From HR to public health: The shift from fixing people to fixing work

For decades, organisations have approached workplace wellbeing with good intent – but often with the wrong focus, writes Dr Kathryn Page.

When people struggle at work, we tend to ask:
How can we help people be more resilient?
What support can we offer?
What program or policy should we introduce?

These are important questions. But they are not the most important ones.

Because increasingly, the challenges we see in workplaces today – burnout, stress, disengagement – are not simply individual problems. They are system problems. And that requires a different lens.

Work is not just an HR issue. It’s a public health issue.

Public health is built on a relatively simple idea: Health is shaped not just by individual choices, but by the conditions people live and work in.

And work is one of the most significant of those conditions.

One of the most influential pieces of research in this space is the Whitehall Studies, longitudinal research that began in the 1960s, which followed British civil servants over time.

What they found was striking: there was a clear social gradient in health, including mortality. People in lower-status roles experienced significantly higher rates of illness and earlier death than those higher up the hierarchy. Importantly, this wasn’t simply explained by access to healthcare or lifestyle factors. One of the key differences was control. Those with less autonomy over their work and lower decision-making authority experienced higher levels of stress and worse health outcomes over time, including higher mortality rates.

Which tells us something critical – how work is structured, particularly the level of control people have, is not just a HR or a performance issue. It’s a health issue.

The quality of work also matters for mental health. In fact – and quite astoundingly for many people – research from Deakin University (then ANU) Professor Peter Butterworth and colleagues found that working in a poor-quality job is worse for your mental health than not having a job at all.

We also see consistent findings from job strain research: when high demands are combined with low control, the risk of mental health problems and even cardiovascular disease increases significantly – in fact, exposure to job strain has been shown to double the risk of depression.

This is a critical insight for organisations. Because it tells us that work is not neutral. It can fundamentally change the trajectory of our lives.

We’ve over-invested in coping. Under-invested in design.

HR has responded to rising mental health challenges with care and intent. Resilience training. Wellbeing programs. Employee assistance services. And these do matter. They support individuals when they need it most.

But they are largely downstream. They assume the conditions of work are fixed – and focus on helping people cope within them.

What has been comparatively underdeveloped is the upstream work: the design of work itself.

We have built systems that are very good at responding once something goes wrong.
But less mature at asking what is creating the conditions for that in the first place.

As a result, we risk medicalising what are often organisational problems.

Good people are struggling – not because they are lacking capability or resilience – but because they are working in systems that are overloaded, fragmented, and not designed for sustainable performance.

From HR thinking to public health thinking

Public health offers a powerful reframing. Rather than focusing only on response, it asks: What are the conditions that create risk? And how do we intervene earlier – at the level of design?

There are four key shifts HR leaders can take from this approach. This is not about replacing HR. It is about expanding its lens.

What this looks like in practice

Taking a public health approach to work means paying attention to the conditions that consistently show up in the research as drivers of health outcomes:

• Workload and demand – is it sustainable over time?
• Control and autonomy – do people have a say in how they work?
• Clarity and priorities – is it clear what matters most?
• Leadership and support – are expectations realistic and human?
• Recovery – is there space to rest and reset?

When these are well designed, work can be a protective factor. When they are not, they become a risk factor.

The system dynamics we often overlook

When work is poorly designed, the system-level challenges and consequences compound over time. As pressure builds, many (often well meaning) organisations respond by adding more – another process, more reporting, more oversight – rarely taking anything away. As demands continue, work becomes increasingly fragmented and complex. Capacity becomes constrained. Experienced people leave, taking capability and context with them. Those who remain carry more, often with less support and less clarity. Over time, the system becomes heavier, less efficient, and more fragile – even as individuals continue to do their best or work harder to hold it together.

Reframing the role of HR

This is where the opportunity for HR becomes both more complex – and more powerful.

HR is not just a support function. It is a system-shaping function. If work is a determinant of health, then HR plays a critical role in influencing that determinant – through job design, leadership capability, performance systems, and organisational norms.

This is not about adding more initiatives. It is about shifting the lens. From asking: How do we support people within this system? To asking: What is it about this system that needs to change?

Practical shifts HR leaders can make

The good news is the shift often starts small – and close to the work itself.

1. Start with teams, not programs: Focus on where work is actually experienced. Ask teams: What’s getting in the way of doing good work right now?
2. Start upstream: Before launching a new initiative, ask: What in the way work is currently designed might be creating this issue?
3. Look for patterns, not just cases: If multiple teams are experiencing the same pressure, treat it as a system signal.
4. Measure the conditions of work: Track workload, clarity, autonomy and recovery – not just engagement.
5. Equip leaders as work designers: Help leaders understand that they shape the experience of work every day.
6. Prioritise subtraction: Remove low-value work before adding more. Space is a design decision.
7. Treat burnout as data: See it not just as an outcome to manage, but as a signal to investigate.

A final thought

We are at an inflection point. We can continue to invest in helping people cope with work. Or we can start designing work that people don’t need to recover from quite so much. Because when we get this right, the impact goes far beyond the workplace.

Work becomes not just a source of productivity – but one of the most powerful levers we have for human health and sustainable performance. And that is a shift worth making.

Dr Kathryn Page is an organisational psychologist and author of “Good Work: Transform your Work from the Inside Out”.

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