CHAPTER 32

HEALTH AND
WELL-BEING
THE OBJECTIVES OF THIS CHAPTER ARE TO:

1 Discuss the nature of health and well-being in an organisational

context
2 Outline the range of initiatives that sit within a health and well-being
agenda
3 Explain the importance of ‘good work’ and job design and its role in
well-being
4 Explore the business case for health and well-being initiatives
5 Examine criticisms of health and well-being initiatives
 Chapter 32  Health and well-being

The nature of health and well-being

The links between employee health and performance were identified long ago. Indeed, the
origins of personnel management lie with social reformers such as the Cadbury family
who, in the late nineteenth century, began to provide housing, healthcare and education
to their workforces. Welfare officers, the early incarnation of today’s HR officers, were
appointed to oversee the well-being of the workforce. Although altruism played a part in
this paternalistic approach towards employees, there was also a strong business case
underpinning these practices. Healthy and well-educated workforces are more productive
than those struggling in poor accommodation and with insufficient access to education
and healthcare. The impact of this focus on well-being on workers’ lives was substantial,
as can be seen in Cadbury’s museum in Bourneville which documents these early attempts
at improving employee health and well-being.
However, HRM’s development has had many stages and, for many years, there was
little enthusiasm to associate the function with what came to be viewed as a ‘tea and
sympathy role’. Certainly the supposed evolution of personnel into HR management in
the 1980s, and its preoccupation with the strategic aspects of business, left little room for
considerations of employee health. In recent years, however, health and well-being have
again become central to the HR agenda. CIPD, for example, has demonstrated significant
interest in health and well-being, arguing that it is wide-ranging in nature:
Given that good leadership and people management practices form the foundations of
building a healthy workplace, every employer needs to focus their attention on these
areas if they want to make a long-term and sustainable difference to people’s well-being.
(CIPD 2019)

Health and well-being thus go beyond the typically narrower concerns of absence manage-
ment to include a holistic approach to managing employees that recognises links to other
important concepts such as engagement. Although a widely agreed definition is lacking,
there is a general consensus that employee health and well-being underpins strong perfor-
mance and productivity: a sound business case clearly underlies attempts to improve the
workers’ lot.
The re-emergence of health and well-being in the HR agenda can perhaps be
explained by the changes to the employment relationship which have been widely
reported since the mid-1980s. Changes to the psychological contract have given rise to
far less job security for employees, organisational restructuring has led in many sectors
to work intensification and the negative consequences for employee morale have been
widely reported. Alongside this, there has been an explosion in stress-related illness and
absence and an increased focus on supporting mental health. An ageing workforce (see
Chapter 23) also requires greater consideration of employee health and well-being.
A need to refocus on employee well-being to prevent detriment to organisations has
become apparent. A further impetus has come from the increasing interest in corporate
social responsibility within firms. Employers have a responsibility to create healthy
workplaces for reasons beyond performance, bearing a responsibility to society to
ensure employees are well treated and healthy. Promoting the work environment as a
source of better health and improving health in the workplace acts as means to reduce
social inequality through employment.

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In the UK, these developments have coincided with government interest in health and
well-being, aimed at reducing sickness absence and tackling developing social phenomena
such as obesity. Much of this work arises from Dame Carol Black’s (2008) review ‘Working
for a Healthier Tomorrow’. The government’s response to this has been wide-ranging and
led first to the establishment of the Health, Work and Well-being Initiative, which has more
recently been replaced by the Work and Health Unit. Outcomes include the Investors in
People Health and Well-being Award and the Workplace Well-being Charter in England,
with similar initiatives in other parts of the UK. There is now also a measure that tracks
well-being at the national level (ONS 2019), complementing more traditional measures of
economic performance. Underpinning policy-maker interest is a strong rhetoric that
improving public health will increase national productivity. One obvious benefit is reducing
working days lost to sickness, which have fallen to around 4 days per employee per annum
in 2017 compared to 7 days in 1993. The emphasis within UK government programmes
has been upon proactive employee support, good employment practice to reduce prospects
of ill health and injury, and effective return to work and rehabilitation strategies. As with
many other areas of the employment relationship, the government has to a large extent
avoided regulation and exhorted employers to action based upon a business case for health
and well-being, for example, that it supports increased employee engagement (Macleod
and Clarke 2014), resilience (Brunetto et al. 2012) and retention (Soane et al. 2013).
Despite burgeoning interest, there is no widely agreed definition of health and well-
being. We take the position here that well-being comprises both employee health and hap-
piness (subjective well-being) (see, for example, Sutton and Atkinson 2014). This is
generally accepted in academic circles but, as we go on to outline in what follows, many
practitioner definitions (or at least initiatives) have a narrow focus on health. A wider defi-
nition supports the inclusion of a varied range of issues. This breadth is evident, for exam-
ple, in the Management Standards on workplace stress introduced by the Health and Safety
Executive which outline six key areas where employers and employees can work together
to reduce stress and improve well-being, as shown in the following Window on Practice.

WINDOW ON PRACTICE
HSE’s Management Standards on managing stress in the workplace

Demands – includes workload, work patterns and the work environment.

Control – how much say a person has in the way they do their work.
Support – includes the encouragement, sponsorship and resources provided by the organ-
isation, line management and colleagues.
Role – whether people understand their role within the organisation and whether the
organisation ensures that they do not have conflicting roles.
Change – how organisational change (large or small) is managed and communicated in
the organisation.
Relationships – promoting positive working to avoid conflict and dealing with unacceptable
behaviour.

Source: http://www.hse.gov.uk/stress/standards/

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 Chapter 32  Health and well-being

The Standards encourage consideration of relationships, job design, autonomy and

employee involvement and support a holistic view of well-being, notwithstanding calls
for them to be updated to reflect the better understanding of mental health that has devel-
oped in the decade or more since their introduction. Nevertheless, they support a view of
well-being that goes beyond narrow concerns of physical health to address more sophis-
ticated workplace issues.

Health and well-being initiatives

CIPD has published a great deal of work in recent years on health and well-being reflecting
growing practitioner as well as policy-maker interest in the topic. Its most recent report,
CIPD (2019) recognises the wider remit of well-being but questions whether practitioners
are delivering enough of the right kind of initiatives to substantially improve employee
health and well-being. While numbers of organisations having a health and well-being
strategy have grown to 40% from only 8% just 3 years earlier, 42% operate on an ad hoc
basis and the rest take no action at all. Data drawn from the report also confirm that the
focus remains firmly upon physical health, with a growing interest in supporting financial
well-being (Figure 32.1).

ACTIVITY 32.1
To what extent do you think that the initiatives set out in Figure 32.1 are likely
to improve employee health and well-being? Where might they be successful?
What issues might they miss?

While there is not a great deal of academic literature on the types of initiatives presented
in Figure 32.1, entering ‘employee health and well-being’ into an Internet search engine
returns a plethora of consultancies offering advice on the subject, alongside a large number
of organisations presenting their own policies and suggesting that employee health and
well-being are important to their success. The NHS’s guidance, for example, can be found
at https://www.nhsemployers.org/ and then you could search for health and well being. The
number of practices which relate to physical health is notable. After free eye tests, for exam-
ple, the most common initiative is gym membership, offered by nearly half of organisations.
A key concern here is obesity which, with its links to illnesses such as cancer and heart
disease, has emerged as one of the most significant threats to health in modern times in the
Western world. While its causes are complex, diet and exercise are thought to be two major
contributory factors and government policy has sought to encourage both individuals and
employers to adopt healthier lifestyles. This is clearly reflected in organisational policy that
is focused upon healthy eating, mechanisms to promote physical exercise such as gym mem-
bership, and other programmes to encourage fitness. Initiatives also include small numbers
of companies that are providing financial well-being schemes such as private medical insur-
ance, personal accident insurance and income protection. Indeed, financial well-being is
emerging as an area of growing importance. The meteoric rise in interest surrounding

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Health promotion

Free eye tests 70 8

In-house gym and/or subsidised gym membership 40 8

Free flu vaccinations 39 9

Health screening 31 17

Advice on healthy eating/lifestyle 41 5

Programmes to encourage physical fitness (for example walking/
31 9
pedometer initiatives such as a Fitbit or other fitness trackers)
Well-being days (for example a day devoted to promoting
32 7
health and well-being services to staff)
Regular on-site relaxation or exercise classes
25 8
(for example yoga, Pilates)
Access to complementary therapies
(for example reflexology, massage) 19 8

Employee support

Access to counselling service 70 5

Employee assistance programme 65 5

Access to physiotherapy and other therapies 33 13

Financial education (for example access to
27 7
advice/welfare loans for financial hardship)
Stop smoking support 23 7

Insurance/protection Initiatives

Private medical insurance 24 33

Long-term disability/permanent health insurance 19 15

Health cash plans 22 10

Group income protection 16 13

Dental cash plans 18 9

Personal accident insurance 14 13

Critical illness insurance 11 14

Self-funded health plans/healthcare trust 16 9

Figure 32.1
Employee well-
being initiatives For all employees Depends on grade/seniority

mental health in recent years is also reflected in a large majority offering counselling and
employee assistance programmes, and to a lesser extent relaxation classes or complimentary
therapies. The focus on mental health is a key challenge for HR practitioners.

ACTIVITY 32.2
What mental health support is offered by your organisation or one with which
you are familiar? How effective is this in creating the necessary open culture
and supportive environment?

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 Chapter 32  Health and well-being

The range of practices adopted by organisations in attempts to promote employee

health and well-being is vast, and not all are captured in Figure 32.1. Our own experiences,
and those of colleagues and other contacts, suggest that it is common for employers to
offer free cholesterol tests, cycle to work schemes, dance and yoga classes, tai-chi – the list
is seemingly endless! A narrow emphasis on physical and mental health, however, over-
looks other key aspects of employee well-being. An increasing body of research demon-
strates the impact of work overload, role conflict, lack of control or autonomy at work,
job insecurity and unsupportive working environments in reducing employee well-being
(Purcell 2014). ‘Good work’, i.e. job quality, (CIPD 2018) is important in alleviating many
of these problems and we move on to explain job design and outline its role in well-being.
First, we consider some of the ethical issues surrounding initiatives that seek to promote
well-being in the following Window on Practice.

WINDOW ON PRACTICE
Regulating well-being: sensory tracking technologies and ethics
Moore and Piwek present a fascinating discussion of the ethical implications that surround
the use of physical well-being initiatives that rely on sensory tracking technologies, for
example, step counters. Central to these are data protection and work intensification con-
cerns and the potential implications for job design and performance appraisal processes.
The authors present a scenario in which employees wear personal tracking devices
that sync to a computer and upload to a central system, providing data on stress, produc-
tive work periods, social interaction and other health diagnostics. Their primary aim is to
provide every employee with personal data and suggestions, for example, on how to
improve physical activity. An obvious outcome, however, is that the organisation has
detailed data on health and performance for each individual employee. The authors argue
that these systems already partially exist in workplaces, and their full implementation is
really not very far away. Indeed, in 2015, over half a million American companies imple-
mented wellness programmes that involved wearing personal tracking devices. Given that
there is currently no regulation of the use of the devices, a number of ethical issues arise.
Work intensification: far from supporting well-being, data from wearable tech-
nologies can be used to drive a faster work pace. Think for example of the armbands used
by workers picking stock in Amazon warehouses.
Discipline: new methods of monitoring performance and productivity offer the
potential for greater surveillance and control.
Stigma for opt out: while most companies do not mandate the use of wearable
technologies in well-being initiatives, as they become more mainstream there is a risk of
employees feeling excluded or even ostracised if they choose not to take part.
Searching for happiness: this is perhaps a dystopian ideal and, where employees
experience pain or unhappiness as a normal part of human experience, they may feel
like failures in not achieving the perfect state held out as possible by well-being
programmes.
Legal matters: there is little regulation of the holding of employee well-being data
by firms. At what point an individual’s privacy is violated is a grey area, as is the extent to
which there is consent to the data held. This is currently an area of fierce debate.
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In raising this series of ethical issues, Moore and Piwek note that there is currently
no particular body charged with addressing them. Attention is needed to the darker side
of what the authors refer to as the ‘“brave new” quantified workplace’ (2017: 314).

Source: Adapted from Moore and Piwek (2017).

‘Good work’ and well-being: job design and

job quality

Job quality is central to employee health and well-being (ACAS 2014) and is supported by
effective job design, that is, the process of putting together a range of tasks, duties and
responsibilities to create a composite for individuals to undertake in their work and to
regard as their own. It is crucial: not only is it the basis of individual satisfaction and
achievement at work, but also it is necessary to get the job done efficiently, economically,
reliably and safely. As long as there have been organisations, there has been debate on the
best way to design the jobs within them and for much of this time the interest in job design
has centred round attempts to improve employee satisfaction with the working situation.
The focus has changed from designing jobs which ensure employee compliance to design-
ing those which generate employee commitment. In this way, job design is seen to be
integral to efforts to improve employee well-being and thus organisational performance.
The most recent WERS (Van Wanrooy et al. 2013) has reinforced the relationship between
elements of job design such as job autonomy and improved employee well-being.
The first attempts at job design were influenced by F.W. Taylor and the scientific school
of management. This approach was founded on the division of labour into simple jobs
and rigid allocations of individuals to narrowly defined tasks. Concerns centred around
efficiency, time and motion studies, for example ensuring tasks were structured in a way
that allowed workers to conduct them in the most efficient manner. This led to highly
specialised jobs, workers at Ford’s factories on assembly lines each carrying out, for
example, very narrowly specified elements of the construction of a motor car. Scientific
management was premised upon the idea of ‘man as machine’, that is rational, unemo-
tional and focused upon economic concerns. Incentives, such as bonuses, were designed
to meet the extrinsic motivations of employees. Jobs were, however, routine, repetitive and
monotonous, leading to boredom and industrial unrest among workers.
The recognition that workers had needs beyond economic ones led, from the 1940s on,
to worker motivation being a key concern within job design. Abraham Maslow, for exam-
ple, suggested that there was a hierarchy of needs within workers and that job design
should meet a range of needs, such as social, rather than simply focusing on economic
concerns. In the period 1940–60, a range of motivational theories influenced job design.
We do not have the space here to provide a comprehensive review of motivation theory
and suggest the reader refers to an organisational behaviour text for further information.

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We do intend, however, to overview one of the most influential pieces of research on job
design, namely Hackman and Oldham’s (1976) Job Characteristics Model (JCM), before
moving on to discuss more recent work on job quality. Despite first appearing in the 1970s,
it has resonance and influence to this day (see e.g. Bryson et al. 2014).
The JCM specifies certain aspects that must be designed into a job in order to ensure
the positive outcomes of meaningful work, responsibility and knowledge. These include
skill variety, task identity, task significance, autonomy and feedback. Delivering these will
lead to high internal motivation and links to enhanced individual and organisational
performance.

Skill variety
Skill variety is the extent to which the tasks in a job require a range of skills and abilities.
Jobs designed in accordance with scientific management principles were highly special-
ised, requiring a narrow range of skills and abilities, and the negative outcomes arising
from the boredom and monotony created by this became evident. The JCM suggested
that jobs should require workers to use a wide range of skills and abilities and led to a
focus on job enrichment, the process of incorporating more skills and abilities into jobs.

Task identity
Task identity refers to the degree to which a job provides the opportunity to undertake a
whole and identifiable piece of work. Completing such a piece of work is critical to posi-
tive psychological outcomes, the negative impact of not doing this again being apparent
from, for example, the alienation caused by working on an assembly line. Car manufactur-
ers such as Volvo have over the years experimented with principles such as autonomous
work teams, where a team is tasked with the construction of an entire car, rather than
individuals being tasked with specified elements of it, in order to provide this task identity.
While such experiments have not been unproblematic, they are an attempt to design jobs
so as to provide workers with meaningful work.

Task significance
Task significance is the extent to which a job has an impact, whether on the organisation,
its employees or customers. The more impact a job is seen to have, the better the psycho-
logical outcomes for the worker. A key aspect of job design is thus that workers should
understand the contribution made by their job to the organisational endeavour. An oft
quoted example in this respect is the hospital cleaner who sees his or her job as helping to
deliver high-quality patient care. When conceptualised in this way, the cleaner’s job takes
on a high level of task significance.
Together, skill variety, task identity and task significance comprise the ‘meaningfulness’
of the work undertaken. Job design should aim to achieve all three in order to promote
motivation in workers and thus higher performance. Although some organisations have
worked to design jobs to achieve this, there are still many contemporary organisations
which adopt somewhat Taylorist principles. One only has to think of the level of routine
and specialisation in jobs such as call centre operatives or fast food restaurant workers to
see that the principles of the JCM are by no means universally adopted. This may go some
way to explaining the typically high level of labour turnover in such organisations.

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Autonomy
Autonomy describes the extent to which the individual undertaking the job has the discre-
tion to make decisions about how it is done, including scheduling the work and deciding
upon the procedures used to carry it out. Autonomy creates the positive outcome of
responsibility, which again influences motivation. Flattening organisation structures since
the mid-1990s have created an organisational preoccupation with worker autonomy in
the guise of ‘empowerment’. Empowerment devolves responsibility to workers and
removes the need for close supervision control – impossible given the removal or reduction
of middle managers in many organisations. More recently, the concern to create worker
autonomy has been reflected in high-performance work organisation designs focusing on
employee involvement mechanisms.

Feedback
Feedback is about receiving direct and clear information about levels of performance. This
leads to worker knowledge which again, according to the JCM, leads to higher motivation.
Krasman (2013) presents an interesting study of feedback in relation to the JCM and its
positive outcomes. It is this need for feedback which underpins many contemporary per-
formance management systems (see Chapter 11).
The JCM led to a paradigm shift in which jobs were designed which required a range
of skills and abilities, provided greater freedom to workers, who often worked in autono-
mous teams, and adopted flexible working practices. Its principles impacted on models
of the flexible firm in the 1980s, high-performance work systems in the 1990s and through
to the organisational development approaches of this century. Job design is, however, still
dependent on individual characteristics; some workers will, for example, be more receptive
to being stretched and challenged than others. Effective job design does not, however,
always guarantee high-quality work, as we outline in the following Window on Practice.

WINDOW ON PRACTICE
Job quality in the gig economy
Wood et al. (2018) examine job quality in the gig economy, that is, the use of online digital
platforms to manage the offer of (usually) short-term work opportunities. These platforms
use algorithms to allocate work and the authors argue that this creates a form of control.
For example, platform-based systems ask clients to rate workers following the completion
of the task – think feedback for Uber drivers. Algorithms rank workers, and those with the
best scores tend to be allocated most work, while work is filtered away from those with
low ratings. This is a very effective form of control, as workers are required to be focused
on client need to obtain high scores and more regular work. While on the one hand then
gig work can offer flexibility, autonomy, task variety and complexity, it often also delivers
low pay, social isolation, unpredictable working hours and a highly intensive working
experience.

Source: Wood et al. (2018).

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 Chapter 32  Health and well-being

ACTIVITY 32.3
Thinking of a job you have held, or one you have observed (e.g. your interac-
tions with workers in fast food restaurants), analyse it in terms of the Job Char-
acteristics Model. To what extent does it offer:

• skill variety
• task identity
• task significance
• autonomy
• feedback?

What are the implications of your analysis for worker motivation and
well-being?

Job quality
Work on job design began in an era of largely standard employment, i.e. full-time and
9–5. While, as we have noted above, its principles informed efforts to make firms more
flexible, for many workers an underlying standard model was presumed. By the current
point in the twenty-first century, however, this model has largely disappeared for many
workers (see Chapter 7) and emerging concern as to the negative effects of non-standard
work for workers has created increased emphasis on job quality. In the UK, this has been
termed ‘good work’ and internationally it is more typically referred to as ‘decent work’.
In the UK, we have seen the government-commissioned Taylor (2017) report, which makes
a number of proposals on how to support job quality. More widely, the International
Labour Organization (ILO) has invested substantial effort into exhorting action on deliv-
ering high-quality work and has most recently published its ‘Work for a brighter future’
report (ILO 2019). This body of research seeks to specify what constitutes a ‘good job’
and, while there is no widely held agreement on this, we draw on recent CIPD (2017)
research that specifies that job quality comprises:

• pay and other rewards

• its intrinsic characteristics (as per JCM)
• terms of employment
• health and safety
• work–life balance
• representation and voice.
We can see here that, as a result of increasing levels of non-standard work, an emphasis
on job design has been extended to include the wider employment deal. One of our key
arguments in this chapter, that we develop below, is that the offer of high-quality jobs is
central to employee well-being. Free gym membership and complimentary therapies are
unlikely to counteract the negative effects of insecure and intensive work experiences for
those working for low wages with little opportunity to influence their working day.
Nevertheless, job quality can be very subjective and it is important to recognise what
motivates and drives employees in order to meet their needs and support their well-being,
as we demonstrate in the following Window on Practice.

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WINDOW ON PRACTICE
Who determines what is ‘good’ work?
By most measures, hotel cleaners have poor quality work: it is low skilled, low paid and
often very routine and intensive. Surprisingly then research suggests that in certain hotels
in certain parts of the world, hotel cleaners can view their work as good quality. Life stage
is one explanation for this. For example, travellers often want jobs that demand little
ongoing commitment but offer an income while they pursue their travels and hobbies.
For hotels by the sea, for instance, the opportunity to surf might combine with other fac-
ets of a job to lead to it to be considered good quality. Locals might, however, have a very
different perception of hotel cleaning jobs, where they are seeking long-term, secure
employment that will support them and their families. Subjective perceptions of job qual-
ity will vary, meaning organisations must tailor their employment offer with care.

Source: Adapted from CIPD (2017).

The business case for health and well-being

Despite our own view that job quality is central to well-being, many organisations empha-
sise physical health and fitness in health and well-being initiatives. Such initiatives are not
cheap: one university spent £50,000 on a programme to encourage staff to keep fit and
this level of expenditure is not unusual. Willingness to invest relates back to the business
case promoted by UK government that we discussed earlier in the chapter. Employers
expect that there will be substantial returns on their investment, often in the form of
improved employee attendance (see Chapter 14). But returns are expected to go signifi-
cantly beyond reduced sickness absence, as we outline in Table 32.1, and recent CIPD
(2019) research suggests that between a third and a half of organisations believe that
health and well-being programmes have improved employee engagement, made their
workplaces more inclusive and reduced sickness absence.

Table 32.1 Benefits of health and well-being initiatives

Recruitment
Improved performance
Competitive advantage
Positive employee attitudes
Retention
Many organisations promote their health and well-being policies in order to
attract applicants for vacancies that they advertise. They seek to be ‘employers
of choice’ in demonstrating concern for employees
Achieved through more productive employees and better service via a reduced
dependence on replacement employees
Some firms argue that investing in health and well-being helps to build
competitive advantage through employees, i.e. other firms struggle to
replicate the workforce quality that results
Employees will be more engaged, committed and contented and these positive
employee attitudes have been demonstrated to be performance enhancing
Fewer employees will be lost due to ill health and intention to quit employment
is likely to be reduced as a result of positive employee attitudes

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Criticisms of health and well-being initiatives

There are a variety of criticisms of health and well-being initiatives, ranging from ques-
tions of definition to challenges of HR’s conception of the issue. While health and well-
being programmes have grown in popularity in recent years, some argue that they contain
little new, rather that they are a rebranding of absence management programmes. Even
where they are seen to contain practices of merit, lack of resources or senior management
buy-in can lead them to be largely ineffective. Such initiatives may also be beyond the
financial means of many smaller firms, which form the majority of organisations.
A further concern is the extent to which organisations have the right to interfere in
employees’ lives. While employers may have a responsibility to tackle work-related stress,
there is an argument that an employee’s weight and fitness levels are nobody’s business but
the employee’s own. Indeed, many employees have expressed concern about information
obtained by employers as part of these programmes being put to inappropriate use, in, for
example, redundancy or promotion selection decisions. When Walmart launched its well-
ness campaign, requiring employees to volunteer information on weight and take steps to
reduce this if appropriate, there were accusations of heavy-handedness and even fascism
from employees and their representatives.
The major criticism of health and well-being initiatives as conceived by the HR com-
munity, however, is their narrow focus on concerns such as fitness and healthy eating (see
for example CIPD 2019). As we noted earlier, academic treatments of health and well-
being take a much wider view on what it constitutes. Recent work, for example, has
defined employee well-being as a combination of employee happiness, health and relation-
ships (see, for example, Peccei et al. 2013) and academic publications on the subject rarely
concern the kinds of initiatives outlined earlier. Rather, they consider issues such as job
design and the extent to which workers have autonomy and experience job satisfaction
(Sutton and Atkinson 2014). It has been suggested that narrow approaches are a facade
to conceal the fact that the employer is seeking to get more out of employees for less:
Overall, ‘wellness’ is a sham. It is aimed at distracting attention from more stressful work,
more bullying and the weakness of unions which means that workers have less ‘voice’ at
work. (Newman 2010: 36)

It is ironic, as we outline in the following Window on Practice, that many employees have
insufficient time to engage with common health and well-being initiatives.

WINDOW ON PRACTICE
Too busy for well-being
A recent study argues that organisations need to create workplaces which provide the
time and space to lead healthy lives. Over one third of the study’s participants said that
they were too busy to engage in health and well-being activities and many do little or no
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physical exercise nor commit time to mental well-being practices, although some did seek
to address signs of stress in themselves. Organisational support in creating an appropriate
environment is essential to avoiding the diseases that could result.

Source: Paton (2015).

A final concern is the effectiveness of the business case that underpins health and well-
being. Hamilton (CIPD 2016), for example, argues that the business case is not easy to
establish, particularly as recent research argues for complex measures that combine evalu-
ation (e.g. job satisfaction), experiential issues (e.g. happiness and stress) and eudemonic
issues (e.g. how worthwhile is job/career). Bryson et al. (2014) further suggest that many
organisations do not understand the business case and, perhaps more problematically, also
argue that it may not hold good where staff are unskilled and can be easily replaced, i.e.
labour turnover is less costly than health and well-being interventions. Employee cynicism
is also a concern where the fundamentals of good quality jobs are not in place. A recent
CIPD blog, for example, highlighted the practice of providing free pizza when asking
people to work late, but a long-hours culture is hardly likely to promote well-being.
Our argument thus far has been that current HR initiatives are too narrowly drawn and
an article in the UK higher-education press makes the point strongly that there is more to
health and well-being than massage and free fruit (Newman 2010). It may also be that this
is becoming apparent to HR practitioners and CIPD’s most recent report (2019) certainly
seeks to widen the agenda. In the Window on Practice below, we draw from recent articles
in People Management, all of which support the argument that a narrow focus on physical
and mental health is unhelpful and that the HR perspective on health and well-being needs
to be reconsidered. A greater focus is needed on the fundamentals of the workplace that
may create poor health and well-being, rather than presenting solutions to problems that
already exist.

WINDOW ON PRACTICE
How effective are current health and well-being programmes?
A raft of criticisms of health and well-being programmes has emerged in recent years.
Cary Cooper, CIPD president, for example, has argued that ‘free sushi’ at work will not
address mental health problems (Brown 2018a). Cooper urges employers to identify what
is damaging mental health and drive culture change to address this. In similar vein, Baska
(2019) argues that ‘mindfulness training and massages at lunch’ will not change workplace
culture. Finally, Whitehouse (2019) suggests that there is more to well-being than ‘free
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fruit’ Fridays. Central to all these criticisms is the idea that these initiatives need a wider
scope. Cooper exhorts organisations to survey employees to find out their views on their
line managers, working hours, work–life balance and other important workplace issues. It
is in tackling these issues, he argues, that organisations will shift culture and improve
employee health and well-being.

ACTIVITY 32.4
What are the key causes of reduced productivity and/or commitment in an
organisation with which you are familiar? To what extent do you think that
these issues will be improved or resolved by the initiatives outlined in
Figure 32.1?

SUMMARY PROPOSITIONS

32.1. The links between health and well-being and employee performance were identi-
fied long ago, although there was little emphasis on them from an HR perspective
for much of the twentieth century.
32.2. For more than a decade there has been a substantial increase in interest in employee
health and well-being from both an organisation and a government perspective.
This has been driven by social, demographic, economic and political changes.
32.3. Initiatives within a health and well-being policy have typically focused narrowly on
employees’ physical and mental health. This focus has attracted a great deal of
criticism.
32.4. Job quality and effective job design are essential to employee health and
well-being.
32.5. It is suggested that health and well-being initiatives have a range of positive out-
comes including improvements in recruitment, performance, engagement and
retention, more positive employee attitudes and enhanced competitive
advantage.
32.6. There are many criticisms of the narrow HR approach to health and well-being.
These include assertions that such approaches differ little from traditional absence
management, are likely to lack management buy-in and are financially beyond the
reach of the many smaller firms in the economy. A business case approach may also
be questionable.
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➤ 32.7. Other concerns surround the argument that an employee’s health is no concern of
the employer and, most fundamentally, that health and well-being initiatives often
tackle the symptoms of poor employment practice. Better job design and more
worker autonomy may be much more effective in improving the lot of the employee.
32.8. There is some evidence that HR practitioners are beginning to recognise the need
for wider conceptions of health and well-being.

GENERAL DISCUSSION TOPICS

1. ‘The positive outcomes from health and well-being initiatives justify their significant
cost.’ Discuss this statement.
2. ‘An organisation does not have the right to concern itself with the weight and fitness
levels of its employees.’ To what extent do you agree with this statement?
3. Evaluate the suggestion that organisations would obtain more significant benefits
from designing jobs well than from providing access to free fruit and low-cost gym
membership.

THEORY INTO PRACTICE

‘Woeful ignorance’ over worker well-being must end

Brown reports on a British Safety Council study that warns that employer’s good intentions
could lead to ineffective employee well-being initiatives. Despite their enthusiasm, employers
are often genuinely ignorant as to what will make a difference to employee health and well-
being. The study calls for rigorous, evidence-based workplace interventions. Other research
by the CIPD has demonstrated that line managers are often ill-equipped to deal with health
and well-being matters, despite good leadership and management practices being the founda-
tion of healthy workplaces. Additionally, initiatives are often one off and stand-alone rather
than integrated into organisational processes. CIPD recommends that employees should be
invited to design health and well-being initiatives, that line managers should be trained in their
use and that attention should be paid to job quality. Perhaps unsurprisingly, many organisations
do not evaluate their health and well-being initiatives. CIPD also recommends that
organisations need to be clear about what they are trying to achieve, and whether they have
achieved it, to build a business case for ongoing investment. ➤

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➤
Questions
1 To what extent do you agree employers do not understand how to improve health and
well-being?
2 What steps can be taken build effective health and well-being initiatives? How effective are
these likely to be?
3 Why is it important to build a business case for health and well-being initiatives? What
evaluation measures could support these?

Source: Brown (2018b).

FURTHER READING
CIPD (2019) Health and Wellbeing at Work. London: CIPD.
This is the latest report on organisations’ engagement with health and well-being. It charts substan-
tial progress over a period of just a few years, but nevertheless demonstrates that much remains to
be done.

CIPD (2017) Understanding and Measuring Job Quality: A Thematic Literature Review and CIPD
(2018) Understanding and Measuring Job Quality: Indicators of Job Quality. London: CIPD.
These two reports provide first an in-depth consideration of job quality research to establish a
working definition of job quality and, second, mechanisms by which organisations can measure job
quality.

Foster, D. (2017) ‘The health and well-being at work agenda: good news for (disabled) workers or
just a capital idea?’, Work Employment and Society, Vol. 32, pp. 186–197.
Foster argues that health and well-being initiatives are increasingly used to replace the term ‘dis-
ability’ which is often considered (wrongly she argues) a negative descriptor. She challenges the
assumption that these initiatives are inherently positive and suggests that they reinforce the norms
of able-bodiness and medicalise stress. She argues instead for a social model of disability and work-
place well-being to focus debate on the causes of ill-health and disability.

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