Lung disease in the construction industry

– the role of occupational hygiene in prevention.

By Chris Keen, Policy and Technical Committee, BOHS

The burden of respiratory disease in construction

Exposure to airborne dust is often considered to be an unavoidable part of working in the construction industry, and historically there has been a view in some parts of the industry that ‘it’s just dust’ and doesn’t represent a serious health risk. In reality, the facts are very different. Construction dusts contain a mixture of individual contaminants, and often these have the potential to do serious, irreversible harm if exposures are not properly controlled. And because of the long latency of most lung diseases associated with these exposures, the true impact is often not fully appreciated. This is compounded by the transient exposure patterns typically found in construction. The provision of long term health surveillance is notoriously difficult in this industry, and many cases of ill health go un-reported and remain hidden. The true burden of respiratory disease in construction workers isn’t accurately known, but estimates are that several hundred people die each year as a result of historic exposures to respirable crystalline silica. The issue is so big as to be the subject of a recent public inquiry, co-ordinated by the All-Party Parliamentary Group (APPG) on Respiratory Health.

The role of Occupational Hygiene and the Breathe Freely Campaign

As these facts have become more apparent, the construction industry have responded and much has been done in the past few years to drive improvements in the industry. Key to providing solutions is the implementation of good practice to prevent, or at least control, the exposures which cause respiratory disease. The recognition, evaluation and control of harmful workplace exposures is the bedrock of the occupational hygiene profession.In 2015 the British Occupational Hygiene Society (BOHS), the chartered society for worker health protection, launched theBreathe Freely in Construction campaign. Historically, interaction between the occupational hygiene profession and the construction industry has not been commonplace, which may go some way to explaining the disease burden associated with construction. The Breathe Freely campaign aimed clearly to address this, and to provide the construction industry with effective support to drive down the dust exposures which are at the root of occupational lung disease.

The basis of occupational hygiene is the hierarchy of control. This recognises that all risk control measures are not equal, and that some are far more reliable than others. Clearly, the elimination of a hazard entirely, or if that is not possible, the control of emissions at source, provides a far more robust control approach than a reliance on personal protective equipment. But we still see, all too often, dust masks being used as the only control against dusts which are known to cause cancer and other life changing diseases. Through Breathe Freely, we have worked with stakeholders including the Health in Construction Leadership Group, the Construction Dust Partnership, the Healthy Lungs Partnership and more to produce a suite of materials providing guidance on effective dust control across a wide range of construction tasks. We have created training materials which allow the upskilling of site supervisors to allow a better understanding of respiratory risks and the associated need to control exposures.  And through a series of roadshows, we have reached well over a thousand construction industry stakeholders directly, to spread our messages. 117 high profile business operating in the UK construction sector have signed up as campaign supporters.

There is no doubt that the Breathe Freely campaign is part of a sea change in controlling respiratory disease risks in construction. Major construction clients, and large principal contractors are now giving this topic much more attention. The application of exposure controls, other than the ubiquitous dust mask, is now the norm on larger construction projects. Dust exposures are reducing and the future burden of lung disease should follow on from this as a natural progression.

However, there is still much to do. The overriding number of businesses operating in the construction industry are SMEs. The level of risk awareness, and the accompanying standards of exposure control, still have a long way to go within this sector of the industry. As our campaign moves forward, we will provide a greater focus on reaching these businesses, with specific targeting on the construction trades known to be at highest risk of dust exposures.  We are always looking for new campaign supporters, and we would especially welcome interest from stakeholders operating in, or interacting with, construction SMEs. You can find out more by visiting our website.

Top Tips for Workplace Health

Good health is good business but where do you start? Whether you are starting a new business or looking for ways to boost the health of your staff, here are some top tips.

Encourage healthy eating

Although it’s easy to tuck into comfort food for lunch, or have endless coffee and chocolate at our desks to boost energy, this can lead to health problems such as putting on weight (which can impact your cholesterol levels) feeling sluggish, and not getting enough vitamins and minerals from your diet.

For large workplaces, promote a healthy diet by having a subsidised canteen in the workplace that serves diverse, nutritious and colourful meals during breakfast and lunch. This could include vibrant salad bars, home-cooked main meals and freshly made smoothies, ideal for those who, after a long commute or a stressful meeting, want to unwind with something delicious that won’t break the bank.

For smaller workplaces, even just sharing information about the nutritional qualities of fruits and vegetables is a great way to get started. Having a filtered water cooler, subsidising reusable metal water bottles and organising a free fruit and vegetable delivery to the office are just a few other ideas that you can implement.

Create a sense of community at work

Encourage better mental health and general wellbeing by creating a sense of community within the workplace. This opens up channels of communication between managers and staff and helps to facilitate any difficult conversations that need to be had with regards to health issues. Consider offering work exercise classes like yoga, HIIT, pilates and bootcamps which all members of staff can join. Or, why not enter a charity fundraiser together like a 5K run, 60K bike ride or a Zumbathon?

Have scheduled breaks other than lunch

Regular breaks, even if it’s just for a 10-minute dose of fresh air, can do wonders for the workplace. Ideas for these scheduled breaks include five to ten minutes of mindfulness or guided meditation focusing on breathing and refreshing a cluttered mind. Why not have a technology-free zone full of books, magazines, sofas and music? This is ideal for office members who might need a moment to collect their thoughts and rest their strained eyes.

Keep the workplace hygienic

During the winter – a hotspot of colds, flu and viruses – you need to make sure that your workplace is always kept clean and tidy to avoid the spread of disease and illnesses. Simply employing an office cleaner to spritz, hoover and clean the office daily is a great way to keep on top of pesky bugs.

Promote and encourage personal hygiene amongst your employees. Consider adding soap dispensers or soap bars next to sinks, providing antibacterial hand gel and surface wipes, or even installing showers in the workplace.

Emphasise a work-life balance

Though you want your employees to work hard and meet productivity targets, you also need to be mindful of their work-life balance. Like having a sense of community in the office, simply remembering and encouraging a positive work-life balance will build positive rapport between you and your employees. This can generally help manage stress levels at work, as high-stress environments can be a precursor to a range of mental health problems and can also weaken the immune system.

Keep it a general rule not to email or contact work colleagues out of work hours about work-related issues (unless urgent), and organise plenty of work socials to keep your colleagues feeling chipper at all times.

Bio

Duality Healthis a private healthcare clinic catering to the people of Newry and Dungannon and surrounding areas.

Supporting cancer patients with work

Every two minutes someone in the UK is diagnosed with cancer.[1]

An estimated one in three people with cancer in the UK are of working age.[2]While not all of these will be in employment, Macmillan research has found that 87% of those in work when diagnosed with cancer say it’s important to them to continue working after diagnosis.[3]

The effect of cancer and its treatment on a person’s ability to work can vary widely. Factors can include the type and stage of cancer, the treatment and its side effects, and how the person copes with a life-altering event like a cancer diagnosis. While some people with cancer continue to work during their treatment, others may need time off or support to help them return to work, while others may need to leave the workplace completely.

The role of GPs

GPs can play an important role in supporting patients with work following a cancer diagnosis. The conversations they have with their patients – whether it’s while completing Fit Notes, during a Cancer Care Review or at another point in the patient’s cancer ‘journey’ – can empower them to discuss their needs with their employer. While GPs don’t need specialist knowledge of workplaces or occupational health, they can help their patients by supporting them to understand the potential impact of their cancer on their work life.

Resources for healthcare professionals and patients

Since the launch of the Council’s Talking Work: A guide for Doctors discussing work and work modifications with patientsearlier this year, Macmillan has developed some additional resources to support healthcare professionals to have conversations specifically about work and cancer. Our Work support route guides– separate versions of which are available for professionals based in England, Scotland, Wales and Northern Ireland – and our Supporting patients with work: 10 top tips guidehelp professionals to feel confident about discussing work with patients and signposting them onto further sources of support.

Macmillan has also created a dedicated team of work support advisers who can help people with cancer and those who care for them to understand their rights at work. The team provides information and guidance on talking to employers and negotiating adjustments and can answer questions on sick pay or taking time off. People with more complex needs can also be referred to one-off legal advice. The team is available Monday-Friday, 8am-6pm on 0808 808 0000. In addition, a wide range of information about work and cancer can be found by visiting macmillan.org.uk/work.

How to build conversations around work and cancer into practice

Along with Fit Note conversations, the Cancer Care Review provides an excellent opportunity to discuss work with patients. Macmillan has worked with each of the main GP IT providers to develop integrated, standardised cancer care review templates within EMIS Health, INPS vision and TPP SystmOne. These templates take a holistic approach to the discussion, covering conversations about employment, financial support and the clinical needs of the person living with cancer.

GPs can use these templates to guide them through conversations with people living with cancer. The templates are also a helpful way to ensure that appropriate information is coded back onto the patient file, as well as supporting signposting to further support, with embedded Macmillan information available to print.

Rebecca Coaker, Services Influencing Manager – Work and Cancer, Macmillan Cancer Support

We’re here to help people with cancer live life as fully as they can, providing physical, financial and emotional support. So whatever cancer throws their way, we’re right there with them.

[1]Estimated by calculating UK-wide incidence of about 360,000 new cases of cancer per year divided by the total number of minutes in a year.

[2]Estimated total prevalence of people in the UK aged 16 to 65. It is estimated based on UK complete prevalence of those aged 0 to 64 in 2015 derived from Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202. (Projections scenario 1). This was adjusted up to those aged 16 to 65 based on 21-year cancer prevalence in England (Transforming Cancer Services Team for London, NHS, National Cancer Registry and Analysis Service, PHE and Macmillan Cancer Support. 2017. Cancer Prevalence in England: 21-year prevalence by demographic and geographic measures. www.ncin.org.uk/about_ncin/segmentation). The proportion is based on UK complete prevalence in 2015 derived from Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202. (Projections scenario 1).

[3]YouGov Plc. Total sample size was 1507 PLWC respondents who were in work when diagnosed with cancer. Fieldwork was undertaken between 29/06/2018 – 22/07/2018. The survey was carried out online.

Please see the attached blog from Health Assured, focusing on Mental Health in the Workplace:

Mental health in the workplace 

For further information visit our website: https://www.healthassured.org

Don’t sleep on it!

Excessive daytime sleepiness (EDS) is the main focus of DVLA concern with people diagnosed with Obstructive Sleep Apnoea (OSA), a condition in which sufferers experience significant periods of not breathing, while they are asleep during to airway obstruction.  Inadequate oxygenation of the body from OSA is bad for general health.  Lack of deep sleep leads to those affected being fatigued and falling asleep easily during the day (even if they are not aware of OSA). Drivers who suffer from Sleep Apnoea must notify DVLA to get their condition reviewed and controlled before they can go on driving. DVLA are solely concerned about falling asleep while driving, not other health issues including exacerbation of diabetes or the increased tendency to heart disease and/or stroke.

Some reports suggest that about 20 per cent of adults suffer a significant degree of EDS, although OSA is only one cause. A far bigger cause is disturbed sleep due to things like shift work and caring duties for infants and sick dependants involving waking nights.

ESS (Epworth Sleepiness Scale) and AHI (Apnoea Hypopnoea Index) scores are used by medical practitioners to assess tendency to EDS.  Some research suggests that ESS results are subjective and sleep specialists warn against them as wholly reliable assessments of EDS. Other research suggests that there is no clear correlation between AHI and ESS scores.

In assessing the risk of sleepiness while driving, AHI is a not very reliable measure for tendency to EDS.  Arguably, were a better tool available and widely adopted, the DVLA might reduce its fixation on OSA. Many more ‘at risk’ drivers might be brought into the DVLA medical surveillance net, while at the same time releasing from continuing medical surveillance some OSA suffers who do not suffer significant EDS. Sleepiness, however, is a very transient and subjective state for which there are few reliable markers.

Medical practitioners should be made more aware of other non OSA related causes of EDS and arguably, where these cannot be brought under satisfactory control, DVLA should be informed as they are in cases where significant OSA is diagnosed.

At present the duty to inform DVLA about OSA is triggered by medical diagnosis. Opinions and guidance vary as to whether, once diagnosed, the OSA suffer should cease driving until given permission to resume by DVLA. DVLA stress that the primary duty not to drive while unfit from any cause rests with the driver. More publicity about sleep and driving may cause some drivers not to go to their doctors for fear of being suspended from driving while awaiting treatment – but in practice this fear is unfounded. Treatment, such as using CPAP (continuous positive airway pressure) equipment at night is available via NHS sleep clinics and with a bit of practice is quite easy to use. It can quickly help the OSA sufferer to feel a whole lot better and have a lot more energy. More guidance is still needed for employers and potential sufferers.  Responsible drivers need to pay more attention to ‘sleep hygiene’ and to finding ways of remaining alert when at the wheel. They need to be prepared to discuss sleepiness issues with their doctors and not be afraid of being caught in the DVLA medical surveillance net.

Sleepiness and road safety have been a big part of RoSPA’s policy and campaigning work on managing Occupational Road Riskcampaigns for nearly twenty years. (See our advice to employers at https://www.rospa.com/road-safety/resources/free/employers.) The key message is that employers must not cause their drivers to drive tired. It needs an intelligent approach. Anyone who feels sleepy at the wheel, regardless of the cause, knows they are becoming impaired and must stop and recover until they are safe to proceed.

RoSPA’sNational Occupational Health Safety Committee (which brings together the main institutional stakeholders in this area) has begun work on tackling fatigue in the workplace. This is not only highly topical because of its links to mental health and ‘wellness’ but its impact on safety and accidents in the workplace have generally been underplayed up to now. New guidance however is now available in the form of the HSE fatigue risk index (see http://www.hse.gov.uk/research/rrhtm/rr446.htm).

ROSPA are thinking about producing some guidance on OSA and Employment (‘OSA and your job’ perhaps?), helping both sufferers and their managers to better understand the issues involved and to avoid over-the-top, excessively risk averse responses that might lead them to exclude OSA sufferers from certain roles ‘on health safety grounds’. Talking to specialists and consultants reveals how reluctant many of their patients are to reveal to their employers that they have had an OSA diagnosis.   There is undoubtedly a lot of prejudice and misinformation in the workplace about this issue, and about fatigue and sleepiness generally – which, of course, goes a lot wider than OSA. ‘cat napping’, as an essential coping mechanism in the workplace, (especially for older workers who make up a bigger proportion of the workforce these days) ought to be a widely understood and accepted coping mechanism, not seen as an outlandish idea.

If you have experience in tackling problems experienced by workers in getting enough good quality sleep we’d like to hear from you.

Roger Bibbings MBE CFIOSH

Partnership Consultant RoSPA                                             May 2019