Alternative therapies

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Many alternative therapies have proved to have a positive therapeutic or medical benefit and there is no reason why these should not be applied to work-related conditions.

In 2001, Jill Kaufman was interviewed for Safety At Work magazine.  The interview is now available at SafetyAtWorkblog.

In 2001, the wellness industry in Australia was just starting and corporate health programs were searching for validity and credibility.  Rehabilitation, just like health insurers, was beginning to allow for a broader range of medical treatments.  It seemed useful to educate the OHS readers of the magazine with this developing approach to worker care.

Jill’s comments should be seen in their historical context but this does not make them any less interesting , or relevant.  Below are a couple of excerpts:

“Placing a long term RTW employee through the Western medical process could, in fact, be continuing to injure them in terms of their self-esteem. A different approach on a holistic basis allows for an understanding of the injury through an understanding of the person.”

“SAW: Many rehabilitation programs measure success by the rapid return of a worker to work duties but also by the financial expenditure on that person’s rehabilitation. Can the value of the approach you advocate be similarly measured?

JK: There can be surprisingly simple solutions to what can appear to be very complicated issues. I think one of the surprising things that companies learn is that it is often not a big financial expenditure or a large amount of time that can provide positive results. If you tackle the problem with the wrong instruments and the wrong tools, it can seem a very long haul to turn around and use a non-Western approach. But in fact shifts in thinking can bring about quick results.”

“SAW: Many call centres are providing yoga, physiotherapy and massages to workers on the premises and often without the workers leaving their workstations. What are your thoughts on this practice?

JK: Often this is doing the absolute minimum that is required. To have people doing yoga at their desk, when a core element of yoga is centring your self, breathing exercises, the call centre is as different to the practices of yoga as you can get.”

The need for a safety philosopher

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It is very hard to be an OHS professional and not feel like one is part of the “nanny state” approach to personal choice.  There is a fundamental disconnection between the responsibilities on business for a safe workplace and the responsibilities on an individual to make themselves safe at work.

When the work processes are seen as mechanistic, where workers are part of that process, safety management is easier.  Hazards are known because the work process and environment are fixed and have no variation.  The employer’s area of responsibility is clear and can be said to be from the engineering/production perspective.

But at different points in history, the spotlight of humanism becomes bright enough that the workers get attention.  Safety management becomes complex because humanity is acknowledged in the work processes; one must consult, talk, listen and engage with the worker who was, previously, an element of the production process.

This is the manicheism of safety management – the machine or the human.

This rumination occurred in response to an article reported by the Australian Broadcasting Corporation on the union representing Sydney bus drivers “asking the New South Wales Government to pay for personal trainers and Weight Watchers programs.”

The union’s bus secretary, Raul Boanza, says, according to the ABC report,

“the union wants the Government to formalise an existing 50 per cent Weight Watchers subsidy by including the provision in enterprise agreements” and

“it will also seek gym memberships or personal trainers on a case-by-case basis on the advice of a medical specialist.”

Apparently

“the Rail, Tram and Bus Union says drivers must pass strict medical standards every two years to keep their licences”.

SafetyAtWorkBlog contacted the union this afternoon and were advised that the person who raised the issue initially “is making no further comment on the matter.”

This is a shame as one of the first questions would have been, “should an employee be held responsible for making sure they are fit for work?”

Let’s indulge in some late-Friday afternoon silliness.  If a widget in a mechanical process is faulty, it is fixed or replaced.  In a mechanistic perspective, if a worker is too fat to undertake the tasks they have performed previously they should be fixed or replaced.  This seems to match the position of Raul Boanza.

But if the widget had a consciousness and the means and responsibility to maintain their own suitability for work, should that widget be fixed or replaced?  This seems to be what each worker in any workplace needs to regularly ask themselves.

As mentioned above these two differing perspectives reflect our society’s (internal) debate on personal responsibility to one’s self and one’s society.

The leading safety academic in Australia is a sociologist.  Perhaps we are in need of a safety philosopher or at least a safety profession that considers safety in its social and personal contexts, that discusses, debates and progresses, rather than worrying about the latest corporate logo.  Perhaps we just need people to take responsibility for their own actions and be accountable for their own errors.

Kevin Jones

The economic costs of a heart attack

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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

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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

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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