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

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.

More workplace stressors, email and upwards bullying

According to a paper presented at the latest Industrial & Organisational Psychology Conference organised by the Australian Psychological Society, poor quality emails are causing almost as much stress in the workplace as the number received.

New Zealand provisional (?) psychologist, Rowena Brown, was presenting findings from her PhD studies and said

“Email is a double-edged sword. We know that email can help employees to feel engaged with and connected to their work colleagues, however the impact of a poor quality email, combined with the expectation to respond immediately, can create unnecessary stress.  Our research raises important issues for employers, who have a responsibility to train their staff in appropriate email etiquette.”

This type of research really doesn’t help business and managers to deal with the stress of their employees because it doesn’t  provide any useful control measures.  There are more significant causes of stress that demand the attention of OHS professionals and managers.

The same conference illustrates one of those other stressors.  Sara Branch, a psychologist Griffith University was quoted on the matter of employees bullying their bosses.

“Upwards bullying, like other forms of workplace bullying, is often more subtle and less obvious to other staff. However, it can also include more aggressive behaviours such as yelling, verbal threats, and confrontational phone conversations.”

“Workplaces need to understand that bullying can occur at any level in an organisation. Although managers clearly have formal authority, they can also be victims of bullying and need just as much support as other staff.”

The study also found, according to a media release about the conference, that one of the main triggers for upwards bullying is organisational change.

“If an employee is disgruntled by change, such as new working conditions, management, or processes, they may blame their manager and respond by bullying them.”

With the increased attention to psychosocial hazards in the occupational health and safety profession, it is necessary to pay attention to these sorts of studies but they are simply new perspectives on established issues that should already be monitored and changed.

These studies may illustrate the issue that OHS professionals can use to gain that managerial or client attention but they should be handled carefully so that these specific issues do not dominate the understanding on the manager or client.

SafetyAtWorkBlog advocates looking outside the OHS discipline for new evidence and understandings of workplace issues be it sociology or psychology but one must avoid reacting to hype.

Kevin Jones

Union abuse of workplace safety

The fragility of Australia’s agreement for OHS harmonisation is illustrated in an article by Michael Stutchbury of The Australian.  He  mentions the potential domino effect resulting from the West Australian Treasurer’s desire to keep his options open.  New South Wales and Queensland see that a (politically unpalatable) out is possible.

Pages from Open_Ltr_to_Premiers_and_Chief_Ministers_re_OHS_harmonisation_14.5.2009The freshest information in his article was that the CEO of the Business Council of Australia (BCA), Katie Lahey, has described OHS harmonisation as “linchpin” in the government’s push for a seamless national business economy, according to Stutchbury.  This perspective is one that should be watched closely as the BCA is not renowned for its OHS innovation or advice.

Stutchbury misinterprets the pledge by the Construction, Forestry Mining and Energy Union (CFMEU)

“to make safety the key to their battle against the ABCC’s powers”.

The union is applying safety to their industrial relations battle with the ABCC because their initial attack failed.  The Government has watered down the ABCC’s powers but the ABCC will continue to exist.  Indeed the “lawlessness” of the unions has caused the Government to continue with regulatory oversight of the construction industry beyond the ABCC.  The unions are flogging a dead horse (albeit for excellent ideological reasons) and, as a result, are reinforcing the political and community perspectives of union “thuggery”.

The ABCC action against unions has not been on the basis of health and safety, as far as SafetyAtWorkBlog is aware.  It has been on the issue of union conduct, the way the union progresses on OHS matters.  The ABCC concerns stem from the process itself and not the origin of the process.

The Australian union movement needs to realise that it is its heavy-handedness on industrial relations that is impeding its progress on several fronts.  It is not getting the ear of what traditionally has been a sympathetic political party and it is failing to gain any ground in the community because of its brash conduct.  As a result it is not attracting new members.

It is also disappointing that health and safety is trotted out as a Plan B.  This has happened repeatedly and has resulted in the tactic being seen as minimally effective.  The union movement needs to see that OHS is a core value of union membership.  Workers can be confident that an OHS issue brought to management with the union’s support will get an audience, and is more likely to get fixed.

The unions will gain new members by emphasising the positive and direct benefits of union membership.  A possible campaign start could be

“You will be safer at work with a union”.

There is a place for ideological protest.  The point needs to be made that the powers of ABCC are inappropriate.  But the ABCC was introduced in response to union arrogance and excessive testosterone.  A change of culture in the union movement some time ago would have allowed it to focus on the future of its members rather than continue with its outdated and unpopular belligerence.

Kevin Jones

Latest guidance on working alone

Western Australia’s WorkSafe has just released its latest guidance on working alone and it is the most practical look at the hazard from any OHS regulator in Australia.Working_alone cover

Importantly, it differentiates between “alone” and “remote”.  In 1995, when the Victorian First Aid Code of Practice raised the issue of isolation, there was considerable confusion.  How can someone in the metropolitan area be isolated or remote?

  • Undertaking an assessment of first aid needs of a multi-storey building which has cleaners or nightshift working at 2am.
  • Working alone in a petrol station in an outer suburb.
  • (Sadly) showing a potential client a new property in a new real estate development on the fringes of the city.
  • Security guard walking the perimeter of an industrial site
  • Delivering pizzas at 3am
  • Home visits from medical specialists

The WA definition of “alone” is very useful and needs to be kept front-of-mind in OHS policy and procedure production.  It could be used in the review process of existing policies and prores to ensure their applicability.

“A person is alone at work when they are on their own, when they cannot be seen or heard by another person, and when they cannot expect a visit from another worker or member of the public for some time.”

The working alone guidance identifies four industry types that require special support for working alone:

  • Agriculture
  • Pastoral
  • Forestry
  • Mining

Although SafetyAtWorkBlog advocates low-tech control options as much as possible (usually because of increased reliability) thankfully this guidance discusses mobile phones, satellite communications, GPS locators and other communications devices.

Kevin Jones

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