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January 7, 2016

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Occupational health

Occupational health and safety

Occupational health is a key priority for business.

The Health and Safety Executive (HSE) has, since the introduction of the Health and Safety at Work etc Act 1974, seemed to have been concentrating more of its efforts on managing the safety rather than health aspect of its remit. While there have been some adjustments over time for what is recorded as a workplace fatality, the organisation’s focus has been successful in reducing annual workplace fatalities from around 650 in 1974 to 144 in 2015/16 (or under 100 when adjusted to align with 1974 reporting requirements).

The HSE rightly promotes the important advances that have been made, proudly stating a positive message about the UK’s health and safety record being ‘the envy of much of the world’ and one that continues support innovation and productivity. As the organisation makes clear, its challenge going forward is to now improve even further on this impressive record. A key part of that process will see an increasing focus on occupational health to ensure British employees are given maximum protection to lower the risk of suffering a work-related illnesses, enabling them to do their jobs within the best possible environment. With 1.2 million people in 2014/15 suffering from an illness they believed was caused or made worse by their work, and thousands dying from work-related cancers – now is the time to act.

There is also a legal and moral responsibility on employers to do whatever is reasonably practicable to support this agenda and ensure they are taking all the appropriate measures to prevent work-related ill health.

In addition to compliance with general duties under the Health and Safety at Work etc Act and the Management of Health and Safety at Work Regulations 1999, some more specific legal duties are relevant to the common health problems. For example:

  • Control of Substances Hazardous to Health Regulations (COSHH) and Approved Code of Practice deals with, among other things, substances that cause asthma. This includes an extensive list ranging from chemicals used for industrial processes to everyday items found in a working environment such as the by-products of certain food types, as well as paint additives and office cleaning products. COSHH also covers fumes, dusts, vapours, gases and even nanotechnology.
  • Manual Handling Operations Regulations are relevant for many musculo-skeletal disorder (MSD) problems. Identifying work-related health risks may not be straightforward, but there are a number of sources that can be used.

In order to safeguard workers, the cause of occupational health risks must first be known. Once the main risks, which include musculo-skeletal disorders as well as potential complications caused by excessive dust and noise, are determined then action can be taken to risk assess these areas individually in the same way as safety issues.

It is important to determine not only the individuals or groups of individuals which are most likely to be exposed to these risks but also the degree to of this potential exposure and the likely consequences resulting from it. This knowledge will also be useful when recruiting new personnel or during rehabilitation for an employee who has suffered from a work-related health ailment to ensure the working environment does not adversely affect any pre-existing medical condition.

Attendance management or, more specifically, monitoring of sickness absence has increasingly become a major occupational health-related issue with many large employers. Information obtained from more tightly-managed attendance records is often an invaluable resource for a company or organisation’s Safety, Health and Environment (SHE) operation (as well as its Human Resources department) and can be very useful in spotting possible work-related health problems.

Through analysis of these records, a SHE manager can determine if there are certain jobs or parts of the workplace where absence tends to be higher which may indicate the potential of an occupational health risk within an organisation. While some degree of caution needs to be exercised when analysing absence patterns, this can unveil common issues including high levels of back pain or work related upper limb disorder symptoms to be associated with certain types of work.

More detail may be available from medically-certificated absences, which tend to be over seven days, than from self-certificated absence. However, it is important to bear in mind that absence certificates are mainly completed by GPs who have little experience or training in occupational health. Some sensitivity may also be needed about personal information for individuals that is protected by data protection laws.

As with any health and safety problems, the hierarchy of control measures in Schedule 1 of the Management of Health and Safety at Work Regulations should be followed. Where possible, removing the hazard is the best option. Reliance on individual protection through personal protective equipment should normally be a last resort.

There are many examples of successful intervention in HSE guidance. Often the process of managing occupational health only requires good communication between managers and workers. There is usually no need to employ specialist assistance or experts although involvement of occupational physicians and specialists can be cost effective in appropriate circumstances.

When expert advice is needed it may not necessarily mean that medical opinion is required. For many musculo-skeletal disorder problems, for example, the views of an ergonomist might be more appropriate or for an asthma problem, the insights of an occupational hygienist are more likely to carry greater weight.

While there are a small number of occupational safety and health advisers in operation, specialist services in this area are not well developed in the UK at present. The HSE is, however, keen to promote the development of better sources of advice and given its increasing focus in the area of occupational health as the new frontier in developing greater health and safety in UK workplaces, I suspect we will see future growth in this market.

The latest occupational health articles

Occupational health improvements

Dr Chris Ide reports on the occupational health improvements made over the past 30 years and identifies some of the future challenges.

When I graduated in 1974, I saw my future in general practice. However, after ‘house jobs’, six and a half years in the regular army and 20 months doing locum work, much of it in the Middle East, I noticed an advertisement in the British Medical Journal from the Health and Safety Executive.

They sought four employment medical advisers, one to be based in Dundee, where I lived. Since I enjoyed the undergraduate course in social and occupational medicine, I applied. Somewhat to my surprise, I was shortlisted and interviewed on my way out to Saudi Arabia. To my amazement, I was offered the job and the rest, as they say, is history.

When I started in September 1983, I suppose that I arrived at the tail end of the ‘traditional’ system, where the ‘big hitters’ of the speciality were employed by the in-house services of the nationalised industries, such as coal, steel, the utilities, railways, and civil service. In the private sector, there were the petrochemical behemoths, the pharmaceutical industry, heavy engineering, the food industry and the major retailers.

Occupational health

The recessions of the late 1970s/early 1980s and early 1990s resulted in considerable downsizing, particularly in the private sector. Reducing head-counts resulted in a corresponding diminution of need for occupational health staff, since the private sector did not envisage being a source of ‘parish relief’ for the professional classes, a view that spread into the public sector as well.

However, the need for competent occupational health advice did not diminish, and was met by the increase in the number of private sector and NHS-based occupational health providers, who sold physician/nurse/technician time to organisations presumably at a lesser cost than that of an ‘in house’ service.

It’s been an enormous privilege being an occupational physician. Looking back over the 30 years I spent in the discipline, while not everything I have touched has turned to gold, I feel a certain amount of pride in my achievements. However, I thought it appropriate to take a straw poll of colleagues in the UK, North America and elsewhere of the challenges, which face us up to the halfway point of this century.

There seemed to be a strong consensus that considerable strides had been made in controlling hazards involved with traditional manufacturing and extractive processes. Therefore, the well-known toxins like lead, mercury and arsenic, various asthmagens and physical hazards like noise and vibration appear to be causing much less disease.

In part, this could be because the hazardous processes have simply been removed to the developing world (‘out of sight, out of mind’).

The advent of disability legislation, sensibly applied, has resulted in individuals with health problems being able to enter, or remain in, the workforce, and continue to lead productive lives. This has been aided by safety advisors undertaking informed risk assessments, and involving managers and others in devising solutions, often at little cost.

Future challenges

Having slain all these dragons, what are the challenges of the future? Well, for a start, there are still the dragons. Far from being slain, they are merely dormant. For as long as employees work with lead/noise/pathogenic micro-organisms/display screen equipment/ionising radiation, etc., then the possibility of work-related disease or injury exists, unless controls remain in place and subject to increased sophistication, to continue to reduce the risk.

Strictly speaking, we have only really controlled gross disease, such as acute/chronic plumbism and erethism. For some decades, it has been known that, for example, lead affects a wide variety of biochemical, neurological, haematological and psychological systems, at blood levels far below half those which, if sustained, result in suspension of adult male workers (currently 60 ug/dl in the UK).

But how do these findings translate into impairment, if they do at all? For example, the incidence of gastro-intestinal and neurological symptoms starts to rise once the blood lead level passes 30 and 25 ug/dl respectively. [1]

When I sat in my hospital occupational health clinics, my thoughts sometimes turned to the nearby Lanarkshire or Lancashire gastro and neuro outpatient departments, where patients would be receiving their diagnosis of irritable bowel syndrome, or unexplained neuropathy.

Yet how many would be asked what they did for a living and, where appropriate, have their blood lead measured? Even when blood lead levels were as low as 10, deaths from heart disease were increased by about one third. [2]

Hearing loss has been demonstrated once blood lead levels pass 7 ug/dl, [3] so pressure is likely to continue to further reduce blood lead levels. However, heart disease is multifactorial in origin, and to what extent do these other factors affect the overall risk, and to what extent does a very small degree of hearing loss affect overall quality of life?

Hazardous materials

‘Today’s solution = tomorrow’s problem’. Substitution of hazardous materials by less hazardous ones has often been advocated, where it is not possible to eliminate the hazard. Early in the last century, polychlorinated biphenyls were introduced as insulators, following a series of disastrous underground fires in mines. However, starting in the last quarter of the 20th Century, evidence has started to accumulate with regards to their potential for causing cancers, particularly melanomas and liver tumours. [4]

Asbestos, particularly its crocidolite and amosite forms, has given rise to the greatest fatal work-related health hazard in the UK and western world, with upwards of 2,000 deaths per year in the UK alone due to mesothelioma, to which must be added the mortality from asbestos-related lung cancer, other tumours, such as those of the voice box, and asbestosis.

Ceramic fibres are frequently advised as substitutes, but although research suggests that they do not appear to be associated with any particular respiratory hazard at current levels of exposure [5], previous workers may have been exposed to higher levels, in any case, since many ceramic fibres have structural properties similar to asbestos, vigilance will have to be maintained for many years yet, in view of the known mesothelioma latency of up to 60 years.

What about nanoparticles, many of which are marketed on the basis of their being very reactive? How do they react on the surface of, or once they enter, the body? [6] Are we gathering the right health and attendance data to enable a good assessment to be made as further data accumulates?

Similarly, in terms of widespread hazards, the impact of climate change needs to be considered. Irrespective of the views one holds on the extent to which change is driven by human activity and fossil fuels use, it’s happening. Should temperatures rise then outdoor workers in agriculture and construction may become more vulnerable to skin cancers from sunlight. In the event of heavier rainfall, then greater hazard of flooding, and mud, resulting in more slips, trips and falls.

The future workforce

Finally, to quote the old Marxist agitators cry “What about the workers?” The future workforce will be unlikely to consist of homogenous groups of blue and white-collar employees. It is already morphing into a complex of multi-ethnic and multi-abled, and increasingly ageing medley, in which gender-based stereotypes will become less relevant.

While the incidence of severe and enduring mental health problems remains relatively small, according to the Labour Force Survey, stress, depression and anxiety remains a substantial perceived health hazard at work, second only to musculoskeletal disorders, but accounting for the greatest number of days lost. [7]

This diminution in the quality of working life is of at least as much relevance as (long term) harm arising from exposure to workplace hazards mentioned previously. Successfully tackling this will require safety advisors and their occupational medicine colleagues to think ‘out of the box’ to avoid medicalising matters, developing novel strategies to maintain and improve communications within and between organisations which will help reduce uncertainty by improving resilience and morale.

I’ll keep this article to find out what I should be writing should I still be around aged 96, and still working.

Chris Ide is retired and has a background in occupational medicine

References

  1. Rosenman KD, Sims A, Luo Z, et al. Occurrence of lead-related symptoms below the current occupational safety and health act allowable blood lead levels. J Occup Environ Med 2003; 45:546-55.
  2. Menke A, Munter B, Batumen V et al. Blood lead below 0.48 micromol/L (10 microg/dL) and mortality among US adults. Circulation 2006; 114:1388-94.
  3. Hwang YH et al. The association between low levels of lead in blood and occupational noise-induced hearing loss in steel workers. Sci total environ 2009; 408:43-9
  4. Prince MM, Ruder AM, Hein MJ et al. Mortality and exposure response among 14,458 electrical capacitor manufacturing workers exposed to polychlorinated biphenyls (PCBs). Environ Health Perspect. 2006; 114:1508 – 14.
  5. Greim H, Utel MJ, Maxim LD, Niebo R. Perspectives on refractory ceramic fiber (RCF) carcinogenicity: comparisons with other fibers. Inhal Toxicol. 2014 Nov; 26(13): 789-810.
  6. Magaye R, Zhou Q, Bowman L et al. Metallic nickel nanoparticles may exhibit higher carcinogenic potential than fine particles in JB6 cells. PLoS One. 2014 Apr 1; 9(4): e92418. doi: 10.1371/journal.pone.0092418. eCollection 2014.
  7. http://www.hse.gov.uk/Statistics/lfs/index.htm (accessed 4th. October 2015).

The difference between occupational health, hygiene and wellbeing in construction

Clive Johnson, head of health, safety and security at Land Securities, explains what the differences are between occupational health, hygiene and wellbeing, particularly in relation to construction.
Although the awareness and management of occupational health in construction has received far less attention than safety over the past ten to fifteen years, there is a great deal more activity now in the more enlightened areas of the industry.

The construction industry has demonstrated its ability to respond to serious injury and fatalities, as we did in 2001, when the then Deputy Prime Minister, John Prescott called the industry to arms. Thirteen years on, we are in a much better place having reduced fatalities by two thirds.

Although the industry and many of the supporting body’s couple health and safety together to manage and control both, health has traditionally taken the back seat due the cause and effect in many cases taking decades to present symptoms and unlike safety, the burden of managing health falls predominantly to the employer . For these reasons the industry must find the means to elevate the status of health and make it an equal partner to safety.

Health is the most challenging topic and where most confusion reigns. Many engaged within the industry do not understand what is required of them as an employer and couple this with insufficient occupational health resource that is familiar with construction, then it is easy to see why we struggle with a workforce that is transient in the extreme.

There is confusion within the industry between occupational health management, occupational hygiene and well-being. All have a role to play and they are complimentary in engaging employers, employees and the population at large.

Free download: Vibration at work factsheet

Download the Vibration at work factsheet which was created in partnership with Southalls for key stats, legislation and advice for health and safety practitioners.

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