Musculo-skeletal aches and pains
80% of the adult population will suffer with back pain at some time in their working lives. Back pain and other musculo-skeletal aches and pains are the single biggest cause of sickness absence. As well as the cost to the individual in terms of pain and discomfort, there is also a huge financial cost to employers resulting in lost working days, increased sick pay and reduced productivity. The TUC estimate that British businesses lose 4.9 million days per year of employee absenteeism through work-related back pain. The cost of back pain to the exchequer is estimated to be in the region of £5 billion per annum. Evidence suggests that appropriate occupational health advice and particularly early access to ergonomic intervention during work and workplace design can reduce the occurrence of back pain and the associated human impact and costs. Good ergonomic design and the implementation of improved material handling techniques and technology could not only help to minimise the health impact but also improve productivity.
More than one million people now cite mental or behavioural problems in support of claims for sickness benefits – a rise of more than 200,000 in a decade. It is estimated that each year one in six workers in England and Wales is affected at any one time by anxiety, depression and unmanageable stress. Research by the Chartered Institute of Personnel and Development finds that it is not just absence that hits business. Most people with poor mental health continue to work yet may struggle with concentration, making good decisions and providing effective customer service. It is estimated that this ‘presenteeism’ costs UK businesses £15.1 billion per year in reduced productivity, while mental health related sickness absence costs £8.4bn.
The World Health Organisation estimates that by 2020, depression will have become the second leading cause of disability in the world – the workplace is a key and cost effective environment to address this.
323,000 people are diagnosed with cancer each year and 109,000 are of working age – at the same time survival rates are improving. At least 8,000 deaths and a further 14,000 cancer registrations are estimated to be related to or caused by work conditions; these are all potentially preventable with the provision of good occupational health and safety and occupational hygiene services on how to prevent, or control adequately, exposures to the cancer-causing agents concerned. Research shows that cancer patients have better outcomes at work if they receive support early on to consider how cancer and its treatment might affect their working lives. More than 4 in 10 people who are working when diagnosed have to make changes to their working lives after being diagnosed.
Following the principles of sound occupational hygiene practice, the workplaces and working conditions in at risk industries need to be reviewed. Where employees are exposed, then an assessment will need to be made of levels of dust, where appropriate measuring personal exposure and comparing to the Workplace Exposure Limits published by HSE. Where levels are elevated, action will be required to prevent or control exposures. This may involve changes to work equipment, work practices or personal protection. Employees that may have been exposed to elevated levels of dust may require medical evaluation or counselling. Any individual with lung cancer needs advice and support from Macmillan and their employing organisation. This will enable an informed choice about when and how they will return to work.
Occupational health practitioners can supplement the work of Macmillan by ensuring that evidence-based decisions about fitness for work are taken, linking knowledge of the illness with functional ability and the needs of the job. The Disability Rights Commission (DRC) reported that 82% of callers with cancer complained of unfair treatment at work following diagnosis and that their employers were failing to make reasonable adjustments. This is despite guidance from the Chartered Institute for Personnel and Development (CIPD) Cancer and Work – Guidelines for employers, HR and line managers. A survey by CIPD found that 73% employers do not have a formal policy for managing employees with cancer and many organisations do not emphasise the importance of provision of information or support. Breast cancer is considered to be a disability under the Equality Act 2010. However, more than 20% employers surveyed were unaware of cancer being considered to be a disability.
There are 2.9 million people who have been diagnosed with diabetes in the UK and a further 800,000 suspected undiagnosed. By 2025, it is estimated that five million people will have diabetes in the UK. Type 2 diabetes is up to six times more common in people of South Asian descent and up to three times more common among people of African and African-Caribbean origin. By 2031, ethnic populations will make up 15% of England and 37% in London. The workplace is an ideal environment to assist employees with long-term chronic conditions and all employees benefit from strategies for controlling diabetes because these strategies can also reduce the risk for, or help to manage, other chronic diseases, including heart disease, stroke, high blood pressure, and obesity. Provision of targeted education addressing diabetes and work, coupled with easy access to clinical expertise in the workplace should be part of an integrated care pathway for this condition.
In England 65% of men and 58% of women are either obese or overweight. Obesity reduces your life expectancy by around nine years on average and is responsible for 9,000 early deaths each year in England. Around one in five cases of heart disease are attributed to obesity. Obese workers take more sick days, have longer sick leaves and incur greater productivity losses than do non-obese workers.
A study (by John Hopkins Bloomburg School of Public Health) found that only 44% of general practitioners reported success in helping people lose weight – workplace programmes can tackle obesity on a daily basis by encouraging a healthy diet and active lifestyle among employees through an organisational culture of health and wellbeing and specific health promotion campaigns. Because most employees spend more than a third of their waking hours at the worksite, the workplace has a unique opportunity to provide health and wellbeing information and in facilitating healthy behaviours. For example, employers could have an active travel policy to encourage walking or cycling to and from work. There might also be groups of workers that play competitive sports or that organise sporting events. There should be healthy eating options in the staff canteen, with calorie labelling of foods.
One in six cases of asthma in people of working age is either caused or aggravated by preventable work-related factors. Certain industries and trades carry a much greater risk such as vehicle paint sprayers, bakers, laboratory workers, certain workers in the chemical industry and those carrying out electrical soldering. Work-related asthma is preventable with provision of good multi-disciplinary occupational health services, including advice on risk assessment and on how to adequately control exposures to respiratory sensitisers such as flour dust, plus health surveillance on those who may be exposed. Many of the people exposed work in SMEs with little or no access to occupational health. SMEs currently account for 99.9% of all private sector businesses and employ 14.1 million people – only 1 in 10 small employees provide access to any occupational health provision, and even fewer have access to allied health professions.
In the UK, one third of the population will be over 60 by 2033 – increasingly many people will have to work beyond current retirement ages either by choice or necessity. There are many myths about employing older workers. Evidence indicates that individual attitudes and skill sets, rather than age, per se, are the important determinants of performance. For older employees, pre-retirement advice will need to be adapted. 4th and 5th decade working courses could provide health coaching, advice on physical activity and careers advice, as well as guidance on planning finances.