“Happiness, I have discovered,” wrote David Grayson at the start of the twentieth century, “is nearly always a rebound from hard work.” Today, that happiness is denied to many. Nearly a million Britons have their ability to work limited by poor health — and a staggering 3.1 million more are deemed entirely too sick to work.
This figure is a record high. Why has our health deteriorated so dramatically? Why here, and why now — especially when other countries haven’t experienced anything comparable?
It’s strange that the number of people too ill to work has risen even as work has become more sedentary. It’s striking that it has gone up as opportunities to work from home have suddenly flourished. It’s bewildering that millions are too sick even for part-time work from home, in front of a screen, at a time when high life expectancy suggests we’re fundamentally healthy.
Health is a vague term, and the WHO’s famous 1948 definition — “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” — speaks more of campaigning than sense. Not everything that counts can be counted, but for an objective proxy of health it seems fair to look at how long we live, and the news here is decent. Life expectancy dipped a little when covid came along, but not by much. Roughly it’s about where it was in 2010. Yet back then 2.1 million people were too unwell to work. That it has risen by fifty percent in fifteen years is remarkable.
What, then, has happened? What is the cause of the problem?
The Office for National Statistics estimates there are 112,000 people who say they are unable to work because of long COVID. Taking that as an upper estimate — assuming everyone’s self-assessment is accurate — it doesn’t seem long COVID can fully explain the current situation. Pleasant to imagine it might be, and that we are merely too stoic to complain, but international data says otherwise. Our increase in sickness has not been mirrored elsewhere.
What, then, has happened? What is the cause of the problem?
As a physician who spends a large amount of his time reading medical journals, I can’t tell you. The British Medical Journal has mentioned it in passing, but the British Medical Journal long ago ceased being a research publication of record; these days it’s a cross between a free industry advertiser and the Guardian. The BMJ have got as far as declaring the rise in long-term sickness to be bad, and reporting it would save the NHS money if it were eliminated. Other journals have shown no interest at all.
In 2023, the ONS estimated that just over half of those who were off work with long-term sickness attributed it to “depression, bad nerves or anxiety”. That’s suggestive, but chiefly what it’s suggestive of — note once more the estimation and the self-reporting — is our failure even to collect good data. (German rates of mental health problems in the unemployed are roughly the same, it’s worth noting, but there the number of those who can’t work due to illness is much lower.) Neither our doctors nor our government are making serious efforts to investigate the rise in long-term sickness. Depression? If that’s the case, why aren’t psychiatrists bellowing from the rooftops?
None of this makes sense. None of this makes sense, that is, unless you assume that nobody in power, either in politics or in medicine, thinks the rise in illness is real. Assume instead that medical researchers, MPs, and civil servants all privately suspect laziness or malingering, and their reluctance to confront the issue openly makes sense. The doctors suspect they have no way of helping, the politicians and their staff think even drawing attention to the problem is an intractable vote loser.
That’s a shame, because in two fundamental ways — the two that matter most — the sickness absolutely is real. The first is economic. The people who are affected aren’t supporting our society, they’re subtracting from it. Being on the list of the long term sick acquires a reality even if the sickness that put you there is dubious. The second — the personal — is even more important. These people are not flourishing. Being on that list comes at a cost to them, whether the cause is physical or psychological. Their lives are diminished.
Real compassion does not consist of sympathetic hand-wringing and financial handouts. The money spent on Universal Credit deserves to be taken seriously but the people it’s spent on deserve that even more. Of those who end up receiving long-term sickness benefits for unemployment, only 1 percent find any kind of work within six months. Assessments to put people onto these benefits have shifted from being mainly face-to-face, back in March 2020, to being only 10 per cent face-to-face by December 2024. Given how difficult people find it to get off these benefits, ushering people onto them too easily isn’t kindness but an act of harm.
The first step in taking the problem seriously is acquiring better data. We don’t need estimates and occasional surveys, we need to know who these people are, why they can’t work, and what it is we can and can’t do to help. As a simple starter, we could randomise those assessments to being face-to-face versus remote. Quickly, we would see what difference it made, what happened to subsequent employment rates. Match that to GP records and we could measure the impact on people’s health, as well as the real reasons—not vague estimates and self-reports — behind their incapacity. This stuff is basic. There is no excuse for the fact we don’t currently bother.
At a time when governments seem to feel everything is their responsibility — telling us which TV programmes to watch and how many pints we can drink — we’re somehow ignoring the fact that almost ten percent of working age people are unable to work due to illness and we don’t know why. No politician claims to be indifferent to the economy or the health and happiness of the population, yet indifference, and a dishonourable lack of curiosity, is what they show.
“Happiness must be tricked,” wrote David Grayson, back in 1906. “She loves to see men at work. She loves sweat, weariness, self-sacrifice. She will be found not in palaces but lurking in cornfields and factories and hovering over littered desks: she crowns the unconscious head of the busy child. If you look up suddenly from hard work you will see her, but if you look too long she fades sorrowfully away.”
Speculating about why so many can’t work is to miss the point and betray the purpose. We don’t need guesses, we need knowledge, and we need to feel furious at its absence. Abandoning 3.1 million people to long-term unemployment for health reasons we don’t understand is neither economically sensible nor morally acceptable. The state — and the medical profession — has an absolute duty to take the problem seriously. Shamefully, neither has. Until we demand they do better, neither will.
