Alcohol use and the link between financial, physical & mental wellbeing
The links between financial wellbeing and physical and mental health represents a huge and complex area of debate. Financial wellbeing still lacks an official definition, let alone a standard measure.
More often than not it’s associated with saving, investing and managing debt. But there’s an aspect that’s often overlooked: how an individual’s background, upbringing and life choices - all things impacted by financial advantage or disadvantage - affect their mental and physical health.
To that end, and to keep things simple, this article will focus on one issue only: namely alcohol use. We’ll investigate the way in which the financial, physical and psychological can and do interact, and look at the knock-on effect for employers.
For a start, alcohol use is a risk factor associated with disease. Public Health England (PHE) states in its 2017 Health Profile for England that alcohol use is a proven behavioral factor for mental ill-health and acute medical conditions (specifically stroke, heart attack and cancer).
Alongside the obvious implications for individuals, from an employer perspective it’s noteworthy that all of these conditions represent the top causes of long-term sickness absence, according to the Chartered Institute of Personnel and Development (CIPD) in its most recent Absence Management Survey.
An uneven impact
What’s more, alcohol use represents an inequality issue. NHS Digital reported in 2012 that people who are in managerial or professional roles are more likely to drink more, and more often, compared to people in routine or manual roles. Yet the latter will experience more social and economic consequences.
The report states: “People who are poor or living in poverty may be less able to avoid or buffer these consequences and are at greater risk of marginalisation because of their drinking behaviours than people who are more affluent.”
A more recent study published last year in The Lancet went further. It found a “marked link” between socioeconomic status and the actual harm caused by drinking excessively.
The report, by the University of Glasgow, found that although alcohol consumption levels across different socioeconomic groups don’t vary markedly, harm from alcohol - based on deaths and hospitalisations - is greater in those living in poorer areas or who have a lower income, fewer qualifications or a manual occupation.
The report concludes: “Experiencing poverty may impact on health, not only through leading an unhealthy lifestyle but also as a direct consequence of poor material circumstances and psychosocial stresses.Poverty may therefore reduce resilience to disease, predisposing people to greater health harms of alcohol.”
Nature or nurture?
It’s widely accepted that health is largely determined by genetics and access to healthcare. But, according to PHE, more important influencers are the physical, social and economic conditions in which individuals are born, raised and live. These are the things that lead to inequalities.
On lifestyle risk factors associated with disease, PHE reported big variations across the most and least deprived areas of the UK for smoking, eating at least five portions of fruit and vegetables a day and inactivity. Interestingly though, for ‘excess weight’ there was little variation.
Significant progress is being made on public health. The prevalence of smoking in the UK continues to decline and is among the lowest in Europe at 17% (although 6% of the adult population now use e-cigarettes, up from 1.7% five years ago, according to data from Action on Smoking and Health). Also mortality rates for heart disease and stroke have reduced by half since 2001.
Healthy life expectancy
Similar public health achievements are shared by many other developed countries. However, the UK and England are still subject to relatively high levels of health inequality in comparison to EU countries, according to data from PHE. Those from more disadvantaged backgrounds can expect to spend nearly a third of their lives in poor health, compared with about a sixth for those in the least deprived areas.
For example, life expectancy at birth for men living in Rutland, a rural county in the East Midlands, is 82.1 years and individuals can expect 68.8 of those years to be healthy (a difference of 13.3 years). In contrast, men living in Nottingham are estimated to have a life expectancy of 77 years: 57.4 of which will be in good health (a difference of 19.6 years).
PHE reports that almost half the gap in life expectancy between the most and least deprived areas in England is due to excess deaths from circulatory disease (heart attack and stroke) and cancer: diseases that have behavioral risks associated, primarily diet and tobacco smoking.
Considerations for employers
The knock-on effect for sickness absence is marked. A study published in January 2018 by BioMed Central, which provides open access to scientific research, investigated the relationship between sickness absence and different alcohol use histories (lifelong abstainers, former drinkers, people with clinical alcohol use disorders).
It found that during an average 10-year follow-up, 56% of the participants had at least one long-term sickness absence period, plus increased risk of absence due to mental disorders. This result was specifically confined to high volume drinkers and former drinkers: groups that also represented strong determinants of disability retirement due to mental disorders.
Currently, around 1.4% of the adult UK population is addicted to alcohol and in need of specialist treatment, according to the latest national statistics. Alcohol is a depressant and can affect long-term mental health – as highlighted on the Drinkaware website - which is further exacerbated by the common social problems: workplace absence; unemployment; divorce; and domestic abuse.
The family also suffers. Living with a high-volume drinker or addict can cause mental anguish in addition to poor financial health in respect of the entire household.
From an employer perspective it would seem wise to identify people with excessive and/or problematic alcohol use as part of routine absence management monitoring and early intervention. Mapping and supporting individuals’ mental health in this way may help prevent sickness absences.
Also, any initiative to raise awareness of financial of mental wellbeing – or both - in the workplace should be brave enough to help break down the taboos of addiction and the impact it has on the mind and the pocket.
Communications, education and training are key.
On that note, it’s worth considering the workplace as a ‘community’, with people of various ages, beliefs, home lives, interests, qualifications, fitness levels, stress resilience levels. Whilst most workplaces now provide access to a wide range of health and wellbeing services, education and awareness in a way that resonates with everyone - in terms of the language used and communication channels leveraged - can often be lacking.
In order to ensure engagement with the services available, this needs to change. Especially considering the ageing population and longer working lives.
In short, it’s important to improve health - and work ‘ability’ - by minimising those things that stop people working.