This article draws on the research of authors participating in this Special Issue, as well as a broader evidence review on how health, disability, labour market inequalities and other factors contribute to high levels of disability benefit (DB) claiming among certain communities. We argue that the evidence points to a complex combination of factors feeding into high levels of DB claiming in the UK and beyond, namely: geographical concentrations of health problems and disability-related barriers; gaps in employability and skills; and labour market inequalities that limit the quantity and quality of work opportunities in some regions. The article then provides a comparative, critical commentary on the evolution of activation and welfare reform policies in the UK and (briefly) Denmark – a welfare state that has experienced similarly high levels of DB claiming, but has adopted very different policy responses. Specifically, we discuss the extent to which emerging active labour market policies, occupational health services and changes to the benefit system reflect the evidence on the nature of the barriers faced by people on DBs. The article concludes by identifying recommendations for health, employment and labour market policies.