Is President Biden fit to run for office from a health perspective? If not, is he fit to be in post now? What about Donald Trump’s fitness to run for office? These questions have dogged the US presidential race and have gathered considerable momentum in the media because they centre around a position that wields huge power. But there are many examples of lower profile roles where a person’s fitness for work also has a large impact and repercussions for the wider public.
Aside from a few exceptions when a health check before appointment is mandatory,1 most job roles generally do not consider the health aspect of fitness for work in their application process. The public visibility of a role such as the US presidency adds further scrutiny to a candidate’s fitness to work and some would argue that this is warranted when it’s for a position with high public influence. As stakeholders in the US government, the public have a right to raise concerns about a candidate’s ability to hold office. The question then becomes what is the best way to investigate external concerns around a person’s fitness for the role on the basis of health while maintaining privacy and protecting health information, and to what extent should the outcome of such an assessment be publicly communicated.
When it comes to fitness for work assessments, as well as disability law in the UK and the US,23 function is the most important metric, rather than clinical diagnosis or age. The form that assessment takes is nuanced and varies according to the role. Workplace adjustments and accommodations can help map a person’s function to tasks. Arguably, there is no reason why positions of power should be any different. Is it, for example, a dealbreaker for the leader of an organisation to chair 8 am meetings if mornings are a difficult time of day—because of diurnal symptoms or treatment side effects? If not, workarounds should be possible with appropriate accommodations. Furthermore, health and workplace demands are rarely static over time, which means reassessment is a key principle in decisions about fitness for work.
What happens in private sector organisations can remain behind closed doors to a greater extent, but the public may still need routes to raise concerns about an individual’s health at work. Take, for example, health concerns raised about a driver for Uber or a pharmacist handing out prescriptions. When the stakes are high, regulation becomes an increasingly important tool for making judgments about a person’s fitness for a role, just as it does for other qualities such as competency.
A proactive approach
Organisations can take a proactive approach to fitness for work by obtaining a thorough baseline health assessment. This sets the tone, enables early support to optimise health for work, and opens up dialogue between individual, organisation, and regulator as early as possible. This said, reactionary mechanisms are still necessary. If serious concerns are raised about an individual’s fitness for their role—whether by themselves, coworkers, or the public—organisations need to have a route to triage, assessment, and outcome. But there are disadvantages to being reactionary when health problems emerge in the workplace. Peers and senior managers may observe that a colleague’s health is affecting their ability to carry out their job, but converting these concerns into action requires communication and trust. This can be complex from a human resources perspective, even in the best organisational climate. In all but a handful of cases where professional regulation or the law applies,45 the individual with the health issue themselves must be willing to seek help to make progress.
Being proactive rather than reactive is also a complicated balancing act. It requires early (ideally pre-employment) disclosure, routes to support to optimise workplace health, and clear policies to hold these in place. The result can be bureaucratic at best and punitive at worst, potentially putting candidates off opportunities and stifling workplace diversity and innovation at the cost of organisational as well as individual outcomes.
The relationship between health and work will become increasingly relevant across global economies. Our populations are getting sicker,6 with more people living with long term health conditions and disabilities. Demographic shifts are also pushing up the upper bounds of working age, and many people work well beyond state retirement age—including both US presidential candidates.7 Employers should invest in a proactive approach to health at work, which will help to contain risk to all stakeholders, including the organisation. Doing this well requires resources to enable an organisation to facilitate a reasonable degree of flexibility around workplace accommodations, and cultural understanding of why this is important and how it adds value.
The question of fitness for work is most visible in positions of power, but it has widespread relevance. In fact, it is the least empowered workers—such as those in insecure employment—who are most vulnerable given they have minimal support navigating problems at the health and work interface.8 These shortcomings can harm the organisation and the individual, and can potentially have grave consequences for the wider community when cases have a bearing on public safety.
