Special Report on Health at Work

Every employer must regard health as an integral part of management, says Dr. Tim Carter, director of medical services for the Health and Safety Executive. ‘One of the dangers,’ he adds, ‘has been that it is so easy for companies to say that they know about safety and can deal with it, but health is for doctors.

‘In fact, the control of health problems at work is very much for the manager, with advisory support.’

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There is a far greater conviction now in industry and commerce that the work of medical teams familiar with the special problems of the work-force contribute to business efficiency. But there is another view.

Dr. Adrian Semmence, of the Civil Service Medical Advisory Service, points out that four in 10 British employees have no access to occupational medicine teams. But does their health suffer, he asks, and if so, by how much? How should any provision of teams be financed? What is the minimum service that any advanced country should reasonably provide for the rising number of those who work part-time, at home and in small businesses?

The answer to all these questions, he says, is that no one knows.

Compare Britain with Denmark and France, for example. The French have many more occupational physicians per head than we do, the Danes a lot fewer. Comments Dr Semmence: ‘No one has yet demonstrated any differences in the health at work of workers in the countries concerned that can be laid at the door of occupational health services.’

He sees dangers in the provision of occupational medical teams. One is that they will be used to treat minor illness or to carry out increasingly complex tests which merely reassure senior staff about their health. ‘Another danger is that they will be employed in diffuse and unvalidated health education,’ he says, ‘particularly on the deleterious effects of stress.’

In Dr. Semmence’s opinion, based on large-scale Civil Service screening studies which showed the harmful effects of cigarettes, alcohol, bad diet and lack of exercise, individual behavior is much more likely to be influenced by a good personal doctor than by ‘the intervention of occupational health and academic physicians’.

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Nevertheless, no one denies the value of preventive medicine, either at work or anywhere else. A growing number of companies has taken steps to discourage smoking. At Esso’s London headquarters, for example, there are anti-cigarette signs and notices everywhere.

Campaigns against excessive use of alcohol are even more important because drink can not only be harmful to health, but is a potent source of accidents. The Government estimates that alcohol misuse costs more than pounds 1,000 million a year in lost production. Problem drinkers, who are at work, not home, most of the time, have at least three times more accidents than other workers and are absent from work five times more than the average.

According to one study, as each problem drinker on the payroll costs an employer at least a quarter of annual salary, growing numbers of companies have begun to use schemes such as the industrial resources training program of Accept (Alcoholism Community Center for Education, Prevention and Treatment).

This is an independent national charity which last year joined forces with the AMI hospital group to design and to open new centers for treating not only alcohol misuse but over-use of tranquilizers and sleeping pills. The first of these Oakhurst centers opened in London this summer.

There are many other areas in which industry can and does prevent damage to the health of its workers, although much remains to be done. The Health and Safety Executive encourages companies to display its posters on safe work systems, which can help to prevent back strain and hernias, for example, with easy-to-follow illustrated instructions on lifting and carrying.

Because of a European directive, about three million British workers will have to be tested for deafness. This will apply to those subjected to noise levels of more than 85 decibels, which is considerably lower than the 105-decibel level laid down by the executive’s code of practice.

That requirement exposes still further some of the difficulties associated with such preventive measures. Setting up an audiometry facility can cost a company about pounds 4,000.

Moreover, protective measures are not as easy to take as they might seem. Three boilermen in the North-East who suffered severe industrial deafness received relatively low compensation because of their contributory negligence – not wearing the hearing protection the employer had supplied. Workers often do not use such gear because it is uncomfortable or interferes with their work, or perhaps causes skin irritation.

But perhaps the most problematical and contentious aspect of preventing ill health at work now stems from another European directive on the control of substances hazardous to health. The proposed COSSH regulations, and occupational exposure limits that complement them, will apply to more than 40,000 substances and will, among other things, require employers to keep health records of all exposed employees for at least 50 years from the date of the last entry.

The background to this is that in 1979-80, the Health Department awarded more than 5,700 new injury benefits for short spells of incapacity, 850 longer-term benefits and 710 death benefits. These were for diseases that could be attributed to exposure at work to substances other than lead and asbestos, which were dealt with separately.

In 1980 there were more than 20,000 deaths from chronic bronchitis, asthma and emphysema, many of which were linked to jobs. And it is estimated authoritatively, by Doll and Peto at Oxford, that up to 10,000 cancer deaths a year could be prevented if occupational hazards were removed.

The Health and Safety Commission’s consultative document on the COSSH regulations, which has prompted 500 submissions, describes the primary aim as protecting the health of people at work and to ensure that others who might be affected by hazardous substances used in work are not exposed to health risks. ‘So far as is reasonably practicable’.

But an editorial in the Journal of the Society of Occupational Medicine questions what ‘reasonable’ is in this context.

Among factors that have prompted the proposed measures, it says, are greater public awareness of industrial health hazards, pressure groups which exploit undue anxieties, the advance of toxicology, which makes it possible to detect and to analyze the smallest quantities of toxic substances and, by contrast, lack of understanding of how mutagenic, teratogenic and carcinogenic effects occur, so that standards of control are based often on ‘mere guess-work’.

The editorial says this may lead ‘to a distortion of standards or the imposition of controls requiring the deployment of disproportionate resources in all too commonly futile attempts to provide reassurance and to reduce anxiety for which no adequate scientific justification can be found.

‘Confronted by this relentless and often fruitless search for reassurance, is it reasonable to continue to pursue a policy of attempting to allay fears that are inherently unreasonable? Increasingly sophisticated methods of detection would reveal that we are all living in an environment of suspect or known carcinogens at the molecular level’.

Though not dismissive of such misgivings, Dr. John Cullen, chairman of the Health and Safety Commission, believes the COSSH scheme marks an important step forward in the whole area of occupational hygiene. He does not believe that the regulations will, in practice, place an undue burden on industry.

Dr. Cullen says: ‘We want employers to assess the risks of particular substances, to assess the exposure, to develop systems of working with those substances which will be reasonably safe and then to monitor them. In the electronic age, the record-keeping for this is not difficult.’

Prevention, then, will seek to be practicable. The easy ‘solution’ with every potential hazard is to ban it but the COSSH system offers a sensible alternative. ‘If you know it is a nasty’, Dr. Cullen says, ‘you can handle it. You do not have to ban it.’

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