Dear Chris,
Many thanks for your response / discussion of these issues, which are so central to today's occupational health practice. I do like your analogy to planned maintenance.
However, 'management issues' and a much broader term 'employment issues' - which might also include factors such as job insecurity, and its impact on people whilst they are at work, the lack of alternative employment outside of the company etc. can tend to lead to management issues becoming 'medicalised' - that is, a way for the individual of escaping from or dealing with an immediate issue at work is by going off sick. This might be deliberate, operating within the current systems and policies, or be unconscious (eg the person genuinely feels unhappy / unwell - and this might relate to their own personal health beliefs - rather than a strictly medical model of health) they may feel that they must be 'unwell' when they are not happy.
The evidence for stress (not a diagnosis), for example, suggests that where people are exposed over a prolonged period that this 'unhappy state' is then associated with the development of more easily defined conditions, such as anxiety / depression / mental health problems, and increased risk factors such as increased smoking / drinking / use of drugs - but that over time this may also go on to increase the risk of cardiovascular disease, raised blood pressure, disturbed sleep etc. and some have linked cancer with stressful working conditions, which are then much more clearly defined medical issues, but because of the time delay difficult to link directly to the working conditions. So its somewhat difficult for OH to separate themselves - perhaps it is easier to bat management issues back to managers at the early stages in this process, or where the effect is felt by an individual, rather than by a group of workers. But should this be the case..
I believe that it was Kimavaki who published a paper in the BMJ showing a doubling of the mortality rates for cardiovascular disease in those in stressful occupations (when compared with those in lower stressful jobs as measured using the Karasek model).
Managers can also find it convenient to try to 'manage' the situation within current systems and policies that include referral to OH - also using the system to their advantage - ie give the problem to someone else by making it a medical issue.
In terms of cost benefit, I did refer only to health promotion and lifestyle screening - whereas I think that the evidence for preventive actions, that reduce exposure and therefore the risk of, and actual occurance of, occupational disease does have a good cost benefit basis.
But to say that health screening will result in improved health .... and that this will reduce absence ..... and increase productivity.... is well stretching it a bit. There are too many factors at work in between these stages to make it uncertain that such benefits will be realised. A bit like saying your planned maintenance will improve industrial relations - well it might, in theory, but its a long shot.
One caviat that I would make, about screening, is that in developing countries, where the incidence of some diseases in the screened population may be higher, and where they may not have the same standard of primary and secondary care, then some form of health screening might be much more beneficial than it is in a country like the UK...... although I am not aware of any research that support this from an occupational health perspective.
We seem to have strayed over a good deal of ground here - must be time for the summer holidays.
Best wishes
Stuart
________________________________________
From: [log in to unmask] [[log in to unmask]] On Behalf Of Chris Packham [[log in to unmask]]
Sent: 17 July 2008 13:06
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] occupational healthprotocool for managing sickness absence
Stuart
I agree with you regarding the complexity of causes of sickness absence.
However, I would contend that many of these are not OH issues but are more
within the remit of management and HR. Unfortunately I often see OH being
drawn into issues that are not part of their remit or within their training
to resolve. Surely, OH's involvement in sickness absence should be limited
to health aspects.
I read your argument about the weakness of evidence on cost:benefit of OH.
Yes, but the same actually applies to almost all forms of preventative
maintenance. As I know from practical experience in managing an engineering
company, a manager will never know for certain whether that preventative
maintenance programme did actually cost less than running his operation
without it and hoping nothing will break down. He assesses the situation on
the "balance of probabilities", i.e how does he rate the risk and cost of a
major breakdown and its likelihood against the cost of the preventative
maintenance programme when making his decision as to what resources to
provide. He will take past history into account, of course, but he will
still be working in an area of considerable uncertainty.
In a sense it is like an insurance policy. You hope that the premiums will
have been paid out for nothing - as you hope you will never have to claim.
However, what the policy does provide is peace of mind. That, as I know from
personal experience, is a powerful persuader - and perhaps why in
engineering so much attention is paid to preventative maintenance.
Chris
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