Why is Britain so sick?

Statistics published earlier this month revealed that the number of adults aged 16 to 64 who were not working due to long-term sickness had reached a new high of 2,829,000 by the beginning of this year.

Given that this is up by 43% compared to the same period in 2019 - and was preceded by a more or less steady decline for the 20 years prior to that - the assumption has been that we are seeing the legacy of the pandemic quite literally sucking the life out of the labour force.

But what's to blame: long Covid, a deterioration in mental health, spiralling NHS waiting lists - all of the above?

Within days, Prime Minister Rishi Sunak was pointing the finger at something else - "sick note Britain" - as he unveiled plans on April 19 for crackdown on sickness and disability benefits and the "over-medicalising the everyday challenges and worries of life".

The Herald: Prior to 2020, economic activity due to long-term sickness had been fluctuating around 2 millionPrior to 2020, economic activity due to long-term sickness had been fluctuating around 2 million (Image: Newsquest)

So what's really going on?

Even before the pandemic, Britain had a higher percentage of economic inactivity among its working age adults due to ill health compared to many EU nations, including Germany, France, and Italy.

This reflects our generally higher levels of chronic illness - diabetes, obesity, heart and lung conditions, strokes and so on - compared to our European neighbours.

What is more alarming to economists and politicians, however, is that the UK remains the only one of the G7 nations where the workforce has yet to return to pre-pandemic levels.

Overall labour market inactivity (for any reason, not just sickness) was 1.1% higher at the end of 2023 in Britain compared to the same period in 2019, whereas the United States, Canada, Japan, France, Italy and Germany had all experienced reductions in the number of people not working - ranging from 0.4% to 1.8%.

The precise role played by long Covid is difficult to gauge.

By the time the Office for National Statistics suspended its surveillance of the condition, in March 2023, there were an estimated 1.9 million people self-reporting symptoms which had persisted for more than four weeks, including 381,000 for whom their ability to complete day-to-day activities had been "limited a lot".

However, the total number of people living with long Covid appeared to be in decline at that point - down by 18% compared to August-September 2022 - in a sign that the number of people recovering may have been outnumbering new cases.

This would tie in with evidence that vaccinations help protect against long Covid and that the incidence rate was lower with the Omicron strain.


On the flipside, most healthy adults under 50 will not have had a Covid booster jag since 2021 and there are cases of people developing long Covid after a third or fourth infection, having previously recovered normally.

The sheer transmissibility of Omicron combined with a lack of mitigations also means that it is causing many more infections than the Delta or Alpha strains ever did.

A lack of ongoing surveillance for long Covid leaves us pretty much in the dark about its current prevalence.

Of course, not everyone with long Covid drops out of the labour market.

Back in November 2022 - giving evidence to Holyrood's health committee - David Freeman, head of labour market statistics at the ONS, noted that people with long Covid accounted for 5% of the economically inactive population compared to 3.3% of those in work and and 3.5% of the unemployed (out of work but seeking a job).

The Herald: The NHS cut back on elective activity during 2020 much more severely than healthcare systems in similar countriesThe NHS cut back on elective activity during 2020 much more severely than healthcare systems in similar countries (Image: Getty)

Worsening NHS waiting list backlogs are likely to be a major contributor, and one that (unlike long Covid) has affected Britain disproportionately compared to other EU and G7 nations.

The UK went into the pandemic with far less spare capacity than neighbouring health systems, which meant that it cut back on elective activity much more steeply.

According to the OECD, the number of hip replacements carried out by the NHS in 2020 compared to 2019 fell by a massive 46% versus a 19% reduction in Ireland, 12% in France, and 6.5% in Germany.

Meanwhile, knee replacements on the NHS plunged by more than 67% at the height of the pandemic compared to 25% in Sweden and 6% in Denmark.

This has left the NHS with much more catching up to do.

Statistics available for NHS Scotland show that there were more than 155,000 people waiting for an inpatient or day case procedure by the end of 2023, up from just under 80,000 in December 2019.

The number who had been waiting over a year has gone from just over 2000 to nearly 42,000 over the same period.

What is less clear from the figures is how many of these patients are of working age.

Separate data from the Private Healthcare Information Network (PHIN) shows that people in their 50s accounted for the majority of procedures performed in private hospitals last year, perhaps signalling a heightened motivation among this age group to pay to alleviate pain and disability rather than lose their income altogether.

The Herald: People in their 50s accounted for the majority of admissions to private hospitals in the UK last yearPeople in their 50s accounted for the majority of admissions to private hospitals in the UK last year (Image: PHIN)

Younger people are also dropping out, however.

Research earlier this year by the Resolution Foundation found that 5% of adults in their 20s were economically inactive last year due to ill health - more than those in their early 40s.

Poor mental health was blamed, although disability benefits paid to those aged 16 to 25 are mainly for autism, ADHD, and learning disabilities, rather than conditions such as depression or anxiety.

Overall, the number of people on disability benefits in the UK has climbed from 1.8 million in 2010 to 2.3m in 2020, before rising suddenly to 3.3m by 2024.

The majority of claimants (40%) have mental and behavioural disorders.

This is the population that the UK Government wants to cajole back into work with stricter eligibility and sanctions.

Critics suggest we might do better to invest in getting people well rather than penalising them for being sick.

Helen Barnard, director of policy at the Trussell Trust, told the Financial Times that more disabled people are turning to its food banks because they cannot afford essentials - even the bus fare to attend hospital appointments.

“We need a social security system that allows you to get better,” she added.