Hear no evil; see no evil…

Social inequality in matters of health as in other aspects of life in the UK at the present time is well documented. Its roots in the neo-liberal policies of governance in the country that have driven the withdrawal of the state from supporting and regulating a fairer distribution of wealth and public service are not hard to see. Yet the focus of attention across the range of media that informs public discourse and dominates supposed ‘public opinion’ remains steadfastly disengaged from analysis of the underlying determinants of the inequality that scars life in the UK.

Nowhere is this more apparent than in the relationship between work and health. Respected analysts of social inequality in health have repeatedly pointed to the obvious role of low pay and insecure, risky and stressful jobs, among the determinants of poor health outcomes in the UK in recent decades. Even recent official statistics, which for a host of reasons are known to underestimate these matters, reveal worrying increases in indicators of the extent of work-related ill-health in the UK right now. Nevertheless, the regulator responsible for protecting the health of British workers remains convinced these workers ‘have never had it so good’ in terms of the protection it offers them, and that the formula for its delivery, worked out some 50 years ago in the 1972 Robens Report and the 1974 Health and Safety Act work Act, has ‘stood the test of time’, remaining as relevant to the British economy now as it was half a century ago. And all this, while its political masters in government find yet further ways to reduce the same regulator’s own resources, relevance and influence. Meanwhile the voice of labour, formerly capable of revealing the calumny of this situation, is muted, as massively weakened trade unions, their power and position steadily eroded by decades of politically driven hostility from successive governments and employers alike, struggles to be heard among the cacophony of noise celebrating the hegemony of neoliberalism that is orchestrated by the state and the interests of capital it primarily serves. Indeed, it is doubtful that there has ever been a time in the country’s history in which Gramsci’s notions of ‘cultural hegemony’ could have been applied more appropriately or revealingly to the values that dominate its public life.

Against this backdrop, the recent publication Work and Health: 50 Years of Regulatory Failure details the contradictions and failings evident in the efforts of the state to regulate the relationship between work and health to the benefit of workers in the UK. To begin with, it points to the current state of affairs in terms of work related health outcomes, arguing, in common with public health analysts like Michael Marmot and Richard Wilkinson, that the health effects of modern work cannot be properly understood by divorcing them from their political, social and economic determinants and regarding them solely as matters caused by specific workplace exposures, as has traditionally been the case in professional and regulatory practice in occupational safety and health. Rather, it points out they are part of a much bigger set of social and economic influences determined by the nature, availability remuneration and organisation of work and employment in modern economies, that require appropriate regulatory responses that extend beyond the narrow focus of traditional occupational safety and health regulation. Indeed, the book’s subsequent arguments for reform place concerns for health at work at the centre of a programme of wider reform to labour law and its administration by the state.

The recent figures on the extent of work-related ill-health published by the Health and Safety Executive (HSE), add weight to the arguments of regulatory failure detailed in the book as well as its calls for reform. They estimate for example, that in 2021/22, 1.8 million workers in Great Britain were suffering from an illness (either new or longstanding) which they believed was caused or made worse by work, equivalent to a rate of 5,390 per 100,000 workers (5.4%), a rate that is higher than that reported in the pre-coronavirus year 2018/19. And they identify, increases in the experiences of work-related stress, anxiety and depression as driving this.

The analysis in Work and Health exposes a multiplicity of weaknesses in the UK system for work health and safety regulation, that lie behind this recent evidence of increases in the burden of work-related ill-health and finds strong evidence of the failure of the reforms of the 1970s to deliver what was expected of them. But it argues that the failures of the Robens recommendations and the legislation following them, cannot be properly understood without situating them in the wider context of change that has occurred in UK society and its political economy in recent decades. In line with a substantial body of existing commentary on current crises in relation to health, the environment, inequality and poverty in UK society, the arguments of the book  repeatedly point out that particular effects identified in relation to work health and safety are symptomatic of the wider damage done to social and economic welfare since the election of the Thatcher Government in 1979 and the relentless pursuit of neo‐liberal political and economic orthodoxies introduced by that government and pursued by successive ones.

Three crucial analytical points are at the heart of the books analysis. Firstly, it is impossible to properly explain either the particularities of failure in relation to work health and safety regulation, or their possible remedy, without situating them in the wider canvass of change in the structure and function of UK society wrought by these political and economic strategies. Secondly, these particularities in relation to work health and safety are no more than further illustrations of the effects of a sustained political agenda that, as widely agreed by its critics, has fostered the interests of capital at the expense of workers. Thirdly, the role of work in the creation of poor health outcomes and their unequal distribution in UK society, requires a reappraisal of the tradition of regarding health and safety at work as somehow separate from wider public and environmental health issues, as well as from labour regulation more broadly. . Following on from this, it is obvious that solutions to current problems lie in wider reforms than simply those that solely focus on the regulation of occupational health and safety management.

As well as its detailed and evidenced analysis of regulatory failure, the book proposes a clutch of reforms to address the situation. These include the strengthening the regulatory duties currently held by employers, transferring their core duty of protection to ‘persons in control of business undertakings’ and extending it to cover all workers who labour on their behalf, including those working within organisations to which work has been outsourced. They also encompass the radical enhancement of the collective rights of workers and hence the capacity that they and their representatives have to advance their own interests and challenge those of their employers at  workplace, enterprise, sector and national levels, alongside a platform of minimum employment rights that, provide workers with access to fair and decent income, greater employment security, treatment based on respect and personal dignity, and work that reflects these principles. Yet further reforms include actions to strengthen the resources, policies, independence and democratic governance of the  HSE in ways that are appropriate to delivering the responsibilities of the state following the recent inclusion of work health and safety in the ILO’s Fundamental Principles of Human Rights.

The book argues that it is only through such reforms that meaningful action can be taken to address the role that work plays in the direct and indirect generation of harm to workers and their families, as well as the generation of morally unacceptable socio-economic disparities in health. Disparities that, for example, include the way in which those in lower socio-economic groups live shorter lives and experience fewer years of disability free living. In short, it is argued that the regulation of work-related health should no longer be primarily viewed through the lens of ‘health and safety regulation’. Instead, it must be seen as a central focus of ‘employment regulation’ more generally.

The book’s authors make these recommendations in the full knowledge that they are unlikely to be heeded by current UK governance. Their purpose is to stimulate a debate that is long-overdue and needed urgently, if the negative effects on health and well‐being suffered by a significant proportion of the working population as a result of the rising inequalities that are driven by neo‐liberal political and economic strategies are to be remedied.

You can order your copy of ‘Work and Health: 50 Years of Regulatory Failure’ here.