Take a moment to consider what shapes and drives your health. Our individuality means that everyone’s answer to this question will differ in some way. What we have in common though, is that the conditions in which we were born and grew up in, and in which we now live, work and age, greatly shape and drive our health. These conditions are called social determinants of health. Knowledge of these determinants, and how to modify them, can help people protect and promote the health of a workforce. This article explores social determinants of health in the context of workplace health promotion and highlights opportunities for employers.

Root causes of employee health and wellbeing problems

It is widely known that people are more likely to experience health and wellbeing problems if they live in a poorer neighbourhood, and if they have a lower level of education. Though these systematic differences in health are avoidable and unfair, they are difficult for employers to change. Fortunately, employers have the power to tackle other root causes of employee health and wellbeing problems, including low pay, and poor employment conditions and poor quality of work.

Low pay

Simply put, people are more likely to be ill and experience poor health if they live on a lower income. Today, the problem of low pay is exacerbated by low-to-modest pay rises in the UK since 2010, increasing inflation and cost of living, and the failure to increase benefits in line with inflation. This combination will lead to increases in poverty, especially in the lowest paid.

Poor employment conditions and poor quality of work

Poor quality and stressful work undermine health. Conditions of poor-quality work include, but are not limited to, job insecurity, a poor work-life balance, a poor effort-reward balance, a lack of varied and interesting work, a lack of autonomy and control over work tasks and the time and location that work can be completed, an inability to build strong working relationships and social support, a lack of support for employee voice and representation, and, jobs that fail to promote health, safety and psychosocial wellbeing.

Organisational efforts to satisfy these conditions are important in contact centres because advisors/agents often experience work-related stress. This is often due to low job autonomy and decision latitude, a high workload, a physical connection to the workstation via a headset, excessive and prolonged periods of forced sitting, complex and emotive conversations with sometimes difficult customers, and continuous monitoring against high performance targets. Consequently, it is possible that a combination of low pay, and poor employment conditions and quality of work, contribute to high attrition and sickness absence rates in contact centres (the latter has been higher than the UK average since 2001).

The health consequences for employees

Workers from poorer neighbourhoods, and who experience work-related stress, low pay, and poor employment conditions and quality of work, are more likely to engage in harmful health behaviours. This includes taking part in less physical activity/exercise, having a poorer diet, smoking, drinking more alcohol, and drug misuse. The subsequent health consequences for employees include a higher risk of experiencing depression and low quality of life, a higher chance of developing diseases such as obesity, cardiovascular disease and type 2 diabetes, and ultimately, a higher risk of dying earlier.

Implications and opportunities for businesses

Implications

Any risk to the health of an employee is a risk to the success of their employer, because unhealthy workers cost businesses more than healthy workers. Unhealthy workers are more likely to experience presenteeism and be less productive when working. Unhealthy workers are more likely to be absent, which can lead to staff shortages, extra stress on staff who are working, and poorer customer service. Over time, poor employee health can contribute to higher sick pay costs, attrition, and, replace and training costs for new staff. These impacts of ill health to the productivity and profitability of a business, highlight the need for employers to prioritise the promotion of employee health and wellbeing.

Opportunities

Beyond reducing costs related to presenteeism, absence and attrition, promoting employee health can improve performance, productivity, and position your organisation as an employer of choice for your current staff and future talent attraction. This opportunity for competitive advantage seems important in sectors with high attrition. Promotingemployee health rather than just protecting it can also improve your organisation’s reputation and bring kudos from within and beyond the sector, for example in the form of awards or accreditations.

Businesses are well placed to adopt and implement actions to tackle social determinants of health. This includes not only supporting employees who are suffering with health and wellbeing problems, but also preventing these problems from arising.

Arguably the most effective way to promote employee health and wellbeing is to offer fair pay (i.e., offer at least the real living wage). Other opportunities include offering contracts with minimum hours, avoiding zero hour contracts (unless employees agree to these), and avoiding the conditions of poor-quality work. People responsible for promoting the health of a workforce can also consider the following practices:

• Provide or advocate for strong, effective leadership and support for employee health promotion.
• Invest a greater share of budgets in health and wellbeing promotion, and make long-term commitments to maintain or increase these budget allocations.
• Consult and work with your employees to co-create meaningful and effective solutions.
• Consider the social determinants of health and health behaviours in all your organisational policies.
• Strengthen or create internal and external partnerships to aid your health promotion efforts.

Like our uniqueness as individuals, every organisation and its employees differ. Each has unique needs and desires to consider when creating and delivering an employee health and wellbeing strategy. Within your efforts, we hope you embrace the messages in this article and respond to this call to action to go beyond protecting employee health and wellbeing, and actively promote it.

About the authors

Dr Lee Graves, Zoe Bell (both Liverpool John Moores University) and Dr Paula Holland (Lancaster University) are researchers with a passion for helping people live happy and healthy lives. In collaboration with Call North West and South West Contact Centre Forum, they are developing solutions for contact centres to promote employee health and wellbeing. For more information, contact Dr Lee Graves, visit the project webpage, and see our Health & Wellbeing Special Interest Group webpages (CNW).

The National Institute for Health Research (NIHR) Applied Research Collaboration North West Coast (ARC NWC) fund this project. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.