Occupational health and the future of health and work

What is the future for workplace health? While it is impossible to make exact predictions about where we will be in five or 10 years’ time, one thing is certain: we are entering a period of severe cutbacks in public spending, increased stress on staff facing increased job insecurity, and intense scrutiny of NHS efficiency.


Equally important is that scientific advances and environmental pressures will lead to significant change in the workplace, with inevitable knock-on effects on health and wellbeing. So how should occupational health (OH) professionals respond?


Dr Sayeed Khan is chief medical officer at manufacturers’ organisation the EEF and special professor of OH at the Institute of Work, Health and Organisations at the University of Nottingham. He believes OH staff must be as well-informed as possible, looking at key innovations and incremental changes specific to OH, and also “horizon scanning”: keeping up to date with scientific and social developments that are going to have an impact on the workplace and the health of the nation.


“Currently, big changes are in the pipeline,” says Khan. “The new government is talking about setting up a new division of public health, and this would very naturally incorporate workplace health. I don’t think my OH colleagues are aware how important all this is. It’s important to keep an eye on what is going on.”


One important source of information on this is the Health and Safety Executive (HSE) website, which has a section devoted to this issue.


The HSE set up a formal horizon-scanning system in early 2005 to co-ordinate and make better use of existing horizon-scanning work. This became the Futures Team when it was recognised that greater scope was offered by expanding into other futures techniques, such as scenario building. The team uses a range of approaches, says Peter Ellwood, section head, Futures Team.


“The system recognises the HSE’s own staff are a good source of information on emerging issues, so the Futures Team tries to obtain intelligence from them. In addition, online reference material, the internet, journals, alerts, expert and community views, personal communication and attendance at meetings and conferences all provide information,” he says.


Issues highlighted include: cyber security, gene therapy, genetic testing in the workplace, human performance enhancement, nanotechnologies, pervasive computing, rapid manufacturing, recycling, and globalisation.


What follows is a brief summary of some of the key topics.


Gene therapy


This has the potential to treat inherited disorders, cancer and some genetic diseases. Currently, most work in the UK is at the research and clinical-trial stage. Most of the health and safety concerns about gene therapy arise from the use of infectious viruses as gene delivery systems because of the potential for spread to workers and the wider community.


Currently, the HSE is keeping “a watching brief” over the technology and working in partnership with organisations such as the Gene Therapy Advisory Committee (GTAC) and the Scientific Advisory Committee on Genetically Modified Organisms (SACGM) to ensure there is continued oversight of gene therapy work.


Genetic testing in the workplace


There are currently genetic tests for more than 1,300 diseases, and genetic testing is continually getting cheaper and faster. Now scientists are researching the sources of more complex disorders involving multiple genes, such as heart disease and Alzheimer’s.


Huge research projects such as the International HapMap Project and UK Biobank are providing key resources for researchers in finding genes that affect health and disease and in understanding the complex interactions between genes, health, lifestyle and environmental factors.


Genetic testing has the potential to offer many benefits in general health – for example, in identifying markers for certain diseases. However, the downside could be that employers think recruiting ‘non-susceptible’ people means they can relax their health and safety standards. Employees could also be screened for susceptibility to non-work-related conditions to see if they are more likely to take sick leave. This is in spite of the fact screening is only an indicator of risk.


British insurers are observing a voluntary moratorium until 2011 on genetic testing for life insurance (apart from high-value policies), but thereafter there is the potential for increasing use of testing, including in the employment arena. In 2004, the Health and Safety Commission stated that it considered it unacceptable to exclude or remove a person from the workplace because they might develop a genetic condition.


Human performance enhancement


Human performance enhancement covers performance-boosting drugs, brain and body implants, bionic devices and biogerontology. There are clearly ethical implications. Examples include the potential use of Ritalin to help employees perform better at work, body implants that have been wired into the brain of US patients to help lift depression, and a chip That has been implanted in the brain of a paralysed knife attack victim in the US to help him move objects using a computer.


Gene therapy may also be used to slow the ageing process: a gene has been discovered that can keep mice alive for 30% longer than their usual life span, for instance.


Nanotechnologies


Nanotechnologies involve materials and structures that have at least one dimension of less than 100nm (a human hair is about 80,000nm wide). Particles with dimensions in the nanometre region have been produced as a by-product of processes such as fire, diesel engines and high-energy manufacturing procedures such as welding.


The health and safety implications of working with materials of this scale have yet to be fully explored. The HSE wants to work with organisations to ensure that any potential health and safety implications are taken into account when nanotechnologies are commercialised.


In July 2009, the Department for Business Innovation and Skills (BIS) launched a website that gathered information on nanotechnogy issues such as research, regulation, innovation and commercial applications.


Pervasive computing


This describes the concept of embedding or integrating computers into the environment so that people can interact with them in a more ‘natural’ way. Also referred to as ‘ubiquitous computing’ or ‘ambient intelligence’. Current examples include the use of Radio Frequency Identification (RFID) tags and GPS systems in vehicles.


Innovations in pervasive computing include devices that sense changes in their environment and adapt and act on them, and work on human-computer interactions and artificial intelligence.


Health implications are likely to result from the extended use of Wi-Fi and the more powerful and longer range WiMax technologies. While, as with mobile phones, no threat has been proven from such exposure, there is public concern about the nature and effects of signals from such technologies.


Rapid manufacturing


Also referred to as ‘direct digital manufacturing’, rapid manufacturing uses additive fabrication processes to construct parts that are used directly as finished products or components. Materials used include a variety of resins, filled nylon powders, ceramics, metals and thermoplastics.


Rapid manufacturing can be used to produce such items as personalised dental copings and hearing-aid shells. A key benefit is ‘mass customisation’, which means that individual one-off items can be produced. Scientists hope to use nanoscale machines to produce complex articles by the direct manipulation of matter on a molecular scale.


There is no suggestion as yet that any of the rapid manufacturing technologies presents a serious cause for concern. The fact the equipment tends to be self-contained could offer health and safety benefits because it reduces the need for human contact with dangerous substances.


Recycling


With greater emphasis being placed on businesses taking a ‘duty of care’ attitude to waste, recycling is expected to increase. The recycling of car components, plastics and electronic products are likely to become more widespread, which has implications for the health and safety of operators and the public.


A particular example is to be found in the response to the incoming Waste Electrical and Electronic Equipment (WEEE) regulations and Hazardous Waste Directive, where there appears to be a growing industry sector developing in the collection and disposal/recycling of these goods.


There are concerns that a number of the articles being handled and disposed of contain hazardous materials, which could pose health risks to the workers involved. Reports are already available from organisations such as Greenpeace that look at the high exposure levels to dangerous materials for staff in recycling industries in developing countries.


Robotics


Although there have been huge advances in the development of robots that look and act more like humans, development of the artificial intelligence (AI) necessary for the construction of a true android has some way to go.


Even so, robots could be used within the service industries and potentially as carers for the elderly – though this in itself must surely raise ethical issues. Scientists in Japan are investigating robotics as a solution to eldercare, and European countries such as Norway are following suit.


More sophisticated pre-programmed robots are entering the workplace. For example: the food industry in preparation/packing; performing surgery; autonomous fork-lift trucks in warehouses; and for milking cows. Robots under development will be able to carry out office work, industrial cleaning, construction, and act as hospital assistants.


This could present new safety risks, which robot engineers are trying to anticipate and minimise. The HSE stresses the current safeguarding regime would not be suited to more sophisticated robots entering existing and new work areas, operating in much closer proximity to workers.


Globalisation


Globalisation is the growing interdependence between the economies and businesses of different countries. Whatever is in store for the global economy, this interdependence is here to stay. Globalisation is not in itself a health and safety issue, but it drives many changes that may impinge on health and safety.


For example, the global economy affects working patterns, and there is more pressure to offer a service 24/7; globalisation means the migration of workers from one country to another is more common. Migrant workers can be at higher risk of exploitation and poor working conditions than indigenous employees, and there may be a risk of spreading infectious diseases.


These are complex and multi-faceted issues. But not only could such trends and innovations have a profound effect on the way we work, they may also herald new opportunities for OH professionals.


“Decisions taken now will have an impact in the future, so it makes sense to consider what the future might be like,” says Ellwood. “It seems likely the advancements listed above will continue and quite dramatic developments in areas such as ICT and medicine will come about.


“The socioeconomic areas are harder to anticipate, but futures is designed to deal with uncertainties. For example, how will the recession affect globalisation, which has been a big driver of change at work?”


While obesity and the ageing population are issues that have already been identified as important trends, Khan stresses there are new areas that may seem like imports from the realms of science fiction, but which will soon be part of working life.


Anyone who has seen the Robert Downey Jr film Ironman will be familiar with the idea of futuristic bodysuits that dramatically increase the strength of the wearer. Now Japanese company Cyberdyne Corporation has begun mass production of a cybernetic bodysuit.


The Hybrid Assistive Limb suit (or HAL) synchronises movements of a mechanical exoskeleton to biological nerve signals detected by biopads on the body. There are currently two prototypes: HAL 3, which has bulkier servo-motors and only has the leg function, and HAL 5, which is a full-body exoskeleton for arms, legs, and torso.


Some innovations are more mundane – but no less important. Khan also highlights the potential of “near patient tests” in which high definition TV can provide a link from the worksite to the clinician, giving them the means to explain to someone how to conduct an ultrasound scan, for example.


“This is not just about reading the results – workers on site can actually conduct the test,” he says. “It is all done remotely, and the quality of technology is as good as being right next to the person. Technology like this could help an OH professional to cover several sites.”


But the Futures Team is not just concerned with such cutting-edge innovation. It also highlights the importance of new health research, such as a report produced by Dr Lesley Rushton, principal research fellow, division of epidemiology, public health and primary care, at Imperial College, London.


Rushton and her team have been working on the issue of work-related cancer for some time, and this year they produced the report The Burden of Occupational Cancer in Great Britain.


The pattern of disease and cause and effect is complex. But Rushton and her colleagues did identify a number of factors that may cause higher than normal incidences of cancer, and their research is continuing. “One important finding of this report is the link between shift work and breast cancer,” says Khan. “This has profound implications for women working shifts.”


All in all, horizon-scanning issues are having an impact on the work of OH – and will be affecting the way OH professionals work to an even greater extent in future. Khan sees this as an intrinsic part of career development for OH specialists in any function.


“For instance, there are lots of small companies working in the waste recycling sector, and there is an important role for OH in terms of providing a service to these firms.


“This is about adding to your knowledge, rather than updating skills,” he says. “And it’s about seeing where new opportunities might lie.”

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