Inseparable by nature

This article is based on a presentation given at the Edinburgh IOSH Branch meeting in February 2005, which set out to encourage increased collaboration between OH and health & safety practitioners by demonstrating the close links involved in the management of all aspects of health hazards at work.

Although a great deal of organisations already have close collaboration between the two disciplines, during my work as an OH&S adviser, it has become clear that a great many organisations and businesses still treat the two separately.

When we look at the evolutionary chronology of the development of OH&S,1 it seems that employers’ indifference to workplace health and safety has been a feature of both ancient and modern societies until relatively recent times.

OH developed rapidly during the First World War because the war had a dramatic effect on manpower.

The upsurge in OH interest was born out of a national need for survival. Waldron points to four factors that have significant impact on developments within the OH arena:



  • The economic need to conserve the efficiency of the workforce
  • Changing attitudes of workers and trade unions towards health &safety
  • Compassion, which includes a sense of caring for others
  • Increasing competence of health and safety professionals to effectively control hazards and deliver health promotion in the workplace that has its roots in ill health prevention.2

With this in mind, when we consider the economic developments of the 20th century, we can see that trade unions grew in many countries and began to exert an influence on OH&S. They pressed for improvements in legislation and for the extension of compensation laws to cover occupational injuries and diseases. As such, they have become more directly involved in the development of occupational health and safety.

Unions now participate in formulating national policy on OH&S. In the UK, the Health and Safety at Work Act (HSWA 1974) provides for the provision of the Health & Safety Council (HSC), which consists of representatives of employers, unions and local authorities.

It is this body that determines policy on health, safety and welfare at work. It proposes Approved Codes of Practice (ACOPS) and produces guidelines on compliance with legislation.

Health, safety, and welfare have evolved alongside each other since the beginning of the Industrial Revolution, yet it is only recently that we are realising that OH&S is integrated and should not be seen as separate entities.

It seems many influential stakeholders are starting to appreciate the inseparable nature of OH from safety. Most managers are aware of the need for co-operation between unions and health and safety professionals. They are all aware of the important relationship they have within the organisation, with the workforce, and the manner in which this has an impact on health and well-being throughout the organisation.

With the introduction of ‘Revitalising Health & Safety’ and ‘Securing Health Together’, as well as the latest Government reforms strategy for partnership working, we can see the overlap of safety OH and safety on all the major issues.

Bill Callaghan, chairman of the HSC, has pointed to the many pilot projects ongoing throughout the UK, by the Department for Work and Pensions (DWP), within certain sectors – for example, within the construction industry, ‘Constructing better health’, Safe and Healthy Working and schemes looking at musculoskeletal disorders. He has also asked what else can the HSE do to invest in OH.3

In response to these projects, I believe we need to highlight the inseparability of OH and safety by breaking down perceived barriers and integrating OH into all H&S committee meetings and agenda items – after all, we all have the same aims, objectives and goals.

The nursing concept of APIE (Assess Plan, Implement and Evaluate) is primarily the same process as the HSE’s five steps to risk assessment, incorporated in the Safety Management System HSG65 (see Figure 1), the differences are only semantics.

Because people with good health have been found to be 20% more productive,4 the OH practitioner must take a proactive approach to address to the physical, psychological and economic health of a business.

According to Pickvance,5 investment in OH&S should be encouraged, but this requires collaboration between the two professions and the management of their organisation.

Before giving my presentation, I consulted my health and safety colleagues and asked them to look at the various aspects of the OH adviser’s role, and how this could be integrated into existing HSG65 Safety Management Systems or other similar systems.

Taking this approach would unify the two professions when looking at the areas covered within the OH and safety system, such as safety policy, risk assessment, planning, organising, measuring and reviewing.

The words ‘health’ and ‘safety’ both stem from one word, which is synonymous with them both – protection. In law, this is expressed as duty of care as defined in the HSWA 1974. Both OH and H&S professionals are trying to maintain this protection/duty of care in the workplace.

Both disciplines have specific skills that rely on good communication and integration, although due to the specialist medical skills held by OH practitioners and the need for medical confidentiality they can also survey, intercept, identify, manage, or refer all things medical. Examining the role of an OH adviser, it becomes apparent how closely the two disciplines of OH and H&S are aligned.

Definition of OH adviser
The discipline of OH is concerned with the two-way relationship of work and health.

It is as much related to the effects of the working environment on the health of the worker as it is to the influence of the worker’s state of health on their ability to perform the tasks for which they were employed. The main thrust of the discipline is to prevent ill-health rather than cure it.

Essential elements of OH services



  • Health promotion and prevention strategies – these are rooted in risk assessment
  • Worker/workplace assessment and surveillance as required by the Management of Health & Safety at Work Regulations 1999
  • Investigation, Monitoring and Analysis of Illness & Injury (RIDDOR 1995)
  • Injury and illness management, case management, counselling, management and administration, legal and ethical monitoring and research

all these elements rely heavily on the need for a level of trust being built between the OH function and the employees.

What does an OHA do?
Occupational health advisers (OHA) focus on the promotion, protection and restoration of workers’ health within the context of a safe and healthy work environment. This means they must deliver:



  • Autonomy and independent clinical judgements – educated to a predefined level to enable them to make decisions and know when to refer the issue to a physician
  • Work from a research-based foundation, using theoretical and conceptual frameworks to guide practice
  • Must act as advocates for workers and encourage them to make informed decisions about their health
  • Work in collaboration with H&S professionals to provide a holistic health and safety at work service
  • OHA are professionally accountable to workers (their primary responsibility), employers, their profession and themselves.

And as you will see from the different workplace hazards encountered by both the OHA and the safety practitioner below, it is clear to see that OH practitioners are involved in all aspects of H&S in the workplace.

Workplace hazards

Physical hazards – Are there hazardous agents within the work environment that can cause tissue damage or other physical harm? This includes radiation, temperature extreme, noise, lasers, microwaves and vibration. Effects of which manifest as –



  • Acute: acoustic trauma or excess heat, cuts, burns, rash
  • Chronic: tinnitus, leukemia, occupational asthma.

Chemical hazards – Any substance synthetic or naturally occurring in the work environment that may be potentially toxic or irritating to the body system through inhalation, skin absorption, ingestion or accidental injection, which can include mists, vapours, gas, solvents, pesticides, explosives and pharmaceuticals. Effects of which manifest as



  • Acute: respiratory irritation, anaphylaxis
  • Chronic: Cancers, bronchogenic and gastrointestinal, occupational asthma and neurological disorders.

Biological hazards – As encountered in laboratories & bio-technology working, including viruses, bacteria, fungi, mould, or parasites. May cause disease via direct contact with infected individuals or animals. Effects of which manifest as:



  • Acute: colds, flu, measles, parasitical infections
  • Chronic: TB, hepatitis B, HIV and AIDS.

Mechanical agents – may cause stress on the musculoskeletal or other body systems, and hazards include inadequate workstation and tool design, frequent repetition of a limited movement (RSI), or repeated awkward movements with hand-held tools. Effects of which manifest as:



  • Acute: neck strain, muscular fatigue and visual fatigue
  • Chronic: carpal tunnel syndrome, tenosynovitis, back injury.

Psychosocial hazards (stress) – Often related to the nature of the job, the job content, the organisational structure and culture, insufficient training and education regarding job requirements, physical conditions in the work place, leadership and management styles also contribute, as do interpersonal conflict, unsafe conditions, overtime, sexual harassment, racial inequality, role conflict, shift work and limited autonomy. Effects of which manifest as:



  • Acute: increased heart rate, increased blood pressure, fatigue, depression, substance abuse and violence
  • Chronic: alcoholism, CHD, mental Illness and GI disorder.

The above list is not exhaustive, there are other workplace hazards and risks, but these should help to illustrate the importance of encouraging collaboration between the disciplines, promoting better understanding between the two professions and continuing to explore a vast knowledge base that is dynamic by its very nature.

Some workplace hazards such as stress, whether it be work related, socio-economic, psychosocial or otherwise are difficult to manage. However, by using a more integrated and constructive approach guided by the HSG65 system, OH advisers will be well placed to address such issues.

The disciplines of OH&S recognise that organisations have their own culture, personality, problems and state of health. The OH&S professional can direct management and employees towards a more cooperative dialogue by highlighting and addressing H&S problems in order to manage them effectively.

John Walker is managing director of Business Health Advisers, an occupational health & safety consultancy.

Go to www.business-health-advisors.co.uk

References
1. Cox RAF, Edwards FC, Palmer K (2000) Fitness For Work, Oxford University Press New York
2. Waldron HA (1993) Occupational Health Practice, Butterworth Heinemann London
3. Investing in the future of OH, Occupational Health Vol 57, no. 1, January 2005
4. Rindler C (2004) Occupational Health
5. Pickvance S (2003) Occupational Health Review, May/June


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