We keep talking about growth as though it lives entirely in tax policy, trade deals and planning reform. Meanwhile, around 2.7 million working-age adults are economically inactive because of long-term sickness. That number rose sharply after 2020. Mental health accounts for a large share. Musculoskeletal conditions remain significant. Post-viral illness is part of the picture, though its precise contribution remains debated.
This is not a single-cause story. It is a systems story.
At various points, ONS surveys have estimated around 2 million people reporting ongoing symptoms after Covid infection, with several hundred thousand describing their daily activities as limited “a lot”. Many remain in work. Some reduce hours. Others move in and out of employment. What matters here is not mechanism, but function. Labour supply is not binary.
Even small shifts in functional capacity are economically material. The UK workforce numbers over 33 million. A reduction of just 1 percent in effective working hours across that base equates to the output of more than 300,000 full-time workers. At median earnings levels, that translates into several billions of pounds annually in lost output before tax effects are counted.
That is macroeconomic, not anecdotal.
Now compare political framing.
Dementia research attracts tens of millions annually from NIHR alone. That is not a criticism. Dementia imposes substantial health and social care costs. But it primarily affects older people, many of whom are already outside the labour market. Its economic impact is indirect, through care systems and family labour displacement.
Yet dementia is framed as a strategic priority.
That reflects something straightforward. Pensioners are numerous, politically engaged and economically influential as a voting cohort. A condition that affects them carries electoral weight.
By contrast, health-related inactivity among working-age adults is diffuse. It cuts across diagnoses. It lacks a single organised constituency. Its costs show up gradually in productivity statistics rather than dramatically in headlines.
The point is not to challenge the legitimacy of dementia funding. It is to observe how urgency is generated in practice.
At the same time, fiscal constraint is real. The NHS is under pressure. Waiting lists remain long. Staff shortages are persistent. No government has unlimited capacity to add new programmes without trade-offs.
So the issue is not expansion. It is alignment.
Health policy focuses on clinical outcomes. Labour policy focuses on participation rates. Treasury oversight focuses on expenditure control. What is less visible is whether restoration of working capacity is treated as a shared objective across those systems.
Current welfare structures remain largely binary. You are fit for work, or you are not. That works tolerably well for permanent incapacity. It works less well for conditions where functional capacity fluctuates over time.
Where someone can manage limited hours for a period and then relapse, the interaction between NHS care, DWP assessments and employer expectations can create friction. Attempted partial recovery can trigger reassessment, uncertainty or financial instability. That is not a moral failure. It is a design feature.
Addressing that does not require a vast new funding stream. It requires coordination. Align rehabilitation plans with benefit case management. Allow graded, flexible returns to work without repeated entitlement resets. Treat partial capacity as something to preserve rather than something to test suspiciously.
This is not about biological certainty. The underlying science is heterogeneous and still evolving. Institutions, however, cannot wait for complete mechanistic clarity before adapting to observable functional realities. In a constrained fiscal environment, avoidable labour market loss is expensive. Growth rhetoric and labour supply design should not operate in separate compartments.
Dementia demonstrates that when political urgency is strong, uncertainty does not prevent strategic framing. The question is whether erosion of working-age capacity attracts similar attention when its constituency is dispersed. That is not a partisan argument. It is an observation about incentives, and incentives, sooner or later, shape outcomes.
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