Housing and air quality tend to dominate discussion of London’s wider determinants of health, but a third driver has grown faster than either since 2020: long-term sickness pushing working-age people out of the labour market altogether. Economic inactivity due to long-term sickness is now the single most common reason people of working age in the UK are neither employed nor looking for work — and the health conditions behind it are as revealing as the numbers themselves.
The Scale of the Problem
Nationally, the number of people economically inactive because of long-term sickness has risen to more than 2.5 million, an increase of over 400,000 since the start of the Covid-19 pandemic, and reached a record 2.8 million in the winter of 2023–24. Long-term sickness accounted for 28% of all economic inactivity by early 2023, up from 23% at the start of 2019, overtaking retirement, caring responsibilities, and full-time study as the leading cause. The trend predates the pandemic but accelerated sharply afterwards — and the UK remains the only G7 country whose employment rate has not returned to its pre-pandemic level.
The health picture underlying that statistic has also worsened. In 2023, 36% of working-age people reported at least one long-term health condition, up from 31% in 2019 and 29% in 2016. Among those who have left the workforce due to sickness specifically, nearly two in five (38%) now report five or more health conditions at once, up from 34% in 2019 — a sign that the people affected are dealing with genuinely complex, overlapping health problems rather than a single diagnosis.
Which Health Conditions Are Pushing People Out of Work
Two categories of condition dominate the data. Mental health problems — depression, anxiety, and related conditions — are now the single largest cause, reported by 53% (around 1.35 million people) of everyone economically inactive due to long-term sickness in 2023. Much of the recent growth in this figure came from mental health being reported as a secondary condition alongside something else, reinforcing the multiple-conditions pattern above.
Musculoskeletal conditions — problems with the back, neck, legs, or feet — are the second major driver, and have grown fastest of all since 2019: reports of leg or foot problems are up 29% (243,000 people) and back or neck problems up 28% (217,000 people) over that period. Cardiometabolic conditions are also cited as a significant contributor, and Long Covid is estimated to have kept up to 110,000 people out of work in the UK, a smaller but still material share of the total.
Age patterns matter too. The largest single group remains people aged 50 to 64, who made up 54% of the economically-inactive-due-to-sickness population as of late 2022. But the fastest rate of growth has been among younger adults: inactivity due to sickness rose 42% among 25–34 year-olds, compared with 16% among 50–64 year-olds, over the same period.
| What changed | Figure (2023 or as noted) | Change since 2019 |
|---|---|---|
| Share of inactive-due-to-sickness group reporting depression/anxiety | 53% (about 1.35 million people) | +40% (+386,000 people) |
| Reports of leg or foot musculoskeletal problems | — | +29% (+243,000 people) |
| Reports of back or neck musculoskeletal problems | — | +28% (+217,000 people) |
| Share of inactive-due-to-sickness group with 5+ health conditions | 38% | up from 34% |
| Inactivity growth among 25–34 year-olds vs 50–64 year-olds | — | +42% vs +16% |
London’s Pattern Is Different — But Not Better
London has its own version of this trend, with some distinctive features. Around 920,000 working-age Londoners — 15% of the total — have a long-term health condition that limits their ability to work. Economic inactivity due to long-term sickness has risen in the capital since the pandemic, but at a slower rate than in the rest of the UK, which sounds like better news than it is: London’s overall working-age population is younger and more mobile than the national average, so a slower rise in this specific measure sits alongside other pressures on the capital’s workforce.
What stands out in London’s figures is the role of mental health among younger adults. A rise in mental health conditions among young Londoners has been identified as a key factor behind the growth in work-limiting long-term sickness in the capital. The inactivity rate for people with a work-limiting mental health condition in London was 52% in 2022 — still high, though down from 65% in 2014. Musculoskeletal conditions contribute significantly too, particularly among older working-age Londoners, mirroring the national pattern but layered onto London’s specific demographic mix.
Why This Belongs in the Wider Determinants Conversation
Employment sits alongside housing and environment as one of the three pillars of the wider determinants of health identified in the Better Health for London agenda, and economic inactivity due to sickness is where all three intersect most directly. A person too unwell to work loses income, which affects housing security and diet; the resulting stress and reduced social contact can worsen the same mental and physical health conditions that caused the initial withdrawal from work, creating a cycle that is hard to interrupt without support that addresses health and employment together, rather than treating them as separate problems handled by separate systems.
Reversing this pattern is not simply a matter of clinical treatment, since the conditions driving it — mental health problems and musculoskeletal disorders — are both areas where early intervention, workplace support, and community-level care can prevent short-term sickness from becoming permanent withdrawal from the labour market. That is precisely the kind of prevention-focused, primary-and-community-care thinking that sat at the heart of the original 2014 review of London’s health system, and it remains just as relevant a decade on, applied now to a workforce that looks different from the one it was first written for.
Conclusion
The rise in economic inactivity due to long-term sickness is one of the clearest recent examples of how employment, not just housing or air quality, functions as a driver of London’s health gap. Mental health and musculoskeletal conditions are doing most of the damage, the people affected increasingly have multiple conditions rather than one, and London’s slightly slower national trend is no reason for complacency given how concentrated the effect is among its younger workers. Any serious account of London’s wider determinants of health now has to include the labour market itself as one of the places where that gap is opening.