Effects of

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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
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HEALTH gtgtgtgt WORK gtgtgtgt 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.
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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

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Effects of Work (On the Worker)

• Work provides
• Income
• Status
• Purpose
• Influence
• Security

• Work imposes
• Costs
• Constraints
• Hassle
• Disempowerment
• Hazards
• Risks to health safety

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Hazard Any exposure that might cause harm
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Risk The chance of that harm actually
occurring in given circumstances.
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HAZARDS/EXPOSURES

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

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EXAMPLES

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

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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

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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

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Work-Related Ill-Health in UK

• The Changing Workforce
• Significantly altered perceptions
• Expectations to be healthy
• Lack of acceptance of risk
• Insecure
• Isolated
• Pressurised

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Work-Related Ill-Health in UK

• Traditional Work Related Ill-Health
• Musculoskeletal
• Trauma
• Toxicological manifestations
• ..
• Modern Work Related Ill-Health
• Stress
• PTSD
• CFS
• WRULD

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The Scale of the Problem
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

• The Cost?
• The Numbers?
• The Effects?
• The Duration?

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Top Four Illnesses/Diseases?

• Musculoskeletal,
• Stress,
• Respiratory,
• Skin Problems.

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Musculoskeletal Diseases

• Most common problem
• 1.1 million people/yr
• Cost 5.7 billion/yr

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• 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

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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

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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

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• 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

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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
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• 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

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Skin

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

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How Do You Make a Difference?

• Prevention (Better than Cure)
• Health Safety Policies
• Screening
• Surveillance
• Treatment
• Workplace Adjustment
• Redeployment (Change of Work)

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What is an Occupational History?
An occupational history is a chronological list
of all the patients employment, expanded as
necessary to detail any evidence of occupational
exposure to potentially hazardous agents and
resulting effects on health.
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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.

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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?

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OH Stakeholders

• Individual
• Employee
• Patient

• Work
• Colleagues
• Employer
• Customers
• Investors
• Public

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