Intersectoral action between health, social protection and labour market policy: thematic brief on labour

September 2019 Thematic brief on Labour Intersectoral action between health, social protection and labour market policy Synergy between sectors: fostering inclusive labour markets and better health outcomes The Health 2020 policy framework has been adopted by all Member States of the WHO European Region to address Europe’s great social and health chal- lenges, calling upon the health sector to reach out to and work with all the vari- ous sectors and parties in the continuing work of improving people’s health and well-being. Inclusive labour markets, healthy pop- ulations and economic productivity go hand in hand. Investing in health fosters a skilled and productive workforce, with workers more likely to retain employ- ment and thus contribute to community and economic productivity. Meanwhile, in-work poverty and job insecurity exac- erbate health inequities and the barriers to employment arising from disability or chronic illness. By working together, the health and employment sectors can build synergy and create healthy and resilient communities and economies. The employment sector can improve the health of people and communities by: • providing sufficient income to support households and preventing in-work poverty by ensuring a minimum income; • preventing job insecurity by providing longer notice periods and increasing severance payments; • supporting active lifestyles and health-enabling working environ- ments; • promoting safe working conditions through strong occupational health schemes; • providing for adequate sick leave; • developing and enforcing anti-discrim- ination policies that reduce the labour market penalties experienced by people with disabilities; • providing adequate paid maternal and paternal leave and protecting new mothers from losing jobs or promo- tions; • improving work–life balance for men and women; and • increasing access to health care for men and women. Summary Key messages The goal of Health 2020 is to significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are universal, equitable, sustainable and of high quality. 1 2 34 5 Health and well-being are best achieved if the whole of government works together, and Health 2020 promotes whole-of- government and whole-of-society approaches. Health and well-being can be improved and health inequalities reduced through the right policies and working with other sectors. Different countries, cities and communities have different starting-points: each is unique and can pursue common goals through different pathways. Social progress is best measured by objective indicators of health, health equity and well-being, and this includes the conditions in which people are born, live and work. HEALTH 2020 Health and well-being are public goods and assets for human development that contribute to strong, dynamic and creative societies. Strengthening the link between good health and work In 2012, all 53 countries in the European Region adopted Health 2020, the new common European health policy framework, and committed themselves to developing integrative polices that engage with all sectors in addressing the social and economic determinants of health and well-being. Access to safe and secure employment and sufficient income streams is a key way to ensure health equity in societies, and underemployment is linked to poor health and well-being. Job insecurity is a challenge reported across the WHO European Region. It increases the risk of mental ill health and poor self-rated health, both strong predictors of mortality. People who lack gainful employment are also more likely to become ill and die prematurely compared with their employed counterparts. Vulnerable groups in particular struggle with in-work poverty, in which income is insufficient to sustain the quality of life. The health risks posed by these challenges affect not only workers but also their families, increasing the risk of infant mortality and low birth weight. Low-quality work also increases the risk of poor mental health, high blood pressure and coronary heart disease, especially in occupations in which employees lack autonomy or cannot use their skills. Labour market policies can improve the quality of work while reducing job insecurity, occupational risks and in-work poverty. Minimum wage, employment protections and mandatory social benefits are just some of the labour measures that can promote better health and mitigate the negative health effects arising from work. 3 All Member States of the WHO European Region have agreed to monitor progress against six common targets: What makes societies prosper and flourish can also make people healthy: policies that recognize this have more impact. Building awareness and capacity to make health objectives part of society’s overall socioeconomic and human development is an essential task. All policy fields, including health, need to reform their ways of working and employ new forms and approaches to policy. This applies to the global, national and local levels. Reduce premature mortality in the European Region by 2020 Increase life expectancy in the European Region Reduce health inequalities in the European Region Enhance the well-being of the European Region population Ensure universal health coverage and the right to the highest attainable level of health Set national goals and targets related to health in Member States Health 2020: a framework for action The goal of Health 2020 is to significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are universal, equitable, sustainable and of high quality. 1. 2. 3. 4. 5. 6. Synergy between sectors: labour policy as a tool to improve health and well-being A healthy workforce is a key driver of both sustainable development and economic growth. Healthy workers can more easily secure and retain employ- ment, which in turn, promotes social inclusion, community participation and economic productivity. By offering financial security for individuals and families, a healthy and employable workforce also contributes to reducing poverty. Investing in health is vital to fostering a skilled and productive workforce. Labour markets are inclusive when everyone of working age has the opportunity to participate in paid work, especially vulnerable and disadvantaged people. Meanwhile, poor health in childhood reduces educational attainment and flows on to reduce productivity and employment prospects later in life. Boosting the health of workers, with special focus on vulnerable groups, increases their productivity and adaptability in rapidly shifting labour markets. People with long-term health problems such as disability or chronic illness face higher barriers to employment. This is often compounded by other concerns, such as high levels of insecurity, in-work poverty and lack of training. Employment protection policies can help bridge the employment gap arising from such health inequities. Poverty and in-work poverty both harm health and weaken labour market activity. Poor working conditions, high levels of stress and low autonomy are associated with poor health outcomes for employees, hindering productivity among labour market participants by increasing the number of sick days and the likelihood of early retirement. Labour market policies such as collective wage setting can address these challenges and boost health outcomes for workers. Higher wages are linked to lower risks of poor mental health and may encourage productivity, reduce sick days and foster human capital development, especially for low- wage workers. Promoting health thus creates a virtuous cycle for achieving labour market goals. Job loss increases the likelihood of mental ill health, which then becomes a barrier to rejoining the workforce. Active labour market programmes that support job searches and training schemes can help protect the mental health of people during periods of unemployment and facilitate their re-entry into work. This bidirectional relationship between labour market policy and health creates several win-win opportunities for both sectors. Ministers responsible for health and employment can work together to ensure that the workforce is healthy and productive, breaking the cycle of poor health, poor well- being and poverty that creates health inequalities and shrinks labour market activity. Strengthening the link between health, better employment and healthier workers 5 6Synergy between sectors: collaboration to improve human development Health 2020 provides a platform for joint work between the social and employment sectors. The health and employment sectors have numerous types of synergy, including in-work poverty, early-years development, and labour market protections, in which objectives overlap and in which win-win areas can be identified. Capitalizing on these types of synergy enables more effective responses to the most press- ing challenges facing our societies, such as social exclusion, sustainable development and inequalities in income and health. KEY AREAS TO EXPLORE TOGETHER INCLUDE: • identifying vulnerable groups with low labour market activity and poor health; • developing joint policy response to support vulnerable groups; and • creating and adopting common sys- tems of measurement and account- ability. How can the sectors work together? What can employment do to make a difference to health? • Reduce occupational hazards • Support active lifestyles and health-enabling working environments • Provide sufficient income to support households • Reduce job strain and job stress by increasing autonomy; prevent burnout • Prevent job insecurity by providing longer notice periods and increasing severance payments • Increase access to health care for men and women • Prevent in-work poverty by ensuring minimum income • Promote safe working conditions through strong occupational health schemes • Provide adequate paid sick leave • Develop and enforce anti-discrimination policies that reduce the labour market penalties experienced by people with disabilities • Provide adequate paid maternal and paternal leave; protect new mothers from losing jobs or promotions • Improve work–life balance for men and women Fostering a healthy start for all children regardless of their socioeconomic background Increase minimum wages to reduce in-work poverty, lowering child poverty. Stronger work–life balance, flexible working hours, maternity and paternity leave, parental leave Favourable in-work time agreements and infrastructure to encour- age breastfeeding Working with the education sector to encourage skills development among children Reducing occupational health hazards (toxins and unhealthy working environments) Increasing labour market participation, including people with chronic illnesses and disabilities, women and inhabitants in rural areas Jointly develop strategy for improving hazardous working environments Reducing the impact of job loss on health and well-being Enhance employment protections, such as severance payments and notice periods Ensure access to timely and effective mental health treatment for those experiencing poorer mental health following job loss Foster opportunities for re-employment THE CHALLENGES THE RESPONSES NEEDED Collaborating to improve the well-being of people and communities What can health do to make a difference to employment? • Increase access to preventive care and treatment for mental health • Increase the development of human capital by addressing early-years poverty • Maintain high levels of productivity among those in the labour force • Reduce the number of sick days through public health and preventive services Reducing health inequalities: to reduce health inequalities, the following should be addressed. LIFE-COURSE STAGE • Social protection for women, mothers to be and young families • Universal, high-quality and affordable early-years education and care system • Eradication of unsafe work and access to employment and high-quality work • Coherent and effective intersectoral action to tackle inequalities at older ages WIDER SOCIETY • Improved social protection, according to need • Co-creation and partnership with those targeted, civil society and civic partners • Action to reduce social exclusion • A gender equity approach BROADER CONTEXT • Tax and transfers to promote equity • Long-term planning through links with other policies SYSTEMS • Greater coherence across sectors • Comprehensive responses • Regular reporting and public scrutiny United Nations 2030 Agenda for Sustainable Development: a political mandate and transformative call for action Health 2020 HEALTH 2020 The United Nations 2030 Agenda for Sustainable Development was adopt- ed by all 193 Member States of the United Nations at the United Nations Sustainable Development Summit on 25 September 2015 in New York. The 17 Sustainable Development Goals are a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity. They build on the successes of the Millennium Development Goals, while including new areas such as climate change, economic inequality, innova- tion, sustainable consumption, peace and justice, among other priorities. The Goals are interconnected and require multisectoral and intersectoral action – the key to success for any one goal will involve tackling issues more commonly associated with another. The Health 2020 policy framework has a political mandate. It has been adopted by all WHO European Region Member States and can be adapted to the different settings and realities that make up the Region. It describes how health and well- being can be advanced, sustained and measured through action that creates social cohesion, security, a good work–life balance, good health and good education. It calls upon the health sector to reach out to the many different actors within and outside government and provides inspiration and direction on addressing the complex health challenges of the 21st century. The framework confirms values, is based on evidence and identifies strategic directions and essential actions. It builds on the experiences gained through previous Health for All policies and guides the actions of both Member States and the Regional Office. Health 2020, the European policy framework for health and well-being, fully aligns with the 2030 Agenda. Both aim to improve health and well-being for all at all ages through whole-of- government, whole-of-society and health-in-all-policies approaches. Both tackle the social, economic, cultural and environmental determinants of health. The 2030 Agenda offers new momentum for implementing Health 2020. It presents a unique opportunity to renew national commitments to advancing health and well-being in the WHO European Region. 8 The right to health, and sector mandates for multisectoral and intersectoral action for health and well-being The capacity of institutions and individuals for designing, implementing and delivering multisectoral and intersectoral action for health and well-being. Resourcing and organization for multisectoral and intersectoral action for health and well-being; and 1. 2. 3. Transformative governance for action between health and employment The adoption of the Health 2020 health policy framework for the WHO European Region in 2012 by all Member States, with governance for health as a twin strategic objective alongside improved health equity, marked an invigorated strategic approach in the European Region to strengthen governance for health and intersectoral action. This provides an excellent founda- tion for operationalizing and implementing the 2030 Agenda and the Sustainable Development Goals, which calls for good governance, new models of partnership and scaling up intersectoral work as the means to achieve global, regional and national goals and targets and to meet today’s complex global challenges. Moving towards models of governance that deliver through their design health, equity and well-being is an example of the transformative response called for by the 2030 Agenda. Involving, managing, coordinating, developing accountabili- ty and coherence, and supporting the implementation of action between diverse actors across all levels of government and beyond are necessary to achieve global, regional and national goals and targets and to effectively address today’s complex global challenges. The transformative approach to im- proved governance is facilitated through whole-systems approaches at each individ- ual level or node within a system (whole of government, whole of society, whole of city and whole of school) that engage all levels of governance within a system, from the international through the national and the regional to the local. For further information, see the Concept note: assessment tool for governance for health and well- being. Capacity for intersectoral governance for health and well-being depends on three key factors: Evidence base Job insecurity, work quality and the wider working environment are important determinants of health. Individuals facing insecure employment, high levels of stress or exposure to dangerous or toxic working environments are more likely to experience poor health and premature mortality. These same groups are also more likely to work fewer hours, deliver less productivity and retire earlier, with corresponding effects on the labour market. In the WHO European Region, strong evidence indicates that losing jobs increases the risk of poor health, reducing people’s disability-free life-years and increasing their risk of premature mortality. Unemployment also increases the risk of suicide. These health effects can be virtually eliminated, however, by robust social protections buffering people against the financial shock of job loss. In-work poverty also threatens the mental health of workers and their families, increasing the risk of child poverty, low birth weight and infant mortality. Since child poverty hinders educational attainment, the risk of poverty across the life-course also increases. Reducing in-work poverty is therefore critical for improving health and reducing poverty. Health 2020 recognizes the employment sector as a co-producer of health; a collaborator in supporting the development of productive and healthy children and adults; a partner in supporting employment protection; an advocate for growth; a supporter of labour market activity; and a partner in striving for policies that promote health equity. SDGs for action between health and employment 10 GOAL SUSTAINABLE DEVELOPMENT GOAL TARGET Sustainable Development Goal targets for action between health and employment Sustainable Development Goal 1: End poverty in all its forms everywhere 1.1 By 2030, eradicate extreme poverty for all people everywhere, currently measured as people living on less than $1.25 a day 1.2 By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions according to national definitions 1.3 Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable 1.b Create sound policy frameworks at the national, regional and international levels, based on pro-poor and gender-sensitive development strategies, to support accelerated investment in poverty eradication actions Sustainable Development Goal 5: Achieve gender equality and empower all women and girls 5.4 Recognize and value unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility within the household and the family as nationally appropriate 5.5 Ensure women’s full and effective participation and equal op- portunities for leadership at all levels of decision-making in political, economic and public life Sustainable Development Goal 8: Promote sustained, inclusive and sustainable economic growth, full and productive employ- ment and decent work for all 8.2 Achieve higher levels of economic productivity through diversifi- cation, technological upgrading and innovation, including through a focus on high-value-added and labour-intensive sectors 8.3 Promote development-oriented policies that support productive activities, decent job creation, entrepreneurship, creativity and innovation, and encourage the formalization and growth of micro-, small- and medium-sized enterprises, including through access to financial services 8.5 By 2030, achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities, and equal pay for work of equal value 8.6 By 2020, substantially reduce the proportion of youth not in employment, education or training 8.7 Take immediate and effective measures to eradicate forced labour, end modern slavery and human trafficking and secure the prohibition and elimination of the worst forms of child labour, including recruitment and use of child soldiers, and by 2025 end child labour in all its forms 8.b By 2020, develop and operationalize a global strategy for youth employment and implement the Global Jobs Pact of the International Labour Organization Sustainable Development Goal 4: Ensure inclusive and eq- uitable quality education and promote lifelong learning opportunities for all 4.4 By 2030, substantially increase the number of youth and adults who have relevant skills, including technical and vocational skills, for employment, decent jobs and entrepreneurship SUSTAINABLE DEVELOPMENT GOAL TARGET 11 Sustainable Development Goal 10: Reduce inequality within and among countries Sustainable Development Goal 9: Build resilient infrastruc- ture, promote inclusive and sustainable indus- trialization and foster innovation 10.4 Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality 9.2 Promote inclusive and sustainable industrialization and, by 2030, significantly raise industry’s share of employment and gross domestic product, in line with national circumstances, and double its share in least developed countries GOAL SUSTAINABLE DEVELOPMENT GOAL TARGET The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands North Macedonia Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan Turkey Turkmenistan Ukraine United Kingdom Uzbekistan Original: English URL: www.euro.who.int © World Health Organization 2019. All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 E-mail: eupcrgov@who.int This brief has been produced as part of the Multi- and Intersectoral brief series by the Governance for Health Programme, Division of Policy and Governance for Health and Well-being, WHO Regional Office for Europe. For more, please see this link