Rising ill-health and economic inactivity because of long-term sickness, UK: 2019 to 2023

• More working-age people are self-reporting long-term health conditions, with 36% saying that they had at least one long-term health condition in Quarter 1 (Jan to Mar) 2023, up from 31% in the same period in 2019 and 29% in 2016.

• The number of people economically inactive because of long-term sickness has risen to over 2.5 million people, an increase of over 400,000 since the start of the coronavirus (COVID-19) pandemic.

• For those economically inactive because of long-term sickness, nearly two-fifths (38%) reported having five or more health conditions (up from 34% in 2019), suggesting that many have interlinked and complex health issues.

• Over 1.35 million (53%) of those inactive because of long-term sickness reported that they had depression, bad nerves or anxiety in Quarter 1 2023, with the majority (over 1 million) reporting it as a secondary health condition rather than their main one.

• For those inactive because of long-term sickness and who had a main health condition that is musculoskeletal in nature, over 70% reported that they had more than one type of musculoskeletal condition.

In November 2022 we published an article about the increase in the number of people who were economically inactive because of long-term sickness. Our Economic inactivity by reason dataset (March to May 2023), shows that the number of people economically inactive because of long-term sickness is now over 2.5 million. This article aims to expand upon the insights already published, but with a particular focus around the health conditions reported by those who are inactive because of long-term sickness.

The Labour Force Survey asks respondents to report their long-term health conditions from a list of 18 different options, as shown in Section 8, Data sources and quality. Between 2016 and 2019, there was a small fall in the proportion of people who reported no health conditions, decreasing from 71% to 69%. However, from the onset of the coronavirus (COVID-19) pandemic, this downward trajectory accelerated so that in January to March 2023, only 64% of working-age people reported having no health conditions. This is an absolute drop of 2 million since the same period in 2019. Conversely, the number of people who reported having one or two health conditions has steadily increased over time, from 8.5 million (21%) in 2016 to 10.6 million (25%) in 2023.

For those inactive because of long-term sickness, there has been an increase of 277,000 (42%) people reporting five or more health conditions between 2019 and 2023, totalling 937,000 adults in 2023. Of those inactive because of long-term sickness, 38% now report they have five or more health conditions, up from 34% in 2019. There has been a larger proportion of people reporting five or more health conditions for both the youngest and oldest who are long-term sick, with 23% of those aged 16 to 34 years reporting five or more health conditions in 2023 (up from 17% in 2019) and 46% of those aged 50 to 64 years (up from 41% in 2019). The proportion that has five or more health conditions for those aged 35 to 49 years has stayed constant (31%), but there has been an increase in the proportion that has three or four conditions (29% in 2019 and 31% in 2023). This suggests that those who are inactive because of long-term sickness have increasingly complex health issues, the majority with more than one health barrier to them returning to the labour market

In 2023, the most prevalent health condition reported by the working-age population was depression, bad nerves or anxiety (5 million people, 12%). This was also the largest health condition for those who are economically inactive because of long-term sickness, with 53% (1.35 million people in 2023) reporting it as a health condition, higher than the 48% who reported it in January to March 2019. This aligns with the Opinions and Lifestyle Survey results, published in our Cost of living and depression in adults article between 29 September and 23 October 2022 where 59% of those who were inactive because of long-term sickness said they experienced moderate to severe depressive symptoms, far higher than the prevalence for those employed or self-employed (15%), or those inactive but for other reasons excluding being retired (24%).

Between 2019 and 2023, the number of people inactive because of long-term sickness who reported depression, bad nerves or anxiety rose by 386,000 (40%). Most of this increase was from people reporting it as a secondary health condition (increased 50% over the same period), whereas it only increased by 14% as a main health condition.

For those who were inactive because of long-term sickness and told us their main health condition, 1.35 million people stated they have a musculoskeletal health condition. Since 2019, problems with legs or feet rose by 243,000 (29%) and problems with back or neck rose by 217,000 (28%).

In December 2022 we published an article that looked at self-reported long-COVID in the labour market, which showed that people reporting long-COVID were more likely to be inactive (excluding retirement) compared with pre-infection. In the Labour Force Survey, respondents were not given explicit guidance on what health condition to report for coronavirus-related illnesses such as long-COVID. As a result, those with long-COVID are likely to fall into the "other health problem or disabilities" category because it includes conditions similar to long-COVID such as post-viral fatigue syndrome. As reported in our November 2022 publication, the largest main health condition reported by those who were inactive because of long-term sickness was "other health problem or disabilities", up to 394,000 people in 2023. Additionally, it increased by 53% between 2019 and 2023 as either a main or secondary health condition, with 754,000 reporting it.

Since the majority of those who are economically inactive because of long-term sickness have multiple health conditions, we have looked at the combinations of main health conditions that are self-reported with other secondary health conditions. We can do this by looking at the combinations of each of the 18 health conditions (as shown in Section 8, Data sources and quality), or at an aggregated level where the 18 health conditions are grouped into 4.

In January to March 2023, over 70% of those inactive because of long-term sickness, who had a main health condition that was musculoskeletal in nature, reported that they had more than one musculoskeletal condition. The largest combination that illustrates this is those who reported their main health condition as problems with back or neck, of whom 166,000 (58% of those with back or neck main health conditions) also reported issues with their legs or feet.

The largest combination of health conditions was those whose main health condition was "other" and also reported having depression, bad nerves or anxiety. This represented 193,000 people who were inactive because of long-term sickness. Depression, bad nerves or anxiety was also highly prevalent for adults who gave their main health conditions as mental illness (56%, 179,000 people) and chest or breathing problem (57%, 80,000 people).

Figure 5: Over 70% of those inactive because of long-term sickness and with a main health condition that is musculoskeletal self-report a further musculoskeletal condition

Combinations of health conditions for people aged 16 to 64 years and economically inactive because of long-term sickness, UK, January to March 2023

Notes:

1. Respondents were able to report multiple health conditions.
2. In 2020 the Labour Force Survey (LFS) added "autism" as an additional option when asking respondents about their health conditions. This means those who reported autism in 2020 may have listed another condition prior to this option being available.

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Long-term, self-reported ill health has been rising across the working-age population, especially since the onset of the coronavirus (COVID-19) pandemic. Also, between 2019 and 2022, the percentage of people who reported a long-lasting health condition that limits either the kind or amount of work they can do rose from 16.4% to 18.1%, and this rise in the work-limiting health conditions was the largest contributing factor to the rise in economic inactivity. For those individuals suffering with long-term health conditions who were in employment, the sickness absence rate in 2022 was 4.9%, the highest it has been since 2008 (see Figure 5 in our April article), compared with 1.5% for those in employment without a long-term health condition.

An important contribution to long-term sickness volumes has come from the large number of "baby boomers" (those born between 1946 and 1964) approaching retirement. Between 2019 and 2022 it is estimated that around 40,000 extra people would be expected to become inactive because of long-term sickness as a result of the changing age composition of the population, but the actual change over the same time period was much larger at 462,000. It is likely that this changing age composition will continue to apply an upward pressure to inactivity volumes in the next few years.

Furthermore, the NHS referral to elective treatment waiting list in England reached 7.4 million in May 2023, up from 4.6 million in January 2020. The Opinions and Lifestyle Survey on winter pressures (from 15 February to 26 February 2023) showed that 33% of those inactive (excluding retired) were waiting for NHS treatment. Of those inactive (excluding retired) and waiting for NHS treatment, 42% said that it had "strongly impacted" their lives, with 72% saying their well-being was affected and almost 50% saying their mobility was affected. For those employed and waiting for NHS treatment, 67% said that it had "strongly impacted" their lives, with 37% saying their work was affected. Of these, 9% said this had caused them to go on long-term sick leave.

Economically inactive

People 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.

Working-age population

Those aged 16 to 64 years.

Musculoskeletal health problems

This includes:

• problems or disabilities (including arthritis or rheumatism) connected with arms or hands

• problems or disabilities (including arthritis or rheumatism) connected with legs or feet

• problems or disabilities (including arthritis or rheumatism) connected with back or neck

Cardiovascular and digestive health problems

This includes:

• chest or breathing problems, asthma, bronchitis

• heart, blood pressure or blood circulation problems

• stomach, liver, kidney or digestive problems

• diabetes

Mental health problems

This includes:

• depression, bad nerves or anxiety

• mental illness, or suffer from phobia, panics or other nervous disorders

Other problems or conditions

This includes:

• progressive illness not included elsewhere (for example, cancer, multiple sclerosis, symptomatic HIV, Parkinson's disease, muscular dystrophy)

• autism (including Autism Spectrum Condition, Asperger syndrome)

• difficulty in seeing (while wearing spectacles or contact lenses)

• difficulty in hearing

• epilepsy

• severe or specific learning difficulties

• speech impediment

• severe disfigurement, skin condition, allergies

• other problems or disabilities

• people who did not disclose their health problem

Our analysis is based on data from the Labour Force Survey quarterly dataset. We have used the Quarter 1 (Jan to Mar) dataset for each year from 2016 to 2023, to make sure we are as up to date as possible.

Our previous publication was focused on respondents' main health conditions only, whereas here we have analysed all self-reported health conditions. Respondents were able to choose multiple options from this list of conditions:

• problems or disabilities (including arthritis or rheumatism) connected with arms or hands

• problems or disabilities (including arthritis or rheumatism) connected with legs or feet

• problems or disabilities (including arthritis or rheumatism) connected with back or neck

• difficulty in seeing (while wearing spectacles or contact lenses)

• difficulty in hearing

• a speech impediment

• severe disfigurement, skin conditions, allergies

• chest or breathing problems, asthma, bronchitis

• heart, blood pressure or blood circulation problems

• stomach, liver kidney or digestive problems

• diabetes

• depression, bad nerves or anxiety

• epilepsy

• severe or specific learning difficulties

• mental illness, or suffer from phobia, panics or other nervous disorders

• progressive illness not included elsewhere (for example, cancer, multiple sclerosis, symptomatic HIV, Parkinson's disease, muscular dystrophy)

• other health problems or disabilities

• autism (including Autism Spectrum Condition, Asperger syndrome)

It is important to note that "Autism" was only added as an option from 2020 onwards. This means people may have listed another condition before this option was available. We believe that this may have an impact when comparing the number of health conditions reported between 2019 and 2020, but Figure 1 shows this is very likely to be small.

In section 4, the health conditions in this list were combined into four main categories. The categories can be found in Section 7, Glossary.

The population of interest in this release includes those in the working-age range of 16 to 64 years. The pension age in the UK is currently 66 years. However, we decided to include ages up to 64 years only to be consistent with official labour market statistics and to ensure that the same cohort of working-age people would be included throughout the span of years covered (2016 to 2023).