As  someone who likes to read into language and discourse, I’ve been thinking recently about the different ways in which the relationship between wellbeing and health on the one hand and work on the other is framed.  Sadly I don’t have time to do a ‘proper’ study to see whether others are saying this or to reference back to all the sources that are leading me to these understandings, but this is where my day to day observations and reflections are leading me.

I see three different types of ‘framing’ going on…for convenience I have named them….

• wellbeing and health in order to work
• wellbeing and health at work
• wellbeing and health through work

So here are my explanations…

Wellbeing and health in order to work

This framing is ‘economic’ dominant in which ‘citizens’ are seen as units of economic production.  If we are not working because of illness – either unemployed or taking sickness absence – then we need to ‘get well’ so that we can work and make a contribution to the creation of economic value.  This framing fits nicely with a pathogenic perspective – where sick people are treated back to being productive.

I’ve articulated it in its extreme but actually it is quite a subtle discourse.  It’s the framing that leads to demands for psychological and talking therapies for unemployed people, subtly arguing that the ‘outcome’ of the therapy should be a person in work – not the outcome in terms of what it means to the individual themselves (perhaps they want to be a better father or mother?).  It’s also the framing that employers use to try and get ‘fast track’ access to services for their staff who are off sick.

But even those without ‘diagnosed’ problems worthy of medical treatment end up participating in this framing – the ways in which we subtly ‘self-medicate’ – the cigarette on the way home; the friday drink; the takeaway or indulgent cake.  Even trips to the gym or a spa.  We always seem to describe these things as a way of treating* ourselves, picking ourselves up again so we are recovered* enough to be a good unit of economic production the next time we are at work.

*note the pervasiveness of the medical metaphors.

Wellbeing and health at work

This is a way in which those with an interest in wellbeing and health have been able to nudge their way into the dominant paradigm I have articulated above. The rough argument being that it is more ‘efficient’ if you care for your employees’ wellbeing and health – predominantly using reduction in sickness absence as the argument (in spite of documented phenomona like presenteeism and leaveism).

At its most basic it is health and safety legislation, where the evidence is strong enough for government to legislate so that employees have some rights to the protection of their wellbeing and health in the workplace.

It is also the discourse that promotes ‘Better Health at work’ awards which, in my experience, lead to lots of ‘health education’ in the workplace and other ‘interventions’ consistent with behavioural modification like canteens that serve healthy food.  Interesting that the onus of responsibility is placed onto the individual – you need to stay healthy [subtext – so you can be productive].

Wellbeing and health through work

Sometimes I see inklings of this – recognition that as a human activity ‘work’ is good for us – it is through work that we can be our most creative, most innovative, we can learn and develop and work adds meaning to our lives.  If we are doing work in the right setting it can also be a place of social wellbeing – connecting and working alongside others we come to call our friends.  People employed full-time spend a large proportion of their lives in the activity of ‘work’ so it should contribute to, not distract from, our wellbeing and health.  It’s sad that most of the time the word ‘work’ is associated more with the word ‘chore’ than with something that is more fulfilling and that ‘stress’ due to work and work conditions is so common.

Here the framing of the relationship can be slightly different – it recognises that the set of interacting factors which give rise to healthy and well individuals also gives rise to productive individuals.  And, on the contrary a different set of interactions gives rise to sick individuals AND demotivated and unproductive individuals.  It’s potentially a win-win – get the conditions right the employee is healthy and happy AND the employer gets productivity [and society gets healthy happy citizens and good GDP!].

It was the late 1950s when Herzberg distinguished between hygiene factors and motivational factors at work [related wikipedia entry] and I find that distinction a really helpful way of teasing out those interacting factors.  But maybe we need to bring the ideas into the 21st century context where work is changing (many trends especially the growth of knowledge work) and we know much, much more about social determinants of health.

For example, Herzberg’s hygiene factors included level of pay and security something that below Living Wage salaries and Zero Hour contracts fly in the face of.  Low pay and low security is associated with poor wellbeing and health AND low productivity.

There is enough research in place – the effort-reward imbalance; the job-strain model, organisational justice – that suggests we need to focus on the ‘quality’ of jobs, the ‘quality’ of our work, the ‘quality’ of our physical work environment and the ‘quality’ of our relationships (both hierarchical and between peers) at work.

This won’t come about from starting out with the economic perspective – we need a new type of conversation – where we reclaim the word ‘work’ as a potential good for the wellbeing of both the citizen and our society.  Am I being too idealistic?