CPD: Working well – articulating the case for OH’s role within “good” work

People walking to work

The links between “good” work and health and wellbeing and increasing well-recognised, as well as evidenced. As Professor Anne Harriss shows, occupational health can play an important role within this in terms of facilitating, enabling and, crucially, sustaining good working practices.

Employers endeavour to engage people fit and able to undertake the requirements of their post. Occupational health (OH) strategies support this aim, adding value to the organisation.

The focus of OH practice is to promote, improve and maintain the health of the workforce. This approach is central to the principles of public health adding value to the organisation.

About the author

Anne Harriss is emeritus professor in occupational health at London South Bank University

Proactive occupational health professionals contribute to a range of strategies promoting employee health, safety and wellbeing. More specifically, their contribution to health and safety committees should drive the development of policies that underpin employee health and welfare.

Furthermore, they are well-positioned to give impartial advice intended to support the workforce and their managers, particularly with regards to health conditions impacting on, caused, or exacerbated, by work. This article provides an overview of a range of factors associated with good work, as this understanding underpins the public health facets of OH nursing.

Organisations must remain cognizant of their statutory duty of care to employees under the Health and Safety at Work etc. Act (1974). This incorporates safeguarding employee health, safety and welfare ensuring that their workplace, and work tasks, cause no harm to either the workforce or others who might be affected by their work practices.

From a moral perspective, work should not be detrimental to health and employers should aim to offer good work that enhances, rather than detracts from, the quality of life. It is in the interest of organisations, their workforces and society that job requirements do not have a negative impact on health and wellbeing.

Job factors

Increasingly, those engaged with their employment situation and finding their work rewarding may choose to work well into their seventh decade and beyond. Others not so engaged with their work may have a financial imperative to carry on working at least until they qualify for their state and/or occupational pension.

As a large proportion of our lives is spent at work, work becomes enmeshed within our identity. For many (but not all) work can be a positive, rewarding experience. For some there can be inherent dangers associated as, unfortunately, not all work is entirely risk-free; many workers undertake tasks involving potential exposure to a range of hazards.

This range of hazards are encountered through work and work processes. The spectrum includes physical and psychological stressors, poorly designed work equipment and processes through to working with hazardous materials.

Some job tasks are associated with ergonomic risk, including poor working postures, moving and handling heavy loads or exposure to physical hazards such as noise, vibration, radiation or thermal challenges.

Exposures such as these are risk factors for work-related ill health. Indeed the Health and Safety Executive (HSE) highlight that in 2016-17 526,000 UK workers reported being affected by work-related stress, anxiety or depression (Health and Safety Executive (2017a).

HSE points to the estimated cost of injuries and ill health during 2016-17 from current working conditions equating to £15bn (HSE 2019).

Occupational factors, including dust or fume exposure, have been linked to risk factors for developing chronic obstructive pulmonary disease (Blanc and Torén, 2007). Although they note an established relationship between these two factors, their later publication, nearly 10 years on, suggests there is much still to learn regarding the exact relationship between work tasks, processes and occupational causes of COPD (Blanc and Torén, 2016).

From an ergonomic perspective, HSE (2017b) highlights the significant burden that work related musco-skeletal disorders has in the United Kingdom, accounting for more than a third (39%) of all work-related ill health.

The good news is that even potentially hazardous tasks can be undertaken safely, with the proviso that effective risk management strategies are in place. These strategies commence with comprehensive risk assessments – the result of which may indicate the requirement of the implementation or improvement in control measures. If these are required to protect worker health, their effectiveness should be monitored, recorded and maintenance schedules initiated.

On balance, there are biopsychosocial benefits associated with safe, good quality work. It protects against social exclusion and provides identity and purpose, income generation and opportunities for social interaction (Black 2008; Black and Frost, 2011; Public Health England 2019; Waddell and Burton 2006).

Having a job is only part of the picture. Employment and socio-economic status are well known to be drivers of inequalities of health. Wilkinson and Picket (2010) cite the findings of the Whitehall I and II studies, which indicate that a higher risk of a variety of health conditions is associated with occupations of lower status.

These include coronary heart disease, mental ill health, long-term respiratory conditions, self-reported ill-health and absence from work (Bosma et al (1997). The association between low job control and the risk of coronary heart disease was acknowledged within the prospective cohort Whitehall II study, which found an association between ill-health and job status (Wilkinson and Picket, 2010).

Over a decade ago, the Department for Work and Pensions (DWP) commissioned Waddell and Burton (2006) to assess whether there is any evidence of an association between work and health benefits.

Their subsequent report poses the question: “Is work good for health and wellbeing?”. It highlights the economic, social and moral justifications suggesting that work is the most effective way to improve the wellbeing of individuals, their families and thus society as a whole.

Changing patterns of work

Work should be good for health, provided there is adequate remuneration, working conditions are good and hazard exposure is controlled.

However, working patterns are changing. Approximately 1.1 million people, or 3.5% of the total number of the UK population in employment, now have a second job (Taylor, 2017 p11).

Some, but not all, of these posts may be undertaken on zero-hours contracts. Under such arrangements, the employer does not guarantee any minimum working hours and the worker is not obliged to accept any work offered.

These contracts are now a fact of life for many, particularly for those engaged in the service and retail sectors. When allocated work, they are eligible for payment of the minimum wage, however those engaged in this way have no guarantee of work from week to week.

Consequently, they cannot predict their monthly earnings, so making financial planning difficult. There may be occasions when their outgoings exceed their income; should this continue they risk going into debt and experience the stress this brings.

Developments in technology are impacting on how work is undertaken. The evolution of the gig economy, whereby people sell their services using apps such as Deliveroo and Uber has been a recent significant change in employment practices. Such employment is the primary source of income for some, for others this will be in addition to more regular full or part-time employment.

The Chartered Institute of Personnel and Development (CIPD) estimates that approximately 1.3 million people in the UK work within the gig economy, equating to 4% of all those in employment. More than half (58%) of gig economy workers do so as permanent employees, but many engage in gig activities in addition to other more “traditional” employment, suggesting that this type of work is used as “top-up income” (CIPD, 2017).

Worklessness

Being in employment provides an income essential for material wellbeing and is associated with benefits for physical and mental health. Just as work is good for health, there is compelling evidence that long-term worklessness has the potential to damage both physical and mental health (Rueda et al, 2012; Waddell and Burton 2006).

There is an unsurprising association between worklessness and poor health status, as worklessness creates poverty that in itself is associated with ill health. Those living on very limited incomes, which may include state benefits, have little option but to consume diets with limited scope for healthy eating.

Healthier, unrefined foods that are low in fat, salt and sugar tend to be more expensive than less healthy alternatives and may be outside their financial reach. To compound this, those not in employment are more likely to participate in?”health harming” behaviours, including smoking (Public Health England, 2019).

In view of the above, it is of little surprise that there is strong evidence of the health ill effects that worklessness brings. These include poorer general physical and mental health, an increase in long-term conditions, medical consultations, and hospital admission rates (Waddell and Burton 2016).

Supporting people into work, or back to work, are key to the UK government’s public health and welfare strategies (Department for Work and Pensions and Department of Health 2017) and one in which OH professionals can take a proactive part.

The Department for Work and Pensions’ Improving Lives strategy aims to support people with disabilities – recognising that good work is good for health but the wrong kind of work can be damaging.

It highlighted the important roles of managers and supervisors within the workplace with respect to creating healthy, inclusive workplaces where all can thrive and progress – as this approach underpins “good” work. In the author’s view, there is under-recognition within the DWP strategy of the extent of the contribution of effective OH services to supporting those with disabilities to return and remain in work.

Mental health

That good work is generally good for health and wellbeing is evident. Sadly, for many, work-related mental ill health remains a significant challenge.

HSE highlight that 526,000 UK workers were affected by work-related stress, anxiety or depression in 2016/2017 (HSE, 2017). This resulted in a loss of 12.5 million working days that were attributed to mental illness (HSE, 2017).

Some professions are regarded by society to be of high status, as they are well-remunerated they are considered “good jobs”. In reality, they are not without a negative impact on mental and physical health as they can be associated with a significant amount of stress.

Medicine is one such profession putting its members under considerable pressure. Kinman and Teoh (2018) note that, compared to the general population, medical practitioners are at a higher risk of burnout and mental health problems, such as depression and anxiety.

This situation is increasing over time, and is associated in part with growing job demands, job complexity and a faster pace of work undertaken against a backdrop of diminishing resources (Kinman and Teoh, 2018).

HSE highlights that healthcare workers consistently report the highest rate of work-related stress, anxiety and depression than workers in any other sector. The findings of other large-scale surveys conducted in the UK highlight the extent of work-related stress experienced specifically by medical doctors and the implications for their health.

The British Medical Association (2017) reports that black and minority ethnic (BME) doctors were more likely than their non-BME peers to experience workplace bullying and harassment to a level that it adversely affected their mental health.

Furthermore, evidence suggests that overseas and BME medical graduates frequently experience stress and lack of social support, seemingly relating to their separation from family. This lack of family support adversely affects their ability to learn and progress with obvious implications for the quality of the care they give (Rich, A, Viney, R, Needleman, S, Griffin, A et al).

Management style and employee engagement

A Dutch study (Elshout, cited in Williams 2019) considered the relationship between management style, employee satisfaction and absenteeism during a merger within a mental healthcare setting in the Netherlands.

This found an association between transactional leadership styles, high sickness absence and low employee satisfaction. This was in contrast to those using transformational leadership styles.

Of particular relevance was how managers applied organisational sickness absence policies and how well they communicated with their employees. There are obvious implications of management styles for enhancing or detracting from employee engagement.

The annual NHS Staff Survey is the largest staff survey undertaken anywhere in the world and has been conducted annually since 2003. The 2017 survey found that in the preceding five years there had been a decrease in the overall level of engagement amongst doctors-in-training (NHS 2018).

Employers must remain mindful that their organisational success depends on an engaged, motivated and productive workforce. Effective management being key to appointing and maintaining a happier, motivated and productive workforce. According to the Advisory, Conciliation and Arbitration Service (ACAS) key elements of effective management include:

  • visionary leaders who value the contribution of their workforce
  • effective line managers with the skills and ability to empower their teams.
  • demonstrating business values that are not just spoken but are lived, walking the walk and not just talking the talk
  • employees being given the chance to express their views and concerns and know that they will be listened to and acted upon. (Advisory, Conciliation and Arbitration Service. 2019)

OH interventions are an important component of public health practice, with OH nurses being well placed to ensure that work processes, work tasks and materials cause no harm to the health of the workforce.

In order to maximise their impact they should be aware of the work-related factors with the potential to harm the workforce, including exposure to a range of hazards whether they are physical, chemical, mechanical, biological, psychosocial or ergonomic.

The impartial advice OH gives to both employees and managers, particularly with regards to the range of workplace adjustments can support those with significant long-term health conditions or disabilities to remain in work.

Conclusion

In 2017, the government-commissioned Good Work: The Taylor Review of Modern Working Practices was published. It too highlighted that having employment is vital to people’s health and wellbeing and that the quality of people’s work is a major factor in helping them to stay healthy (Taylor, 2017).

Working practices that benefit employees shapes good work. Of importance is being employed in secure positions, receiving fair payment, terms and conditions, and access to training and development.

Crucial to this is a combination of responsible corporate governance, effective management and positive employment relations. The provision of good work relies on the quality of management.

However, OH professionals can also contribute by supporting organisational strategies including proactively promoting, improving and maintaining worker health, safety and welfare.

References
Advisory, Conciliation and Arbitration Service (2019) Employee engagement. Available from: http://www.acas.org.uk/index.aspx?articleid=2701

Blanc, P, and Torén, K (2007). “Occupation in chronic obstructive pulmonary disease and chronic bronchitis: an update”, International Journal of Tuberculosis and Lung Disease, 11 (3), pp. 251-257.

Blanc, P D, and Torén, K (2016). “COPD and occupation: resetting the agenda”, Occupational and Environmental Medicine, 73 (6), pp. 357-358.

Bosma H, Marmot M G, Hemingway et al (1997). “Low job control and risk of coronary heart disease in Whitehall II” (prospective cohort) study. Br Med J 1997;314:558.

Chartered Institute of Personnel Development (2017). To gig or not to gig. Stories from the modern economy. London: CIPD. Available from:
https://www.cipd.co.uk/Images/to-gig-or-not-to-gig_2017-stories-from-the-modern-economy_tcm18-18955.pdf

Department for Work and Pensions/Department of Health (2017) Improving lives: the future of work health and disability. London. Available from:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/663399/improving-lives-the-future-of-work-health-and-disability.PDF

Health and Safety Executive (2017a) Work-related stress, depression or anxiety statistics in Great Britain. Available from: http://www.hse.gov.uk/statistics/causdis/stress/

Health and Safety Executive (HSE) (2017b) Work-related Musculoskeletal Disorders (WRMSDs) Statistics in Great Britain 2017. Available from: http://www.hse.gov.uk/statistics/causdis/musculoskeletal/msd.pdf

Health and Safety Executive (2019) http://www.hse.gov.uk/statistics/ 

Kinman, G and Teoh, K (2018). “What could make a difference to the mental health of UK doctors? A review of the research evidence.” London: SOM. Available from: https://www.som.org.uk/sites/som.org.uk/files/What_could_make_a_difference_to_the_mental_health_of_UK_doctors_LTF_SOM.pdf

NHS (2018). Staff Survey Co-ordination Centre. NHS Staff Survey Results – Key Findings by Occupational Groups. Available from:
http:// www.nhsstaffsurveyresults.com/key-findings-byoccupational-group/

Public Health England (2019). “Health Matters: Health and Work”, available from:
https://www.gov.uk/government/publications/health-matters-health-and-work/health-matters-health-and-work

Rueda, S, Chambers, L, Wilson, et al (2012). “Association of returning to work with better health in working aged adults: a systematic review.” American Journal of Public Health 102 5410556

Rich, A, Viney, R, Needleman, et al (2016). “You can’t be a person and a doctor: The work-life balance of doctors in training – a qualitative study.” BMJ Open.2016; 6(12):e013897. Doi:10.1136/bmjopen-2016-0138970

Waddell, G and Burton, K (2006). “Is Work Good for Your Health and Wellbeing?”. London: TSO.

Wilkinson, R, and Pickett, K (2010). The Spirit Level: Why Equality is Better for Everyone.” London: Penguin Books.

Williams, N (2019). “How managers cause sickness absence”, Occupational Medicine 69(3) 160.

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