Category: psychiatric

Workplace health initiatives in unstable economic times

All through the Presidency of George W Bush, safety professionals have been critical of the lack of action on workplace safety.  As with many issues related to a new Democrat President in Barack Obama, organisations are beginning to publish their wishlists.  The latest is the American College of Occupational and Environmental Medicine (ACOEM).

On 9 January 2009, ACOEM released a media statement which began

“American College of Occupational and Environmental Medicine (ACOEM) calls on the Health and Human Services Secretary-designee Tom Daschle to address the critical link between the health, safety, and productivity of America’s workers and the long-term stability of its health care system and economy as he begins work on the Obama administration’s health care agenda.”

The requested changes could be interpreted as a criticism of what the situation has been under George W Bush.  ACOEM says the next government

“must put a greater emphasis on ensuring the health of the workforce in order to meet the twin challenges of an aging population and the rise of chronic disease…”

ACOEM President Robert R. Orford, MD goes into specifics

“…calling on Daschle to focus on preventive health measures aimed at workers that could range from screening and early detection programs to health education, nutritional support, and immunizations.”

The ACOEM reform program is based on the following

  • “investing in preventive health programs for workers;
  • creating new linkages between the workplace, homes and communities to reinforce good health;
  • providing financial incentives to promote preventive health behaviors among workers; and
  • taking steps to ensure that more health professionals are trained in preventive health strategies that can be applied in the workplace.”

Accepting that one Australian State, Victoria, is considerably smaller than the US (Victoria  has a population of around 5,200,000, the US had 301,621,157 in 2007), it is interesting to remember what the Victorian Government proposed (or promised) just on 12 months ago concerning its WorkHealth initiative.

“Over time the program is expected to free up $60 million per year in health costs, as well as:

  • Cut the proportion of workers at risk of developing chronic disease by 10 per cent;
  • Cut workplace injuries and disease by 5 per cent, putting downward pressure on premiums;
  •  Cut absenteeism by 10 per cent; and
  •  Boost productivity by $44 million a year.”

[It would be of little real benefit to simply multiple the Victorian commitments by the differential with the US population to compare monetary commitments, as there are too many variable but if the WorkHealth productivity was imposed on the US, there could be a $2.6 billion, not a lot considering the size of President Bush’s bailouts and Barack Obama’s mooted bailout package.  However, in the current economic climate, in order to gain serious attention, any proposal should have costs estimated up front and, ideally, show how the initiative will have minimal impact on government tax revenues – an approach that would require.]

In each circumstance there is the logic that unhealthy people are less productive than healthy people.  This sounds right but it depends very much on the type of work tasks being undertaken.  It is an accepted fact [red flag for contrary comments. ED] that modern workloads are considerably more supported by technology than in previous labour-intensive decades.  Perhaps there are better productivity gains through (further) increased automation than trying to reverse entrenched cultural activity.

In late 2008 an OHS expert said to a group of Australian safety professionals in late-2008 that WorkHealth

“is not well-supported by the stakeholders.  The trade unions feel it is a diversion away from regulated compliance and that it is going to refocus the agenda on the health of the worker and the fitness of the worker as the primary agenda, which is not what the [OHS] Act is setup to focus on. The employers are basically unkeen to get involved on issues they think are outside their control.”

The expert supported the position of some in the trade union movement that WorkHealth was always a political enthusiasm, some may say folly.

This is going to be of great importance in Australia with the possibility of new OHS legislation to apply nationally but also muddies the strategic planning of any new government that needs to show that it is an active and effective agent of change, as Obama is starting to do.  In the US, the public health system is not a paragon and the workplace safety regulatory system is variable, to be polite.  Fixing the public health system would seem to have the greater social benefit in the long term, and a general productivity benefit.

(It has to be admitted that the packaging of health care in employment contracts in the US is attractive employment benefit and one that seems to be vital to those who have it.  Australia does not have that workplace entitlement but those employers struggling to become employers-of-choice should serious consider it, particularly as a work/family benefit.)

Each country is trying to reduce the social security cost burden on government and it would seem that public health initiatives would have the broader application as it covers the whole population and not just employees, or just those employees who are unfit.

Work health proposals in both jurisdictions need to re-examine their focuses and to pitch to their strengths.  Business has enough to worry about trying to claw its way out of recession (even if the US government is throwing buckets of money to reduce the incline from the pit).  OHS professionals have enough work trying to cope with the traditional hazards and recent, more-challenging, psychosocial hazards.  Workplace health advocates are muddying the funding pool, confusing government strategic policy aims, and blending competing or complementary approaches to individual health and safety in the public’s mind.  

 Kevin Jones

Update 16 January 2009

More information on this issue is available HERE

Mental support research

In SafetyAtWorkBlog in 2008 there have been several posts concerning suicide.  There is a growing research base on the matter and The Lancet adds to this through an article published in December 2008.

Researchers have found that the type of mental health services provided to the community can affect the rate of suicide.  This is important research even though SafetyAtWorkBlog regularly questions the applicability of research undertaken in Scandinavian countries to the rest of the world.  Bearing the cultural differences in mind, the research will stir debate and, hopefully, localised research along the same lines.

Below is the text of the press release about the research:

WELL-DEVELOPED COMMUNITY MENTAL-HEALTH SERVICES ARE ASSOCIATED WITH LOWER SUICIDE RATES

Well-developed community mental-health services are associated with lower suicide rates than are services oriented towards inpatient treatment provision in hospitals. Thus population mental health can be improved by the use of multi-faceted, community-based, specialised mental-health services. These are the conclusions of authors of an Article published Online first and in an upcoming edition of The Lancet, written by Dr Sami Pirkola, Department of Psychiatry, Helsinki University, Finland, and colleagues.

Worldwide, the organisation of mental-health services varies considerably, only partly because of available resources. In most developed countries, mental-health services have been transformed from hospital-centred to integrated community-based services. However, there is no decisive evidence either way to support or challenge this change.

The authors did a nationwide comprehensive survey of Finnish adult mental-health service units between September 2004 and March 2005. From health-care or social-care officers of 428 regions, information was obtained about adult mental-health services, and for each of the regions the authors measured age-adjusted and sex-adjusted suicide risk, pooled between 2000 and 2004 – and then adjusted for socioeconomic factors.

They found that, in Finland, the widest variety of outpatient services and the highest outpatient to inpatient service ratio were associated with a significantly reduced risk of death by suicide compared to the national average. Emergency services operating 24 hours were associated with a risk reduction of 16%. After adjustment for socioeconomic factors, the prominence of outpatient mental-health services was still associated with a generally lower suicide rate.

The authors conclude: “We have shown that different types of mental-health services are associated with variation in population mental health, even when adjusting for local socioeconomic and demographic factors. We propose that the provision of multifaceted community-based services is important to develop modern, effective mental-health services.”

In an accompanying Comment, Dr Keith Hawton and Dr Kate Saunders, University of Oxford Department of Psychiatry, UK, say: “The message to take from these findings must be that while well thought out and carefully planned new developments that increase access to secondary care services for mental-health patients are to be encouraged, measured progress towards flexible community care, not rapid ongoing change, should be the order of the day.”

 

The insidiousness of “reasonably practicable”

WorkSafe Victoria recently released a guideline, or clarification, on what it considers to be the issues surrounding “employing or engaging suitably qualified persons to provide health and safety advice“.

SafetyAtWorkBlog remains to be convinced that such a process will lead to better safety outcomes in the small to medium-sized enterprises at which this program is aimed.  The OHS legislation clearly states that the employer is the ultimate decider on which control measures to implement to address a workplace hazard.  This is echoed in the WorkSafe guideline

“It is important to note that employing or engaging a suitably qualified person to provide OHS advice does not discharge the employer from their legal responsibilities to ensure health and safety as required under Part 3 of the OHS Act. This duty cannot be delegated.”

A business manager will weigh up the advice sought or given from a variety of sources and make a decision.  A good business manager will take responsibility for the good or bad results of their decision.  But they need to have a clear understanding of their obligations and Victoria’s legislation could be confusing.

The guideline says that

“Employers are expected to take a proactive approach to identify and control hazards in the workplace before they cause an incident, injury, illness or disease.”

This reitereates one of the safety principles in the 2004 OHS Act

“Employers and self-employed persons should be proactive, and take all reasonably practicable measures, to ensure health and safety at workplaces and in the conduct of undertakings.”

But the principles are not legislative obligations.  As Michael Tooma writes in his “Annotated Occupational Health and Safety Act 2004”

“… it is the intention of the Parliament that the principles be taken into account in the administration of the Act.”

The principles are there for judicial colour and community reassurance but with no real impact.

The obligations on an employer, the section that determines the actions and plans of the business owner or managers, are, as well as general duties:

“Duties of employers to employees

(1) An employer must, so far as is reasonably practicable, provide and maintain for employees of the employer a working environment that is safe and without risks to health……..

(2) Without limiting sub-section (1), an employer contravenes that sub-section if the employer fails to do any of the following-

(a) provide or maintain plant or systems of work that are, so far as is reasonably practicable, safe and without risks to health;

(b) make arrangements for ensuring, so far as is reasonably practicable, safety and the absence of risks to health in connection with the use, handling, storage or transport of plant or substances;

(c) maintain, so far as is reasonably practicable, each workplace under the employer’s management and control in a condition that is safe and without risks to health;

(d) provide, so far as is reasonably practicable, adequate facilities for the welfare of employees at any workplace under the management and control of the employer;

(e) provide such information, instruction, training or supervision to employees of the employer as is necessary to enable those persons to perform their work in a way that is safe and without risks to health. “

The “as far as is reasonably practicable” insertions allow business considerable flexibility in arguing the validity of their decisions after an incident but hamper the employer in being “pro-active” – (a hateful and lazy piece of business jargon).

The impediments to “pro-activity” can be seen in the general duties of Section 20 where 

“to avoid doubt, a duty imposed on a person…to ensure, as far is reasonably practicable, health and safety requires the person –

(a) to eliminate risks to health and safety so far as is reasonably practicable:…..”

This contrasts with the objects of the, same, Act which states that one of the aims is

“to eliminate, at the source, risks to the health, safety and welfare of employees and other persons at work:…”

It is strongly suspected that a crucial element of OHS legislation and management will likely disappear and this is to eliminate hazards “at the source”.  Outside of the objects of the Act this aim is not mentioned anywhere else in the legislation.  “Reasonably practicable” will erase this important social and moral clause.

Eliminating something “at the source” encourages research into new ways of eliminating hazards by placing an obligation on us to determine the source.  “Reasonably practicable” encourages us to research control measures until it is practicable to do so no more.  That is a half-quest that solves nothing.  What if Frodo was asked to dispose of the ring in Mordor only if “reasonably practicable”? The story would have been a novella instead of a classic trilogy.

Employer associations are lobbying for increased workplace flexibility.  That has nothing to do with the health and safety benefits of the employees but rather the health and safety of the balance sheet.  “Reasonably practicable” similarly focuses on business management and not safety management.

The battle against this insidious weakening of the OHS profession is not lost.  Heart should be taken from the preparedness of governments to roll-back unpopular legislation such as some industrial relations initiatives.  Hindsight can be an important motivator for change.

Recent fatalities data may sway some in government that OHS regulators are achieving their social and operational targets but OHS professionals know that fatality rates are not an accurate indication of the success of safety initiatives.  New workplace hazards are appearing regularly and many of the new ones don’t result in death but lead instead to misery and an incapacity to live a healthy life or to work again in a chosen profession.  

“Reasonably practicable” allows businesses to try, in differing degrees, to eliminate the hazards, such as psychosocial hazards, of its workforce and then shift them to social security and disability benefits.  And why not? It seems that corporations can serve their clients and stakeholders “as far as is reasonably practicable” and then expect a bailout from government over their mismanagement.  Immorality applies to much more than economics.

Sexual harassment and occupational health and safety

Some old-time safety professionals are struggling with the inclusion of psychosocial hazards in their safety management programs.  Some deny the relevance of sexual harassment to their duties and hope that the issue can be contained within the human resources department, the “dark arts” of workplace safety. 

Many of these same safety professionals are calling for more evidence-based decisions on workplace safety.

Evidence is now in on the social and work impact of sexual harassment. Australia’s Human Rights Commission has issued Effectively preventing and responding to sexual harassment: A Code of Practice for employers‘  which states on page 48

Employers have a common law duty to take reasonable care for the health and safety of their employees. This common law duty is reinforced by occupational health and safety legislation in all Australian jurisdictions.

An employer can be liable for foreseeable injuries which could have been prevented by taking the necessary precautions. As there is considerable evidence documenting the extent and effects of sexual harassment in the workplace, it has been argued that the duty to take reasonable care imposes a positive obligation on employers to reduce the risk of it occurring.

A work environment in which an employee is subject to unwanted sexual advances, unwelcome requests for sexual favours, other unwelcome conduct of a sexual nature, or forms of sex-based harassment, is not one in which an employer has taken reasonable care for the health and safety of its employees. A work environment or a system of work that gives rise to this type of conduct is not a healthy and safe work environment or system of work. An employer could be regarded as not having acted reasonably to prevent a foreseeable risk if practicable precautions are not taken to eliminate or minimize sexual harassment in the workplace.

Failure to fulfil the duty of care can amount to a breach of the employment contract as well as negligence on the part of the employer. This means that an employee who has been harmed could bring an action against their employer in contract or tort.

The guide can do with considerable translation to what businesses see as useful codes of practice in the application of safety management but perhaps that is for the private sector and State OHS regulators to work on.

There seems to be enough information available now on sexual harassment, fatigue, bullying, violence, fitness for work, shift work, depression and other matters, that the safety profession should be more embracing of these concepts in their own planning.  Let’s hope that in this discipline we do not have to wait for generational change to achieve a change in approach.

sexual-harassment-cop2008-cover

Important victory for aircraft maintenance workers

The Department of Veterans’ Affairs may have to pay compensation to the maintenance crews of F-111 fighter planes.  In the 1970s employees worked within the fuel tanks of the fighters with little, if any, PPE.  In 2004 these workers were excluded from a healthcare and compensation scheme even though, according to one media report, evidence was presented that the workers had

  • a 50% increased risk of cancer
  • a two-fold increase in obstructive lung disease;
  • a two-and-a-half fold increase in sexual dysfunction; and
  • a two-fold increase in anxiety and depression.

One of the reasons the maintenance crews were denied compensation was that the Royal Australian Air Force (RAAF) had destroyed the maintenance records from before 1992.

An inquiry into the affair has received a submission from the commonwealth Ombudsman, John McMillan, and Labor MP, Arch Bevis, that strongly criticised the destruction and inadequacy of records.

In safety management, record-keeping is often seen, and dismissed, as “red tape”.  The reduction of red tape is not the elimination of red tape and the reality of Australia’s increasing litigious legal system is that more records need to be kept, and for longer, than ever before.

Perhaps, the government, in its pledge to reduce red tape and business costs, should look at the lawyers’ insistence to business that the first port-of-call after an industrial incident is to call them so that everything becomes covered by legal-client privilege.

Perhaps it is the pressure to create paperwork than the paperwork itself that is the problem.  In the case of the F-111 maintenance crews, regardless of the lack of paperwork, justice seems to be happening.  It is just sad that so much pain and suffering had to be endured before getting close to a resolution.

Click HERE for a personal reflection on the health issues of the workers from one of Australian Rugby League’s champions, Tommy Raudonikis.

Physical activity, mental health, alcohol consumption and productivity

The Victorian Government’s workplace health strategy may be “coughing up blood” but health promotion continues.  Last week, Australian health insurer, Medibank Private, released some statistics and cost estimates related to physical inactivity.

According to the media release, physical inactivity costing the Australian economy $13.8 billion a year. The findings are based on research conducted in conjunction with KPMG-Econtech which builds on Medibank’s 2007 research and “captures the healthcare costs, economy wide productivity costs, and the mortality costs of individuals passing away prematurely as a result of physical inactivity.”

Craig Bosworth of Medibank Private says, 

“Most Australians are aware of the benefits of physical activity but this latest round of Medibank research has revealed some alarming effects of physical inactivity. An estimated 16,179 people die prematurely each year due to conditions and diseases attributable to physical inactivity and that is frightening. And whilst the majority of these are from the older population there is also a large number of people dying under 74 years of age due to physical inactivity, particularly in the male population.”

Bosworth goes on to say:

“Like other health risk factors, physical inactivity can have an adverse effect on organisations as well as individuals. Specifically, physical inactivity can impact on employee productivity by causing increased absenteeism and presenteeism, which impose direct economic costs on employers. The Medibank research has found that productivity loss due to physical inactivity equates to 1.8 working days per worker per year.”

Three audio statements on this research are available – physical-inactivity-telephone-grabs-edit

The SuperFriend Industry Funds Forum Mental Health Foundation has also released statistics on mental health in the workplace. The survey also found that 50 per cent of Australians admit to often feeling stressed and a quarter often feel depressed. 

John Mendoza, Chair of SuperFriend’s Mental Health Reference Group, said, “There is increasing evidence of a link between stress in the workplace and mental illness. The cost of workplace stress to Australian business is potentially crippling.” Listen – workplace-mental-health-edit

The Superfriends survey found

StreetWise
StreetWise
  • One in two Australians believe that having a few drinks is a good way to maintain or improve their mental health;
  • 80 per cent of Australians believe watching TV has a positive impact on their mental health;
  • Australians are putting their bodies ahead of their brains, with three-quarters of Australians engaged in activity to maintain or improve their physical health, while only 50 per cent are actively engaging in activity to maintain or improve their mental health.
  • Older Australians are more likely to heed the call ‘use it or lose it’. While 57 per cent of all Australians feel they take good care of their mental health, 68 per cent of those over 50 feel they are looking after themselves emotionally.
  • Australians aged 40 to 49 are the unhappiest and unhealthiest. Those in this age group are more likely to feel stressed and depressed and less likely to look after their physical and mental health.

A good starting point in planning to manage stress is the StressWise publication by WorkSafe Victoria.

For many decades, perhaps centuries, unhappiness at work was countered, to varying degrees, through the consumption of alcohol.  According to the latest Australian Unity Wellbeing Index people who drink everyday are the happiest, whereas non-drinkers have a lower sense of wellbeing.

Amanda Hagan of Australian Unity summarises some of the research findings and supports the link between physical activity and positive wellbeing. Listen – australian-unity-wellbeing-index-aap-medianet-edit

WorkHealth – end is nigh after less than one year

Early in 2008, the Victorian Government sprung a surprise on the OHS and health promotion industries by announcing a world-first initiative – WorkHealth.  This program was to be funded by interest generated from the WorkCover scheme to the tune of hundreds of millions of dollars over the next five years.

WorkHealth loses stakeholder support

Two weeks ago, a well-respected OHS professional advised that key stakeholders in WorkHealth were very cool on the program.  This confirmed previous questions raised in SafetyAtWorkBlog about the promotion, transparency and organisational support for WorkHealth.  The professional stated that others were questioning the placement of WorkHealth in the OHS field rather than in health promotion.

Rumour has existed for some months that WorkHealth is a scheme that has been pushed by a narrow range of OHS and workers compensation advocates.

What made WorkHealth so interesting was that the concept originated from within the workers compensation field with workers compensation money.  At the time, the wisdom of committing such a large amount of money to the initiative was questioned by many in the trade union and business areas.  Why head in this direction when there were established mechanisms to reduce OHS and workers compensation costs?

The global economic problems, it is suspected, would have flowed to the investments of the WorkCover scheme and it would be interesting to know what the revenue allocation to WorkHealth now is calculated at.

OHS/Industrial Relations conflict

In The Age newspaper on 26 October 2008, WorkHealth gained some attention as business groups have now seen the criteria for the health assessments of workers.  David Gregory of the Victorian Employers’ Chamber of Commerce and Industry described the criteria as a potential “industrial weapon”.  According to the article,

“WorkSafe told The Age the idea of an initial ‘tick test’ screening process had been abandoned, and the proposed $130 million worth of prevention programs are not in the pilot at all.”

As is evident from the quote, it is the pilot scheme that is being rolled out, however it is clear from the comments of David Gregory and the state secretary of the Australian Manufacturing Workers’ Union, Steve Dargavel that industrial relations sensitivities have not been considered.

Gregory makes excellent points that good OHS professionals are already aware of – workplace safety can only succeed when industrial relations implications and conditions are considered before any intervention process.

OHS has broadened to include the hazards of fatigue, stress, anxiety, depression, workloads, bullying and other matters that have encroached on health promotion and human resources over the last decade or so.  A worker health program would have been more likely to be accepted through this osmosis rather than a surprise announcement.

Is this the end?

WorkHealth could work if it had been generated as a workplace application of public health programs.  The challenge would have been to legitimise the expenditure in an already cluttered health promotion sector.  How would WorkHealth have achieved this testing regime when business is already assessing its workers for psychological disorders, cholesterol, prostate health, hearing, asthma, and a whole range of modern health issues?  It is unlikely that it could so.

It came down to health assessments in a different context – a context where there had been insufficient groundwork to establish the value of the program to its fundamental stakeholders, the unions and employer groups.  To a much lesser extent, the program was not sufficiently integrated into the WorkSafe authority’s program before the announcement.

Also, the timing has been proven to be wrong.  The global economic problems are beginning to squeeze business’ bottom line.  The calls for workers’ compensation premium relief will increase in the same way that businesses have begun questioning the viability of an emissions trading scheme.  WorkHealth is likely to be one of those program cut, so the government will claim, due to the changing economic climate.  The lessons to be learnt are more wide-ranging than just economics.

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