NHS Health Scotland
Outcome Indicators
1.5, 1.6, and 1.7

There is evidence and rationale to support the association between the national outcomes and one or more of the long-term outcomes: improved health, wellbeing and productivity of the working age population; increased opportunities to work; improved and supportive working conditions; more people being in work, well and productive; and improved efficiency and productivity of Scottish workplaces.


Improved health and wellbeing of the working age population
Work is, for most people, good for long-term health outcomes.[9] Maximising the number of working-age people who are in work and promoting health through the workplace will contribute to improving the healthy life expectancy of the population of Scotland. By offering support to those whose ability to work is compromised by health problems, the Scottish Government aim to improve their health and reduce the negative impact of unemployment on individual and population health, and reduce health inequalities.[10]

Inequality is both a cause and consequence of mental and physical health problems.[6,7] For instance, mental health problems are more common in socially disadvantaged populations and are associated with unemployment, less education, low income or material standard of living.[6] The evidence for the impact of income inequality on wellbeing (largely assessed by life satisfaction) is mixed but according to Dolan et al [8] relative income has a significant negative relationship to happiness and life satisfaction.[6]

Improving health and work short-term and intermediate outcomes through activities supported by the workplace will improve the health and wellbeing of workers.[1- 5] This will be particularly important to monitor in the current economic climate to avoid any potential high negative impact of rising unemployment by supporting individuals in work, moving towards work and those at risk of unemployment through redundancy (see also ‘External factors’ in section 8b).

Increasing topic specific short-term and intermediate outcomes detailed in other logic models will improve specific topic-related healthy lifestyle behaviours and health and wellbeing outcomes for the working age population (e.g. reduced smoking, reduced alcohol consumption, healthy diet). Details of these outcomes and the evidence/evidence-informed recommendations are provided in the other outcomes frameworks on healthy weight, tobacco control, alcohol, mental health improvement and physical activity.

Increased opportunities to work
Providing individuals with the right health services to enable them to work and continuing to support them in the workplace will ensure greater opportunities for individuals with health issues to return to and remain in work and well. There is evidence of an association between provision of opportunities and increased early return to work and decreased duration of sickness absence.[1,2]

There is review level evidence that commitment and coordinated action from all the players is crucial for successful vocational rehabilitation management of long-term sickness absence, in particular communication between all stakeholders should be initiated at an early stage of absence.[1, 2]

Clearly this outcome is also based on an assumption that there will be (good) jobs to go to and this will be influenced by factors external to Health Works sphere of influence.

Improved and supportive working conditions
There is review level evidence:

  • that provision of supportive working conditions can support individuals to return to and remain in work and well, improving early return to work and decreasing duration of sickness absence.[1,2,11]

  • that the return to work process and vocational rehabilitation interventions are more effective if they are closely linked to, or located in, the workplace,[1] highlighting the importance of creating supportive working environments.

  • that proactive company approaches to sickness, together with the temporary provision of modified work and accommodations are effective and cost-effective.[1]

Informed by reviews of effectiveness evidence, Waddell, Burton and Kendall [1] present a strong scientific evidence base and a good business case for many aspects of vocational rehabilitation. Effective return to work and vocational rehabilitation interventions depend on healthcare that includes a focus on work and workplaces that are accommodating; both are necessary and inter-dependent.

Details of the outcomes and the evidence/evidence-informed recommendations relating to supportive environments and specifically to managing mental health in the workplace are provided in the outcomes framework on mental health improvement.

More people in work, well and productive
The positive links between work and health, as well as the potential negative influence of unemployment and worklessness on ill health have been well evidenced.[9, 12-15] There is a review level evidence that work is generally good for physical and mental health and well-being, that worklessness is associated with poorer physical and mental health and well-being, that unemployment is linked to higher levels of mortality and psychological morbidity, and that work can be therapeutic and can reverse the adverse health effects of unemployment.9 However, it should be noted that these conclusions are qualified with a series of important considerations relating to the evidence.[9]

Overall, the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long-term unemployment or prolonged sickness absence.[9] Individuals who are out of work for long periods of time due to sickness experience a drop in income which can result in poverty and social exclusion, and the longer someone is not working the less likely they are to return to work.[9]

Improved efficiency and productivity of Scottish Workplaces
It is not within the scope of this paper to provide a comprehensive analysis of the economic evidence for the activities and outcomes in thisoutcomes framework (although a small amount of evidence relating to the business case for the health and work agenda is included in parts). However, there is a clear rationale that where individuals health and wellbeing is improved through the stated activities in models 2 and 3 their productivity will improve, therefore contributing to improved productivity within workplaces. This in turn will ensure workplaces are more efficient, contributing to reductions in unit costs and increased profits.

Scottish policy note:
In addressing some of the causes and effects of ill-health in the working-age population of Scotland the Health Works strategy aims to make a significant contribution to economic recovery. Therefore, the strategy is consistent with, and is indeed a key element of, the achievement of the central purpose of higher and sustainable economic growth. For example, the strategy will contribute to improved health and wellbeing which is crucial to people’s ability to engage in education and training, and to increase their participation in the labour market. The Scottish Council of Economic Advisers has identified improving productivity as a critical contributor to sustainable economic growth.

There is a growing body of evidence that employers who invest in promoting the health and wellbeing of their employees see significant benefits to the bottom line through improved attendance, better motivation, increased productivity and better staff retention. Higher productivity will (other things being equal) mean lower unit costs of production and lower output costs in general. Improved productivity will, therefore, increase the competitiveness of Scottish industry.
(Adapted from: Health Works, p10)


  1. Waddell G, Burton AK, Kendall N (2008). Vocational Rehabilitation: What works, for whom, and when? Vocational Rehabilitation Task Group report. The Stationary Office:  London.

  2. NICE (2009). NICE public health guidance 19 Managing long-term sickness absence and incapacity for work. NICE: London.

  3. Hill D, Lucy D, Tyers C, James L (2007). What works at work? Review of evidence assessing the effectiveness of workplace interventions to prevent and manage common health problems. The Stationary Office: Leeds.

  4. Task Force on Community Preventive Services (2010). Recommendations for Worksite-Based Interventions to Improve Workers’ Health. American Journal of Preventive Medicine, 38(2) Supplement 1: S232-S236.

  5. Sockoll I, Kramer I and Bodeker W (2009). Effectiveness and economic benefits of workplace health promotion and prevention. Summary of the scientific evidence 2000 to 2006. iga.Report 13e. Initiative Gesundheit & Arbeit: Germany.

  6. Parkinson J (2007). Establishing a core set of national, sustainable mental health indicators for adults in Scotland: Final rationale paper. NHS Health Scotland: Glasgow.

  7. Bambra C, Gibson M, Sowden A, Wright K, Whitehead M and Petticrew M (2010). Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. Journal of Epidemiology and Community Health, 64: 284-291.

  8. Dolan P, Peasgood T & White M (2006). Review of research on the influence on personal well-being and application to police making. Defra: London.

  9. Waddell G, Burton AK (2006). Is work good for your health and well-being? The Stationary Office: London .

  10. Scottish Government (2009). Health Works. A review of the Scottish Government’s Healthy Working LivesStrategy

  11. Campbell J, Wright C, Moseley A, Chilvers R, Richards S, Stabb L (2007). Avoiding long-term incapacity for work: Developing an early intervention in primary care. Universities of Exeter & Plymouth Peninsula Medical School Report for Dame Carol Black’s review of health of Britain’s working age population.

  12. Acheson D, Barker D, Chambers J, Graham H, Marmot M, Whitehead M (1998). Independent inquiry into Inequalities in Health Report. The Stationery Office: London.

  13. Marmot M, Wilkinson RG (2006). Social determinants of health (2nd edition). Oxford University Press: Oxford.

  14. McLean C, Carmona C, Francis S, Wohlgemuth C, Mulvihill C (2005). Worklessness and health - what do we know about the causal relationship? Evidence review (1st edition). Health Development Agency: London.

  15. NICE (2007). NICE public health guidance 06 Behaviour change at population, community and individual levels. NICE: London.