On 10 May, a joint event run by the Society of Occupational Medicine (SOM) and the Royal Society of Medicine (RSM) looked at global issues in occupational health and the implications of Brexit. Ann Caluori reports.
The joint event in May of the SOM and the RSM, “Occupational health in a global market”, was timely as the triggering of Article 50 at the end of March had moved the UK into uncharted waters. With the lines between the UK, Europe and the rest of the world ready to be redrawn, speakers at the conference in London asked: what does Brexit mean for the UK workplace and workforce health? How do international companies approach healthcare in their workforce? And what are the future global health risks that we face?
The event occurred in tandem with the release of the Occupational Medicine (OM) virtual issue on global health.
Dr Rickard Moen, chief medical officer at offshore medical support and OH provider Iqarus, kicked off the event with a lecture on healthcare in war zones, hostile and remote territories.
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In areas where there is political and regulatory instability with health reconstruction a low priority, it can be a huge challenge for OH services to provide care for employees, and get people (or mortal remains) out and cared for.
Major medical risks of providing healthcare in unstable territories include terrorist activities and mass casualty events, while indigenous medical risks include regional epidemics and food and water hygiene.
Travel in areas of instability requires investment and logistical planning. Medical operational challenges include blood supply, and procurement and supply chain issues. A key “value-based question” to ask is: are we going to look after expats only, and not local employees?
Mitigating steps include: pre-deployment selection of staff; providing non-discriminator care for local employees and training them to take over from expats; and coverage for mental health.
The TUC’s Hugh Robertson returned us to home ground as he gave an impassioned talk on Brexit.
Although businesses and their organisations overwhelmingly supported the Remain campaign, workers’ rights and health and safety had not featured much in the referendum debate.
During the two-year negotiation period, all existing regulations apply. The Government’s red-tape initiative is investigating what can be dropped, and the Great Repeal Bill will allow powers to deregulate. Regulations at risk may include eye testing for display screening equipment and the Working Time Directive, although the Queen’s Speech in June stated: “My ministers will seek to enhance rights and protections in the modern workplace.”
Brexit could be viewed as an opportunity to make OH better and we should aim to develop a safety system that goes beyond minimum levels, Mr Robertson suggested, reverting the UK to its exemplar status.
Employment law expert Professor Diana Kloss MBE advised on the legalities of sending employees abroad, explaining that the Health and Safety at Work Act 1974 applies solely to the UK and off-shore installations, so these Regulations, including those dealing with hazards, do not apply outside our borders. Where the employee is working in an EU or European Economic Area (EEA) country, the law is likely to be similar to the UK, which also stems from EU directives.
UK civil law imposes a duty of care on employers to take reasonable measures to prevent foreseeable damage to their employees. They should provide reasonably safe premises and equipment, safe personnel, a safe system of work and assess the risks.
The case of Palfrey v ARC Offshore Ltd (2001) is an example of where the employer was found to be liable to the family of an engineer sent to West Africa, who died of malaria because the company had failed to advise of the risks and provide medication when the engineer stopped over in the country where he contracted the disease.
In the closing session, Dr Richard Heron discussed the importance of international collaboration in occupational medicine.
In 2012, leaders in the American College of Occupational and Environmental Medicine (ACOEM) and the UK’s SOM began discussing an initiative designed to build stronger collaborative relationships between occupational medical societies around the world and created the framework for a new organisation, the International Occupational Medicine Society Collaborative (IOMSC). Since 2013, the IOMSC has grown from the initial group of 18 societies in 16 countries to 39 societies in 35 countries.
Dr Heron outlined the IOMSC’s mission: to identify and improve workers’ health and workplace safety on a global scale. In July 2015, the IOMSC conducted a member survey to help quantify its global reach and to identify common modes of practice and key changes that are occurring in the workplace.
Survey results indicated that worldwide, similar issues and challenges are apparent, including the growing complexity of diseases and illnesses and the rapid change in workforce and population trends.
While many of the professional challenges and societal trends are similar, the scope and delivery mode of OM services varies from country to country, and is influenced by governmental/regulatory structures.
However, as a group, IOMSC medical societies report being well positioned to address these professional issues, and to advance OM through education, sharing of best practices, and advocacy.
Highlights from the day’s other sessions
2015 UN Landmark agreements: Professor Virginia Murray delivered the Apothecaries’ Lecture on the 2015 Landmark agreements on climate change, sustainable development goals and disaster risk reduction, asking if there was a role for occupational health.
Sustainable development goal 8 is to “promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all”. The role of OH is to support public service workers and those who are preparing for emergencies (Sendai Framework).
The past 30 years have seen an increase in the number of floods and storms – again, Professor Murray emphasised there is a role for OH to engage and support.
Drivers for OH global standards: Dr Julian Eyears, of International SOS, explained that there is an enthusiasm to improve OH by corporates – which may be due to a company’s core agenda, desire for good reputation, or simply to be in line with other companies.
Global OH offers stress management, business travel medicine, support for wellness and prevention of non-communicable disease and health impact assessment. Technology will impact greatly on current practice – for example, remote OH consulting, which will allow OH to be taken to far-flung areas, and the internet of medical information can examine eyes and measure temperature. The projection is that this will link up transport, medical, logistics, security, surveillance, industry and energy.
The responsible supply chain: Dr John Atherton, director of the International Council on Mining & Metals, spoke about the drivers for responsible sourcing, both internal, such as employee expectation and reputation, and external, for example, regulatory requirements and non-governmental organisation (NGO) pressure.
The US requires companies to identify the provenance of the countries they are sourcing from, and the EU has recently adopted a similar act. Companies are increasingly vulnerable to consumer pressure in this area. In the future, the aim is to develop a more integrated, value-chain approach based on common principles.
Health partnerships in the era of Brexit: Ben Sims, CEO at Tropical Health & Education Trust (THET), discussed the creation of new health partnerships to strengthen NHS services through clinical skills, managerial knowledge, interpersonal skills and innovation.
Health partnerships have attracted significant support from UK Overseas Development Assistance in recent years and an increasing number of NHS institutions now benefit from engaging internationally. THET have partnered with more than 130 NHS and academic partners in the past five years, but there is scope for much more.
It became clear throughout the day that although there are differences in the way OH is delivered globally, there is a desire for collaboration within the international OH community, and we would perhaps do well to build upon this collaboration as we head towards Brexit and the uncertainties it brings.
Ann Caluori is communications and events coordinator at the Society of Occupational Medicine.