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Nick Triggle
By Nick Triggle
Health correspondent
There is, it seems, an epidemic of illness among the working-age population.
This week the Office for National Statistics once again warned about the number of people being driven out of the jobs market because of ill-health.
And on Friday the government in England said it wanted to change the way they are supported alongside a crackdown on what it calls the "sick note" culture.
But it is not just those who are out of work who are affected. Research by the Health Foundation shows there are as many people aged 16 to 64 in work whose health limits what they can do as there are out of work because of ill-health.
Line chart showing the number of people in the UK aged 16 to 64 with work-limiting conditions. The number in employment rises from 2.5 million in 2013 to 3.7 million in 2023, while those not working rises from 3.3 million to 3.9 million.
Overall, it estimates nearly a fifth of the working-age population in the UK has what it calls a work-limiting condition.
In fact, the think tank believes the problem has become so bad that it is threatening the economic potential of the country.
So why are working-age people so ill? Christopher Rocks, who heads up the Health Foundation's work in this area, says it is a "complicated" picture.
He says while there has been a lot of focus on the issue since the pandemic, the trend has actually been developing for the past decade at least.
"The 2008 financial crisis had a major impact on society - we saw an economic downturn and public spending cuts. That had an impact on people's health in many different ways. The pandemic and subsequent cost of living crisis exacerbated trends, but the signs were there before Covid hit.
"Access to health care has become more difficult, while those fundamental building blocks of health - such as good housing and adequate incomes - are under strain."
How that has affected people varies depending on their age and where they live. Research published this week warned the numbers with major illness was set to increase significantly. with the people in the most deprived areas suffering the most - many with multiple conditions.
The work, also published by the Health Foundation, found there were three main conditions causing a significant burden of ill-health: chronic pain, type 2 diabetes and mental health problems. Each is a reflection of the different challenges facing the country.
Chronic pain is known as the invisible condition, says the charity Versus Arthritis, because it so often goes unseen. But it can have a devastating impact, stopping people from working and socialising and even robbing them of their independence.
Caused by underlying inflammation or damage to the body's tissues, chronic pain usually refers to persistent or recurrent pain that has gone on for more than three months. It is most commonly associated with conditions such as arthritis, osteoporosis or joint problems, related to the back, shoulder or neck.
The fact that the population is ageing - a greater proportion of the working age population is in their 50s and 60s - is a major cause of the numbers going up.
But the situation has been made worse by the increasing difficulty people face getting treatment, says Tracey Loftis, head of policy at Versus Arthritis.
The hospital waiting list has been rising pretty consistently for the past decade as spending on the health service has been squeezed.
And Ms Loftis points out joint treatment, such as knee and hip replacements, has some of the longest waiting times of any speciality. "Behind every statistic is a person living with unimaginable pain, many of whom are struggling," she adds.
Then there are mental health conditions, such as anxiety and depression. These are increasing in all age groups, but particularly so among the young.
A report by the Resolution Foundation in February found young people were now more likely to experience a mental health problem than any other age group - a complete reversal of the situation two decades ago when they were least likely to.
It found more than a third of 18- to 24-year-olds are reporting symptoms of mental illness.
The finding prompted some to question how real the trend was. Were young people just more open to talking about their mental health struggles?
Dr Shari McDaid, of the Mental Health Foundation, says: "No doubt that is a factor in the figures that are being reported, but we cannot underestimate the impact the past few years have had. The young people of today were the toddlers and infants of the 2008 financial crash.
"They have lived through the turbulence and conflict of Brexit and then there was the pandemic - what happened with lockdown and schooling affected a generation of young people during their most formative years.
"They have then had the cost of living crisis to deal with with young people starting their working lives with huge financial stress and working in poor quality and insecure jobs. We know adverse events are cumulative - the more you experience the more likely you are to struggle."
But she also says you cannot ignore the impact of social media, citing the bullying many have experienced and the way it induces body image worries because of the "highly idealised" way they are presented.
The fact type 2 diabetes features in the top three causes is another consequence of the changing nature of society - our diets and increasingly sedentary lifestyles.
The risk factors of type 2 diabetes are multiple and complex. They include age, family history and ethnicity, but being overweight is a major cause.
Nearly three quarters of adults are overweight or obese - and that, according to Diabetes UK, is translating into an increase in cases of type 2. While less common, rises in the under 40s are particularly sharp.
Social deprivation is a crucial risk factor, with rates of type 2 diabetes more than twice as high in the most deprived areas than they are in the least deprived. Income, education, housing and access to healthy food are all strongly linked to developing the disease, says the charity.
Tackling all of this is a huge challenge, particularly with public finances so tight. The Health Foundation's report this week said it would require a cross-government approach to address the underlying causes of ill-health, as well as extra investment in the NHS, councils and voluntary sector.
"You need a healthy workforce if you want a healthy economy," adds Mr Rocks.
Employers also needed to do more, the report said, including improving working conditions, supporting the wellbeing of their staff and making reasonable adjustments for those whose health limits what they can do.
The experience Lee Vaughan, 50, who works as a leisure centre manager in Sheffield, illustrates how those with health problems can be supported.
He has struggled with chronic pain for decades. In his early 20s he had to have a hip replacement because of arthritis.
His pain is made worse by emotional triggers when he is stressed, tired, frustrated or worried.
"Over the years I have learnt to live and manage the pain, but it can be really debilitating. I've had to take time off work. Fortunately my employer has been very understanding. They've made adjustments and I now work part-time.
"That's really important - without that support I would have had to have left my job."