— Richard Lilford, ARC WM Director
The alarming rise in long-term sickness rates recorded after the COVID-19 pandemic never struck me as convincing. I was unconvinced by reports of spiralling economic inactivity due to long-term illness. Apart from my inbuilt scepticism, the statistics did not make clinical sense – what kind of ‘sickness’ was causing people to stay off work. Cardiovascular disease? No, illness rates are declining. Cancer? No, rates are fairly stable. Bone and joint? No, most jobs in the economy can be done perfectly well, even if joints are hurting. This left mental health. There is a rise in teenage mental health problems, especially in girls. But this could not account for spiralling disability. Deteriorating mental health across the whole community does not seem a plausible cause of the increase in people registered as not working due to ill-health.
Although I did not buy the argument that a surge in ill-health was the cause of the problem, I did not have time to interrogate the data myself. Enter John Burn-Murdoch.[1] He found two problems with the illness epidemic hypothesis.
- The rise is largely ‘illusory’. The original data that led to the scare is mis-leading. It is based on the Labour Force Survey, for which response rates are plummeting, leading to bias when comparing current with previous data. New and better data have become available from the UK Household Longitudinal Study, which has a more constant response rate. This finds that labour market participation is slightly higher than before the pandemic. Meanwhile, the Resolution Foundation estimates similar levels of activity both sides of the pandemic.
- Many unemployed people who would not have reported ill-health six years ago now report it because they are incentivised to do so. Three factors are at work here. First, health-related benefits are more generous than unemployment benefits. Second, a shift to online assessment as part of universal credit has made it easier to register a longterm illness. Third, it is hard to move back from long-term illness to ‘looking for work’ because simply applying for a job will invalidate the (more) ‘generous’ health benefits, thus ‘baking-in’ long-term sickness. Yet further evidence comes from the observation that long-term sickness rates in the working age population tend to track benefit generosity.
In short, the initial statistics told a ‘damned lie’, and the benefits system does the rest. Of course, none of this means that we should not try to reduce waiting lists and waiting times, and that doing so would not produce some productivity gains. However, the argument that we are experiencing a massive increase in long-term illness is weak.