1 Introduction

The link between long-term sickness and labour market participation has become a prominent issue among UK policymakers since economic inactivity due to ill-health rose following the pandemic.[1] The latest Office for National Statistics (ONS) data showed that, in the 12 months to September 2024, 2.5m people were inactive because of long-term sickness in the UK.

Tackling health-related economic inactivity is central to the government’s approach to its Get Britain Working White Paper, with the aim of increasing the national employment rate from 75.8% to 80% in the long run[2].  This employment strategy will rely, in part, on greater devolution to local areas, to integrate health, skills, and employment support.

However, London’s population and labour market characteristics differ from the rest of the country. This means that national-level trends in long-term sickness and inactivity, may also be different in London.

GLA Economics has explored in depth the issue of long-term sickness in the London workforce, with a forthcoming report. This supplement introduces this research and summarises a few of the key findings.

Definitions

• Economically inactive people are those not in employment who have not been seeking work within the last four weeks and/or are unable to start work within the next two weeks (ONS).[3]

• A long-term health condition (LHC) is defined in the ONS Annual Population Survey as a health condition that has lasted 12 months or more.

• A work-limiting health condition (WLHC) is a long-term health condition that limits the amount and/or the type of work that someone can do. Not all long-term health conditions are work-limiting. Someone may report a work-limiting health condition and yet be in employment.

All analyses shown here have been carried by GLA Economics based on microdata from the ONS Annual Population Survey.

2 Long-term sickness and the London labour market

There has been a rising trend of health-related inactivity in the UK since around 2015, which accelerated following the pandemic (Figure A1). In London, there was a rise after the pandemic, but this was much slower than in the UK.

Figure A1. Number inactive due to long-term sickness

Beyond inactivity, 29%, or 1.8m, of London’s working-age population reported a long-term health condition in 2023, a five percentage-point (pp) rise on the decade (Figure A2). For 15% of London’s working-age population, or 920,000 people, this long-term health condition limited the kind and/or the amount of work they could do.

Figure A2. Prevalence of long-term health conditions

Both the proportions of working-age Londoners with a long-term health condition in general, and a work-limiting one in particular, were broadly stable up to the pandemic. However, there is a clear rise in these shares in London since the pandemic.

For the rest of the UK, the rise of LHCs predates the pandemic. The prevalence of WLHCs was also rising before the pandemic, although it also appears to have accelerated in the years since.

The prevalence of LHCs and WLHCs is lower in London than in the Rest of the UK. In 2023 London had the lowest prevalence of WLHCs as a share of the population of any region/country of the UK.

However, because of the size of London’s working-age population, lower rates of sickness in London compared to the rest of the UK still translate into substantial absolute numbers (Figure A3), with the second biggest total count of workers with a WLHC across all UK regions/countries. Therefore, a lower prevalence of WLHCs in London compared to the rest of the UK when expressed as a share of total population does not mean it is a small-scale issue for the capital.

Figure A3. WLHC levels by region/country

People with a WLHC in London in 2023 had an employment rate of 51%, meaning they were slightly more likely to be in work than out of work (unemployed or inactive) (Figure A4). This corresponds to about 460,000 employed Londoners with a WLHC, or about one in ten workers residing in London. This is also a sharp increase in a short time: in 2014, the employment rate of people with a WLHC in London stood at 42%.

Figure A4. Labour market participation of Londoners with WLHC

This corresponds to about 160,000 more workers with a WLHC in London in 10 years.Nonetheless, the employment gap with people without WLHCs remains very large. The employment rate of people without WLHCs stood at 79% in 2023, a 28pp difference compared to people with WLHCs.

Further, we find that people with a WLHC are slightly more likely to be in work in London than in the rest of the UK. But they tend to be, compared to employed Londoners without a WLHC, in more precarious employment, with higher rates of temporary employment, solo-self-employment, or under-employment (describing a situation in which someone desires to work more than their current hours). They are more likely to be found in lower-paid occupations too. And the share of hours of work lost through sickness that they represent is disproportionate compared to the share of workers they represent.

There is also inequality in the socio-demographic profile of people without and with WLHCs. These conditions are more prevalent, on average, for people with lower levels of education, older people, and among most ethnic minority groups in London. Our full report explores in more depth these issues of labour market and socio-demographic inequality.

3 Types of health conditions

Our full report explores in depth the links between types of conditions, socio-demographic characteristics, and labour market participation. A few key results are summarised here. Health conditions are grouped under four broad types in the data.

The most striking finding is the rise in the number of Londoners affected by a work-limiting mental health condition, as shown in Figure A5.

Figure A5. Types of WLHC in London

In 2014, about 147,000 working-age Londoners reported a work-limiting mental health condition, less than any other broad types of illnesses. In 2022 (the latest available year of data regarding illness type), around 236,000 of them did, more than any other broad type of illnesses, and an increase of nearly 62%, or 90,000 people, on the period. It is worth noting that the rising trend precedes the pandemic, starting in the middle of the 2010s.  

This has been by far the biggest increase. The period also saw a rise in “other” conditions. The number of Londoners affected by a musculoskeletal condition was, on the other hand, falling in the last 10 years, but that trend has reversed since the pandemic.

The rise in the prevalence of WLHCs has been driven by young adults in London (Figure A6).

Figure A6. Prevalence of mental health WLHC by age

In the latest data, 1 in 20 Londoners aged 16-34 reported a mental health condition limiting the kind and/or type of paid work they could do. Again, this rise pre-dates the pandemic. 

Mental health WLHCs are more prevalent among younger working-age Londoners than in older age groups. This is different from cardiovascular/lung and from musculoskeletal WLHCs, which become more prevalent as age increases. “Other” WLHCs are slightly more prevalent for 16-34 aged Londoners than for 34-44 aged Londoners, but the prevalence in both groups is lower than for the 45-54 age group and the 55-64 age group.  

The rise in mental health WLHCs among younger working-age Londoners, and the higher prevalence of other types of conditions amongst older age groups, may be related to patterns of health-related economic inactivity since the pandemic (Figures A7 and A8).

Over the last 10 years, the number of Londoners aged 16-24 who are economically inactive rose by 20,000, and the number of those economically inactive due to long-term illness rose by 14,000. The rise in long-term sickness alone hence amounts to 70% of the increase in total inactivity in this age group.

For Londoners aged 50-64, total economic inactivity rose by 30,000 people over the last 10 years, and the number economically inactive because of long-term illness rose by 35,000. So, if it was only for long-term sickness, inactivity amongst older working-age Londoners would have risen even more – it is only decreases in inactivity due to other reasons that have limited the rise.  

Figure A7. Economic inactivity and long-term sickness by age group

These results need to be put in perspective with results regarding the type of conditions affecting Londoners, which showed that most types of WLHCs were more prevalent for the oldest working-age Londoners, except for mental health, with a strong rise in mental health WLHCs among younger working-age Londoners.

It suggests that policy responses seeking to re-engage economically inactive people with long-term health issues may need to be differentiated by age group and illness type.

Another way to study this is to look at the link between labour market participation and broad illness type (Figure A8).

Inactivity rates tend to be higher for people with a mental health WLHC (52% in 2022). This is down from 65% in 2014: as the prevalence of mental health WLHC rose in London, the inactivity rate of people with WLHCs fell. But it remains the highest, compared to other types of conditions. People with musculoskeletal conditions, more prevalent among older working-age Londoners, have the second biggest rate of economic inactivity, which has rebounded since the pandemic.

Figure A8. Inactivity rates by type of condition

4 Summary

London has a lower prevalence of WLHCs in its working-age population than the rest of the UK, and a less marked rise in inactivity due to ill-health since the pandemic than the rest of the UK. Nonetheless, the WLHC prevalence has been rising in the last 10 years in London, and inactivity due to long-term sickness represents one in five inactive Londoners.

Further, lower rates still translate into substantial absolute numbers given the size of London. There is, therefore, a long-term sickness issue in London’s working-age population, with London-specific challenges.

This challenge is particularly acute for younger working-age Londoners, especially in terms of mental health, and older working-age Londoners, for physical health conditions.

While the employment rate of Londoners with WLHCs has been rising over time, it is still much below the employment rate of Londoners without WLHCs. The employment of Londoners with WLHC tends to be more precarious, concentrated in certain occupations, and is associated with more absences due to sickness.

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[1]  Economic update: Inactivity due to illness reaches record. House of Commons Library.

[2] Get Britain Working
White Paper (DWP, HMT, DfE)

[3]https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/economicinactivity#:~:text=People%20not%20in%20employment%20who,within%20the%20next%202%20weeks.