Category Archives: Blog

Launch of the Healthy Ageing Consensus Statement

Last week saw the launch of the Healthy Ageing consensus statement, produced by Public Health England and The Centre for Ageing Better. The Council for Work and Health fully supports the vision of the consensus statement; for England to be the best place in the world to grow older. Good work can provide people with a sense of purpose, belonging and self-respect as well as the known health and financial benefits that work gives. However, it’s becoming more important than ever to recognise that older people are not only choosing to work for longer because they can but also because they have to for financial means. And with this, we are seeing a profound shift in our workforce demographic.

Older workers bring a broad range of skills and experience, loyalty, stability and reliability to the workplace and this is becoming important for employers as we see skills shortages in specialised roles across all industry sectors. Employers need to have good, proactive age management practices in place to meet the needs of all staff as their workforce ages.

We must have a realistic perspective with our ageing workforce and understand the physical and mental changes with come with the ageing. An understanding that we are living longer with long-term health conditions and advances in medical care enable us to continue to work whilst managing these health conditions and living our lives well. What is of vital importance is how we can raise awareness for employers, employees and healthcare practitioners on how work can be adapted to support people to stay in work for longer and still be well. There are many ways to do this not least looking at how others approach it, such as the good practice seen in employers such as BMW and B&Q, considering flexible working opportunities, adapting business strategies where they take advantage of older people’s rich experience, giving them mentoring and consultative projects.  It may also be about providing access to additional training or coaching to support career moves later in life.

Proactive support, in the form of access to wellbeing initiatives and early interventions such as access to occupational health, physiotherapy and psychological therapies, have been proven to be very effective and supportive to both the older employee and the business. Employers who take a solution focussed approach to a diverse and multi-generational workforce have benefitted in terms of productivity and retention of experience.

For individuals as well, it is important they consider the fact that they may need to work differently or in a different capacity in the later stages of their career. There are many ways to do this and employers and local organisations can provide guidance and support to help individuals consider and plan for this.

It is important to remember that age is a protective characteristic of the Equality Act and employers have the same responsibilities for health and safety of older employees as they do for all their employees.

We urge employers and society to remove the stereotype of older people and their ability to contribute to the workforce, it does not reflect the older worker to in today’s society and we are simply not oldat 60 anymore. All workers should be treated individually as any changes in health are very different in each person. Adapting work practices based on individual needs is very important and assessing it on a case by case means and not making assumptions based on out of date stereotypes.

The Council for Work and Health welcomes the opportunity this consensus brings to focus on promoting good health and good work to benefit of both older employees and the businesses they work for.  Find out more about the consensus statement and its five pillars here .

We urge as many employers and organisations as possible to sign up to the consensus statement and raise awareness about positive approaches to successful ageing workforce policies.



Lung disease in the construction industry – the role of occupational hygiene in prevention

Lung disease in the construction industry

– the role of occupational hygiene in prevention.

By Chris Keen, Policy and Technical Committee, BOHS

The burden of respiratory disease in construction

Exposure to airborne dust is often considered to be an unavoidable part of working in the construction industry, and historically there has been a view in some parts of the industry that ‘it’s just dust’ and doesn’t represent a serious health risk. In reality, the facts are very different. Construction dusts contain a mixture of individual contaminants, and often these have the potential to do serious, irreversible harm if exposures are not properly controlled. And because of the long latency of most lung diseases associated with these exposures, the true impact is often not fully appreciated. This is compounded by the transient exposure patterns typically found in construction. The provision of long term health surveillance is notoriously difficult in this industry, and many cases of ill health go un-reported and remain hidden. The true burden of respiratory disease in construction workers isn’t accurately known, but estimates are that several hundred people die each year as a result of historic exposures to respirable crystalline silica. The issue is so big as to be the subject of a recent public inquiry, co-ordinated by the All-Party Parliamentary Group (APPG) on Respiratory Health.

The role of Occupational Hygiene and the Breathe Freely Campaign

As these facts have become more apparent, the construction industry have responded and much has been done in the past few years to drive improvements in the industry. Key to providing solutions is the implementation of good practice to prevent, or at least control, the exposures which cause respiratory disease. The recognition, evaluation and control of harmful workplace exposures is the bedrock of the occupational hygiene profession.In 2015 the British Occupational Hygiene Society (BOHS), the chartered society for worker health protection, launched theBreathe Freely in Construction campaign. Historically, interaction between the occupational hygiene profession and the construction industry has not been commonplace, which may go some way to explaining the disease burden associated with construction. The Breathe Freely campaign aimed clearly to address this, and to provide the construction industry with effective support to drive down the dust exposures which are at the root of occupational lung disease.

The basis of occupational hygiene is the hierarchy of control. This recognises that all risk control measures are not equal, and that some are far more reliable than others. Clearly, the elimination of a hazard entirely, or if that is not possible, the control of emissions at source, provides a far more robust control approach than a reliance on personal protective equipment. But we still see, all too often, dust masks being used as the only control against dusts which are known to cause cancer and other life changing diseases. Through Breathe Freely, we have worked with stakeholders including the Health in Construction Leadership Group, the Construction Dust Partnership, the Healthy Lungs Partnership and more to produce a suite of materials providing guidance on effective dust control across a wide range of construction tasks. We have created training materials which allow the upskilling of site supervisors to allow a better understanding of respiratory risks and the associated need to control exposures.  And through a series of roadshows, we have reached well over a thousand construction industry stakeholders directly, to spread our messages. 117 high profile business operating in the UK construction sector have signed up as campaign supporters.

There is no doubt that the Breathe Freely campaign is part of a sea change in controlling respiratory disease risks in construction. Major construction clients, and large principal contractors are now giving this topic much more attention. The application of exposure controls, other than the ubiquitous dust mask, is now the norm on larger construction projects. Dust exposures are reducing and the future burden of lung disease should follow on from this as a natural progression.

However, there is still much to do. The overriding number of businesses operating in the construction industry are SMEs. The level of risk awareness, and the accompanying standards of exposure control, still have a long way to go within this sector of the industry. As our campaign moves forward, we will provide a greater focus on reaching these businesses, with specific targeting on the construction trades known to be at highest risk of dust exposures.  We are always looking for new campaign supporters, and we would especially welcome interest from stakeholders operating in, or interacting with, construction SMEs. You can find out more by visiting our website.




Top tips for workplace health – Duality Health

Top Tips for Workplace Health

Good health is good business but where do you start? Whether you are starting a new business or looking for ways to boost the health of your staff, here are some top tips.

Encourage healthy eating

Although it’s easy to tuck into comfort food for lunch, or have endless coffee and chocolate at our desks to boost energy, this can lead to health problems such as putting on weight (which can impact your cholesterol levels) feeling sluggish, and not getting enough vitamins and minerals from your diet.

For large workplaces, promote a healthy diet by having a subsidised canteen in the workplace that serves diverse, nutritious and colourful meals during breakfast and lunch. This could include vibrant salad bars, home-cooked main meals and freshly made smoothies, ideal for those who, after a long commute or a stressful meeting, want to unwind with something delicious that won’t break the bank.

For smaller workplaces, even just sharing information about the nutritional qualities of fruits and vegetables is a great way to get started. Having a filtered water cooler, subsidising reusable metal water bottles and organising a free fruit and vegetable delivery to the office are just a few other ideas that you can implement.

Create a sense of community at work

Encourage better mental health and general wellbeing by creating a sense of community within the workplace. This opens up channels of communication between managers and staff and helps to facilitate any difficult conversations that need to be had with regards to health issues. Consider offering work exercise classes like yoga, HIIT, pilates and bootcamps which all members of staff can join. Or, why not enter a charity fundraiser together like a 5K run, 60K bike ride or a Zumbathon?

Have scheduled breaks other than lunch

Regular breaks, even if it’s just for a 10-minute dose of fresh air, can do wonders for the workplace. Ideas for these scheduled breaks include five to ten minutes of mindfulness or guided meditation focusing on breathing and refreshing a cluttered mind. Why not have a technology-free zone full of books, magazines, sofas and music? This is ideal for office members who might need a moment to collect their thoughts and rest their strained eyes.

Keep the workplace hygienic

During the winter – a hotspot of colds, flu and viruses – you need to make sure that your workplace is always kept clean and tidy to avoid the spread of disease and illnesses. Simply employing an office cleaner to spritz, hoover and clean the office daily is a great way to keep on top of pesky bugs.

Promote and encourage personal hygiene amongst your employees. Consider adding soap dispensers or soap bars next to sinks, providing antibacterial hand gel and surface wipes, or even installing showers in the workplace.

Emphasise a work-life balance

Though you want your employees to work hard and meet productivity targets, you also need to be mindful of their work-life balance. Like having a sense of community in the office, simply remembering and encouraging a positive work-life balance will build positive rapport between you and your employees. This can generally help manage stress levels at work, as high-stress environments can be a precursor to a range of mental health problems and can also weaken the immune system.

Keep it a general rule not to email or contact work colleagues out of work hours about work-related issues (unless urgent), and organise plenty of work socials to keep your colleagues feeling chipper at all times.


Duality Healthis a private healthcare clinic catering to the people of Newry and Dungannon and surrounding areas.

Supporting cancer patients with work

Supporting cancer patients with work

Every two minutes someone in the UK is diagnosed with cancer.[1]

An estimated one in three people with cancer in the UK are of working age.[2]While not all of these will be in employment, Macmillan research has found that 87% of those in work when diagnosed with cancer say it’s important to them to continue working after diagnosis.[3]

The effect of cancer and its treatment on a person’s ability to work can vary widely. Factors can include the type and stage of cancer, the treatment and its side effects, and how the person copes with a life-altering event like a cancer diagnosis. While some people with cancer continue to work during their treatment, others may need time off or support to help them return to work, while others may need to leave the workplace completely.

The role of GPs

GPs can play an important role in supporting patients with work following a cancer diagnosis. The conversations they have with their patients – whether it’s while completing Fit Notes, during a Cancer Care Review or at another point in the patient’s cancer ‘journey’ – can empower them to discuss their needs with their employer. While GPs don’t need specialist knowledge of workplaces or occupational health, they can help their patients by supporting them to understand the potential impact of their cancer on their work life.

Resources for healthcare professionals and patients

Since the launch of the Council’s Talking Work: A guide for Doctors discussing work and work modifications with patientsearlier this year, Macmillan has developed some additional resources to support healthcare professionals to have conversations specifically about work and cancer. Our Work support route guides– separate versions of which are available for professionals based in England, Scotland, Wales and Northern Ireland – and our Supporting patients with work: 10 top tips guidehelp professionals to feel confident about discussing work with patients and signposting them onto further sources of support.

Macmillan has also created a dedicated team of work support advisers who can help people with cancer and those who care for them to understand their rights at work. The team provides information and guidance on talking to employers and negotiating adjustments and can answer questions on sick pay or taking time off. People with more complex needs can also be referred to one-off legal advice. The team is available Monday-Friday, 8am-6pm on 0808 808 0000. In addition, a wide range of information about work and cancer can be found by visiting

How to build conversations around work and cancer into practice

Along with Fit Note conversations, the Cancer Care Review provides an excellent opportunity to discuss work with patients. Macmillan has worked with each of the main GP IT providers to develop integrated, standardised cancer care review templates within EMIS Health, INPS vision and TPP SystmOne. These templates take a holistic approach to the discussion, covering conversations about employment, financial support and the clinical needs of the person living with cancer.

GPs can use these templates to guide them through conversations with people living with cancer. The templates are also a helpful way to ensure that appropriate information is coded back onto the patient file, as well as supporting signposting to further support, with embedded Macmillan information available to print.

Rebecca Coaker, Services Influencing Manager – Work and Cancer, Macmillan Cancer Support

We’re here to help people with cancer live life as fully as they can, providing physical, financial and emotional support. So whatever cancer throws their way, we’re right there with them.


[1]Estimated by calculating UK-wide incidence of about 360,000 new cases of cancer per year divided by the total number of minutes in a year.

[2]Estimated total prevalence of people in the UK aged 16 to 65. It is estimated based on UK complete prevalence of those aged 0 to 64 in 2015 derived from Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202. (Projections scenario 1). This was adjusted up to those aged 16 to 65 based on 21-year cancer prevalence in England (Transforming Cancer Services Team for London, NHS, National Cancer Registry and Analysis Service, PHE and Macmillan Cancer Support. 2017. Cancer Prevalence in England: 21-year prevalence by demographic and geographic measures. The proportion is based on UK complete prevalence in 2015 derived from Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202. (Projections scenario 1).

[3]YouGov Plc. Total sample size was 1507 PLWC respondents who were in work when diagnosed with cancer. Fieldwork was undertaken between 29/06/2018 – 22/07/2018. The survey was carried out online.


Cold Stress: The Dangers of Working Outdoors

What is Cold Stress? Is It Dangerous to Work in Extreme Cold Conditions?

The UK experiences a temperate oceanic climate in which apart from the relatively warmer months of June through September, it is mostly too cold to work in the outdoors without appropriate protective clothing. Working either outdoors in a cold environment or indoors in the refrigerated areas and warehouses over a long period of time may pose serious health threats. Over the last five years, 168,000 deaths due to cold-related illness were recorded in the UK alone, ranking it among the bottom three across Europe. There is a higher risk for people working in maritime, commercial fishing, agriculture, and construction.

While working in such cold conditions, internally, the human body has to work extra to maintain the core temperature of 98.6° F. When the body is unable to achieve it due to lack of proper clothing, exposed body parts, wet clothing, etc., it may fall prey to one or more of cold stress illnesses. Some of the most dangerous cold stress-related illnesses include but are not limited to frostbites, frostnip, chilblains, immersion foot, and trenchfoot.

So, the question of how one can prevent the risk of developing cold stress arises. Wearing layered clothing with a warm woollen cap or hoodie is a good start. Stay hydrated and eat high-calorie food to maintain energy all day. Check out this infographic from Emtraining Solutions that entails various illnesses related to cold stress and other ways to prevent them.


Don’t sleep on it!

Don’t sleep on it!

Excessive daytime sleepiness (EDS) is the main focus of DVLA concern with people diagnosed with Obstructive Sleep Apnoea (OSA), a condition in which sufferers experience significant periods of not breathing, while they are asleep during to airway obstruction.  Inadequate oxygenation of the body from OSA is bad for general health.  Lack of deep sleep leads to those affected being fatigued and falling asleep easily during the day (even if they are not aware of OSA). Drivers who suffer from Sleep Apnoea must notify DVLA to get their condition reviewed and controlled before they can go on driving. DVLA are solely concerned about falling asleep while driving, not other health issues including exacerbation of diabetes or the increased tendency to heart disease and/or stroke.

Some reports suggest that about 20 per cent of adults suffer a significant degree of EDS, although OSA is only one cause. A far bigger cause is disturbed sleep due to things like shift work and caring duties for infants and sick dependants involving waking nights.

ESS (Epworth Sleepiness Scale) and AHI (Apnoea Hypopnoea Index) scores are used by medical practitioners to assess tendency to EDS.  Some research suggests that ESS results are subjective and sleep specialists warn against them as wholly reliable assessments of EDS. Other research suggests that there is no clear correlation between AHI and ESS scores.

In assessing the risk of sleepiness while driving, AHI is a not very reliable measure for tendency to EDS.  Arguably, were a better tool available and widely adopted, the DVLA might reduce its fixation on OSA. Many more ‘at risk’ drivers might be brought into the DVLA medical surveillance net, while at the same time releasing from continuing medical surveillance some OSA suffers who do not suffer significant EDS. Sleepiness, however, is a very transient and subjective state for which there are few reliable markers.

Medical practitioners should be made more aware of other non OSA related causes of EDS and arguably, where these cannot be brought under satisfactory control, DVLA should be informed as they are in cases where significant OSA is diagnosed.

At present the duty to inform DVLA about OSA is triggered by medical diagnosis. Opinions and guidance vary as to whether, once diagnosed, the OSA suffer should cease driving until given permission to resume by DVLA. DVLA stress that the primary duty not to drive while unfit from any cause rests with the driver. More publicity about sleep and driving may cause some drivers not to go to their doctors for fear of being suspended from driving while awaiting treatment – but in practice this fear is unfounded. Treatment, such as using CPAP (continuous positive airway pressure) equipment at night is available via NHS sleep clinics and with a bit of practice is quite easy to use. It can quickly help the OSA sufferer to feel a whole lot better and have a lot more energy. More guidance is still needed for employers and potential sufferers.  Responsible drivers need to pay more attention to ‘sleep hygiene’ and to finding ways of remaining alert when at the wheel. They need to be prepared to discuss sleepiness issues with their doctors and not be afraid of being caught in the DVLA medical surveillance net.

Sleepiness and road safety have been a big part of RoSPA’s policy and campaigning work on managing Occupational Road Riskcampaigns for nearly twenty years. (See our advice to employers at The key message is that employers must not cause their drivers to drive tired. It needs an intelligent approach. Anyone who feels sleepy at the wheel, regardless of the cause, knows they are becoming impaired and must stop and recover until they are safe to proceed.

RoSPA’sNational Occupational Health Safety Committee (which brings together the main institutional stakeholders in this area) has begun work on tackling fatigue in the workplace. This is not only highly topical because of its links to mental health and ‘wellness’ but its impact on safety and accidents in the workplace have generally been underplayed up to now. New guidance however is now available in the form of the HSE fatigue risk index (see

ROSPA are thinking about producing some guidance on OSA and Employment (‘OSA and your job’ perhaps?), helping both sufferers and their managers to better understand the issues involved and to avoid over-the-top, excessively risk averse responses that might lead them to exclude OSA sufferers from certain roles ‘on health safety grounds’. Talking to specialists and consultants reveals how reluctant many of their patients are to reveal to their employers that they have had an OSA diagnosis.   There is undoubtedly a lot of prejudice and misinformation in the workplace about this issue, and about fatigue and sleepiness generally – which, of course, goes a lot wider than OSA. ‘cat napping’, as an essential coping mechanism in the workplace, (especially for older workers who make up a bigger proportion of the workforce these days) ought to be a widely understood and accepted coping mechanism, not seen as an outlandish idea.

If you have experience in tackling problems experienced by workers in getting enough good quality sleep we’d like to hear from you.

Roger Bibbings MBE CFIOSH

Partnership Consultant RoSPA                                             May 2019


Do Fit Notes always Fit the Problem?

Do Fit notes always Fit the Problem?


Minister Matt Hancock recently launched the NHS Long Term Plan that highlighted our need to address the high rates of employment sickness absence due to musculoskeltal (MSK) problems and/or mental ill health.


Let’s look at some stats: 9 to 10 million GP Fit Notes are signed annuallyin England alone. A colossal number, likely to be taking an inordinate amount of precious GP time, particularly when 80% of these are used by employees as evidence of their illness for their employer as required by HR policies. 93% of GP Fit notes say that the person is not fit for work. Surely it’s time for another approach that chimes with the upcoming changes in GP Surgeries?


Work related problems are mainly identified in GP surgeries which are already taking the strain of high patient demand with a shrinking workforce. So it is great news that the NHS Long Term Plan sets out to expand the multi disciplinary team (MDT) workforce in GP surgeries to help meet demand. Ambitious pilots using allied health professionals (AHPs) like occupational therapists, paramedics and physiotherapists have shown safe, cost effective results that patients and families welcome. Seeing an AHP as a First Contact Practitioner from your GP surgery is going to become more the norm.


Which leads me back to my question….do Fit Notes always fit the problem? So, if you were off work, would you use a confidential work clinic based in your GP surgery? You may be surprised to learn that a growing number of patients are doing just this and using newly opened clinics in Southampton and South Pembrokeshire. Occupational Therapy Led Vocational Clinics are for people who are in employment and struggling with MSK and/or mental health problems. A safe space where they can talk through what work difficulties they face and how these may be resolved. Everybody gets an AHP Health and Work Report which can be shared with the employer with advice about how work modifications could keep the person in work.


  • Does the patient get individualised work and symptom management advice? Yes
  • Does the employer get more detailed, accurate info about how to support staff? Yes
  • Can the employer use the AHP Health and Work Report as evidence for statutory sick pay? Yes.
  • Does it cut down on GP time writing GP fit notes? Yes but …


… embed this new approach, we need employers to understand that there are alternatives to the traditional GP Fit Note. If they and the employee want to use alternative evidence than the GP fit note, this is available now and the legislation allows it.


So the question for employers may be ….would you prefer a detailed report saying how someone can stay at work by an AHP or a GP fit note just saying they are not fit for work? The answer will depend on the clinical situation of course, but the AHP Health and Work Report can provide the clear instructions that employers often crave.


Full results of the Occupational Therapy Led Vocational Clinics will be available in March 2020. These Clinics are one of 19 initiatives across the UK selected to receive funding from the Work and Health Challenge Fund.




Genevieve Smyth

Professional Adviser

Royal College of Occupational Therapists


Preparing for a Wellbeing Programme – A case study from Defence

Martin Short, Head of Wellbeing, Diversity and Inclusion. MoD Business Unit

In July 2018, following an 18-month secondment to the What Works Centre for Wellbeing, I returned to the Ministry of Defence (MoD) to design a wellbeing programme for a large MoD business unit of some 5000 staff spread over a number of different locations.

The organisation had never had a centrally coordinated wellbeing programme so, while I had considerable freedom of action, there were three big challenges to overcome before we could move forward.

The first challenge was that, as an organisation, we had no common understanding of what ‘wellbeing’ actually meant – or why it was important to both individuals and organisations. The second was that our wellbeing-related data was low grade and unsuitable for taking an evidence-based approach. Finally, while many staff were doing great work at local level, they worked in isolation and we had no joined up wellbeing community.

To tackle these challenges I designed a ‘start-up’ phase made up of three core activities which we called – Educate, Measure and Connect.


It is impossible to hold meaningful conversations about any topic if it means different things to different people, so I spent four months visiting every site and delivering over thirty ‘Wellbeing Awareness Briefs’. It didn’t matter so much what our wellbeing concept was, but it was important that we shared the same one. These one-hour presentations covered:

  • Wellbeing: What it is and why it matters to both individuals AND organisations.
  • What we know about Wellbeing across the life course and the factors that exert influence.
  • Wellbeing in the Workplace – the role of individuals, managers and leaders. This general approach is illustrated well in theACAS  Mental Health at Work Framework.


The annual Civil Service People Survey gives some insights into wellbeing but lacks detail, so we augmented it with data from another survey tool – a workplace wellbeing diagnostic tool developed by the What Works Centre for Wellbeing. This higher resolution data allowed us to diagnose where our main workplace wellbeing issues lay and also created a benchmark from which we could measure our progress as we started to take action.

One of the most interesting findings came from a graphic that we called the ‘Heatmap’. This plotted how far our different sites were from the organisational average for each of the five ‘drivers’ of workplace wellbeing measured by the tool. As can be seen from the heatmap below, not one of our sites has the same wellbeing experience – and the military and civilian experience is often profoundly different – even at the same site. This suggested that, for our organisation at least, a ‘one size fits all’ strategy would probably be ineffective. It also led us to the conclusion that the best model for our needs involved a light central structure which measures, monitors and advises, with evidence-informed action being delegated to local leadership and wellbeing networks.


The final preparatory activity was termed ‘Connect’. While I knew there were many staff doing great work at local level (Mental Health First Aiders, Mindfulness groups, Peer Support Groups, Sports Clubs etc.) we had no central visibility of what was actually happening locally. The Connect activity was simply a gathering together of information about what wellbeing and mental health related initiatives were happening and where.

What did we achieve?

Our three preliminary activities have allowed us to do a number of things:

  • Develop a shared understanding of what wellbeing means to us as an organisation – so our future conversations are better informed and make sense to staff.
  • Diagnose our main wellbeing challenges and establish a data benchmark from which we can measure progress when we run the survey again.
  • Complete an audit of the wellbeing-related resources we already have and identify and connect our pan-organisation wellbeing network.
  • Helped us understand the significant impact of local issues on staff wellbeing, thus guiding us towards appropriate governance structures.

The next phase will be the analysis of those issues that we wish to address at organisation level, followed by the generation of local action plans to address the needs identified at our different sites. At present we are planning to re-run the survey in late 2020 to check our progress.

The views and opinions expressed are those of the author and do not necessarily reflect the official policy or position of the Civil Service or the Ministry of Defence.

The SOM has a wellbeing special interest group. To view the slides from the most recent meeting, please click on the links below:An Evidence-based Approach to Understanding Workplace Wellbeing Challenges Supporting healthy high performance`

The Right Kind of Incentive Can Help People to Stay Active

Hans Pung is the President of Rand Europe. Marco Hafner is a senior economist at RAND Europe

Having the motivation to keep exercising regularly can be challenging for many of us. The benefits of regular physical activity are widely recognised yet about one third of the world’s adult population is not meeting the minimum weekly level of physical activity as recommended by the World Health Organisation. Weekly exercise can result in a lower risk of some diseases such as cardiovascular disease, diabetes and cancer, as well as maintain a healthy body weight and mental health. So the question is: what will motivate people to keepheading out the door, whether it’s for a swim or to the gym, for some much-needed activity?


Existing evidence suggests that incentive programmes can have a positive impact on people’s healthy behaviours, and in particular on physical activity, but the type of incentive matters. A recent RAND Europe report has highlighted the impact a particular “loss-framed” financial incentive scheme has had on people’s activity levels. Think of a loss-framed incentive as more of the proverbial “stick,” as opposed to the alternative gain-framed method or “carrot” reward for healthy behaviour. The stick in our study being people having to pay higher or lower monthly amounts for a smartwatch, depending on how physically active they were.


In the study researchers reviewed the data of more than 400,000 people, across the US, UK and South Africa, who had signed up to the Vitality Active Rewards programme run by multi-national health insurer Discovery. Members were rewarded for healthy behaviour with “Vitality points” which they could then use towards benefits – the carrot – such as movie tickets or free hot drinks. Members on the Vitality Active Rewards programme could also take up the Apple Watch benefit. This allowed members to buy the smartwatch and fitness tracker at a discounted price. Monthly repayments would then vary according to their level of activity during the previous month. If people exercised regularly and tracked their activity to earn enough points they would not have to pay any further costs.


Analysis of the data showed that those people who took up the Vitality Active Rewards with Apple Watch benefit increased their physical activity by about 34 per cent per month, compared to those who only participated in the Vitality Activity Rewards points programme. This meant that on average, people were exercising nearly five days extra every month. Also, the type of activity was recorded as advanced, meaning that not only did people exercise more while on the programme, they also exercised more intensely.


Notably, the study also looked at whether the increased physical activity levels persisted over time. Members on the Apple Watch scheme had two years to pay off the watch and researchers found that the levels of raised activity were sustained throughout the 24 month period. So it would suggest that people needed the extra push from a loss-framed incentive to stay motivated and maintain a positive behaviour change, over and above the rewards offered on the Vitality Activity Rewards points scheme. Offering members the opportunity to update their smartwatch every two years and continue the repayment process may also help them to stay active.


Previous studies contributing to this area of research have been done before, but never on so large a scale. Neither have they covered such a wide subject area. People who took part in the scheme varied widely in their fitness levels and the RAND Europe study showed that the benefit also incentivised those that initially tended to be more inactive, such as obese individuals, to become more active. Granted, fewer people in this at-risk group took up the benefit, however for those that did, they also showed a significant increase in activity levels.


While by no means a magic bullet, the combination of modern technology and the loss-framed incentive would seem to make a significant impact on people’s motivation, helping them to huff and puff their way to the desired amount of activity every week. This effect is important to consider when designing fitness and wellbeing programmes, whether it be for a health insurance company, employer or local GP. Finding ways to encourage healthy behaviour is vital and this might be the type of motivation people need to make it a way of life.


Hans Pung is the President of Rand Europe. Marco Hafner is a senior economist at RAND Europe and lead author on the “Incentives and physical activity” study.