Work and health communities
I caught up with Prof Kim Burton and Dr Brian Douglas to discuss what we could learn from the history of work and health communities in the UK.
The social determinants of health are by no means a new concept. Neither is the role work can play in elevating the social determinants. There have been iterations on work and health communities as part of workers’ compensation packages for decades. Famously, George Cadbury established Bourneville, a residential and recreational village for his Birmingham workforce. Physical activity was at the centre of the model village which was designed to encourage the residents to undertake plenty of outdoor sports.
Sir Titus Salt also founded a model village for his textile factory workers, providing them with a hospital as well as education and other community benefits to health. Salts Mill and Saltaire still exist, and is now home to a David Hockney gallery. Here’s his painting of the mill.
In another historical example local to Prof Kim Burton, the Huddersfield Dispensary was a room above a pub in a cobbled yard that was one of the first examples of charitable healthcare. Within a few years it had become a hospital half a mile away, the Huddersfield Infirmary, which was funded by wealthy local mill owners. The catalyst for the new building was a serious workplace accident involving several workers, and the hospital was initially used solely for acute care with the focus on treating workplace injuries. A very early charitable occupational healthcare model.
Reversing the concept of work and health communities, the psychiatric asylum system eventually built out therapeutic communities where work began to feature as part of recovery and staying well. Psychiatric care has a dark history but as leadership and evidence evolved conditions improved. Therapeutic employment was adopted at Hanwell Asylum (incidentally the forerunner to the St Bernard’s site of the London mental health Trust where I currently deliver occupational health support) by the mid 1830s. When social campaigner Harriet Martineau visited in 1834 she saw the value of work in treatment and recovery “In the bakehouse… are a company of patients, kneading their dough; and in the wash-house and laundry, many more, equally busy, who would be tearing their clothes to pieces if there was not the mangle to be turned.”
When the asylums closed and community services were first developed, attempts were made to replicate occupational activities in the community. Dr Brian Douglas recalls visiting factories in Hackney employing those recovering from mental illness during his psychiatric training. These schemes gradually closed, and patients were expected to use the same return to work infrastructure as the general population. This does not necessarily provide a slower more structured approach that can be advantageous in community rehabilitation.
There is good evidence that allowing patients longer periods of quality rehabilitation in safe environments pays dividends in reducing symptoms, helping them to function and return to the community. The investment pays for itself in the longer term due to reduced need of acute mental health services and social interventions. Perhaps a third of the current prison population have mental illness and could benefit more from a rehabilitation approach. Therapeutic employment could be part of the solution, and the need for a rethink is greater than ever with a prison population of close to 100 000 and only around 1000 vacancies on the estate.
Lara’s take
The relationship between work and health is powerful. Historically it has been leveraged bilaterally.
Employers investing in worker health to elevate social determinants and productivity.
Health services rolling out vocational rehabilitation and therapeutic employment with the benefits spanning social capital, purpose and productivity.
There are lessons for our future here.