Work and health: We need to focus on people not institutions

Recent concerns that the parlous state of the people's health is a drag anchor on economic growth surface an age-old public health conundrum: health selection versus social causation as determinants of poor health and inequalities. Consensus has emerged that dwindling labour market participation is the cause of sluggish economic growth, with long-term sickness identified as the main determinant of historic and stubborn economic inactivity. As more people become and remain absent from labour markets, the modern conundrum becomes; does good health enable work or is good work vital for good health? Given the high rates of economic inactivity in working aged people across many high-income countries [1], this is an urgent question for policy and public health communities alike [2]. Governments everywhere need working age people to work, they are the engine of the economy. This is a specific challenge in the UK. With 9 million people economically inactive, the engine is asleep.