Effects ofEffects of Work on HealthWork on Health

Jeremy OwenJeremy OwenArmy Professor of Occupational MedicineArmy Professor of Occupational Medicine

Royal Centre for Defence Medicineand

Institute of Occupational Health, University of Birmingham

February 2006

HEALTH >>>> HEALTH >>>> WORKWORK >>>> >>>> HEALTHHEALTH

To ignore the two way interactions between work and health is to risk To ignore the two way interactions between work and health is to risk misdiagnosis, mismanagement and overall failure to do your best for your misdiagnosis, mismanagement and overall failure to do your best for your patients and society at large.patients and society at large.

Learning PointsLearning Points Pluses and minuses of work on healthPluses and minuses of work on health

Revisit concepts of hazard and riskRevisit concepts of hazard and risk

Major UK occupational health problemsMajor UK occupational health problems

Revisit occupational historyRevisit occupational history

Supplemented by small group seminarsSupplemented by small group seminars

Effects of Work Effects of Work (On the Worker)(On the Worker)

Work provides:Work provides:• IncomeIncome• StatusStatus• PurposePurpose• InfluenceInfluence• SecuritySecurity

Work imposes:Work imposes:• CostsCosts• ConstraintsConstraints• HassleHassle• DisempowermentDisempowerment• Hazards &Hazards &• Risks to health & safetyRisks to health & safety

HazardHazard

Any exposure that might cause harmAny exposure that might cause harm

RiskRisk

The chance of that harm actually occurringThe chance of that harm actually occurring in given circumstances.in given circumstances.

HAZARDS/EXPOSURESHAZARDS/EXPOSURES

ChemicalChemical

PhysicalPhysical

Mechanical (ergonomic)Mechanical (ergonomic)

BiologicalBiological

Psycho-social/organisationalPsycho-social/organisational

EXAMPLESEXAMPLES

ChemicalChemical

PhysicalPhysical

Mechanical (ergonomic)Mechanical (ergonomic)

BiologicalBiological

Psycho-social/organisationalPsycho-social/organisational

Work-Related Ill-Health in UK

Changing nature of ‘work’Manufacturing Service IndustriesPhysical SedentaryFixed products VarietyLarge firms SMEsPaternalistic DetachedStrong Unions Reduced

Membership‘Job for Life’ Portfolio Careers

Work-Related Ill-Health in UK

Changing nature of ‘work’Long Contracts Mobile WorkforceJob Security Target DependentFull Time Part Time, ‘Flexitime’Male Workforce Diverse WorkforceRetire at 65yrs Work beyond 65yrsCultural strata More social

flexibilityWomen at home Women at Work

Work-Related Ill-Health in UK

• The Changing Workforce:– Significantly altered perceptions

• Expectations to be ‘healthy’• Lack of acceptance of ‘risk’• Insecure• Isolated• Pressurised

Work-Related Ill-Health in UK

• ‘Traditional’ Work Related Ill-Health:– Musculoskeletal– Trauma– Toxicological manifestations– …..

• ‘Modern’ Work Related Ill-Health:– Stress– PTSD– CFS– WRULD

The Scale of the Problem

• The Cost?

• The Numbers?

• The Effects?

• The Duration?

WRI costs £10 billion/yr in UK

2+ million believe they have a WRI

Cost of £434 per employee/yr

7.8 days absent per employee/yr

Top Four Illnesses/Diseases?

Musculoskeletal,

Stress,

Respiratory,

Skin Problems.

Musculoskeletal Diseases

Most common problem:

– 1.1 million people/yr

– Cost = £5.7 billion/yr

Musculoskeletal Diseases

Most frequent causes include:Most frequent causes include:

• Repetitive and heavy liftingRepetitive and heavy lifting• Bending and twistingBending and twisting• Repeating an action too frequentlyRepeating an action too frequently• Uncomfortable working positionUncomfortable working position• Exerting too much forceExerting too much force• Working too long without breaksWorking too long without breaks

Occupational Stress

Close second!

9.1 million UK workdays lost each year are 9.1 million UK workdays lost each year are attributed to stress related illnessesattributed to stress related illnesses

Cost to industry is £3.7 billionCost to industry is £3.7 billion

Costs for Govt Sick Pay + NHS is £7 billionCosts for Govt Sick Pay + NHS is £7 billion

20% of workers report high or very high levels of stress at work

Respiratory

Work related death due to lung disease (2000):

– Mesothelioma 1628– Asbestosis without meso 186– Other pneumoconiosis 279– Byssinosis 4– Allergic alveolitis 7– TOTAL 2104

OCCUPATIONAL ASTHMAOCCUPATIONAL ASTHMA

Most frequently reported occupational Most frequently reported occupational respiratory disease in Great Britainrespiratory disease in Great Britain

1500-3000 new cases a year1500-3000 new cases a year

7000 cases of work related asthma when 7000 cases of work related asthma when those whose asthma is made worse by work those whose asthma is made worse by work are addedare added

Cost Cost £1.1 billion£1.1 billion each year each year

SWORD reported cases/year SWORD reported cases/year

isocyanatesisocyanates 128128 flour or grain dustflour or grain dust 80 80 glutaraldehydeglutaraldehyde 49 49 wood dustwood dust 49 49

natural rubber latex natural rubber latex 38 38 solder/colophony 35solder/colophony 35

laboratory animals 32laboratory animals 32 glues and resinsglues and resins 30 30

OCCUPATIONAL ASTHMAOCCUPATIONAL ASTHMA

Who develops hypersensitivity is unpredictableWho develops hypersensitivity is unpredictable

The dose of exposure needed is unpredictableThe dose of exposure needed is unpredictable

Hypersensitivity is irreversibleHypersensitivity is irreversible

Removal from exposure immediately warning Removal from exposure immediately warning symptoms start may allow complete recoverysymptoms start may allow complete recovery

Cases must be reported under RIDDOR SchemeCases must be reported under RIDDOR Scheme

Skin

Work-related skin diseases:

– Self-reported prevalence

= approx 39,000

– Annual incidence reported by specialist doctors = approx 3,900

How Do You Make a Difference?How Do You Make a Difference? Prevention (Better than Cure)Prevention (Better than Cure)

Health & Safety PoliciesHealth & Safety Policies

ScreeningScreening

SurveillanceSurveillance

TreatmentTreatment

Workplace AdjustmentWorkplace Adjustment

Redeployment (Change of Work)Redeployment (Change of Work)

An occupational history is a chronological list of all the patient’s employment, expanded as necessary to detail any evidence of occupational exposure to potentially hazardous agents and resulting effects on health.

What is an Occupational History?

Why take an Occupational History?

To determine if there is evidence that:

• work is a likely cause of ill health.• work has aggravated existing ill health.• health or ill health has an effect on the

capacity for work.

The Occupational HistoryThe Occupational History

What do you do for a living?What do you do for a living?

What do you What do you actuallyactually do at work? do at work?

What do you work with?What do you work with?

How long have you been doing this type of work?How long have you been doing this type of work?

Do you have more than one job?Do you have more than one job?

Have you done any different kinds of work in the past?Have you done any different kinds of work in the past?

Have you been told that anything you use at work may make you ill?Have you been told that anything you use at work may make you ill?

Has anyone at work had the same symptoms?Has anyone at work had the same symptoms?

Do you have hobbies e.g. DIY or gardening, that may bring you intoDo you have hobbies e.g. DIY or gardening, that may bring you into contact with chemicals?contact with chemicals?

Is there an occupational health doctor or nurse at your workplace?Is there an occupational health doctor or nurse at your workplace?

OH Stakeholders

Individual

- Employee

- Patient

Work - Colleagues- Employer- Customers- Investors

- Public

Society- Community- Health Service- Country - Legislators- Media?

And don’t forget ….. YOU and I!