For the majority of its history, Britain’s National Health Service has scarcely ever considered the specific health needs of working people, other than those of its own staff. Almost by definition, the nhs was originally dedicated to supporting people who were outside of the labour market—new mothers, children, the sick, the elderly and the dying. British doctors issued ‘sick notes’, certificates that were given to patients, informing their employers that they were unable to work. But in recent years policy-makers have begun to challenge these assumptions, along with the binary split between health and illness, economically productive and economically needy, on which they rested. In 2008, a review of the health of Britain’s working-age population was published jointly by the Department of Health and the Department of Work and Pensions. Most strikingly, it calculated that the annual cost to the British economy of health-related absence from work was £100bn, only around £15bn less than the entire cost of the nhs. [1]
‘Wellbeing’ provides the policy paradigm by which mind and body can be assessed as economic resources, with varying levels of health and productivity. In place of the binary split between the productive and the sick, it offers gradations of economic, biological and psychological wellness. And in place of a Cartesian dualism between tasks of the body and those of the mind, blue and white collar, proponents of ‘wellbeing’ understand the optimization of mind and body as amenable to a single, integrated strategy. One of the leading influences on the uk government’s work and wellbeing programme, Gordon Waddell, is an orthopaedic surgeon whose book The Back Pain Revolution helped transform policy perspectives on work and health. Contrary to traditional medical assumptions—that ‘rest and recuperation’ are the best means of getting the sick back to work—Waddell argued that, in the case of back pain, individuals could recover better and faster if they stayed on the job.
Waddell’s findings suggested that, even where work is primarily physical, medical and economic orthodoxy had underestimated the importance of psychological factors in determining health and productivity. Being at work has the psychological effect of making people believe themselves to be well, which in turn has a positive effect on their physical wellbeing. Hardt and Negri argue that, while ‘immaterial’ or ‘cognitive’ labour still only accounts for a small proportion of employment in quantitative terms, it has nevertheless become the hegemonic form of labour, serving ‘as a vortex that gradually transforms other figures to adopt its central qualities’. [2] Waddell’s work is a case of this transformation in action. The emerging alliance between economic policy-makers and health professionals is generating a new consensus, in which the psychological and ‘immaterial’ aspect of work and illness is what requires governing and optimizing, even for traditional manual labour. In place of the sick note, a new ‘fit note’ was introduced in 2010, enabling doctors to specify the positive physical and mental capabilities that a patient-employee still possessed and which an employer could still put to use.
There was another, more urgent reason for the new policy paradigm. As labour has become more ‘immaterial’, so has the nature of health-related absence from work. Some £30–40bn of the annual £100bn lost to the uk economy through health-related absence was due to mental-health disorders. [3] Around a million people in the uk are claiming incapacity benefit due to depression and anxiety. [4] Figure 1 indicates the gradual ‘dematerialization’ of incapacity over recent years. The turn towards ‘wellbeing’, as a bio-psycho-social capacity, enables employers and healthcare professionals to recognize the emotional and psychological problems that inhibit work, but also to develop techniques for getting employees to improve their wellbeing and productive potential. Even more than back pain, mental illness is considered to be better treated by keeping people in work, than absenting them from it. In contrast to a neo-classical or utilitarian perspective, which would treat work as the opposite of utility, many economists also now argue that work is a positive force for mental health, and that unemployment causes suffering out of any proportion to the associated loss of earnings.
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‘Wellbeing’ provides the policy paradigm by which mind and body can be assessed as economic resources, with varying levels of health and productivity. In place of the binary split between the productive and the sick, it offers gradations of economic, biological and psychological wellness. And in place of a Cartesian dualism between tasks of the body and those of the mind, blue and white collar, proponents of ‘wellbeing’ understand the optimization of mind and body as amenable to a single, integrated strategy. One of the leading influences on the uk government’s work and wellbeing programme, Gordon Waddell, is an orthopaedic surgeon whose book The Back Pain Revolution helped transform policy perspectives on work and health. Contrary to traditional medical assumptions—that ‘rest and recuperation’ are the best means of getting the sick back to work—Waddell argued that, in the case of back pain, individuals could recover better and faster if they stayed on the job.
Waddell’s findings suggested that, even where work is primarily physical, medical and economic orthodoxy had underestimated the importance of psychological factors in determining health and productivity. Being at work has the psychological effect of making people believe themselves to be well, which in turn has a positive effect on their physical wellbeing. Hardt and Negri argue that, while ‘immaterial’ or ‘cognitive’ labour still only accounts for a small proportion of employment in quantitative terms, it has nevertheless become the hegemonic form of labour, serving ‘as a vortex that gradually transforms other figures to adopt its central qualities’. [2] Waddell’s work is a case of this transformation in action. The emerging alliance between economic policy-makers and health professionals is generating a new consensus, in which the psychological and ‘immaterial’ aspect of work and illness is what requires governing and optimizing, even for traditional manual labour. In place of the sick note, a new ‘fit note’ was introduced in 2010, enabling doctors to specify the positive physical and mental capabilities that a patient-employee still possessed and which an employer could still put to use.
There was another, more urgent reason for the new policy paradigm. As labour has become more ‘immaterial’, so has the nature of health-related absence from work. Some £30–40bn of the annual £100bn lost to the uk economy through health-related absence was due to mental-health disorders. [3] Around a million people in the uk are claiming incapacity benefit due to depression and anxiety. [4] Figure 1 indicates the gradual ‘dematerialization’ of incapacity over recent years. The turn towards ‘wellbeing’, as a bio-psycho-social capacity, enables employers and healthcare professionals to recognize the emotional and psychological problems that inhibit work, but also to develop techniques for getting employees to improve their wellbeing and productive potential. Even more than back pain, mental illness is considered to be better treated by keeping people in work, than absenting them from it. In contrast to a neo-classical or utilitarian perspective, which would treat work as the opposite of utility, many economists also now argue that work is a positive force for mental health, and that unemployment causes suffering out of any proportion to the associated loss of earnings.
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