At its site in Bermondsey, east London, Tideway, the contractor that is building and will operate the £4.2bn Thames Tideway sewer tunnel, offers some unusual services for its workers. Long hours and transient lifestyles away from their families can lead to stress and ill health, so Tideway has negotiated block bookings with local doctors and dentists, and sends a financial adviser to help employees with their budgeting.

Across the business, it offers sports activities and gym membership, neck massages, yoga classes and time off for volunteering in charities and schools. It involved staff in extensive consultations to help design its new headquarters, opened a year ago near London Bridge. There are quiet spaces, faith rooms, inclusive toilets and ways to help create a friendly environment for meetings.

Steve Crofts, head of health, safety and wellbeing, has long experience of managing the considerable isolation, stress and suicide among workforces in the construction sector. “I didn’t think I’d see the day when a company would offer regular yoga, pilates and mindfulness,” he says. “But we absolutely believe this is a moral obligation. We want to see a happy workforce. We also see a spin-off in reduced absences and increased productivity.”

Tideway is one of a growing number of global employers — in the public, private and non-profit sectors — that are investing significantly in programmes to support the physical, mental and social wellbeing of their employees. The trend reflects a growing realisation of the importance of wellbeing to staff recruitment, retention and productivity, even among policymakers. Matt Hancock, who became UK health secretary last year, highlighted preventive healthcare as one of his key priorities in the job.

Tideway's office space in Bermondsey, London offers employees a tailored approach

“Prevention [or working to keep people out of hospital] cannot be solved purely by the health and care system alone. Everyone has a part to play. To make serious progress on prevention we need to understand that. From the education we receive, to the home we live in, to the job we do and so much more — all of this shapes our physical and mental health,” he said in a speech last year.

Productive days lost per employee per year due to illness and other factors
3.1Musculoskeletal pains
6.1Insufficient physical activity
6.6Sleeping less than seven hours a night
6.9Unrealistic time pressures at work
7.9Money worries
8.9A chronic health condition*
11.8Being bullied at work
44.7Mild to moderate depression
*per condition
Note: productive time lost due to both absenteeism and presenteeism
Source: VitalityHealth/RAND Europe; Britain’s Healthiest Workplace Survey 2014-2018

Yet the Institute of Health Promotion and Education, a UK professional body, cautioned in response that while the principles of prevention Hancock outlined were welcome, there remained questions about a focus on what it described as “downstream” activities, which are attempts to influence individual behaviour, instead of “upstream” approaches, which would target social or environmental factors.

In the UK, the prospect of Brexit is not only creating political distraction but increasing the pressure on public finances, highlighting how acute such competing demands will prove in the months ahead and serving as a reminder that they risk undermining a focus on public health.

Data from the latest annual Britain’s Healthiest Workplace survey — compiled by Rand Europe, the research organisation, funded by insurer Vitality and produced in association with the FT — show just how heavy the burden of ill health can be on UK workforces. The findings also indicate the potential for constructive interventions by employers, which some have reported make good economic as well as good moral sense.

The patterns are echoed by the findings of related surveys in five Asian countries also featured in this magazine. Among the biggest drivers of absenteeism and presenteeism (when employees go to work but report themselves to be unproductive) is lack of sleep. That pattern is rising: 37 per cent of the more than 26,000 people from 129 organisations who responded to the 2018 survey said they were sleeping less than seven hours a night, against 28 per cent in 2015. More than 44 per cent reported problems with the quality of their sleep.

There was also a rise in those reporting depression and work-related stress. One factor was financial worry. If such pressures have a negative impact on mental health, they are also closely linked to limited physical activity and poor diet.

One striking aspect of the data are the differences in ill health by age. The survey shows that young people aged 18-20 are particularly affected. That raises questions about the need for more “onboarding” programmes by employers. These offer targeted support for new recruits and aim to reduce the stresses they experience, including adjustment to the world of work, financial pressures made worse by the cost of housing, and help with handling the distractions of the internet.

Percentage of employees getting less than seven hours sleep a night
Source: VitalityHealth/RAND Europe; Britain’s Healthiest Workplace Survey 2014-2018

The other group that stands out is older employees. A disproportionate number report musculoskeletal conditions, which academics say are often proxies for wider stress and ill health. Older workers typically also reported the lowest levels of physical activity and the highest rates of obesity.

Those on lower earnings report higher rates of depression and greater stress than higher earners, citing concerns such as lack of choice over the tasks they carry out, lack of respect, a failure to be consulted and absence of support from their line managers. Such pressures will not be easy to address.

The good news is that wellbeing programmes seem to make a difference. Longitudinal analysis of workplace health interventions by Rand Europe for Vitality from 2014 to 2018 showed that those employees who consistently participated in programmes designed to support physical and mental wellbeing tended to be healthier and more productive. Those who began to turn their lives around during the four-year study period and started participating in a workplace health intervention reduced their lost productivity the most.

One difficulty for employers seeking to engage more actively is an evidence gap — the data “proving” that the effectiveness of any particular intervention can sometimes be less than robust.

“There seems to be increasing focus on how to calculate a return on investment on wellness,” says Shaun Subel, director of corporate wellness strategy at Vitality Health Insurance. “That opens up potential for bad decisions to be made, because it is very easy to make claims when there is no consistency, and some factors cannot be directly measured. There’s a lot of funny accounting.”

Nor is there much detailed and comparable evidence on the economic costs of interventions. Data are usually based on employee perceptions and subjective judgments, rather than on any objective analysis of productivity or health outcomes.

Experts say the most effective programmes are those that address mental health, which accounts for the lion’s share of days lost to absenteeism and presenteeism. Unfortunately, effective mental health interventions can require wholesale restructuring of managerial cultures in organisations, which means they are potentially far more difficult to achieve than the rather simpler measures around physical health, such as improved canteen offerings, gyms or sports activities.

Implementation presents another problem. The latest Britain’s Healthiest Workplace survey shows a large gap between the number of programmes offered by employers, and the far smaller numbers that their staff use and are aware of or believe are useful.

Greater promotion of what is available may be a powerful initial step, with varied approaches required for different age groups and employment categories. Research by Vitality shows that younger male workers tend to say they value gym discounts and fresh fruit in the workplace, while younger women say they like workshops and team activities, for instance. Older men report using screening services but neglect physical activity and nutritional support, while older women track physical activity, use nutritional support services and engage with apps that target wellbeing.

For many employers, a more fundamental issue is funding any provision at all. Many services are easier for profitable white-collar businesses in large cities to provide but much more difficult for smaller businesses, those in isolated locations or those whose staff are dispersed across different, sites such as retailers.

Nevertheless, as Crofts at Tideway argues, much can be achieved even in construction companies, which often have very diverse and fragmented workforces. Employers like his, he says, have the power to influence their sub-contractors to encourage the adoption of better conditions in a wider range of businesses.

“I’m a firm believer that the client has to set expectations,” he says. “For us, from the chief executive downwards, we see the obligation to support the workforce. Sadly it’s not the case across the industry. There is still a lot of work to be done to engage, to get people to understand the benefits. But these activities pay for themselves tenfold.” 

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