Effects of Work on Health

1. Effects of Work on Health Jeremy Owen Army Professor of Occupational Medicine Royal Centre for Defence Medicine and Institute of Occupational Health, University of Birmingham February 2006

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

3. Learning Points • Pluses and minuses of work on health • Revisit concepts of hazard and risk • Major UK occupational health problems • Revisit occupational history • Supplemented by small group seminars

4. Work provides: Income Status Purpose Influence Security Work imposes: Costs Constraints Hassle Disempowerment Hazards & Risks to health & safety Effects of Work (On the Worker)

5. Hazard Any exposure that might cause harm

6. Risk The chance of that harm actually occurring in given circumstances.

7. HAZARDS/EXPOSURES • Chemical • Physical • Mechanical (ergonomic) • Biological • Psycho-social/organisational

8. EXAMPLES • Chemical • Physical • Mechanical (ergonomic) • Biological • Psycho-social/organisational

9. Work-Related Ill-Health in UK Changing nature of ‘work’ Manufacturing  Service Industries Physical  Sedentary Fixed products  Variety Large firms  SMEs Paternalistic  Detached Strong Unions  Reduced Membership ‘Job for Life’  Portfolio Careers

10. Work-Related Ill-Health in UK Changing nature of ‘work’ Long Contracts  Mobile Workforce Job Security  Target Dependent Full Time  Part Time, ‘Flexitime’ Male Workforce  Diverse Workforce Retire at 65yrs  Work beyond 65yrs Cultural strata  More social flexibility Women at home  Women at Work

11. Work-Related Ill-Health in UK • The Changing Workforce: • Significantly altered perceptions • Expectations to be ‘healthy’ • Lack of acceptance of ‘risk’ • Insecure • Isolated • Pressurised

12. Work-Related Ill-Health in UK • ‘Traditional’ Work Related Ill-Health: • Musculoskeletal • Trauma • Toxicological manifestations • ….. • ‘Modern’ Work Related Ill-Health: • Stress • PTSD • CFS • WRULD

13. The Scale of the Problem WRI costs £10 billion/yr in UK 2+ millionbelieve they have a WRI Cost of £434 per employee/yr 7.8 days absent per employee/yr • The Cost? • The Numbers? • The Effects? • The Duration?

14. Top Four Illnesses/Diseases? Musculoskeletal, Stress, Respiratory, Skin Problems.

15. Musculoskeletal Diseases Most common problem: • 1.1 million people/yr • Cost = £5.7 billion/yr

16. Musculoskeletal Diseases • Most frequent causes include: • Repetitive and heavy lifting • Bending and twisting • Repeating an action too frequently • Uncomfortable working position • Exerting too much force • Working too long without breaks

17. Occupational Stress Close second! 9.1 million UK workdays lost each year are attributed to stress related illnesses Cost to industry is £3.7 billion Costs for Govt Sick Pay + NHS is £7 billion 20% of workers report high or very high levels of stress at work

18. 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

19. OCCUPATIONAL ASTHMA • Most frequently reported occupational respiratory disease in Great Britain • 1500-3000 new cases a year • 7000 cases of work related asthma when those whose asthma is made worse by work are added • Cost £1.1 billion each year

20. SWORD reported cases/year • isocyanates 128 • flour or grain dust 80 • glutaraldehyde 49 • wood dust 49 • natural rubber latex 38 • solder/colophony 35 • laboratory animals 32 • glues and resins 30

21. OCCUPATIONAL ASTHMA • Who develops hypersensitivity is unpredictable • The dose of exposure needed is unpredictable • Hypersensitivity is irreversible • Removal from exposure immediately warning symptoms start may allow complete recovery • Cases must be reported under RIDDOR Scheme

22. Skin Work-related skin diseases: • Self-reported prevalence = approx 39,000 • Annual incidence reported by specialist doctors = approx 3,900

23. How Do You Make a Difference? • Prevention (Better than Cure) • Health & Safety Policies • Screening • Surveillance • Treatment • Workplace Adjustment • Redeployment (Change of Work)

24. What is an Occupational History? An occupational history is a chronological list of all the patient’semployment, expanded as necessary to detail anyevidenceof occupationalexposureto potentiallyhazardous agentsand resultingeffectson health.

25. 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 hasan effect on the capacity for work.

26. The Occupational History • What do you do for a living? • What do you actually do at work? • What do you work with? • How long have you been doing this type of work? • Do you have more than one job? • 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? • Has anyone at work had the same symptoms? • Do you have hobbies e.g. DIY or gardening, that may bring you into contact with chemicals? • Is there an occupational health doctor or nurse at your workplace?

27. And don’t forget ….. YOU and I! OH Stakeholders Individual • Employee • Patient Work • Colleagues • Employer • Customers • Investors • Public Society • Community • Health Service • Country • Legislators • Media?