Too Poor to Be Sick

How structural racism connects poor-quality work, inadequate sick pay and early workforce exit

“Report cover featuring the title ‘Too Poor to Be Sick: Race, work and ill-health’, with the Race Equality Foundation logo in the top corner, a grey-toned background image, and a purple and yellow design band across the lower section listing the authors’ names.”

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.

Too Poor to Be Sick: Race, Work and Ill-Health, is a report and major evidence contribution on work, ill-health and racial inequality.

 

Key Findings

Drawing on national and international evidence, lived experience its 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, required to send hospital photos with same-day newspapers to prove they’re unwell
  • Without urgent intervention, early economic exit of fastest-growing segment of UK workforce threatens productivity and widens health inequalities

Lived Experience Vignettes

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.

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.

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

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