In their 2024 Economic and Fiscal Outlook, the Office for Budget Responsibility identified poor health as one of the greatest long-term fiscal risks. Policymakers, researchers and health professionals have converged at a shared understanding that population health is not a luxury but a necessity for economic prosperity. However, the relationship between health and employment flows both ways: it’s true that poor health can be a barrier to work, but poor work can lead directly to poor health. In this spotlight, we look at the issue from both directions and finish with examples of what our members are doing to turn this vicious cycle into a virtuous one.
Health is a barrier – but now how you might think
While poor health may seem like a straightforward barrier to employment, many disabled and chronically ill people face higher socially created barriers to employment than ones that stem from their own health.
Disabled people describe being disincentivised to experiment with employment, as they fear losing vital benefits or housing if they cannot sustain the role long-term. Engagement with poorly designed access to work programmes can trigger negative health outcomes and make it less likely that the claimant will be able to move into work in the future. According to a study by the New Economics Foundation, the threat of benefit sanctions had a negative impact on mental health for 73% of claimants living with a disability.
Within the job, delays in getting Access to Work accommodations can effectively push people out of the job. Flexibility is a critical factor in determining whether many people, including those with ill health, are able to stay in employment, but it is often unavailable after a probationary period, or not at all in many low-wage jobs.
Poor quality work as a cause of poor health
In 2025, Growth and Reform collaborated with The Health Foundation on a structured evidence review of systemic social determinants of health, including how employment can either improve or degrade health depending on delivery. Evidence is growing that the ABC method of job support – that is, a pathway starting with (A) any job, progressing to (B) a better job and (C) a career – is not effective at moving people into sustainable careers and at worst can lead to people exiting the workforce due to ill health. This is in part because the first step, “any job”, can push people into poor quality jobs that degrade their health and thus push them further from the labour market.
Low pay, insecure contracts, fire-and-rehire schemes, and unpredictable hours are all hallmarks of poor-quality jobs and are common in the hospitality, retail, and health and social care sectors. New evidence from the Trades Union Congress (TUC) found that nearly half of workers moving into economic inactivity due to ill health previously work in those three sectors, highlighting the need to ensure quality employment opportunities in the foundational economy.
In addition, low pay pushes people into taking on multiple jobs at once to make ends meet. Early evidence from ongoing research projects such as Moonlight reveal how multiple job holding is associated with low pay and low hour/insecure work patterns, meaning that multiple job holders may be working six or seven full days per week and simultaneously lacking protections offered by stable employment. In Glasgow, interviewees with multiple jobs described feeling “absolutely done in” and like “a hamster on a wheel”.
Examples from our members
Greater Manchester’s Good Employment Charter, the first of its kind in the UK, is a membership organisation that supports employers to improve their employment practices. The standards it sets for higher pay, more secure hours, and flexible working arrangements are associated with better employee health. Employers that wish to become full members undergo assessment and approval to ensure they meet the standards set out by the charter. Building on their own success, GMCA has helped other places develop and implement their own employment charters, including Liverpool City Region’s Fair Employment Charter.
In 2025, the North East Combined Authority, with national funding from the DWP, launched its Trailblazer Project to support economically inactive people overcome complex barriers to work. The first year of the programme was dedicated to creating an evidence base for system improvement, and one of the first key findings precisely echoes what we found in our systematic review: joined-up services and coordinated systems are one of the surest ways to improve outcomes. The research outputs around supporting disabled people into employment (referenced earlier in this article) were created in conjunction with disabled people themselves, including recommendations and guides for employers.
