The Olympic Park Project is responsible for building the infrastructure and main venues for the London 2012 Olympic Games. It is facing unique challenges for occupational health – which is a new service for much of the construction industry – including the work environment, the multiple health hazards and the behaviour of the workforce itself.
Large construction projects can be very complex. For example, preparation for the London 2012 build includes:
Excavating and cleaning 1.5 million cubic metres of soil
Demolishing 220 buildings
Clearing vegetation
Moving flora and fauna to a designated nature reserve
Re–routing electricity cables underground
Dismantling 52 electricity pylons
Widening existing rivers
Building numerous bridges, roads and tunnels.
Construction workers often work in inherently hazardous environments, each with their associated health risks, such as:
Excavations and confined spaces – oxygen deficiency, flammable and toxic environments
Tunnelling –silicosis
Demolition –asbestosis
Working atheight – falls and suspension trauma
Working on or near electricity – risk of electrocution, electric shock and burns
Working outdoors – bacterial hazards such as tetanus and leptospirosis, and cold– and heat–related illnesses.
They are also exposed to a large number of chemicals from solvents, glues, paints and cement, which place them at risk from a wide variety of occupational lung and skin conditions.1
Exposure to ergonomic hazards such as heavy lifting, awkward postures, and pulling and pushing increases vulnerability to musculoskeletal problems.2,3 The use of heavy machinery and vibrating tools can lead to the development of noise–induced hearing loss and hand–arm vibration syndrome respectively.4
There may also be psychosocial hazards such as bullying, drug and alcohol abuse, infections and stress–related disorders. In some cases these are associated with issues such as pay rates, working hours, travel and other demands of work without effective psychosocial support.5
HSE data
Construction workers nationally have a high overall mortality rate, independent of social class, with bricklayers and labourers recorded as having the second highest mortality rate.5 They also have a high incidence of self-reported work-related illness (SWI). The latest survey, carried out by the Health and Safety Executive (HSE)in 2007–08, estimated that 88,000 people whose current or most recent job in the past year was in construction suffered from an illness that was caused or made worse by their work.6
Traditionally, many construction workers are itinerant, and often live in rented accommodation during the week and travel back home at the end of their working week. This can encourage unhealthy lifestyles. Such workers may have a poor diet because of limited access to cooking facilities and healthy food choices, and can resort to convenience foods high in salt and saturated fat, such as takeaway meals.
Previous studies have found high alcohol intake among construction workers, with consumption regularly exceeding the government‘s recommended limits. In one case study, the workers often indicated to OH nurses during consultations that boredom was one of the main contributory factors. Many felt that one of the few ways to socially interact after work was at the local pub, with colleagues in a similar situation.
The UK construction workforce is predominantly male, with an average age of 39.7 Mortality for coronary heart disease (CHD) is much higher in men, and men are more likely to die from a sudden cardiac event.8 Analysis of data from Heathrow Airport’s Terminal 5 construction project shows that a third of the workers have medical problems including high blood pressure, obesity and glucose on urine analysis. Obesity, hypertension and diabetes have all been cited in the Framingham Heart Study as indicators for the early development of CHD.9
The Gender Access Survey8states that men aged 16 to 45 are half as likely to go to their GP as their female counterparts. It is suggested that men are more likely to see their GP only when they believe they are actually ill therefore they tend to present late, with more advanced symptoms of disease.
Many construction workers are employed through agencies and on short–term contracts where employers seldom attribute financial costs to the effects of work-related ill heath, which further reinforces failure to seek medical advice.
The Park Health team
Olympic Park’s medical team, Park Health, has previously been involved in construction projects such as the Channel Tunnel and Terminal 5, and it has created a model for managing OH on large construction projects. This centres on adopting a holistic approach, focusing on changing health behaviours, encouraging workers to seek preventative advice, early treatment of medical conditions and the prevention of occupational ill health in the workplace.
The Construction, Design and Management Regulations10state: “Contractors and designers have a duty to control and eliminate risks”. Park Health provides advice and guidance on the mitigation of health risks from the early design phases, throughout construction and all the way through to completion of a project.
This is achieved through a multidisciplinary approach from OH doctors and nurses, occupational hygienists, physiotherapists and ergonomists. Design solutions are offered, plus advice on positive purchasing policies for the provision of lower–risk alternatives.
Park Health has recognised that changing the way services are provided is in itself a step towards helping men to become more interested in their personal health.
A nurse-led walk-in treatment service is made available for workers for the active management of accidents, general ailments and lifestyle issues. The nurses have a wide skill mix, from accident and emergency to OH, and work to Patient Group Directions – documents thatempower staff other than doctors to legally give medicine to patients. They also have access to occupational physicians and a visiting GP.
Park Health offers an emergency response service for the treatment of serious work accidents and sudden incidents of ill health. The team works alongside the emergency services and operates to the same treatment protocols. Consultation begins before each project starts on site and requires regular communication throughout.
Medical assessment
All new starters to the projects are obliged to complete a medical questionnaire, which is screened by a nurse. Safety–critical workers are referred to the OH department for a functional health assessment, which includesvision, blood pressure and hearing tests, plus locomotor assessment and urine analysis.
Health assessments for safety critical workers are not a statutory requirement, but the Health and Safety at Work Act11states that an employer must provide a safe system of work. There is a clear implication that medical fitness may be a prerequisite of ensuring such a system.
Group 2 DVLA driving standards12 are used as medical benchmarks. A risk assessment approach is adopted, as direct application of these standards may not always be suitable in construction, where most driving takes place on private roads and therefore could result in challenges under legislationsuch as the Disability Discrimination Act.
Workers who do not satisfy the medical standards often have problems that can be corrected, such as high blood pressure or poor visual acuity. In these cases, a recommendation is made to the employer that the worker is not fit for safety–critical work until the problem has been addressed – for example, by referral to the GP for treatment of hypertension, or obtaining corrective lenses for poor vision. It is usually possible to allocate the worker to alternative duties in the meantime.
Enabling people with health problems to remain at work and improving opportunities for those with disabilities firmly underpins government initiatives such as Securing Health Together and Revitalising Health and Safety,13,14 and lie at the heart of the inclusive employment policies on the Olympic Park Project.
Tailored programmes
The OH nurses work in collaboration with occupational hygienists to tailor programmes for contractors, including health surveillance. Individual support is identified by both teams, which review the current Control of Substances Hazardous to Health (COSHH) assessments, risk assessments and method statements. They also monitor data and observe the practical use of control measures and the behaviour of the workforce itself on site.
Random drug and alcohol testing regimes are undertaken, dependent on the clients’ requirements. Drug testing in construction is becoming more commonplace due to the implications for health and safety. A US study showed that companies that tested workers and job applicants experienced a 51% decrease in injury rates within two years of implementing a drug and alcohol–testing programme.15
The project’s health and wellbeing programme complements national strategy16 and links this to occupational ill health, covering the four key areas of work–related skin and lung conditions, noise–induced hearing loss and hand–arm vibration.
Engaging employees
Park Health has used initiatives to encourage engagement of employees by making health fun. For example, in order to raise awareness of work–related upper limb disorders (WRULDS), the team held strongest men and women contests by testing grip strength. While staff queued to demonstrate their upper body strength, nurses provided education on WRULDS. Park Health has enhanced the wellbeing programme by establishing strong links with local NHS health providers, such as diabetic teams and sexual health teams, to assist with health promotion activities.
Construction workers need to be made aware not only of the elements of their work that can pose a serious risk to their health, but also of the detrimental effect it can have on their working, social and family life.
Park Health offers talks for management and operatives on wellbeing and work-related ill health and injury. These talks are often delivered to large groups of employees, sometimes in excess of 100, and often in unusual environments – there are no ‘lecture theatres‘ on site.
The OH team has won two awards for its innovative approach to managing health in construction. Members attribute a large part of their success to the early engagement of operatives and contractors. More than 1,300 employees attend the department each month. Ensuring that the contractors understand the role of the team raises the profile of OH and encourages the contractors to view OH as an ally.
Looking ahead
Construction has an ageing workforce. National data shows that the trend is increasing, with the number of those aged 40 and over rising on average by about 2% per year since 1990.17
There is also concern about the shortage of skilled workers in construction. It is predicted that 350,000 extra construction workers will be needed over the next five yearsto meet a skills shortage in the industry.18
OH provision should be understood in the context of the Olympic Park efforts to provide good, secure jobs and skills training for local people, and the commitment to good working conditions, such as support for the London Living Wage and care about working hours.
Although awareness of OH is increasing, it still does not receive the same level of priority as safety. OH nurses need to encourage employers to embrace OH as part of the safety arena, and recognise the value of the contribution of OH towards achieving the government objectives, rehabilitation of those with work-related ill health, and retention of skilled employees.
Stephanie Martin-Halls is occupational health manager of Park Health, the site–based occupational health service for the Olympic Park Project.
References
1 Sullivan PA et al (1995). Respiratory disease risks in the construction industry. Philadelphia (PA): Hanley & Belfus, Inc Occupational Medicine: State of the Art Reviews, vol 10, no 2, p313-34
2 Schneider SP (2001). Musculoskeletal injuries in construction: a review of the literature. Appl Occup Environ Hyg16 Nov:1056-64
3 Latza U et al (2002). Impact of repetitive manual materials handling and psychosocial work factors on the future prevalence of chronic low-back pain among construction workers. Scand J Work Environ Health 28(5):314-23
4 Suter AH (2002). Construction noise: exposure, effects, and the potential for remediation–a review and analysis. Am Ind Hyg Assoc J 63(6):768-89
5 Snashall D. (2005). Occupational health in the construction industry. Scand J Work Environ Health 200531 suppl 2:5-10
6 HSE (2007).Work-related injuries and ill health in construction http://www.hse.gov.uk/statistics/industry/construction/ill-health.htm. Accessed 14 Feb 09
7 Male Health (2009). Construction workers suffer the highest rate of deaths of any occupation. http://www.malehealth.co.uk/userpage1.cfm?item_id=2540#con. Accessed 14 Feb 09
8 Wilkins et al (2008). The gender and access to health services study final report. DOH, Nov.
9 Dawber T et al (1963). An approach to longitudinal studies in a community: the Framingham Study. Ann N Y Acad Sci 1963, 107:539-556
10 HSE (2007). Construction, design and management regulations. HSE books
11 Great Britain Parliament (1974). The Health and Safety at work etc. Act. London: HMSO
12 DVLA (2009). For medical practitioners: At–a–glance guide to the current medical standards of fitness to drive. DVLA, Swansea, Feb
13 HSE (2000). Securing health together: A long–term occupational health strategy for England, Scotland and Wales. HSE Books
14 HSE (2002). Revitalising health and safety in construction. Discussion document. HSE Books
15 GerberJ & YacoubianG (2002). Assessment of drug testing within the construction industry. The Journal of Drug Education.32(1), pp52-68
16 HM Government (2005) Health, work and wellbeing – caring for our future. A strategy for the health and wellbeing of working–age people. Produced by DWP, DOH and HSE
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17 Adidesh A et al (2007). Occupational health standards in the construction industry. Health Laboratory. RR584 research report. HSE Books
18 Construction skills (2008). Construction industry warnings on workforce timebomb. http://www.cskills.org/search/index.aspx?keyword=AGEING+WORKFORCE&btnGoSearch=Go. Accessed 22 Feb 09
