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Work is not a health outcome

A couple of days ago I saw this tweet on Twitter:

“Work as a health outcome is a fundamental principle for us. There must be a shared approach within the health and social care system” Jenny Osbourne from @GM_HSC #ERSAMBW #disabilityconfident #nooneleftbehind — Pluss (@PlussInspires) May 23, 2018

This phrase creates a visceral reaction in me every time I see it; it immediately makes me feel sick. And my healthy friends to whom I mention it react with incredulity. Yet so many organisations that ought to be on the side of sick and disabled people – organisations like ERSA, parts of the NHS, and people like Jenny Osbourne – seem to believe it is true.

I wanted to explore why I respond the way I do and try to articulate my concern.

Saying that work is a health outcome is like saying that anything is a health outcome. We could just as meaningfully say that marriage is a health outcome, or that sport is a health outcome; that taking up a new hobby, or becoming a parent, or buying a house is a health outcome.

When you try putting non-health matters into that space, it becomes apparent why the phrase is meaningless. People can be married with children, regular participants in sport and hobbies, and an owner occupier – and be sick. They can be all those things – and be healthy. It wouldn’t make sense to say ‘marriage is a health outcome’ or ‘home ownership is a health outcome’.  It would be ludicrous to say ‘sport is a work outcome’ or ‘parenthood is a work outcome’.

It’s not just ludicrous to say that work is a health outcome. It’s also damaging.

Ignore the protestations that of course the people delivering the services are able to recognise that work isn’t always a good thing; that some jobs make people ill; that some people are too ill to work; that you should never push someone to work who wasn’t able to; that you always put the wellbeing of the patient first. It’s simply not true. Because none of those beliefs are compatible with the phrase ‘work is a health outcome’.

If you genuinely believed in putting the person first, in focusing on their wellbeing and health as an individual, you wouldn’t be linking work with health. You’d know that telling someone that work is a health outcome is like telling an otherwise healthy unemployed person that they’re sick. You’d know that making work a health outcome tells a person that they’ve failed if they don’t return to work. You’d know that you are putting pressure and stigma on a person who already feels ill and stigmatised. You’d know that you’re basically telling people that they’re only worth treating if they’re going to go back to work; that they’re not worth the effort if they don’t think that they can or will or want to go back to work.

You wouldn’t use a meaningless and harmful mantra like ‘work is a health outcome’. You’d use something that tells the person that you care about them, as a person, not about abstract ideologies regarding what counts as being healthy and well-rounded and, ultimately, worth anything at all.

If you want someone to feel safe and cared for, you don’t set their goals for them before you’ve ever even met them.

You’d ask them for their goals. Do they want to go back to work? Or do they want to focus on providing a home for their family? Do they want to increase their fitness, or do they want to reduce their pain? Are they more bothered about the nausea or about the dizziness? About walking or about sitting through their child’s school play?

You’d say that health comes first, not work. That family comes before work. That you’re there to help them, not to increase the labour force.

For the person, not the government.

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