The Workplace as a setting for Health Protection and Health Promotion in Ireland

Anne Drummond

Associate Professor in Occupational Safety and Health

UCD School of Public Health, Physiotherapy and Sports Science

Occupational HealthEnvironmental, occupational and personal risk factors

Health ProtectionWork systems designed to protect workers from disease and injury by preventing and reducing risks

• Occupational risk factors (hazards)

• Multi-disciplinary• Ergonomics• Occupational Hygiene• Occupational Health• Occupational Safety

Health PromotionActivities that improve or maintain health. Assisting workers in improving health behaviours

• Personal risk factors (smoking, diet, drinking, stress)

• Often behaviour-orientated

WHPHealth Protection Wellness

This is the data our OSH statistics try to capture

Work-related injury, illness and FatalitiesData from:• Fatality notification to HSA• HSA accident notification • Central Statistics Office (CSO),

Quarterly National Household Survey (QNHS)

• Occupational Injuries Scheme• THOR

Accident Injury

Timeline: Seconds

Health Status + (Multiple) Exposure Illness

+Timeline: Days, months, years or decades

Occupational or work-related?Occupational Disease

A case of occupational disease is defined as:

“a case recognised by the national authorities responsible for recognition of occupational diseases.

The data shall be collected for incident occupational diseases and deaths due to occupational disease”.

Work-related illness

• Work-related health problems and illnesses are those health problems and illnesses which can be caused, worsened or jointly caused by working conditions.

• This includes physical and psychosocial health problems.

• A case of work-related health problem and illness does not necessarily refer to recognition by an authority…

Work-related

Work Life

http://www.hsa.ie/eng/Publications_and_Forms/Publications/Corporate/HSA_Statistics_Report_2013-2014.pdf

Self-employed SMEs

http://www.hsa.ie/eng/Publications_and_Forms/Publications/Corporate/HSA_Statistics_Report_2013-2014.pdf

Work-related Illness rates are rising

Work-related ill-healthDrilled down into the CSO data

https://www.esri.ie/pubs/RS40.pdf

MSDStress, depression, anxiety

https://www.esri.ie/pubs/RS40.pdf

WR Illness • F > M (2008-2012)• Boom > recession• Probability of illness increases with age,

longer hours of work, short number of hours, highly variable working hours, shift work and working at night

• Self employed do not differ from employed

(pages 60-61)

Illness rates rising

Associated with certain work patterns

https://www.esri.ie/pubs/RS46.pdf

Social patterning to riskRisks in agriculture, forestry and fishing, mining, quarrying and manufacturing

Psychosocial risksParticularly in public sector and the health and social work sector

Occupational Health Risks to our Working Population• Rising rates of work-related illness

• Commonest conditions are ‘MSD’ and ‘Stress, Anxiety and Depression’

• Presenteeism? • Leaveism?

• Impact of job characteristics (working hours, shift patterns, night work) on health• Work-related illness• Sectors at risk (agriculture, construction,

transport, health sector)

http://www.cso.ie/en/media/csoie/census/documents/census2011profile3/Profile,3full,doc,for,web,sig,amended.pdf

4.6 million population3.1 million in the 15 to 64 age group (working age population)2.2 million in the labour force, of which 1.9 million are at work

Among those aged 15 years and over:939,000 males at work839,000 females at work.

Census 2011

Public Health Perspective• Rising rates of chronic illness• Highest causes of death in under 65s

• cancer and diseases of the circulatory system• Modifiable lifestyle and behaviour factors

http://health.gov.ie/publications-research/statistics/statistics-by-topic/causes-of-death/

http://www.cso.ie/en/media/csoie/census/documents/census2011profile8/Profile,8,Full,document.pdf

Disability

Work can be a contributory factor to chronic disease

Safety and Health at Work• Health and Safety Authority

2001

2008

NATIONAL Strategy for Workplace Health and Wellbeing 2008

National Strategy for workplace health and wellbeing• Workplace culture … that will promote health and wellbeing, prevent ill

health, and support rehabilitation to the workplace of those who are out of work through ill health or disability

• Recognition that it goes beyond legislative requirements• Multi and cross-departmental response needed (HSA, HSE, DSFA, DHC,

NDA, IBEC, ICTU, FOM [RCPI], IES,

• Small and micro enterprises 97% of businesses• About 0.8 million workers

• Public sector and medium to large enterprises• About 1.2 million workers

Workplace Health PromotionLarge organisationsPublic sector organisationsMulti-nationals

Small and micro enterprisesConstruction Workers’ Health Trust

20112008

Key indicator: improving the promotion of health and wellbeing at work

2011

2010

http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review

“Work is good and unemployment bad – for physical and mental health, but the quality of work matters”

“Puts ill health prevention in the context of the social determinants of health … involvement of stakeholders…schools, workplaces, home…all have the potential to help or hinder ill-health prevention”

“Occupational health and vocational rehabilitation should be fully integrated into the NHS, providing a Fit for Work model….”

2011 prompted by Black Report

2010

Employees“… clear patterns in the data that show that provision is more prevalent in large organisations, especially those in the public sector and those with trade union presence”.

EmployersFindings reflected employees’ experience

Larger organisations, public sector organisations and those with Unions

Promotion of health and well-being at work

2011 prompted by Black Report

2010

Focus on sickness absence but followed up on health and wellbeing

• More than a third of employees had a health condition (spread across all occupations, industries and sizes of organisation)

• 42% with a health condition remained in work, despite it having a considerable effect on their work

• Over a third considered that their health condition had been made worse by their work

• Health and Wellbeing Policies explored were:

• Flexible working (74%)

• Injury prevention training (76%)

• Occupational Health Services (65%)

• Independent counselling services (39%)

• Stress management training (31%)

HSA is represented on Healthy Ireland Council Cross-Sectoral Group

Healthy Workplaces Bill currently proposed

Workplace Health and Wellbeing Checklist

Public sector Private sector• Large

• SMEs• Micro• Self-employed• Farmers ?

Probable mental health problems

http://health.gov.ie/wp-content/uploads/2015/10/Healthy-Ireland-Survey-2015-Summary-of-Findings.pdf

Changes individuals

may like to make

Occupational Health Cochrane

Evidence

Limited evidence

Occupational ContextHours of work, night and shift work, job tenureSelf-employed and high risk work patternsIn addition to known occupational hazards

National ContextAgeing workforce, Retiring later,

Ottowa Charter

• “Health is...seen as a resource for everyday life, not the objective of living”

It goes on to say:• “Health is a positive concept emphasising social and personal

resources, as well as physical capabilities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing”

CSHW AD

http://www.euro.who.int/en/publications/policy-documents/ottawa-charter-for-health-promotion,-1986

Luxembourg Declaration on Workplace Health Promotion in the EU

CSHW AD

http://www.enwhp.org/fileadmin/downloads/free/Luxembourg_Declaration_June2005_final.pdf

“The combined efforts of employers, employees and society to improve the health and wellbeing of people at work”

“WHP is a modern corporate strategy which aims at preventing ill health at work and enhancing health promoting potentials and wellbeing at work”

Jan 2007 version

National Health Perspective• The Workplace as a setting for Health Protection and Health Promotion

in Ireland ?

• Health protection from work-related hazards• OSH system, albeit facing new problems• Addressed under the remit of the HSA• WHP not universal; growing but economic issues

• Health protection from non-work or work-life risk factors• Public Health System; facing new problems (which follow through to the

workplace)• Working-age population is a prime target for health protection and health

promotion activities• Sectors and company types not in the WHP net• Multi-departmental approach• Who pays for it?

CSHW AD

• 'Well-being at work cannot be brought about simply by way of health and safety policy: there are strong links with the way work equipment is designed, with employment policy, with policy on disabled people, and with other policies like transport and, of course, health policy in general, whether it be preventative or curative”

• European Commission. (2002). Adapting to change in work and society: a new Community strategy on health and safety at work 2002–06.

• http://europe.osha.eu.int/systems/strategies/future/#270