Prevention The Medical Approach

Presented By: Dr. Kalicharan Ramnarine

OUTLINEINTRODUCTION

/DEFINITIONHEALTH

SURVEILLANCE PROGRAMME

STRESS IN THE WORKPLACE (SYMPTOMS)

DETERMINANTS OF STRESS

MANAGEMENT OF WORKPLACE STRESS

CONCLUSION

INTRODUCTIONOccupational Health is the promotion and maintenance

of the highest degree of physical, mental and social

well-being of workers in all occupations by preventing

departures from health, controlling risks and the

adaptation of work to people, and people to their jobs.

(ILO/WHO 1950)

The concept of workplace health surveillance is new to

Occupational health and is different from medical screening.

INTRODUCTION CONTHealth screening refers to the early

detection and treatment of diseases associated with particular occupations.

NIOSH defines occupational health surveillance as “the tracking of occupational injuries, illnesses, hazards, and exposures.”

The National Institute for Occupational Safety and Health (or NIOSH).

INTRODUCTION CONT: The Joint ILO/WHO Committee on

Occupational Health at its 12th Session in 1995 defined an occupational health surveillance system as “a system which includes a functional capacity for data collection, analysis and dissemination linked to occupational health programmes.

This means having a system to look for early signs of ill health caused by hazards at work.

INTRODUCTION CONT:

It includes health records for individuals and may involve questionnaires or medical examinations to inform the employer.

Corrective action may involve referral for treatment and/or adaptations to work for individuals affected.

Serve as an indication that controls may be failing, review of risk management and action.

OCCUPATIONAL HEALTH SURVIELLANCEIt is essential to the planning, implementation

and evaluation of occupational health programmes and control of work-related ill health and injuries and the protection and promotion of workers’ health.

SURVEILLANCE PROGRAMMEYou must decide whether the work you do

needs health surveillance. Ask yourself whether any of your workers are at risk from:

noise or vibration solvents, fumes, dusts, biological agents and

other substances hazardous to health asbestos, lead or work in compressed air ionizing radiations or commercial diving –

these require a particular type of high-level medical surveillance.

DEVELOPING A HEALTH SURVEILLANCE PROG (HSE)

SURVEILLANCE PROGRAMME CONTNIOSH defined three indicators of

workplace health surveillance programme.

Availability of easily obtainable dataPublic health importance of the

occupational health effect or exposure to be measured

Potential for intervention activities

SURVEILLANCE PROGRAMMES

Major limitations: underreporting of occupational health

disorders (very common in most of the undeveloped and developing countries)

inability to diagnose the etiology by the occupational health care workers and

availability of the data such as death records.

WORK STRESS

INTRODUCTION/ BURDENHigh job demands and unjust effort-

reward are risk factors for mental and physical health problems.

Studies have indicated that work stress is associated with heart disease, depression, and musculoskeletal disorders .

Leads to increased spending on healthcare.

Prevention and management of this psychosocial risk not priority.

WORK STRESS

Definition: “Work-related stress is the response people may have when presented with work demands and pressures that are not matched to their knowledge and abilities and which challenge their ability to cope.”

WHO 2007.

IMPACT OF WORK STRESS According to Marmot & Wilkinson, 2006 the

working environment and the nature of work itself are both important influences on health.

Systematic reviews shows stress at work is associated with heart disease, depression, and MSDs ( Melchoir et al.2007)

Leads to absences from work and also presenteeism, (although present at work, the performance is poor and sometimes even hazardous to themselves as well as others around them).

LEGISLATION T&T - OSHA

The Occupational Safety and Health Act, 2004

No mention of work stress

EFFECTS OF WORK STRESSPhysical symptoms

Mental health symptoms

Social symptoms

Emotional health symptoms

SYMPTOMS OF WORK STRESS

PHYSICAL BEHAVIOURAL

Ulcers (G. I.)Weight lossHigh blood pressureHeart diseaseMusculoskeletal

disordersPain (generalized)

An increase in alcohol consumption

difficult' in the workplace less co-operative,

more accident prone, less sociable. inability to cope with

family/domestic roles, neglect of personal

appearance

LOOK OUT FOR THESE SIGNSPSYCHOLOGICAL

Memory LossDepressionMental ConfusionDifficulty ConcentratingLoss of Sexual DesireIrritabilityInsomniaFeelings of guilt and uselessness

DETERMINANTS OF WORK STRESS PSYCHOSOCIAL HAZARDSWorkloadWork Schedule/Pressure (urgency/competing demands)Surveillance (by management)/ controlJob insecurityStructural and Managerial ChangesPhysical conditions (environment)/ Equipment.Job designWork organization/ Work-home interface

DETERMINANTS OF WORK STRESSJob content Lack of variety or short work cycles,

fragmented or meaningless work, under use of skills, high uncertainty, continuous exposure to people through work

Workload & work pace Work overload or under load, machine

pacing, high levels of time pressure, continually subject to deadlines

DETERMINANTS OF WORK STRESS

Work schedule Shift working, night shifts, inflexible work

schedules, unpredictable hours, long or unsociable hours

Control Low participation in decision making, lack

of control over workload.

DETERMINANTS OF WORK STRESS

Environment &equipment Inadequate equipment availability,

suitability or maintenance; poor environmental conditions such as lack of space, poor lighting, excessive noise

Organisational culture& function Poor communication, low levels of support

for problem solving and personal development .

DETERMINANTS OF WORK STRESS

Interpersonal relationships at work Social or physical isolation, poor

relationships with superiors, interpersonal conflict, lack of social support, bullying, harassment

Role in organization Role ambiguity, role conflict, and

responsibility for people

DETERMINANTS OF WORK STRESS

Career development Career stagnation and uncertainty, under

promotion or over promotion, poor pay, job insecurity, low social value to work

Home-work interface Conflicting demands of work and home,

low support at home, dual career problems

STRUCTURAL/MANAGERIAL CHANGES IN THE MODERN WORLDPrivatizationGlobalisationMergers/acquisitionsDownsizingGrowing too rapidlyTechnological introduction

All contribute to work stress !

Management of WORK STRESSAn effective risk assessment approach is

necessaryMeasure the current situation (using surveys

and/or other techniques) Work in partnership with employees and their

representatives to make practical improvements

Agree and share an action plan with employees and their representatives

Regularly review the situation to ensure it continues to improve

Management of Work stress Medical Management of physical sign /symptoms.

Employee Assistance Programme

Present in many larger organizations in Trinidad and Tobago.

Confidential

UK National model for work stress (see slide below)

Stress Management cont:HSE developed the Management Standards

for dealing with work-related stress in an organization whatever the size or type.

The Standards identify six factors to be addressed:

Demands – including issues such as workload, work patterns and the work environment

Control – how much say the person has in the way they do their work

Support – including the encouragement, sponsorship and resources provided by the organization, line management and colleagues

STRESS MANAGEMENT CONTRelationships – including promoting

positive working to avoid conflict and dealing with unacceptable behaviour

Role – whether people understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles

Change – how organisational change (large or small) is managed and communicated

ACTIVITIES THAT CAN IMPROVE EMOTIONAL HEALTHRead something you enjoyListen to soothing musicDo breathing exercisesWalkExperience natureTake a relaxing bathPlay with a petTend to your bodyEngage in a physical activity

CONCLUSIONDuring the implementation of a health

surveillance system, involve your workers and their representatives at an early stage, so they understand its purpose and their roles and responsibilities in any resulting health surveillance programme.

Ask for advice from a competent occupational health professional in developing a health surveillance programmer

CONCLUSION CONT:

Work-related stress is the response people may have when presented with work demands and pressures that are not matched to their knowledge and abilities and which challenge their ability to cope. (WHO, 2003)

Psychosocial risks (work-related stress ) are major challenges to occupational health and safety (EU-OSHA, 2007