Too Poor to Be Sick

How racial inequalities in employment are harming the health of Black, Asian and minoritised ethnic workers

The role of work in supporting health has moved into the policy spotlight. Yet despite this renewed focus, far less attention has been paid to how racial inequality in the workplace can reinforce and widen health inequalities.

"Health advantages observed in younger minoritised ethnic individuals are eroded by the realities of racism and disadvantage."

Key Findings

Drawing on national and international evidence, alongside lived experience, the analysis reveals:

  • Black and Asian workers experience health of people decades older by their 40s and 50s – yet major 2025 policy reviews such as the Employment Rights Act 2025 treats the workforce as racially uniform

  • Critical evidence gaps in national data mean racial disparities in sick pay access, sickness absence and return-to-work outcomes remain unmeasured

    Workers denied sick pay, disciplined for illness and refused reasonable adjustments for health conditions

    Without urgent intervention, early economic exit of fastest-growing segment of UK workforce threatens productivity and widens health inequalities

Recommendations

Measurement: Improve integration of ethnicity variables into national data on employment and ill-health, including quantifying racial disparities in sick pay access, fit-note use and return-to-work rates.

Design and evaluation: Assess future reforms to Statutory Sick Pay and occupational health for differential impact by ethnicity and employment type, developing co-production mechanisms with minoritised ethnic workers.

Mechanisms and lived experience: Support mixed-methods research investigating how racism and discrimination operate through employment practices, benefit eligibility and healthcare navigation.

Framing and accountability: Recognise racism as a determinant of health within work and welfare policy.

Here’s what should alarm policymakers most: we still cannot measure the full extent of the problem because national datasets do not routinely disaggregate by ethnicity.

This evidence gap is not accidental – it reflects structural racism in how we monitor workplace health and outcomes.

Picture of Jabeer Butt looking at camera.Jabeer Butt OBE, Chief Executive, Race Equality Foundation

Too Poor to Be Sick: the people behind the evidence
Real stories illustrating the impact of racial inequalities in work and health

I do feel pressure, I have to go into work and I have to keep working because most jobs won’t pay you, especially if it was retail, will only pay you until you leave. So, if you leave earlier than planned then you’re only getting paid to that time.

I remember a specific scenario. I was much younger. I called my manager, I let her know that I wouldn’t be able to come in and she said, well, you still have to come in. So, I went in and halfway through my shift, I actually collapsed on the floor, I fainted. She didn’t believe it. She said, oh, I was making it up and a customer had to be like, no, she’s not getting up. And then they had to call the ambulance. And she said, yeah, you came in, so if you feel well enough to come in, you’re well enough to work. That was the excuse.

One of the things I suffer from is sickle cell, so there [isn’t] any information about working with someone that has sickle cell so they don’t understand when you’re like, “I’m having a crisis”. They don’t understand, the amount of pain that one goes through when they have a crisis.

The only support I’ve ever had was: make sure every single day when you’re calling in sick, make sure you take a photo of a newspaper right next to your face that shows the dates so we can believe that you’re in hospital. So that’s the only support that I’ve ever been given.

It’s quite painful because you’re over-explaining, and then you go back to work and you’re over-achieving, or you’re over-pouring into your work because you don’t want to be seen as the burden or you feel like, oh, I’ve missed too many days off work. I have so much catch-up. You’re going back into work because you’re trying to please the company, you’re trying to please your manager, then you overwork yourself and then you’re back to square one. So, it’s like a repeat, circle over and over. It’s never-ending, to be honest.

If I could tell the government, previously or current, about sickness in employment, I would probably say if you want everything to be equal, if you want to be diverse, we need to ensure that everyone is also topping up on the training. Everybody understands what empathy and sympathy is. Making sure you’re also implementing it and penalising the companies

That treat people unfairly, not just really, really unfairly and maybe just having some sort of rep, not just like an umbrella, like, you know, a specific body that we can go to and we feel like we’re heard, we’re seen, our voice matters. It won’t be a body that works for the government or works for the company, but it will be someone neutral, you know, like, where you can speak, and you’re heard, and maybe they can take that to the government. They can take that concern to your company. That would be lovely.

I’ve got rheumatoid arthritis, and I suddenly couldn’t walk at all at work. When I got sick initially, I didn’t receive any financial help from my employer, due to them changing their sickness policy a year prior to me becoming sick.

Even to get sick pay from the government, you had to have three days off where there was no pay. You have to get a doctor’s note to confirm that you are genuinely sick to get pay. I don’t feel that’s a very fair system, and especially when you’ve been diagnosed to the chronic long-term illness and it’s just not going to go away in a few days.

I literally just had to talk to myself and ask, you know, why I was actually at work. I needed the money to carry on, to pay my mortgage, my student loan at the time. So, yeah, there was other people were relying on myself, and so mentally that just kept me going. Otherwise I shouldn’t have actually been at work at that point. I wasn’t 100% focused on the patient, as well as being quite unwell, as well. The only changes work had made were bringing my patients to me instead of going up and down stairs. But the time limits to see the patients were exactly the same.

I feel that my Caucasian colleagues get far greater support. They’re able to disclose their medical conditions without scrutiny, whereas myself and other minority colleagues find that we just don’t want to disclose, our conditions, illnesses. We feel they are just going to scrutinise how well we do at work. So yeah, we, well I, don’t feel like I can disclose.

If I didn’t have financial pressure, I’d probably take some time off because I feel that if I recovered quicker, I could go back to work sooner. And, I’ll just be a lot more focused at doing the job that I’m very good at. It’s just giving myself that opportunity; that break to just get myself better.

It’s tiring. It’s really, really fatiguing. There isn’t sick pay that I can rely on, or that’s going to have enough money to cover my basic everyday needs. So yeah, I just have to continue, going in as normal. So even when I couldn’t walk, my hands were hurting. I just felt like I had to be present for my patients.

So, you’re paid in full for four weeks, and then when I actually got at all that, taking it off completely. So, I had no sick pay from work. And so, when I had to stop work, there was no financial support. It’s just extremely, sort of very, very tiring to be at work when I’m not feeling well.

People’s Stories

These two anonymised pen portraits draw on the experiences shared through our research, further illustrating the real-world impact of racial inequalities in work and health.

Wendy began working in the 1970s and spent over three decades at one organisation for 30 years, building a long career in frontline roles. For much of that time she was the only Black person in her workplace, and she recalls experiencing persistent racism from colleagues and managers. Managers would often threaten her with dismissal if she voiced any concerns about her work. The strain of constant discrimination, alongside growing health problems, made working life increasingly difficult, and she eventually left the workforce in the mid-1990s after developing a severe, debilitating condition.

Her experiences with health services have been marked by misdiagnosis, dismissal, and a lack of holistic care. She was repeatedly told her symptoms were minor or unrelated, despite being in significant pain. At times, physical symptoms were minimised or explained away with comments that left her feeling unheard and judged, such as doctors offering solutions such as to just ‘take a bath’. She describes being tone-policed, not taken seriously, and navigating additional barriers such as language challenges within her family and community. She continues to live with the impact of the delayed diagnosis.

Wendy briefly returned to work more recently, taking a local job in the hope of improving her circumstances. Instead, she found herself facing unclear disciplinary action and physically demanding tasks that left her with fluid on her knees. She felt unsupported and increasingly unwell, and ultimately had to stop. Looking back, she feels that racism in her early career, the lack of proactive medical care, and the absence of culturally competent support all shaped the difficulties she faced.

packets of tablets in yellow and purple

Megan is a young Black queer woman with a wide-ranging work history across frontline service roles, community-based work, and creative freelancing living in the North West of England. She has worked consistently since her mid-teens, often balancing multiple jobs at once, including shift-based service work and community-oriented roles. Creative organising and DJing are meaningful parts of her life, giving her both income flexibility and a sense of belonging. She values work that is people-focused and purpose-driven, and she has often moved between short-term contracts, freelance roles, and part-time employment to maintain stability.

Her health and wellbeing changed significantly after she began experiencing seizures, in addition to longstanding ADHD. Before the seizures, she often struggled with lateness, focus, and exhaustion linked to ADHD, especially in roles requiring her to sit in front of a computer for extended periods of time. The onset of seizures brought new challenges, including memory difficulties, fatigue and long periods where everyday activities became difficult for her. She often felt disoriented and emotionally overwhelmed, especially in the early months, and found the process of stabilising her health to be slow and draining. Although navigating the healthcare system was frustrating at times, she has found particular support from specialist nurses who were responsive and understanding. She has struggled to engage with certain support offers such as accessing Personal Independence Payments (PIP) and Occupational Health due to the admin barriers.

Megan’s experiences of workplace support varied sharply across different employers. In one role, working in the hospitality sector for a large corporate employer, managers provide her with flexibility and proactive support, adjusting shift patterns, ensuring she is never left alone and responding empathetically when seizures occur at work or she has to cancel without much warning. This helped her feel valued and allowed her to continue working at a pace that suited her health. Whilst this work offered her a promotion and full-time position, the flexibility of her current zero hours contract suits her, allowing her to structure work around medical appointments and changes in her day-to-day capacity.

In contrast, another employer responded poorly to her health needs and proposed changes that she felt were unfair, stigmatising, and discriminatory, including attempts to reduce her responsibilities and pay under the guise of supporting her phased return to work following extended sick leave. This caused significant stress, worsened her health, and led her to pursue formal complaints and external advice. In the complaints process itself, Megan has felt as if she is being sidelined, often feeling as if people are speaking on her behalf, working for her not with her and subsequently focusing on elements of her complaint around race which are not her priority.