The economic costs of a heart attack

A new Australian report estimates the total costs of heart attack and chest pain (Acute Coronary Syndrome or ACS) to the Australian economy – “total economic cost of $17.9 billion.”  This Access Economics report, released in June 2009, has broad application for public policy but has some relevant information for safety and health management in the workplace.

Costofheartattackandchestpain coverIf we take “productivity” as applying to work, as is reasonable, the report states that for 2009

“Indirect [health care system] costs [from ACS] are expected to account for $A3.8 billion, primarily due to lost productivity.”

This is a useful statistic for those workplace health advocates.  In fact, the report specifically identified the workplace as

“…an excellent environment to facilitate the ongoing rehabilitation and lifestyle changes to prevent the re-occurrence of ACS event”.

One gap it identified in the treatment and monitoring of ACS was  something that many have been advocating for some years, particularly with the aging population and increasing obesity rates:

“a standardised national program to support employees and employers and the extension of rehabilitation practices.”

Much of the report advocates important rehabilitation resources and services for when the patient is discharged from hospital.  The report includes the following graphic but also recommends the basic elements of post-hospital care after an ACS event.

Costofheartattackandchestpain-261-2 rehab table

“For rehabilitation to be effective, comprehensive patient follow-up interviews after discharge are essential.  At these follow-up interviews, the patient should undergo both physical assessments (e.g. blood pressure, cholesterol tests, ECGs) and emotional and psychological assessments (e.g. signs of depression, anxiety, stress, financial hardships).  The psychological impact following an ACS event is an important, but often neglected, area in the management of ACS.  Thus, if patients can better understand their conditions, it can empower them to cope with their anxieties caused by ACS.”

In specific reference to workplaces, the report says:

“Returning to work can require an adjustment in duties and the conditions under which the employee works.”

It is up to OHS and return-to-work professionals to determine exactly what strategies should be applied in these circumstances.

There were a couple of references in the report that may be worth following up:

Bhattacharyya MR, Perkins-Porras L, Whitehead DL, and A Steptoe (2007), Psychological and clinical predictors of return to work after acute coronary syndrome, European Heart Journal, Vol 28, Iss. 2, pp. 160-165.

Kovoor P, Lee AKY, Carrozzi F, Wiseman V, Byth K, Zecchin R, Dickson C, King M, Hall J, Ross DL, Uther JB, and AR Denniss (2006), Return to full normal activities including work at two weeks after acute myocardial infarction, American Journal of Cardiology, Vol 97, No. 7, pp. 952-958.

Kevin Jones

New research on casino worker risks from secondhand smoke

The yet-to-be-released August 2009 edition of the American Journal of Public Health has an interesting report into the health risks of casino workers in Pennsylvania from second hand tobacco smoke.  The research report is quite complex for the casual readerr but the increased level of risk to casino workers seems convincing.

According to the report, secondhand smoke

“in Pennsylvania casinos produces an estimated excess mortality of approximately 6 deaths per year per 10000 workers at risk”.

People in the casinos for 8 hours would be breathing air that would match the “unhealthy air” definition of the US Air Quality Index.

The reseacrh concludes

“It is clear, however, that Pennsylvania casino workers and patrons are put at significant excess risk of heart disease and lung cancer from SHS through a failure to include casinos in the state’s smoke-free-workplace law.”

Randy Dotinga wrote for the Health Behavior News Services on the research report and asked questions of a gambling industry representative:

“Holly Thomsen, a spokesperson for the American Gaming Association, a trade group for the casino industry, said its members are committed to “the highest level of safety and comfort” inside casinos.

Casinos serve both smoking and nonsmoking customers, she said, and “we realize that balancing the needs of these two distinct sets of patrons, as well as those of our employees who don’t smoke, is of paramount importance.”

The AJPH article reference is

Repace, J. Secondhand smoke in Pennsylvania casinos: A study of nonsmokers’ exposure, dose, and risk. Am J Public Health 99(8), 2009.

Kevin Jones

Sleep disorders and workplace safety – new research grant

Recently, the Australian Government awarded some research grants of which at least one is relevant to workplace safety.  $2.5 million was given for the establishment of a Centre for Clinical Research Excellence in Interdisciplinary Sleep Health (CRISH).

When the grant was announced Professor Ron Grunstein of the Woolcock Institute of Medical Research said,

“Adequate sleep is as important as exercise and diet. Sleep loss and sleep disorders contribute to mortality, chronic disease, mental health problems and the economic health burden.

“This funding will allow us to establish a network of leading sleep researchers and physicians in different specialties to investigate the biology of sleep, and look at ways to prevent and treat sleep disorders.”

Amongst several social benefits of the research, the issue of shiftwork health was mentioned.  There are many contributory factors to the health of shiftworker and sleep disorders is only one, but an important one.

WakeUpAustralia-CoverThe most recent Australian data on the costs of sleep disorders was from 2004 by Access Economics, an organisation that the government often relies on for data.  Its report, Wake Up Australia, estimates that  sleep disorders such as obstructive sleep apnea and insomnia underlie 9.1 per cent of work related injuries.

The origin of this statistic needs to be closely examined in the body of the report (page 23) as there is quite a bit of statistical magic applied however the 9.1% figure has been referred to in relation to the potential benefit of the CRISH project.  The statistic is not invalid but it is also not so simple.

Kevin Jones

Peanut allergy fatality saga to continue

Safety management in the education sector seems to be one of the hardest management challenges.  There are overlapping safety obligations through OHS legislation, education department guidelines, public health matters and meeting the demands of parents and students.

700 Peanuts - Federal Court coverA decision in the Federal Court of Australia on 30 June 2009 illustrates the challenges.

A 13 year old boy from Scotch College, in Melbourne, Nathan Francis, died after eating from a ration pack of beef satay on a Defence Forces camp.  The school, which was supervising the camp, were aware of the boy’s severe allergy to peanuts.

The Australian Department of Defence was fined over $A200,000.

The full judgement of the court raises several  issues that are relevant to the management of safety of people in one’s care.  The judge has recommended a State coronial inquest to determine the roles and responsibilities of Scotch College in Nathan’s death.

Justice for Nathan and his family is likely to have many more months to go. [ SafetyAtWorkBlog will follow the issue.]

A fantastic audio report on the decision is available at the ABC website. The payment of the fine back to the government is not dealt with in this blog.

The first section of the judgement (below) indicates what the judge believes are the failures that need to be addressed through an appropriate safety process:

  • Communication;
  • Instruction;
  • Provision of appropriate supplies;
  • The importance of labelling; and
  • Following procedures and guidelines

Some readers may find that this prosecution could make an interesting case study for safety management.

Kevin Jones

Justice North found that the Federal OHS Act was breached by the Commonwealth government through the Chief of Army.  The respondent

(a) supplied Cadet Nathan Fazal Francis, Cadet Nivae Anandaganeshan and Cadet Gene van den Broek with one-man combat ration packs (CRP’s) containing a satay beef food pouch which contained peanuts or peanut protein for their consumption despite having been informed that the said cadets were allergic to peanuts;
and, in so doing, it failed to:

(b) warn parents of the [Australian Army Cadets] AAC cadets about the contents of the CRP’s;

(c) warn AAC cadets about the contents of CRP’s;

(d) warn AAC cadets with pre-existing food allergies of the contents of CRP’s;

(e) make appropriate use of information provided by AAC cadets and parents of AAC cadets regarding pre-existing or known allergic conditions and correlate that information with the potential risk of being exposed to allergies through the supply of food contained in CRP’s;

(f) ensure that the contents of CRP’s allocated to AAC cadets did not include food products or allergens that may have triggered allergic responses by removing or requiring the removal of peanut-based food products from CRP’s;

(g) prevent distribution or provision of peanut-based food products to AAC cadets with pre-existing allergic reactions by:

i. inspecting the contents of CRP’s to be allocated to those individual AAC cadets who had given notice of allergic conditions;

ii. isolating cadets with pre-existing medical conditions and/or notified food allergies at the time of distribution of CRP’s and issuing them with CRP’s that did not contain peanut products or other food allergens;

iii. removing all CRP’s known to contain peanut protein or other food allergens from circulation amongst AAC cadets;

iv. requiring all AAC cadets with notified allergic conditions to provide their own food supplies;

(h) issue any or any adequate instructions or provide adequate supervision regarding distribution of CRP’s;

(i) issue any adequate instructions or provide adequate supervision regarding consumption of contents of CRP’s;

(j) prevent the consumption of CRP’s containing food allergens by AAC cadets with food allergies;

(k) distribute CRP’s after consulting or considering pre-existing medical conditions; and

(l) take into consideration the findings of a report dated 22 November 1996 by the Australian National Audit Office entitled ‘Management of Food Provisioning in the Australian Defence Force’.

SafetyAtWorkBlog Progress

The middle of the year is a good place to measure progress.  Since its inception in February 2008, SafetyAtWorkBlog has been viewed almost 42,000 times.  The site has received almost 300 comments and 434 articles have been posted.

For a site that inhabits a niche area, does not receive advertising revenue and provides commentary and unique content almost all the time, the blog is a proud achievement.

Thanks to all the regular viewers.

Kevin JonesBlog stats

Cheeky workers compensation premium statistic

“The premium has dropped eight per cent from last financial year. This is the third consecutive drop in the Commonwealth sector premium rate.” [my emphasis]

Fantastic news – eight per cent reduction in 12 months!  The media release goes on:

“… this is a very pleasing result for Commonwealth agencies as it indicates injuries are continuing to fall due to effective prevention strategies that promote safer workplaces.”

The second quote is from Martin Dolan, CEO of Comcare in Australia, on his second-last day in the job.

But 8%? In one year?

The Comcare media release includes a table of premium figures for the five years.  The overall premium rate in 2008-09 was 1.36%.  For 2009-10 it will be 1.25%, that’s the 8% fall in Comcare media release terms.  In reality it is a fall of 0.11%

The premium rate is indeed low and it may be justified in congratulating Comcare on a job well done but expressing such a fall as  8%?  This is a cheeky farewell statistic for a CEO which should have said

“a 0.11% fall from 2008-09 and a decline of 0.5% over 4 years”.

This is surely a fairer statistic and a worthy achievement in itself, if not quite so sexy.

Kevin Jones

UPDATE: 1 July 2009

Martin Dolan is moving to the Australian Transport Safety Bureau.

Safety culture improvements in Spain

The improved safety status in workplaces that have an active union presence has been verified through research, but what of the efforts on safety management from outside the union research efforts.

Below is the abstract of an article that was published online late-2008 (and is available for purchase).  The research was conducted in a country with a negative safety culture so the improvements may be more marked than from outside Spain.  However, the full study (not accessed by SafetyAtWorkBlog) may provide an interesting before-and-after story.

“Occupational accidents severely deteriorate human capital, and hence negatively affect the productivity and competitiveness of countries. But despite this, we still observe a scarcity of preventive practices, an unsatisfactory management commitment and an absence of safety culture among Spanish firms. The result is evident in firms’ high accident rates.  This situation is a consequence of the general belief among firms that investing in safety is a cost, and hence has negative repercussions for their competitiveness.  The current work aims to identify good practices in safety management, and analyse the effect of these practices on a set of indicators of organisational performance.  For this, we first carry out an exhaustive literature review, and then formulate a series of hypotheses.  We then test the proposed model on a sample of 455 Spanish firms.  Our findings show that safety management has a positive influence on safety performance, competitiveness performance, and economic-financial performance.  Hence they provide evidence of the compatibility between worker protection and corporate competitiveness.”

The full article is available in Safety Science (Volume 47, Issue 7, August 2009, Pages 980-991).

Kevin Jones

B Fernández-Muñiz, J Montes-Peón and C Vázquez-Ordás, ‘Relation between occupational safety management and firm performance’ (2009) Safety Science 47: 980-991.

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