The pandemic emphasised the value of both occupational health and occupational hygiene as never before. There is now a real opportunity for the two professions to come together to share knowledge and expertise, argues Alison Margery.
In 1984, Lord Gregson rose in Parliament to speak on the ‘Science and Technology Committee on Occupational Health and Hygiene Services’ (Hansard, HL Deb 15 November 1984 vol 457 cc423-62).
He said: “For the purpose of this inquiry your committee have distinguished between occupational health, representing the physical and mental wellbeing of the workforce, and occupational hygiene, the control of physical, chemical and biological factors in the workplace which may affect the health of the workers. We readily admit that this is an artificial distinction as many occupational health services will also provide hygiene services.”
It was the last substantive mention in the UK parliament of the role of occupational hygiene in UK health policy until the Department for Work and Pensions’ Select Committee report on asbestos this year.
The notion that occupational health providers are actively involved in the preventative side of worker health protection is one that has not been a feature of occupational health services in the UK for the most part.
In recent years, there has been a growth in this integrated approach with stunning results, as evidenced in the Olympic Park and large projects such as Hinkley Point.
Separation of OH and occupational hygiene
However, the success in managing workplace risks and the burden of occupational disease has been as a result of the separation of management and performance strategies between the province of occupational health and occupational hygiene.
For occupational health it has increasingly been about supporting the mental and physical wellbeing of the workforce. For occupational hygiene, the focus has been more on prevention and control of exposures that may lead to illness in the first place.
Future of OH
This separation has been effective in these contexts because public clients have accepted that prevention is as important as support.
It has also been particularly successful where the performance measures have been separated, but there has been inter-professional working.
Even back in 1984, the committee recognised, however, that large industries may enable support in occupational health and occupational hygiene but that small undertakings may not.
The shape of the modern workplace is such that the notions envisaged by early reports and even the Robens Committee of the 1970s are redundant today.
Our aspiration must be towards a right to access to occupational health provision for all. But the capacity to deliver this in a meaningful and effective way poses a fundamental challenge to the model we currently have.
Danger of missed opportunities
There is a danger that, in the absence of good occupational hygiene for all, occupational health will forever be picking up the pieces for unnecessary exposures and screening large populations with basic testing because of obvious missed opportunities to prevent the risk from being there in the first place.
Our profession of occupational hygiene has a quaint name that derives from another age, despite being a science which is at the forefront of scientific endeavour.
We perhaps have not done enough to get it better understood. Quite simply anything that is in the arsenal of tools to prevent exposure to any form of disease in the workplace is the province of the hygienist. It’s for this reason that the route to the highest level of qualification, chartership, takes around seven years post-graduation.
Occupational hygiene, to many, revolves around sampling, monitoring and testing. However, to view the science of occupational hygiene like this is as reductive as considering that primary health care is just about taking blood and urine samples, commissioning tests and referring to specialists.
Monitoring is the visible, data-gathering dimension of a complex science that steps through the stages of seeking to eliminate, substitute, engineer out, manage and ultimately provide personal protection in order to prevent us being exposed to occupational hazards.
The scope of understanding required of an occupational hygienist is built upon epidemiology, toxicology and the mechanisms in relation to the human body through which exposures translate to disease or the potential for future disease.
However, this element is akin to understanding how to park a car. Hygienists need to understand the complex and variable routes by which everything from nano-particles, aerosols, viruses, radiation forms, vibrations and numerous other vectors of harm navigate their way through the plethora of workplaces to affect the body.
Occupational hygienists need to highlight to occupational health providers where there is risk, because a risk-based approach to occupational health provision is the only way in which precious resources can be targeted.”
The unique and adaptable insights of occupational hygiene came into their own during the pandemic. Occupational hygienists had correctly identified the likely pathway of infection within weeks of it becoming an issue in the UK and highlighted effective precautions to prevent infection.
The record of the safety-critical industries, where occupational hygienists are typically available, in containing the impact of Covid-19 and continuing to operate was evidenced by the absence of power cuts and supply shortages, even at the height of the so-called ‘pingdemic’.
Twin pillars that need to work together
However, the future places occupational hygiene and occupational medicine as twin pillars of not just workplace health but of our health and social care infrastructure.
Workplace exposures are all preventable. We expose workers to disease as a result of economic and regulatory choice. No other pathway to illness is so easy to block off. That is why prevention, with occupational hygiene at the sharp end can pay such dividends.
However, there will be areas of risk that we are willing to accept as a society, there will be aspects of exposure that escape from processes and that is why we need occupational health specialists.
But the professions need to work together. The handover between the two is critical to prevention. Occupational hygienists need to highlight to occupational health providers where there is risk, because a risk-based approach to occupational health provision is the only way in which precious resources can be targeted.
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Similarly, occupational health specialists need to be feeding back to hygienists wherever a disease might be an indicator of a workplace exposure that needs controlling.
It is becoming ever more urgent to do so. Since 1984 medical advances have meant that more occupational illnesses are detectable, capable of screening and treatable. There is also a greater understanding of the impact of workplace exposures, bringing, for example, more substances into the fold of carcinogens and at lower exposure levels.
This means that the cost and demand of treatment goes up, the scope of illnesses attributable to the workplace widens and the demand for occupational health support will increase exponentially.
The NHS, already under severe pressure from crises of demand, carries the burden of occupational illness in its X Ray departments, oncology clinics, orthopaedic wards and outpatient clinics.
From the ante-natal burden of reprotoxins through to the audiology demands caused by ototoxins, workplace exposures are piling the pressure on beleaguered NHS workers themselves.
Savings and benefits for the economy
Related to this, the social care costs, lost revenue from taxation, loss of skills and productivity will all continue to burn a hole in the economy and structure of society.
Occupational health practitioners can work in inter-professional partnership with occupational hygienists, understanding how the virtuous circle of shared knowledge about symptoms and cause can be harnessed for the purposes of prevention, as well as diagnosis.”
But what if, by working together, occupational hygiene with its expertise in prevention could work in tandem with occupational health with its capacity to prevent disease deterioration and even to enable rehabilitation?
What would the effect of that be? In health terms, it would obviously see the diversion of thousands of people from needing health and social care. Beyond that, in economic terms, the savings could be vast.
The British Occupational Hygiene Society (BOHS) has calculated that the cost of treatment, benefits and lost revenue arising from a single instance of workplace COPD amounts to £180,000.
With an estimated 40,000 work-induced COPD cases in the UK, by improving workplace controls occupational interventions could have a dramatic impact on outcomes. The thousands of lives improved and hundreds saved sit alongside the tens of millions saved to the economy each year, the decreased demand for respiratory care, enabling more treatment capacity in the NHS for less preventable diseases.
But it also makes the economic case for occupational health early intervention. Because rather than being a cost burden, occupational health can genuinely drive cost saving.
This is a positive effect being realised, one where occupational health practitioners can work in inter-professional partnership with occupational hygienists, understanding how the virtuous circle of shared knowledge about symptoms and cause can be harnessed for the purposes of prevention, as well as diagnosis.
BOHS’ partnership working with the key occupational health bodies is beginning to provide the strategic bridges towards the future. A future where Lord Gregson’ assumption of the inevitable interconnection between occupational health and occupational hygiene provides the protection for all workers that Parliament aspired to 40 years ago.