Income maintenance during unemployment, old age or long-term sickness is a key facet of welfare provision and an important mediatory factor in the relationship between socio-economic position and health status. Since October 2008, the main long-term sickness absence benefit in the UK (Incapacity Benefit) has been replaced by Employment Support Allowance. Despite the importance of income maintenance for health and health inequalities, this change has been largely ignored within public health circles. After outlining these reforms and providing a historical policy context, this article utilises welfare reform theory and empirical literature to argue that these changes represent a broader international transformation from welfare to workfare states, the re-emergence of labour discipline, and a political shift in how people suffering from ill health are categorised as disabled or not and perceived as 'deserving' or 'undeserving' of state support. Finally, the case is made for the need to develop a new critical public health research and practice agenda around worklessness.