Why is health-related economic inactivity on the rise?

More people in the UK of working age are leaving the labour force because of poor health than in other similar countries. An effective policy response requires understanding the rise of work-limiting mental health issues among younger workers and musculoskeletal conditions among older workers.

Over the past decade, the number of people in the UK reporting a work-limiting health condition has grown by over 20%, rising from 3.2 million to 3.9 million.

As well as being a challenging experience for the people in question, this also affects the labour market. Indeed, work-limiting mental health conditions among young people (those aged 16-34) have risen by 77%, with 1.2 million of them now reporting themselves as being economically inactive while living with such a condition.

It’s not just young people who are affected. Musculoskeletal conditions among older workers (those aged 50-64) have also grown in recent years, rising by 32% (900,000 cases) over the past decade.

There is an open debate about why we are seeing these declining trends in health. It is unlikely to be driven by a single factor, instead reflecting a complex interaction of a range of variables, such as changing social relationships, the Covid-19 pandemic, the changing nature of work, and government.

Why is mental health among young people declining?

Several factors have been suggested to explain the rising levels of poor mental health among young working age people.

Social media is part of the story. In the UK, about 70% of people think that the changing nature of social interactions because of social media use is contributing to worse sleep, higher levels of anxiety and depression, bullying and negative body image in young people compared with older generations.

Research from 2023 shows that the pandemic led to an increase in anxiety, depression and loneliness among young people around the world (Bell et al, 2023). The experience of lockdown may have had lasting impacts on young people’s ability to cope and engage with the world of work.

Covid-19 has also had lasting impacts on the functioning of the NHS as staff and money were diverted to fighting the pandemic. This led to increasing waiting lists and reduced funding for other healthcare services such as mental health. There are currently about 1.8 million people on NHS mental health waiting lists, and individuals can wait for up to two years for an appointment. During that time, their condition may worsen, leading to them being unable to work.

In some of our own research, we look at how reductions in central government funding of local authorities may have contributed to declining young people’s mental health. We suggest that young people's mental health will be partially influenced by the wider economic conditions and expectations about future economic growth. For example, a rising government deficit from the global financial crisis of 2007-09 led to changes in funding allocation decisions to local authorities.

A worsening economic outlook may have also directly affected household's financial position, increasing financial insecurity and affecting young people's mental health as a result.

Not all areas are affected equally. Regional differences in outcomes may stem from areas having different economic backstops. Using survey data from the Understanding Society survey and administrative data on local authority spending, we find that young people’s mental health declined from 2008, and that the biggest decline was in those areas more affected by the decrease in central government funding, such as the North East (see Figure 1).

Figure 1: Effects of austerity on young people’s mental health by region

Source: Brown et al (2024).

A final suggestion for declining youth mental health comes from the former manager of the England football team, Gareth Southgate. His argument is that in some cases, working from home has stopped young people from forming meaningful relationships at work with mentors and other colleagues. This lack of engagement and attachment to a team may mean that more individuals leave the workforce, contributing to rising economic inactivity in young people.

How do musculoskeletal conditions affect older workers?

Musculoskeletal conditions are issues such as joint pain, back pain or arthritis. Many of these conditions affect older workers (people aged 50 or over) and are associated with growing older, a lack of physical activity and/or living with obesity.

Work itself can affect musculoskeletal health. Sitting at a desk for a long time (office work) or physical work such as operating machinery or being a tradesperson (joiner, plumber, painter/decorator) may make existing musculoskeletal conditions worse.

Some of the factors contributing to the rise in economic inactivity for older workers with musculoskeletal conditions resemble those for poor mental health in younger workers. Long NHS waiting lists for treatment for people with musculoskeletal conditions may lead to conditions getting worse, forcing people out of the workforce.

Firm size could play a part. Workers employed in small and medium enterprises (SMEs) may not have access to occupational health at work. Their employers may not have the support or knowledge to help people with musculoskeletal conditions to adapt so as to be able to continue doing their job. These people may then need to leave the workplace.

Stress is another variable. Feeling stressed at work may mean that workers do not take enough breaks, leading to physical changes such as muscle tension and increasing their risk of physical injury.

Over the past decade, we have seen two important changes in the types of work that people do that may be contributing to the rise of musculoskeletal conditions. The growth of online shopping has increased the number of warehouse jobs. Many of these jobs involve picking, packing, loading and unloading boxes at speed, increasing the risks of lasting injury to joints or the back.

The pandemic also drove up home working. Poorly set up homework stations and sitting long hours in front of computer without a break increase the risk of developing a musculoskeletal condition or making an existing condition worse.

What can policy-makers do?

There is no single magic bullet for preventing or treating health conditions such as poor mental health and musculoskeletal conditions that stop people from working. There is also no single authority with the remit to tackle the issue. Potential solutions and policy recommendations will require different organisations and government departments working with the private sector.

It is also worth noting that while there are some overlapping factors – such as NHS waiting times – that may affect people suffering with both mental health and musculoskeletal conditions, there are also other factors that are unique to mental health and young people or to musculoskeletal conditions and older age groups. This means a one-size-fits all policy response is unlikely to work. Different age and health groups require different support.

TheKeep Britain Working Review is an independent government report led by Sir Charlie Mayfield, former chairman of the John Lewis Partnership. The report identifies several ways in which government and employers can work together to help people with existing health conditions to remain in employment.

Plans include better integration of health and employment support, and testing new ways of keeping people in work to generate an evidence base of what works. This is a developing area, and we still need to identify what works, for whom and where.

Former Labour government minister Alan Milburn is currently undertaking a review on the rising levels of young people not in work, education or training (NEETS). The interim report identifies several structural challenges related to the design of the education system, a health system focused on treatment rather than prevention, and a welfare system that does not support young people with poor health to find employment. Solutions and policy recommendations from the report are due later in the autumn.

Conclusions

More people than ever are leaving the UK workforce because of poor health. This is a particular problem for young workers (aged 16-34) with poor mental health and older workers (aged 50 and above) with musculoskeletal conditions.

There is no one factor that explains the increase for either of these age groups. This makes it harder to develop policy and/or solutions as multiple organisations will need to be involved.

Employers, schools, the NHS, and the Department of Work and Pensions will need to work together to prevent work contributing to poor health and help those with poor health to remain in work.