The UK labour market faces a growing and complex challenge: rising economic inactivity driven by long-term health conditions. Over 2.8 million people are currently out of the workforce due to health-related reasons—a figure that continues to grow. The UK Government has recognised the severity of this issue with the launch of its “Get Britain Working” White Paper, aimed at reducing economic inactivity and supporting individuals back into meaningful employment. However, getting people back into work is only one piece of the puzzle. To create a sustainable approach to employment, we must also build workplaces that foster engagement, inclusion and wellbeing.
While reducing economic inactivity is critical, it is equally important to recognise the growing number of individuals in work who are living with work-limiting health conditions – now estimated at approximately 3.7 million and rising. This trend represents a significant public health challenge and a pressing concern for economic productivity and workforce sustainability. Long-term health conditions are now the fastest-growing reason for economic inactivity, with the most rapid increase seen among younger workers – challenging traditional assumptions of workforce vulnerability. To address this challenge effectively, it is not enough to focus solely on health outcomes; organisational culture and employee experience must also be part of the solution.
Against this backdrop, findings from the Engage for Success (EFS) annual engagement survey highlight the critical role of employee engagement in mitigating these risks. The data reveals a strong link between low engagement, unmanageable job stress, and the risk of economic inactivity – particularly for those with long-term or work-limiting health conditions. One in four employees stated they had either a physical and/or mental health condition that was classified as long-term. Employees in this group consistently report reduced engagement and job satisfaction, often driven by unmanageable job stress, a perceived lack of managerial support, and organisational cultures that failed to prioritise employee wellbeing. One in eight employees categorised themselves as neurodivergent and expressed similar responses as employees with long-term health conditions. As a result, both employees with long-term health conditions and neurodivergence were more inclined to contemplate leaving the organisation, reinforcing the need for more inclusive and supportive workplace practices.
Survey findings highlighted a critical concern around the employee disclosure of health conditions and how they are supported in the workplace. While one in four employees reported having a physical and/or mental health condition, over a third had not disclosed it to their employer. Among employees identifying as neurodivergent, two-thirds chose not to disclose to their employer, with fear of discrimination cited as the primary reason. Even when disclosure of health conditions or neurodivergence occurred, support was often lacking. More than a third of those who shared their condition reported that no workplace accommodations were made. This lack of support had a tangible impact: engagement levels were 20 percent-points lower for those who disclosed a health condition but did not receive support, compared to their peers without health conditions. Moreover, employees without reasonable adjustments experienced unmanageable job stress three times the rate of those without work-limiting health conditions.
Work-related stress reportedly costs the UK economy an estimated £28bn a year, and its growing prevalence is a pressing concern. Survey findings reveal that unmanageable job stress is five times higher in organisations that do not prioritise the people issues. In these environments, employees report lower enjoyment in their work, viewing it as a financial obligation rather than a fulfilling experience. This erodes engagement, productivity, discretionary effort, and collaboration. In contrast, high levels of engagement can buffer the effects of workplace stress. Even under pressure, engaged employees continue to contribute ideas, support their colleagues, and maintain a sense of enjoyment in their work. What sets them apart is receiving strong managerial support, having a voice in decision-making, and trusting in ethical leadership.
The survey highlighted an additional challenge – organisations fostering a culture of presenteeism. Findings revealed that presenteeism was especially common in organisations that failed to prioritise people-related issues. Beyond its detrimental impact on engagement levels and employee wellbeing, the cost of presenteeism is estimated to be five times higher than sickness due to prolonged loss of productivity. This issue was particularly prevalent among employees with long-term health conditions, neurodivergence, and unmanageable job stress. As a result, these employees face an increased risk of further health deterioration, deeper disengagement, and loss of productivity.
The increasing costs of long-term and work-related health conditions are compounded with the productivity losses caused by low engagement and presenteeism. Employee engagement is key in mitigating these risks, but it must be supported by an inclusive culture that prioritises people and wellbeing. However, a proactive and collaborative approach is required. A coordinated effort between public policy and organisational practices with employee engagement at the heart of this response is crucial. Without this shift, employees with long-term and work-limiting health conditions risk deepening the cycle of exclusion, disengagement, and economic inactivity.
Dr Sarah Pass is Senior Lecturer in HRM at Nottingham Trent University
James Court-Smith is a data scientist, visiting Fellow at Nottingham Business School and Director at Stillae Ltd
March 2025