On the right track

Scotland’s
Health at Work programme has had a mixed reception since its launch four years
ago. While Shaw’s Rhonda Fraser believes the project fits well with the OH
remit, Dorothy Ferguson, chairwoman of the RCN’s Occupational Health Nurses’
Forum in Scotland, argues that its lifestyle focus makes it inappropriate.  By Rhonda Fraser

Occupational
health practitioners have suggested that Scotland’s Health at Work (Shaw) only
represents the icing on the cake of workplace health. The "real" work
of occupational health and safety must be given priority and only when
everything is in order can organisations afford the luxury of becoming involved
in health promotion.

But
the programme’s advisers would argue that health promotion is integral to the OH
function. Good safety cannot be achieved by enforcement of rules and
regulations only. It needs to win the hearts and minds of employees, so that
they share the responsibility for their safety and that of their colleagues.
Participation in Scotland’s Health at Work brings a focus and enthusiasm for
health at work – and creates a culture where health and safety is valued.

Launched
in September 1996 as a national workplace health award scheme, the programme’s
aim is to make the active promotion of good health an integral part of Scottish
corporate culture.

Common
goal

All
15 Scottish health boards work together on the scheme in collaboration with
organisations, their common goal being to improve health.

It
aims to improve both the quantity and quality of health promotion in the
workplace by providing employers with a strategic framework of relevant health
promotion activity and the incentive of public recognition for good practice.

The
programme feels that while due emphasis should be given to preventing work-related
ill-health and injury, there is a need to put more "health" into
"health and safety" at work by encouraging and supporting employees
to live healthier lives and by developing a health promoting culture.

Occupational
health professionals have been concerned that Scotland’s Health at Work does
not require participating organisations to put specific occupational health and
safety measures in place. But while the programme seeks to support occupational
health and safety, it is beyond the resources and intention of the scheme to
make judgements on the standards reached by participating organisations in
these disciplines.

Much
of the criteria recognises the value of occupational health and health and
safety legislation in the workplace, but there is also a recognition of the
wider aspects of health that are not normally tackled by occupational health
professionals. For example, human resource, personal development and the role
of the organisation in promoting health in the wider community.

Shaw
has been welcomed by other occupational health professionals in participating
workplaces. They have found that the scheme has supported and complemented
their work, while providing guidance and practical help in the health promotion
aspects in which they feel less well qualified.

There
is already evidence of improved attitudes among employees. Health is becoming
something that is seen and talked about in the participating workplaces, and
individual change, for example, giving up smoking, is being matched by organisational
change, such as the establishment of staff health forums and mental health and
drugs policies to help create healthier work environments.

In
February 1998, the Halliburton Group set up an initiative to raise awareness of
health throughout its companies. Scotland’s Health at Work came on board and it
soon realised the enormity of the work that lay ahead.

The
sheer logistics of providing health information soon became apparent –  with 118 notice boards servicing 68 onshore
and 21 offshore gatekeepers became involved in the updating and displaying of
current topics

Questionnaires
were issued in the UK to 6,000 staff in the North covering health, safety and
environmental concerns. The issues raised then had to be addressed in order to
achieve their bronze Scotland’s Health at Work award.

The
northern healthline co-ordinator Penny McIntosh said, "To implement a
workplace health strategy which had to cover 18 separate buildings employing
6,750 staff was a daunting task. However, the criteria for the bronze award
required by Scotland’s Health At Work was a terrific springboard and helped us
enormously."

Alternative
approach

Where
in the past research has highlighted barriers to effective health promotion in
the workplace, Scotland’s Health at Work is providing new opportunities to make
a real impact in promoting health at work in Scotland.

Many
workplaces opt for unusual or slightly different approaches to promoting health
at work. For example, Greater Glasgow Health Board’s belly dancing taster
session or Scottish Nuclear’s shiatsu massages. These activities are open to
all members of staff and always receive a very favourable response.

Another
fun initiative is a national Scotland’s Health at Work venture – the Max. Its
purpose is to encourage companies large and small to participate in some form
of activity in a week-long fitness promotion.

This
year’s Max event attracted over 150,000 staff from all over Scotland who
participated in a variety of activities including a small ships race, a space
hopper challenge, themed lunchtime walks, cycle, football and skipping
challenges, fun runs, hill walks and aerobathons.

It
will take many years to achieve the ambitious objectives that Shaw has set
itself. Bringing Scotland’s Health at Work from concept to reality has been a
challenge, but the support and commitment of all parties and the enthusiastic
response from participating workplaces suggests that it can succeed in making a
difference to health at work and in the wider community.

Rhonda
Fraser works for Scotland’s Health at Work programme

It
is accepted that the promotion of health and the prevention of ill-health
feature within the role of the occupational health nurse1,2,3. Research by
Molloy4 points out that occupational health practice embraces all aspects of one
model of health promotion5.

Molloy4
also acknowledges the multi-disciplinary approach within occupational health.
Collaborative working is a feature of good occupational health practice and is
a key part of health promotion as well. The Scotland’s Health at Work award
scheme offers the opportunity to develop partnership working within one area of
the OH practitioner’s role.

A
clear definition of terms is as essential when discussing health promotion in
the workplace as in other spheres of professional activity. It should therefore
be recognised that the health promotion officer’s understanding of
"promoting health in the workplace" may be more restricted than the
OH practitioner’s understanding of the term. When setting priorities for health
promotion within the workplace, the OH nurse will include aspects of safety and
hazard control, whereas the health promotion officer may focus on lifestyle
issues.

While
not underestimating the importance of lifestyle health promotion, the OH professional
will first wish to ensure the employees safety at work. Naidoo and Will6 state
that "Unless the organisational context is also considered, and modified,
[health promotion] programmes are likely to have limited effect".

Employers
may well welcome the Scotland Health at Work awards and the associated
publicity. OH practitioners include the education of the employer on
occupational health issues within their remit and so may not be surprised to
read that they are positively received by the employers. This does not
necessarily justify this programme as the most appropriate approach within a
workplace, nor indeed endorse the priorities which Scotland Health at Work may
set as being the most crucial issue within any specific setting.

Simnett7
emphasises the need for evaluation of such activities while exploring the
potential for collaborative working in health promotion. A rigorous evaluation
of the scheme would perhaps be appropriate and would be one way to develop the
collaboration between the health promotion worker and the OH practitioner.

References

1
Hodges,D (1997) The role of the occupational health nurse. In Oakley,K.
Occupational health nursing. Whurr: London

2
English National Board & Department of Health.(1998) Occupational Health
Nursing. ENB:London

3
SOHN& AOHNP (1997) Occupational Health Nursing.SOHN &AOHNP: London

4
Molloy, J (1995)Health Promotion in the workplace. In Bamford, M Work and
Health Chapman& Hall: London

5
Tannahill, A (1985) What is health promotion? Health Education Journal,44.167-8

6
Naidoo,J & Wills,J (1994) Health Promotion: foundations for practice.
Bailliere Tindall: London

7
Simnett,I (1995) Managing health promotion Wiley & Sons:Chichester

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