows just what can be done when reasonably tough employment laws, high-quality active labour market programmes and high benefits are combined. That creates an inclusive labour market with decent work for the overwhelming majority of employees, which results, unsurprisingly, in a happier and healthier population.
On some measures, though, there is evidence to show that we have actually gone backwards rather than forwards over the last 20 years. Job control is one such example. According to a recent Economic and Social Research Council skills survey, there was a marked decline in job control between 1992 and 2006 across all occupational groups. Those in skilled trades were only moderately affected, but associate professionals, those in "elementary" jobs and personal service workers experienced a sharp reduction in task discretion.
The employees surveyed reported that their efforts are increasingly subject to external sources of control—specifically, closer supervision, more intense pressure from customers, more peer pressure from colleagues, a closer relationship between pay and performance, and more intrusive performance management systems, among others.
The growing use of information technology-based management systems, for example, means that the working practices and outputs of many employees are far more closely monitored than they were a generation ago. They are obliged to work in very structured fashions, which leaves little room for flexibility or discretion and is also inherently more stressful. It is unlikely that they are receiving any additional pay by way of compensation.
As many as half of all employees are now affected by information and communications technology-based systems of that kind—everyone from employees connected to electronic point-of-sales systems at retail checkouts and call centre operators to clerical staff operating computers, and professionals and managers, who use networked computing services, including e-mails, intranets and the internet.
While many employers may congratulate themselves on introducing technology that allows them to monitor and manage the performance of their employees in such an accurate and cost-effective fashion, it is clear that most employees are not quite so appreciative. The consequence of a decline in job control and task discretion is that employees no longer feel that they are active participants in their organisations. Their sense of commitment diminishes, they feel less responsible for the consequences of their actions and they feel increasingly dissatisfied. That is not only bad for the health of the business, but even worse for the health of the employees.
Senior executives often talk about the stresses involved in holding down a powerful, high-profile job. Stress of that kind is nothing, however, compared with the stress involved in holding down a post where the person has no, or next to no, control over the work they do. The security guard in the entrance lobby is far more likely to have a heart attack than the so-called highly stressed executive who sweeps past him every morning.
Yes, lifestyle factors play a part, but the studies that have controlled those factors point to job-specific factors such as job control and task discretion and the culture of the organisation as the major causal factors. It is clear that until we tackle the inequalities in the pay, status, autonomy and job security of different groups of workers in so many British workplaces, we shall have no chance of ironing out the marked social gradient in health that is now apparent among men in Britain.
The 2005 European Working Conditions Survey tells us that many of our neighbours have been more successful than us in enabling employees to maintain a sense of job control and satisfaction. Denmark, Finland, the Netherlands, Norway and Sweden all perform substantially better than we do in terms of employee autonomy in the workplace. I believe that there are two main reasons those countries perform so well. First, union density is very high in all of them. A strong union presence helps to neutralise attempts by employers to impose more controls on the working practices of their employees. Even if those attempts are not always successful, the fact that employees know that they have the union on their side, fighting their corner, makes them feel more in control, which is almost as important.
The second reason is that all those countries have invested heavily in workplace reform programmes. All their Governments have understood the importance of trying to improve, or at least protect, the quality of its citizens' working lives, and have invested heavily in programmes that focus on job enrichment or on improving companies' productivity or organisational performance. It is reasonable to suppose that that investment has helped to keep those countries ahead of their EU competitors in terms of the extent of the autonomy that exists in their workplaces. It has probably played at least some part in helping to improve overall health outcomes and minimise health inequalities among the working population.
What measures should our country be taking to improve its outcomes? One thing that we ought to be doing is ensuring that employees' rights that are already on the statute book are properly implemented. Earlier this year, the TUC estimated that at least 1.5 million employees were not receiving the national minimum wage. A national minimum wage helpline has now been set up that allows employees to make complaints about their treatment, but more needs to be done to boost awareness of that service among people in lower-paid occupations, and to make them confident enough to use it.
Many employees are reluctant to take action even when they know that they are being exploited, either because they are worried about how their employer will react or because they do not think that action would be taken in any event. Perhaps the best way of addressing that fear is to continue to promote the advantages, or more specifically the protections, that union membership provides. As well as investing in enforcement measures, we need to consider what practical steps can be taken to help employers to improve the job quality of their employees.
One possibility is the establishment of a "workplace innovation challenge fund" to provide pump-priming funding for employers who are interested in introducing programmes of job enrichment, empowerment initiatives aimed at enhancing autonomy, and new forms of work organisation. We could also insist that companies provide more detailed information about health and safety performance—including the measures that they have taken to improve job quality among employees—in their annual reports. That would help to focus corporate Britain's attention on the importance of job quality as a means of helping to improve the health, the well-being and, ultimately, the performance of employees. Given that the best-performing companies are invariably those that invest most in improving job quality, other companies, seeing their success, would be encouraged to follow their lead. In time, a focus on job quality could be seen as an essential feature in the blueprint of a successful organisation.
I also support the current move to end the British opt-out from the European Union working time directive. Among the EU 15, only Spain has a higher percentage of workers than Britain who work more than 48 hours a week. I am convinced that bringing Britain into line with the rest of Europe would have an appreciable impact on health outcomes. After all, there is compelling evidence to suggest that excessive working time can have an adverse impact on both physical and mental health, and can expose employees to the higher risk of workplace accidents.
Some people will doubt whether a time when Britain is in the middle of an economic downturn is a good time at which to be focusing on job quality issues, but I believe that now is precisely the right time to be thinking about such issues. Investing in people will ensure not only that corporate Britain remains competitive in the downturn, but that we are well placed to flourish and grow in better times ahead.
Noel Coward once said:
"Work is much more fun than fun."
As a famous, well-paid actor and writer who had almost total job control, he was well placed to make such a remark. It is very unlikely that we shall ever see a time when the majority of the working population would also, without hesitation, describe their work as consisting entirely of fun; but if we can make men's experience of work more positive, so that work becomes an opportunity for personal growth and fulfilment, we shall have taken a huge stride forward in terms of improving their sense of health and well-being, and consequently their health outcomes.
I realise that many of the issues that I have raised are beyond the strict remit of my hon. Friend the Minister. However, I believe that, as the lead Department in the tackling of health inequalities, the Department of Health has a vital role to play in making the case across Whitehall for more concerted action to help to improve men's and women's experience of work. By focusing on that, the Government have the opportunity to make a real dent in the level of inequality in this country.
I congratulate my hon. Friend Dr. Stoate on securing this important debate and on the content of his speech, which as always was informative and interesting. This is quite an historic occasion, in that a general practitioner has initiated the debate and the response from the Dispatch Box is coming from a former nurse. This occasion should be noted for its history, as well as for the fact that, having had a debate on women's issues, we should be ending our parliamentary day by debating the importance of men's health.
There are many areas of concern for both the mental and physical health of men. Some of the facts and figures can make startling reading. Although nationally life expectancy is the highest that it has ever been, the biggest health inequality that exists between men and women is the fact that a man is still likely to die earlier than a woman. You cannot get much more unequal than that, Mr. Deputy Speaker. The gap is even wider for men from less affluent backgrounds, as my hon. Friend stated so well. We do not yet fully understand the reasons for that, but one possibility is that men are more vulnerable to the wider determinants of ill health, such as poverty and, sadly, unemployment. That is a particular concern at the moment because of the economic downturn. The inequalities that were so admirably raised by my hon. Friend will be addressed by all Departments.
We need to find ways of protecting the population, of course including men, from the harmful effects of the economic forces that are raging around us. One way to do that is by encouraging them to take better care of their health. By so doing, we will not only improve men's life expectancy and well-being; there will also be a cachet, in that that could, in turn, improve their capacity to contribute to the economic life of the country. Thus, what could otherwise be a vicious circle could turn into a virtuous one. Nowhere is that more apparent than in the workplace. We know, for example, that engaged, healthy employees are likely to be absent less, more fulfilled at work and more productive. In November 2008, the Government published "Improving health and work: changing lives," their response to Dame Carol Black's review of the health of the working-age population. The response has three key areas: creating new perspectives, improving work and workplaces, and supporting people to work.
In January 2009, the Secretary of State for Health also announced a joint Department of Health and NHS review of the health and well-being of the NHS work force, in partnership with both employers and staff. The Department, as an exemplar employer, has also established a health, work and well-being board and launched its health, work and well-being strategy in December 2008. My hon. Friend the Member for Dartford mentioned the excellent work of the Royal Mail, which has contributed to the well-being of its work face. I am pleased to say that Dr. Steve Boorman, who was part of the Royal Mail and is now seconded to us, will lead our work force on occupational health.
All those initiatives will help both men and women, but there are reasons to believe that they may be particularly beneficial to men. We know, for example, that getting men to go to the doctor when something is wrong can be a real task and that they are often pushed into going by mothers, wives, girlfriends and sisters. We need to get the message out to men that going to see their GP as soon as they realise that something is wrong can make a world of difference to them.
My hon. Friend is absolutely correct: that is part of the reason people who have difficult jobs and difficult work situations, and who cannot necessarily be paid if they take time off work, need longer opening sessions. Early detection of some conditions can even mean the difference between living or dying from that disease. One reason men do not go to the doctor may be that they are reluctant to take time off work. Workplace-based health programmes may therefore help them to overcome some of those barriers.
Unhealthy lifestyles may be another reason men live less healthy lives than women. Some conditions, such as sexually transmitted infections, can be treated very simply and quickly, and of course may prevent partners from becoming infected, too. The embarrassment of such diseases is being overcome by the initiatives taken in many clinics to respect privacy and dignity.
Men often have less healthy diets and higher alcohol and drug intake. They are involved in more accidents and are more likely to commit suicide.
The Department of Health does an enormous amount to try to get the right messages out about having a healthier lifestyle, eating better and exercising more, so that everyone has the opportunity for health and well-being. However, we know that men respond better to different forms of information and health messages. Linking health messages to football is one sure way of getting many men's attention. Only last week the Minister of State, Department of Health, my right hon. Friend Dawn Primarolo, spoke at an event about "premier health". The premier league, using the power of football, is engaging children and young people in participation in sport and in intervention programmes that address key social issues. It is well known that many men and boys have a real passion for football. I do not forget my sisters—women have that passion, too, but the sport is attended more by men and young boys. Football can engage, motivate and inspire people to achieve health. The Football Foundation is closely involved with us.
Of course, merely watching football may not always be the best thing for men's health. At times, I have experienced my hon. Friend Alan Keen watching football and I am not sure it has the best effect on his health—but that is because he supports Middlesbrough.
The Department works in partnership with other key players in men's health, particularly the Men's Health Forum. That essential partnership working ensures that we have expert input and that we reach far more men than if we were working alone. In 2008, men's health week focused on work and health, and the forum received more than £50,000 from the Department towards that initiative. The Health and Safety Executive also worked with the forum to produce a booklet, "Men and Work," which covers topics ranging from healthier eating to coping with stress. Men's health week 2009 is focused on men's access to health care services, based on the findings from a project that the forum carried out for the Department of Health in 2008.
The current direction of travel towards more individualised care, as set out in the next stage review, should help men to feel in control of their health. It could be another way of making them come forward. There are many other examples of the Department of Health working to improve the health of men indirectly or directly. The Yorkshire and Humber region has made men's health a priority and is working with the Men's Health Forum and Leeds metropolitan university, which has the world's first professor of men's health.
As we have seen, men are much more likely to take their own life than women, and are often reluctant to seek help when in distress. The national suicide prevention strategy in England was launched in 2002 with the aim of supporting the target to reduce the death rate from suicide and undetermined injury by at least a fifth by 2010. In addition, we contributed towards production of the Haynes "Brain Manual" and "Brain Mini Manual," which the Men's Health Forum has published for men of all ages who are interested in becoming more aware of mental health issues.
A relatively new health trainer programme is having success in getting men to engage with their health and, most important, change their unhealthy lifestyle behaviours. Health trainers often live and work in the communities they serve, so they are seen as understanding what it is like to live there and what the problems in those communities might be. They know all the local services and can signpost people to them, and work across a variety of places in order to be easily accessible. When people go to see a health trainer, they choose what they want to work on and agree what they can manage. Nobody tells them what to do, and men, like all of us, respond well to that—there are no lectures, but real partnership working is encouraged.
In summary, the Department has chosen to improve men's health by ensuring that different health policies take into account their needs, including trying to improve their working conditions, encouraging them to have healthier lifestyles and urging them to come forward for help earlier. As my hon. Friend made clear throughout his speech, however, this is also about addressing inequalities. The Department of Health cannot do that alone. It depends on where people live and the job they do—if they have a job—and the money they earn, and that is the responsibility of all of us in this House.
I thank my hon. Friend for securing this debate on such an important subject, and for all the work he does on health in Parliament and outside.
Question put and agreed to.