OH Today Autumn 2021

Special Edition ioh.org.uk

OH TODAY

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Partners of OH Today

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OH TODAY

Autumn 2021

CONTENTS From the President

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Women’s Wellbeing in

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Male-Dominated Industries Editor LYNN PRATT

Disability and IT Accessibility

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Assistant Editor JANET O’NEILL Production Editor IAN GARNER

The Role of Occupational Health Leadership in Promoting Equality,

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Diversity & Inclusion at Work

Menopause, Work and

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Occupational Health Copyright © iOH 2021

Published by iOH, The Association of Occupational Health and Wellbeing Professionals

Importance of Ethnicity in

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lung function

Being Transgender in the Workplace

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How Diverse is your Inclusion strategy?

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Hidden Disabilities

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email: admin@ioh.org.uk

Views expressed in OH Today are those of the contributors and not necessarily those of iOH.

insights into what works

ISO 45003 Managing Psychosocial Nor does iOH necessarily endorse any of the products or services mentioned or advertised in the publication.

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Risks An overview

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From the President Neil Loach

I

hope you enjoy reading this special

about returning to doing routine face to

diversity and inclusion edition

face health surveillance, particularly

highlighting some of the challenges

with Spirometry. The guidance from

within the occupational health

HSE below will assist you in making the

environment. Ethnicity issues in lung

correct decision and I am sure there will

function, menopause, IT accessibility,

be much debate around this on the

transgender and women's health are all

various social media platforms.

featured. If we are to shape the future of Occupational Health, improve the access, experiences and health outcomes for those in the workplace we must discuss issues and help employers to value differences through inclusion, regardless of age, disability, gender, race, religion, beliefs, sexual

HSE (2021) Face to face assessments for health surveillance and safety critical medicals should be subject to a suitable and sufficient risk assessment and continue to follow the relevant UK government guidance on working safely.

orientation, language, health status,

There are different approaches and

perspectives, opinions and personal

timescales for easing of restrictions (and

value.

how that is affected by variants) in

As time ticks by and the seasons change

Scotland and Wales.

for us all once again it is time to reflect

You should make sure the measures

on what has happened for us over the

identified by your risk assessment take

summer.

account of the public health regulations

I do hope that the summer has brought you more of a sense of normality. I know

and guidance for the nation you are working in.

that some of you will have had long

If health surveillance or safety critical

awaited holidays either at home or

medicals require spirometry, it should

abroad and this is to be celebrated as we

be subject to a suitable and sufficient

get some new freedoms despite the

risk assessment and appropriate

change in the procedures that we must

controls put in place, including

endure. Pre-flight tests and pre-return

provision of suitable personal protective

tests are cumbersome, expensive, but

equipment.

necessary, if we are ever going to

As you will no doubt agree, the basis of

venture further than “OurGate”. The New Normal is born.

This brings me to changes in practice

any return to normality will be subject to risk assessment identifying that it is safe to conduct the tests for both the

with some of you still feeling uneasy

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worker and for the staff involved. This is

or 2 year placement or even the

also a reawakening of the issues that we

opportunity for Alternative Practice

face on a day-to-day basis. These have

areas which is a requirement of the

always been the case but we may have

Specialist Community Public Health OH

lost some focus on this as practitioners

Course to do 15 days in an alternative

over the last few years with many OH

setting to broaden OH experience.

Practitioners being lost in the deluge of management referrals.

As it is now there is a whole new cohort of students starting on their education journey at our universities. Please remember to support them if you come

across them. Encourage them with your passion and flair and enlighten them to the wonderful career framework that awaits them. If any of your organisations can support a placement student in the future, please do get in touch with your local OH Course provider. This could be for a full time 1

On a final note, I have 2 pieces of "Good News" information to share with you.

This year's winner of the iOH Ruth Alston Memorial Award is Charlotte Wakeley. Charlotte was a student at The University of Derby where we sponsor

this award. The award is for excellence in OH Nursing Studies and I am delighted that she was chosen as she excelled in everything she did and managed to secure a First Class Honours degree. We look forward to you being presented with your award later in the year. Photos will be shared later

The second good news is that we have a new Mascot for iOH. Meet Rufus! He is a 10 week old Miniature Schnauzer that was brought into the Loach household 2 weeks ago. Both Rufus and I are proud to serve iOH! I will give you updates on his progress as and when I can. I hope that you look forward to meeting him at some of the live events in the future - venues permitting

Please enjoy reading this new edition of OH Today. I am sure that you will enjoy the articles. Remember that you can also write for us if you would like to share examples of best practice.

Neil Loach President, iOH

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Women’s Wellbeing in Male-Dominated Industries

By Danny Clarke

D

id you know that women employed in traditionally male -dominated occupations such

as medicine have higher rates of suicide than other employed women?1 The main risk factors that research has unearthed are poor health and lifestyles, unsupportive workplace relationships,

Change is slow Well, undoubtedly there have been significant changes in workplace culture and general employment conditions for

women over the last few decades.

Yet even with these changes, sexism still prevails in some workplaces, to the

job overload, and job demands.

detriment of women.

We already know that male-dominated

Many workplaces have attempted to

industries can, in many cases, be full of risk factors for men – but what about women’s health in male-dominated industries?

tackle such issues by focusing on overt sexism, such as comments made by colleagues, little emphasis, however, has been put on the innate sexism that

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is embedded into some organisations

health to take lesser priority in

that ranges from maternity leave

comparison to other aspects of

discrimination to sexist jokes –

employment, such as the gender pay

specifically when it comes to male-

gap.

dominated industries – which is inevitably bad news for women’s health.

Regardless, workplace sexism can contribute negatively to women’s health

Women working in male-dominated

in male-dominated industries no matter

spaces are suffering from levels of stress

which form it takes.

that are harmful to their health, due to a

It’s not all bad news, though.

complex range of factors such as social

isolation, sexual harassment, and low levels of support from co-workers2.

Elevated cortisol levels are associated with hypertension, diabetes, heightened risk of infections and depression, amongst other health conditions, and are not anything to be taken lightly.

The rise in women’s representation Women make up 26% of Science, Technology, Engineering and Mathematics (STEM) employees now3, even with gender pay gaps still being wide in certain STEM fields.

Is sexism embedded in male-dominated workplaces?

How many times have women been unofficially assigned extra responsibilities relating to caregiving, simply because they are women?

From emotional labour to cleaning and acting as the ‘workplace mother’, women are often expected to fulfil extra responsibilities (unpaid) that merely reinforce the idea that they are around

to fit a stereotype that benefits male colleagues.

This is all encouraged by gender expectations that push the concept of traditional gender roles into higher importance, from dress codes down to personality and communication style.

Perhaps the argument could be made that the emphasis on other aspects of gender disparity have allowed women’s 8

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Part of this shift is due to women in the UK being 38% more likely to go to

university than men, with more women on degree courses than men.

With education being such an empowering force for women, the drive that it provides towards pursuing ambitions in male-dominated fields is considerable.

Plus, since the early 2000s, women have become more qualified than men, as educational qualifications for women continue to increase faster than men’s.

With more women entering maledominated industries, the door opens for other women who may have been initially dissuaded by majority male workplace cultures, and may have had reservations about pursuing careers in certain sectors.

Still, change isn’t as fast-moving as many of us may have hoped for, in many

cases, due to a reluctance within specific

with adequate qualifications, women

industries to have open discussions

still feel as though they cannot thrive or

about the cultures that may be driving

work effectively in male-dominated

away female employees.

industries – it all begins with workplace culture.

What needs to change?

Merely putting an emphasis on employing more women into a specific

Sadly, it’s true that many women do

field isn’t going to combat the issue if

leave the workforce due to family

the women will have a reluctance to

obligations.

stay anyway. There’s little point in having women-centred recruitment

The main contributor to this is a

practices or targets if the culture means

workplace culture that is inflexible towards a work-life balance, meaning

they don’t stay.

that women feel unable to continue

An entrenched masculine culture, or a

their personal obligations alongside

culture of stereotyping and inflexibility,

their work obligations - 69% women say

needs to be addressed before focusing

they feel pressured by society to put

on recruitment strategies, otherwise it

family ahead of career .

simply becomes a case of not seeing the

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Women working in maledominated spaces are suffering from levels of stress that are harmful to their health

If women feel shamed for taking time off or trying to juggle work and home life, it is inevitable that they will leave the

workforce. Women ages 25 to 44 are three times as likely as men to be not working due to childcare demands5.

forest for the trees.

Here are a few key areas to focus on when attempting to make male-

dominated industries better for women: •Open up opportunities– if there are

This lack of support and progression can

no options for progression or building

be prevalent across male-dominated

skills, why would anyone stay in their

industries, such as engineering, with

career? Equal opportunity needs to be

40% of women who gain engineering

given to women, whether in the form of

degrees eventually deciding to leave the

higher-level work or additional

profession .

professional development

Primarily, this emphasises that even

opportunities.

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•Support networks – having other

top-to-bottom organisational change

women in the workplace can go a long

matched with a willingness to change.

way, but more so when it is line managers and upper management, as women are likelier to feel seen and heard, and also benefit from a strong support network.

The culture that persists due to maledominated industries isn’t just detrimental to women, they are also detrimental to men – suicide rates for construction workers in the UK is over three times the national average (you

•Feedback – many male-dominated workplaces will have countless female

can read more about male suicide in male dominated industries here).

employees who will have suggestions

Making these changes shouldn’t be

about how to make the working

viewed as tokenistic gestures or box

environment better, yet they can’t give

ticking, but instead, something that

these suggestions unless the floor is

benefits all employees, across all

opened up for them.

industries.

Change doesn’t occur overnight because it requires intention, consistency, and

Danny Clarke Founder Simply-People

References ¹Men’s work, women’s work and suicide: a retrospective mortality study in Australia ²Stress at work: How working in a male dominated environment can impact women’s health ³Women in STEM | Percentages of Women in STEM Statistics

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Women in the Workplace Report

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Women leaving the workforce: A mental health problem

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How to help women sustain careers in male-dominated spaces

Autumn 2021

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Disability and IT Accessibility By Stephanie Foster, C

A

s a society we are increasingly becoming reliant on digital technology. Never has this

been highlighted more than during the recent pandemic, as more of us have worked or studied from home. But it has also emphasized that there can be barriers to accessing and using technology as a result of health and disability issues. The World Health Organization (WHO) highlights that

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almost all of us will at some point expe form of disability or impairment, be tha permanent

Clinical Training Lead, PAM Group

erience some at temporary or

almost all of us will at some point

settings> Ease of Access and gives the

experience some form of disability or

user the ability to adjust the computer

impairment, be that temporary or

display, including making text bigger,

permanent (World Health Organization,

everything bigger or everything

2021). Like any other service industry,

brighter. Adjustments can be made to

software and internet providers have a

the cursor, or pointer as it is sometimes

moral and legal duty to make their

known, changing its size and colour.

services accessible. While Assistive

There is also the facility to “find” your

Technology is a specialty in its own

cursor on the screen quickly. This can

right, many accessibility features and

be set up using the mouse properties

adaptations are now included as

(Start menu> Settings> Devices> Mouse>

standard in our IT equipment and do

Additional mouse options -top right of

not need specialist assessment or

screen). Select pointer options and

training to use. But how many of us

check the button to allow you to locate

know they are there? Well, the aim of

the cursor when you press the Ctrl key.

this article is to shine a torch into the

It is also worth noting that the mouse

recesses of your computers and gadgets

properties allow you to swap the

to illuminate and draw your attention

functions of the left and right buttons,

to just a few of these features. While

change the speed of the double click or

this may inform your practice, you may

remove the need to hold the button

also find a few accessibility features

down when clicking and dragging.

that can make your own life easier.

These features may help where there

Thinking about how we interact with IT, we tend predominantly to receive

are issues with coordination or manual dexterity.

information from the device visually.

There is an onscreen magnifier that can

Making text bigger, brighter and bolder

zoom in, cover the whole screen, as a

can help mitigate some of the issues for

separate window or as a lens that

those with low vision. (RNIB, 2021). An

follows the cursor. The magnifier is

obvious adjustment is to have a larger

easily accessible by using the keyboard

screen as this automatically increases

shortcut of pressing the windows and +

the size of the display. To increase the

keys at the same time. On a phone or

size of the icons on your desktop simply

tablet this can often be achieved by

press and hold the control key (Ctrl)

placing two fingers on the screen and

and use the scroll on your mouse.

opening out (like a pinch in reverse).

Alternatively, while on your desktop,

Bright colours can be easier to see as

right click with your mouse and select View from the pop-up menu. This then gives you the option to select large, medium or small sized icons.

they reflect more light, therefore choosing a black background with a text colour that has a high contrast can make the text stand out. In windows 10

The Ease of Access page can be

there are some pre set options that

accessed through the start menu>

again can be accessed through the Ease

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of access page. Start menu> settings>

as your browser, it can also be accessed

Ease of Access>High contrast. There are

by the keyboard shortcut ctrl+ Shift +G.

also filters available for different types of colour blindness. Using these can make it easier to differentiate between red, green, blue, and yellow.

If you are using Teams for meetings (or consultations) there are numerous accessibility features included. If like me you are a visual learner, you may find

The amount of light available can also

the video explaining these easier to

greatly assist with contrast and clarity.

follow. Although primarily aimed at

The RNIB highlights that as we age, we

teachers, it walks through the tools

need increasing levels of light to see

available. (link in the Useful websites

clearly, with most people aged 60

section). These features

needing three times more light than

include Immersive

when they were 20. (RNIB and

reader – this is

Pocklington Trust, 2013). Natural

similar to read

daylight can vary depending on the time

aloud, but has

of day or weather, leading to a conflict

been

Types of impairment

Digital Acc

of needs regarding electric lighting in a shared workspace, with some colleagues requiring low lighting e.g., people with

Visual

migraines, Autistic Spectrum Disorder

Impairment

or albinism for example. Task lighting may therefore be a solution. This ideally should be positioned between the user

developed

and the task so that any shadow is below

taking into

eye level height to reduce glare. It is also

consideration

possible to adjust the screen brightness

the needs of

Ease of Access> Vision > Display >

people with

Brightness.

dyslexia – Spotlight

Read aloud is a feature available in Word, powerpoint and outlook and, as its name suggests, it reads the text to you. You can select a range of voices and adjust the speed. I use this facility to help me proofread my reports, it helps me pick up typos that I otherwise do not see, as well as helping with the flow of my writing. I’ve included a link in the resource section on how to access this.

Most browsers also have this facility, and it can usually be accessed via the browser menu found in the top righthand corner of the screen via the symbol. If you are using Microsoft Edge

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allows the presenter / meeting chair to focus the screen on the person who is currently speaking, while All together facilitates everyone being displayed on the screen in a set place to avoid the confusion and sensory overload of people’s images constantly

changing position. Live Transcription and Recording allow speech to be converted to text in real time, and for a recording of the meeting to be made and available for individuals to refer back to.

This is useful if individuals find it hard to process and remember verbal information.

Cogn

Impair

Live Transcribe serves the same

found by clicking on the information

purpose but is available via android

icon when using this feature. Most

tablets and phones. This also converts

smartphones and tablets have a speech

speech to text as it occurs in a face to

to text feature as standard.

face setting, assisting in communication for those with a hearing impairment. In these times of mask wearing, it can help those who would normally rely on lip reading to support their understanding of verbal communication.

nitive

rment

Sticky keys, this allows access to keyboard shortcuts by enabling the user to press keys in succession, rather than sheet on how to use this facility as well

applications include

as hints and tips on using a keyboard

Intelligent

one handed. This focuses on reducing

personal

cessibility

difficulties using a keyboard include

at the same time. AbilityNet has a fact

Other speech to text

t that may impact on

Some features to help address

assistants.

These can help with

key strikes by utilising predictive text and auto text insertion using features such as quick parts or autocorrect.

I would highlight that any new technology or software takes time to learn and that this can initially reduce

Mobility

productivity. Adequate support and

Impairment

training are therefore key, as it can take internet searches, playing music, email, calendar, lists and reducing the

amount of keyboard use required. Examples include Siri – for iOS devices (iPads and iPhones), Google Now – for Android and iOs devices and Cortana – for Windows. Dictate is a feature that is currently only available with an Office 365 Word subscription. In

word it can be accessed using the microphone icon or by using the keyboard shortcut Alt +‘. From my personal experience it works best when used with a separate microphone, but it

several months to become proficient. It may be worth highlighting this when we

give managers advice regarding adjustments, so as to manage expectations and help ensure that this is factored in when setting workload and targets.

The aim of this article has really been to provide only the briefest of introduction to these features, therefore you may find some of these resources helpful if you wish to delve deeper. Be warned, like any browsing, it can take you down

the rabbit holes of the internet. So don’t forget to follow out your own normal advice to carry out a DSE risk assessment and make sure you get up and move on a regular basis

does make some mistakes. To insert grammar there are specific phrases, as there are too for editing. These can be

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Useful Websites

British Dyslexia Organization Free online course providing awareness training on assistive technology such as text to speech (TTS)

AbilityNet AbilityNet helps people of any age and with any disability to use technology to achieve their goals at home, at work and in education. They have a range of fact sheets including, adaptions for visual impairment, hearing loss, Autism, dyslexia, dementia, ergonomics and phones and tablets.

Factsheets Keyboard – Single Handed Use

Android Accessibility Overview Live Transcribe

Apple/iphone Accessibility

Microsoft Accessibility How to use Speech Recognition in Windows Dictate your documents in Word Read aloud Listen to your Outlook email messages with Read Aloud Keyboard shortcuts in Windows

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Microsoft Teams Accessibility Overview View Live transcribe Making meetings inclusive Accessibility and inclusion in Microsoft Teams (Video)

References World Health Organization, 2021. Disability and health.

[Accessed 16 August 2021].

RNIB, 2021. Making the most of your sight.

[Accessed 16 August 2021].

RNIB and Pocklington Trust, 2013. Lighting Solutions Guide: Improve the lighting in your home.

[Accessed 16 August 2021].

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The Role of Occupational Health Leadership in Prom Work – Reflections of an Occupational Physician

By Dr Sade Adenekan MBChB MPH MSc MFOM

E

quality, diversity and inclusion

embedding EDI, it did not take me long

(EDI) is very pertinent and

to see the relevance and see where

timely topic today especially

allyship would fit in. Allyship is not just

over the last 16 months or so with the

a fancy concept – it is evidence based

emergence of the COVID-19 pandemic

(music to any clinicians ears) and

which has also brought a number of EDI

historically a concept that has used

related issues to light - be it in light of

more within the employee welfare,

the disproportionate impact of COVID

wellbeing and working with affinity

on Black, Asian and other Ethnic

groups also known as ERGS (employee

Minority communities and other

resource groups) e.g. gender, race,

marginal groups in society not only here

mental health to mention a few; but if

in the United Kingdom but more

you do not remember anything about

globally or just the overall challenge of

this concept, remember these the three

talking about health inequalities!

things about allyship as explained by

Needless to say, Occupational Health is

Sheree Atchen, a global EDI leader who

not just about providing adjustments for

described allyship as actively promoting

employees with disabilities as I will

EDI by being intentional, positive and

hopefully demonstrate in this reflective

making a conscious effort in order for

piece, but more as an agent of change

you to make that difference in changing

through an EDI framework of allyship.

culture at work.

Let us start with the basics – equality is

Jennifer Brown a world renowned expert

about everyone having an equal chance

on allyship stated that “allyship is a

regardless, Diversity is about one’s

journey” and not a destination and more

“uniqueness” and Inclusion is the “act”

importantly, there are no fixed or

of creating fairness. On reflecting on

perfect answers … she created an ally

what this has to do with Occupational

continuum as a way to help

Health and whether or not we as

acknowledge the personal journey of

practitioners have a role in promoting or

allyship as shown in Fig 1.

Figure 1: The Ally Continuum Source: From Unaware to Accomplice by Jennifer Brown 18

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moting Equality, Diversity & Inclusion at

When I first started in Occupational

obtain a reputation as being a service of

Medicine, there was the perception that

poor value for money spent. On the

I was expected to only provide advice,

other hand, as professionals we can

recommendations, guidance …. and not

actively engage and promote awareness,

getting necessarily involved (or seem to

take on more active and advocacy roles

get involved) in any management

to make that difference for the better

related issues or employee-employer

when it comes to advancing the

“disputes” and I was taught and trained

inclusive culture at work as both

to “remain as impartial” as much as I

Jennifer and Sherre both alluded to in

could whilst doing so! … and when

their articles.

things did not necessarily go the way I expected , I found myself trying as much as possible to avoid getting a formal a complaint that would ruin my ARCP (Annual Review of Competency Progression) as a trainee or annual

So what do I mean by being an ally for EDI in our occupational health roles?

appraisal when I ultimately became a

I will hopefully illustrate this by using

Consultant!

three personal stories from my clinical

As funny as that might seem …. I think for many of us as practitioners that

practice (names and personal details changed for confidentiality purposes):

would seem to be the case for not

Peter was a 32 year old Logistics

wanting to get involved with EDI - but

Manager who was referred just before

really, is that what we are about?

going through a disciplinary. He has

I think the Allyship spectrum that ranges from being apathetic to becoming an advocate does reflect a lot of what we do as Occupational Practitioners but in essence, we have a choice …. we could commence and

remain at the apathetic end of the allyship spectrum as part of our personal allyship journey with little or no awareness of the organisational EDI issues and position ourselves as far away as possible from the essence of EDI and be perceived as a medical service that believes in silo-working with poor strategic engagement and minimal impact and therefore be perceived and

been off work with stress for 10 months and had been previously referred to occupational health twice in the last 2 years. I had asked for further clarification following receipt of his referral on this particular occasion. He was described as a “poor team player” who did not “engage” with others and did not make “eye-contact” when spoken to by his manager. Although he had a prior history of anxiety having fled a war-torn country, that was not the reason for his referral. During his consultation, I identified a number of EDI ”related” factors: African culture of not looking at older people / leadership in the face, not going to pub after work ioh.org.uk

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for religious reasons which was the

supportive intervention through the

“customary” way of socialising and

company EAP (Employee Assistance

“team building” in his particular team.

Programme) and more importantly

As a result, I ended up delivering a

introduce menopause guidance and a

number of culture awareness training /

checklist as part of a HR policy review.

stress awareness session for both management and their human resources teams.

clinical practice. Stress in the workplace is common and takes up about 75% of

year old Project Manager and was also

my clinical case load and it is clear that

referred for work stress. He kept falling

accessing an occupational health service

asleep in meetings and after being

did make a difference for each one of the

embarrassed in a meeting in front of his

cases of “stress at work” - Peter needed

colleagues by his line manager, he then

to be understood within the context of

went off with stress. His consultation

culture and his religion, John within the

revealed that he was a new dad of 10

context of his work-life balance and

week old twins, juggling a

Sally within the context of her age and

“disproportionate” work –life balance.

accompanying physiological changes -

He was not aware of the organisation’s

all presented to Occupational Health as

work life HR policy and the advice was

stress at work cases but all were clearly

for the policy to be shared and explained

managed differently based on these

to him via HR and he was able return to

simple leadership principles of

a flexible work pattern which allowed for

awareness, involvement, engagement

him to work as well as support his wife

and being outcome focussed.

earned rest he needed.

Sally was a 53 year old Office Manager and was referred as she was “forgetting things” and was reprimanded by her line manager for forgetting to lock the safe after misplacing her keys! She then off with stress and was thinking of retiring after 28 years’ service. At her consultation, she admitted struggling with being perimenopausal and managing her symptoms and concentration at work. She cited that she worked within the context of a predominantly male team / environment and as such, did not feel able to inform her manager about her experience.

Following her assessment, I was able to provide the FOM guidance on managing menopause at work to her manager (with her consent), refer her for some OH TODAY

that we commonly come across in our

My second case was John who was a 38

with the babies … and get the well-

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These cases illustrate the EDI factors

Autumn 2021

Well you might ask the question – what if I am not in a leadership role?

I would simply respond by stating that I managed all three cases “trainee” which is not exactly at “leadership” level and I was able to still make a difference by raising awareness, engaging and educating. As I have subsequently evolved into a more strategic role, I find myself now more involved with strategy

and policy development, working with employee resource groups (ERGs), law and not just Human Resources departments - the lesson being that – leadership has a role at all levels when it comes to Occupational Health - be it as a technician, nurse, physiotherapist, physician and not just at directorship & Chief Medical Officers levels!

In summary, I think as Occupational

Health professionals we are uniquely

promoting and embedding change

placed to make a difference when it

through EDI. Second, even the same

comes to promoting EDI at work and

situation can end up being addressed

allyship has been shown to work be it by

differently as demonstrated in my

simply promoting awareness, improving

personal stories of managing stress at

engagement or just by being curious!

work within my occupational health

After all, as Maya Angelou stated …

clinic. Finally, as an occupational

when we know better, we do better!

health provider, I would challenge you

So what are my 3 key messages?

Allyship a journey and there are no fixed

to be curious, be unique, be fair and play your part in creating inclusion and fairness at work as you might just make a difference ….. for the better!

or perfect answers when it comes to

Dr Sade Adenekan is a Consultant Occupational Physician & Accredited Specialist in Public Health in the United Kingdom who previously worked in the NHS for over 20 years in Primary Care, Public Health and Health Services Management before retraining in Occupational Medicine. She currently works for a Corporate Global Oil & Gas Company and is passionate about Mental Health and Equality, Diversity & Inclusion within the Workplace.

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Menopause, Work and Occupational Health

By Emma Persand Work related stress and menopause Did you know6 • Every woman will go through menopause transition and 25 % will have symptoms that significantly

affect their health and wellbeing.

• 3 out 4 women experience hot flushes • 50% of women say work is more challenging • 47% of women do not tell their manager why they needed a day off • 25% have considered quitting their job • The workplace can support or make things worse 22

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Less than 20% say their workplace provided information about menopause, only 10.2% said their workplace had a menopause policy or guidance and 77% would have liked more information

about menopause at work When working as a case manager within an NHS occupational health department, I was seeing more and more women* over the age of 40 experiencing symptoms of work-related stress, being perceived as underperforming and sometimes even dropping out of work with inconsistent

Workplace discussion on reproductive and sexual health is rare: and yet surveys report that women want and need more knowledge to make informed decisions on lifestyle strategies and interventions to help them to thrive.

GP intervention. Statistics from the

poorer outcomes with menopause

British Labour Force surveys report that

transition as their own attitudes and

women between the ages of 45-54 years

beliefs are influenced by the cultural

report a high incidence of work-related

attitude and media representation of

stress. The timing of midlife stressors of

menopause, alongside socio- economic,

juggling a job with child and elder care

ethnicity, sexual and gender identity

combined with domestic and financial

and lifestyle factors.

responsibilities means that women and

The perimenopause phase is little

health care professionals are likely to

understood by women and health

attribute some physical, psychological,

professionals. Symptoms can begin up

and emotional symptoms to stress,

to 10 years before menstruation ceases

rather than perimenopause oestrogen

and is caused when the sex hormones

decline. Due to this, women did not

begin to fluctuate due to declining egg

access or were not offered correct evidenced based information, treatment, and support.

In western society, menopause is viewed as a mid-life phase of a woman’s reproductive health and for a large part of the population this is the case, as the average age for a woman to reach menopause in the UK is 51.

However, premature onset can occur • in 1 in 100 women before 40 years of age • can be surgical induced after a hysterectomy, • caused by ongoing treatment for poly cystic ovarian syndrome, endometriosis, and breast cancer

Diagram 1

The experience of lowering hormone

Follicle production during women’s fertility cycle

levels within days or weeks instead of

– courtesy E.R. Trevelde et al 1998

years can be particularly intense.

Women suffer in silence and have ioh.org.uk

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Oestrogen affects the reproductive tract, the urinary tra breasts, skin, hair, mucous membranes, pelvic muscles, psychological symptoms, not just altered menstrual cyc

Occupational Health making a difference!

get support for their health to prevent

follicles - see diagram 1.

Women over the age of 50 represent the

The Chief Medical Officer, Professor

fastest-growing demographic in the

Dame Sally Davies in 2015, called on

workplace, with nearly 8 out of 10 of

employers to create a culture where

natural menopause age women in work.

women feel comfortable discussing the

Millions of women are entering

menopause to promote an inclusive

menopause with 40 % experiencing

workplace. The workplace can influence

symptoms affecting their health and

a menopause experience, positively if

wellbeing⁶. There are substantial

the physical and psychological hazards

differences in the working lives and

are adequately risk assessed and

employment situation of women and

managed6. Organisations have a duty of

those who identify as women, trans men

care to do so by educating and

and non-binary. There is a need to

supporting their managers and

consider gender, race and ability

employees to ensure fair and equal

discrimination, informal work, and the

treatment, especially as legal cases

care burden outside of work when

under the Equality Act 2010 indicate

looking at work-related risks and

severe menopausal symptoms meet the

prevention strategies. Gender inequality

criteria as an impairment. Recognition

inside and outside of the workplace can

of reproductive and sexual health

affect women’s occupational safety and

conditions needs to be placed on a par

health, psychologically and physically,

with other potential workplace health

compounding the already existing

these from damaging their career and potential earning power¹.

issues. Women need to be empowered to

Top 6 Symptoms Perimenopause, menopause and post menopause • Fatigue

Others included

• Hot flushes • Difficulty concentrating • Anxiety/worry, • Insomnia, • Problems with recall, memory and concentration

• Erratic periods • Heavy bleeding • Night sweats • Difficulty sleeping • Mood swings • Fatigue • Reduced libido

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act, the heart and blood vessels, bones, and the brain with varied physical and cle.

health services. In 2018/19, women

made up 54.6% of admissions to hospitals.

The impact of the pandemic on women’s health³

Top 7 workplace factors influencing the severity of symptoms:

• In England, January-August 2020, there were 4.7 million fewer people referred for routine hospital care compared to the same period in

• • • • • • •

2019 - a reduction of a third (34%) High temperature Poor ventilation

• The ONS found that female gender

Humidity

was a characteristic associated with

No access to quiet area/space

higher levels of depression during

Dry air

the pandemic.

Lack of light Noise issues

• Key workers, including those within the NHS, experienced high levels of exposure to COVID-19. The majority of these are women; 54%

inequalities of health and work

compared with 42% of men.

outcomes.

It is worth noting that men* taking

testosterone hormone blockers for prostate cancer treatment can experience hot flushes and the same working conditions can affect the severity of the symptoms and quality of life. https:// pubmed.ncbi.nlm.nih.gov/19962840/

• 40% of female key workers in health and social care work in frontline roles which required face-to-face interaction (compared with 17% of men).

• Ethnic minority women are overrepresented in both health and social care, with one in five NHS workers being from an ethnically

Considering the bio/ psycho/social approach to assessing women’s health.

Before the Covid-19 pandemic, the GP consultation rate for women was 32% higher than for men, in part, due to reproductive related consultation ²

diverse group. Ethnic minority nurses are also significantly more likely to be on the lowest nursing band than all other nursing grades put together with more exposure to the virus.

• Lone parents (the vast majority of whom are women) were twice as likely to have poor mental health,

Although women have a longer life

compared with other family types,

expectancy, they are more likely than

immediately before and in the early

men to experience ill-health and require

stages of the crisis. Overall, 51% of single parents reported having ioh.org.uk

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Preventing the negative impact of menopause in the workplace

objective is to measure the quality of

life, severity of complaints and to measure changes over time and across different cultures. Outcomes are measured as an impact on the

Use of Occupational Health is a MAJOR

individual’s life and work to gauge

opportunity in the workplace, not only

severity but are of most use when

to help with advice on managing the

assessing interventions such as

symptoms but to identify health risks

treatment and/or self-management

and introduce preventative strategies.

strategies and/or work adjustment, over

Menopause transition at any age and in

time.

whatever context is an important biomarker for an increased risk for

various associated diseases and

Other tools and information to be

signposted towards:

problems. Early menopause raises

Frax: fracture risk assessment

concerns about the longer-term effects

Diabetes

of spending more years without oestrogen such as bone density loss,

Men, prostate treatment and hot flushes

musculoskeletal symptoms, vaginal, bladder and sexual effects, which influences quality of life contributing to personal and work-related stress.

Chronic disease can begin 10 years after

Making the business case

the onset of natural menopause such as

cardiovascular disease and osteoporosis.

The 2017 government report addresses

These diseases and poor quality of life

the organisational risks of not

can be prevented with early

acknowledging the impact of the

identification, timely intervention,

workplace and lack of support.

lifestyle modification, supplements, and

Businesses risk an increase in attrition

therapeutic options.

of female talent or difficulty recruiting experienced staff without a recognised

Using the date of ‘last menstrual period’

support structure or ability to signpost.

provides limited insight into the whole

for further information when required.

life course of reproductive health according to the Royal College of GP’s

menopause toolkit, who recognise that 25% of women of reproductive age will have menstrual health issues that will seriously impact their health and wellbeing. However, use of a gender

Employment tribunals involving

employees and menopause related issues have tripled in recent years.

Three significant cases to consider when building a business case for inclusion -

sensitive assessment, such as the The menopause rating scale ² (Diagram ) will

• Merchant v BT (2012)

identify any menopause red flags to the

• Tiffen vs Surrey Police

OH professional, increasing awareness,

• Davies v Scottish Courts and

and enabling signposting for further support and information. The key 26

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Tribunal services (2018

One of the greatest under appreciated sources of innovation and new business may, in fact, be women over 50, with new ideas, lots of life ahead of them, and with the verve to get it done(Coughlin, 2017)

Diagram 2 Tools to support Occupational Health practice

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Occupational Health should be part of

Inclusive signposting based on the

the wider health and wellbeing strategy

diverse needs of your employee.

and can provide a vital role in ensuring

https://www.womens-health-

it is inclusive to meet the needs of all

concern.org

employees. A sign of a healthy

https://www.nhs.uk/conditions/

organisation is demonstrated with the

menopause/

skill of managers knowing when to involve occupational health in the health and wellbeing management of employees. An inclusive health and wellbeing strategy that includes reproductive and sexual health could assist in addressing operational concerns of absent management, presenteeism and attrition through: • Access policy and/or a management guide for menopause and women's health, • Encourage the inclusion of these topics in wellbeing conversations,

https://www.menopausedoctor.co.uk https://www.bhf.org.uk/ informationsupport/heart-mattersmagazine/medical/women/ menopause-and-your-heart

Royal Society of Osteoporosis https://www.daisynetwork.org https://patient.info/news-and-features/ pelvic-floor-exercises https://www.squeezyapp.com/

• Educate all key personnel,

https://www.nutrition.org.uk/

• Conduct a risk assessment to identify

healthyliving/lifestages/

hazards that can be reduced (include

menopause.html?start=2

environment and welfare) • Liaise with Occupational Health • implement reasonable adjustments with the use of a WRAP (Wellness Recovery Action Plan), • Support flexible and agile working • Encourage Women’s Wellness networks

Emma Persand is a qualified nurse and Director and Founder of Lemur Health - an organisation that provides consultancy, education, and training to support and retain women employees.

Emma delivers group cognitive behavioural therapy sessions to women suffering from physical and psychological symptoms brought on by the menopause transition.

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Importance of Ethnic What is Ethnicity?

W

e define ethnicity as context -specific, meaning the

environment we grow up in

has distinct unique physical, social, cultural, economic, and historical circumstances that result in different courses of development in populations.

It can be viewed as a multifactorial social construct that is tied to race and used both to differentiate between diverse populations and used to establish a personal or group identity.

Classifications should not be interpreted

as being scientific or anthropological (the study of humankind), however these classifications are widely used in life and other medical sectors where ethnicity may be essential. Categorizing subjects into ethnic groups is done on the assumption that ethnicity is a substitute for genetic relatedness of a population, but it does not account for genetic variation.

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How was ethnicity in lung function viewed in the past?

In the 18th and early 19th century, statisticians and scientists believed that white people were at the top of the hierarchy and social order and “minority” racial groups were both biologically inferior and barriers to progress. In 1896 a respected statistician Frederick Ludwig Hoffman suggested those of African descent had “inferior vitality “because their vital capacity (VC) was found to be 6-12% smaller than Caucasian, this contributed to the belief that those of African descent had a higher mortality. However, his views were contested by other scientist who believed that other factors such as the social economic society (SES) and inequalities to health care access in that current time should have been considered for biological differences between ethnic groups. By 1990, the

Autumn 2021

By Charlene

UK Applicatio Vitalog

city in lung function

e Mhangami

on Specialist graph

application of a correction factor

observed differences between

(generally 6–12%) or the use of

populations. The ethnic differences in

population-specific standards, both of

lung function arise from differences in

which could be programmed into the

body build (such as chest size or the

spirometer, were commonplace in

ratio of sitting to standing height), early

pulmonary training programmes in the

life bodily development, environmental

USA and this practice of the correction

factors e.g., growing up at altitude. As

factor was used widely across Europe,

well as genetic or ancestral differences,

although there was no major supporting

there are social and structural

evidence of a smaller VC in those of

determinants of the differences

African descent.

observed between populations that factor into interpreting lung function. It

Explanation for the differences between ethnicities

has long been acknowledged environmental and social determinants impact the growth and development of

the lungs, this can begin from early childhood. There is evidence of social

Numerous reports have documented

and environmental factors having an

ethnic differences in lung volumes. It is

impact across multiple generations. A

recognized that there are distinct

biological perspective is that evolution

observable differences in lung function

has given rise to the origin of mammals

depending upon where you live in the

of widely different size. Each species is

world. However, in respiratory medicine

equipped with a scalable design of

a lot of assumptions have been made

lungs; as it is scalable it fits small and

about the underlying cause for the

large animals, and airways which meet

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the organism's metabolic demands.

approximately 80% of that for a male of

Therefore, this can explain differences

similar age and height with regards to

within human lungs. During this process

ethnicity the race correction was used.

of evolution changes occurred in

For those older than 70 results were

phenotype, giving rise to populations

extrapolated (estimated) from the

that differ slightly in body build and

regression equations.

dimensions. Also, an increase in the proportion of mixed-race persons will gradually blur race/ethnic distinctions.

Reference equations Reference equations are available for a wide range of populations and even for subpopulations within countries. In fact, there are >400 published equations for spirometry alone. Differences between equations arise from factors such as how healthy subjects were selected (with

Global lung initiative

respect to exclusion criteria, age range,

In 2012 The GLI Network aimed to pool

ethnicity, and sex), the number of

and collate as much of the existing

subjects included (sample size),

available spirometry data from healthy

equipment, testing protocols, quality

individuals around the world to derive

control and, very importantly, the

all-age, multi-ethnic reference

statistical approach used to derive the

equations. The GLI Network was largely

equations. These differences can have a

based on collaboration, altruism, and a

major effect on how lung function

common goal: to improve how lung

results are interpreted, with results from

function is interpreted. Reference

the same subject being abnormal using

equations were derived for healthy

one equation while falling within the

individuals aged 3–95 years for several

normal range in another. Previously the

ethnic groups including Caucasians (i.e.,

use of the European Community for

white subjects of European descent,

Steel and Coal (ECCS) equations

n=57 395), African Americans (n=3545),

produced in 1983, were recommended

and North(n=4992) and Southeast

for use within Europe. The ECCS

Asians (n=8255), where North Asian

working party performed a literature

refers to Korea and China north of the

review using data from the previous

Huaibei River and Qinling Mountains,

three decades, from which mean

and Southeast Asian refers to Thailand,

regression reference equations were

Taiwan and China (including Hong

created. The ECCS reference equations

Kong) south of the Huaihe River and

were derived from white European adult

Qinling Mountains. The availability of a

males aged between 25 – 70 years

large number of spirometry records from

working in coal mines and steel works.

3–95-year-old subjects of different

There were no females included and

ethnic backgrounds allowed the Global

values for female adults were

Lung Function Initiative to look into

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Figure 1 Predicted values for a, b) FEV1, c, d) FVC and e, f) FEV1/FVC by sex and ethnic group. a, c, e) Males and b, d, f) females. Graphs were generated using mean height for age in Caucasians to illustrate proportional differences between ethnic groups of the same height and age; in practice, differences in height for age further affect predicted values. The rise and fall in FEV1/FVC around adolescence are due to differential changes in FEV1 and FVC. Standardization of Spirometry 2019 update, An Official American Thoracic Society and European Respiratory society Technical Statement: Executive Summary.

ethnic differences in greater depth. In addition, since many individuals were either not represented by these four groups or were of mixed ethnic origin, a

composite equation was derived as the average of available data to facilitate interpretation in such individuals until a more appropriate solution is developed with appropriate data. This is the first study to present spirometry prediction equations spanning ages 3–95 years for

Effect on results A study in figure 1 shows Spirometry values including Forced Expiratory Volume in 1 second (FEV1) and Forced Vital Capacity (FVC) differed proportionally between ethnic groups, such that FEV1/FVC remained virtually independent of ethnic group. This shows that FEV1/FVC ratio is independent of ethnicity.

ethnic and geographic groups from 26 countries.

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Who goes where?

GLI ethnic groups Caucasian Persons having origins of Europe, Israel, Australia, USA, Canada, Mexican Americans, Brazil, Chile, Mexico, Uruguay, Venezuela, Algeria, and Tunisia.

African American Persons of black heritage.

Northeast Asian Persons having origins of Korea and China north of the Huaihe River and Qinling Mountains.

Southeast Asian Persons having origins of Thailand, Taiwan, and China (including Hong Kong) south of the Huaihe River and Qinling Mountains.

Other/mixed Select this option if unsure of ethnicity.

Recommendations The GLI spirometry predicted equation sets, which have been available for nearly a decade now, represent a significant step forward in the accurate

that the group called ‘Other/mixed’ is

used. Individuals in this group are compared to the average of the four main ethnic groups.

The future

interpretation of lung function in every

GLI manages ethnicity much more

ethnic group. The previously used

accurately, though there is still plenty of

equations, although the best available

work to do on this. Additional data from

at the time, are deeply flawed and lead

the Indian subcontinent and Arabic,

to misinterpretation, misdiagnosis and

Polynesian and Latin American

potentially life changing decisions.

countries, as well as Africa will further

When using the GLI equations you

improve these equations in the future.

should choose the ethnic group that is

With ongoing data collection, it is hoped

most appropriate to the individual you

that the majority of “missing groups”

are testing. Although ethnicity should

will be included within the next 5

be a consideration it is a slippery

yrs. Provided a sufficiently large and

concept and frequently your subject

representative dataset is collected using

won’t fit neatly into any specific group.

standardised protocols, it should be

When assessing lung function in an

possible to derive suitable ethnic

individual not represented by one of the

coefficients for specific groups without

four main groups it is recommended

re-calculating the GLI equations.

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Being Transgender in the Workplac

M

y name is Christina Riley. My

Seven years ago, while working at

pronouns are she, her and

Balfour Beatty, I had started my new job

hers and it has been 30 years

wondering if this would be the place I

since my graduation in construction

could transition to female while

management. I am a Transgender

keeping my job. It felt impossible. Their

Woman working in the construction

diversity and inclusion plan still had a

industry. For 22 of those years, I worked

long way to go on supporting people

in project management in my male

like me.

gender. I was Chris back then. Over the

years that followed my graduation, I came to realise that my gender identity was different to that, I was assigned at birth. In other words, I was born a boy in terms of my sex, but as time went by, I realised my gender expression, and gender identity didn’t match the person that people perceived me to be. Inside I felt Christina was the real me.

Over time I developed chronic anxiety from hiding my authenticity both at

home and in the workplace. This manifested itself in the form of panic disorder, where my heart would spontaneously race during the day and in my sleep. I would also have crushing palpitations in my chest. After 10 years of chronic anxiety, I thought I would never recover.

But then two things happened. The first was a particularly bad episode of palpitations and I realised I had to tell

someone of my gender dysphoria. I eventually told my GP in a letter and was referred to for talking therapy. At the first appointment, I broke down and cried as I told the therapist of my gender identity crisis. Over the following 6 sessions, I came to accept who I really was, and in this final acceptance, I cured the 10 years of panic attacks that had taken my happiness for so long.

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But one day, I walked into my office and looked at the TV screen in reception.

On the screen in front of me, they were advertising the launch of their LGBT network.

From that moment, the penny dropped, and I saw a way for me to come out as Christina in the workplace. I attended the meeting in a different office, and at the end of the meeting I came out as transgender to the HR Director.

My director was really surprised that someone wanted to come out to the meeting. I don’t think she expected it.

But the meeting did create a safe space for me to be quite open about my gender identity and my plan to transition. The rest is history. MY HR Director went on to tell my Managing Director with my consent, and we put in place a plan for me to leave work one day. Take a short holiday, and return two weeks later as Christina.

Some events happened in those two weeks. The 200 plus colleagues were informed of my transition. And I took

ce By Christina Riley some time to prepare myself. My first

of being female and an older female in

day back to work as Christina was

the Construction industry! The hurdles

extremely daunting. It was hard enough

for women in construction feel just as

just getting out of the car, let alone

challenging as they have always been. I

walking through the doors, and using

still sit in meeting rooms with 20 men,

the lift. But my fears soon disappeared

as the only woman. Having to find my

as I was welcomed back into the office.

voice and be heard is still something that I have to rise to. We have made some progress in recent

years though, while onsite female construction operatives remain around 3% of the workforce, we are seeing more women in site manager positions. The catch though is keeping us in the industry because the culture is not always welcoming, nor enabling a sense of belonging. Being an older female in the industry can often mean that

some opportunities are given to someone with more of a career ahead of them.

Diversity and Inclusion is an uphill battle for women, but the Covid 19 pandemic has led to Those first

some improvements, with the

few weeks

majority of people still working

were special.

from home, raising greater

As I felt my

awareness of the importance of

identity was truly

agile working. This applies to

embraced. I now

both genders, young and old,

know that coming

those at the top of their careers, and

out was the best thing that I could have

those who are just beginning.

done for my happiness and my productivity in the workplace.

Seven years on I have an understanding

So there is some hope

Christina Riley

Christina won the British LGBT Awards in 2017 and has received numerous rewards for her diversity work

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How Diverse is your Inclusion strategy?

By David Mitchell - Business Development Neurodiversity ToHealth

W

ith the Government recent

attending regular meetings.

release of the National Disability Strategy, it has

never been more pertinent for businesses to develop inclusivity strategies for disabled employees.

How do you start support?

One of the vital support strategies for

Many employers are utilising services

such situations is a Workplace Needs

such as Disability Awareness Training

Assessment.

for Managers to enable them with skills and knowledge to recognise where support is needed, specifically when the employee has not disclosed a hidden disability.

These assessments are tailored to both the employee's disability and working role. Assessments are available for any disability from physical, Neurodiverse, Hearing Impaired or Visually Impaired.

Many people have been through

The assessment is delivered to enable

education and early employment

an individual with solutions for

without knowing they have a

reasonable adjustments in work, to help

neurodiverse condition; additionally,

them in their daily working duties.

employees may excel well in a particular

These can be basic adjustments to a

position and receive a promotion. This

working environment, such as seating

can be a daunting prospect for someone

away from a window which may cause

with a neurodiverse condition, causing

distractions if the employee has ADHD,

anxiety and stress if the promotion

or noise-cancelling headsets to reduce

requires entirely different work duties,

environmental noise.

such as reporting, managing staff and 38

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If further support solutions are

required, this may include assistive

without knowing this for many years.

technology such as hearing aid support

This helps them come to terms with

technology to assist with meetings and

having a disability and how it will

or the use of telephones. Literacy

impact their everyday life and work

support software such as text to speech,

and also helps to ingrain trust in the

to support reading, or speech to text to

recommended adjustments and

provide dictation. With these solutions,

support solutions offered.

assistive technology training may be recommended to ensure the technology's correct use and guarantee the best enabling support is achieved.

Where can I get this support?

ToHealth Ltd, a division of Pam Group,

Coaching Along with technology solutions, on the job coping strategy sessions may be recommended. These help the individual with specific job duties and reduce anxiety by introducing coping strategies and preparation tools. If organisation

are a complete end to end solution provider. As mentioned above, we can deliver workplace needs assessments, provide compatible assistive technology and training along with coping strategy and disability awareness training solutions.

software such as mind mapping is

Co-Coaching may be a great solution

Who is eligible, and what funding is available?

with the employee's permission,

Funding may be available from the

introducing all the strategies mentioned

Government Access to Work scheme.

earlier but delivering these solutions

The employee must apply for this

recommended, it can be utilised for project planning, report writing and general day to day workload preparation.

with the line manager, who then learns about the support needed for the employee and how they can add additional support and understanding when assigning work to the individual.

funding, and the employer will be advised once an application is made so they can make reasonable adjustments.

Contributions may be applicable. You must have a disability or mental illness

This solution can often avoid conflict

defined as a disability under the

and misunderstanding of the work

Equality Act 20210. Any person above

capabilities of the employee but also can

16 years of age in a paid job or about to

strengthen the working relationships,

start or return to work, apprentices and

reducing stresses for both the manager

Kickstarter scheme are eligible.

and employee may have encountered

Further information on employer

otherwise.

Another solution to aid employees

contribution is available on the Access to Work Government website

whose news of being disabled has emotionally impacted them is the Disability Impact Awareness Training, available for people who have a hidden disability and have lived

ToHealth offers a managed service to support employees and employers through this administration process. ioh.org.uk

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39

Hidden Disabilities – insights into what works

By Sally Canzio SCPHN, Occupational Health PAM Group Training Lead

A

group of workshops took place

hidden disabilities, were held to gain a

with individuals who declared

better understanding of the impact on

hidden disabilities, as a safe

work. 1 in 5 people (21 %) has a

space to talk about their experiences and

disability, according to Family

this article provides a background as

Resources Survey (UK) 2018 to 2019 of

well as an overview of the insights

which, a large proportion have hidden

produced.

disabilities as can be seen in Figure 1,

Hidden disabilities are common health problems, often episodic, invisible, and unpredictable, which makes planning and management of the condition at work difficult. They can be physical, sensory, mental, or neurological with

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with 42% stating this affects their work.

By 2030 40% of the UK working population are predicted to have a longterm health condition and that doesn’t account for the 1.5% of the population with Long COVID (ONS).

few outward signs but can have a major

A hidden disability is a condition that

impact on people’s lives. Workshops

might not be noticed and not all

aimed at employees with physical or

conditions need treatment or

mental health conditions, considered as

adjustment. It is important to

Autumn 2021

remember that comparisons between

included depression, anxiety disorders,

people with similar conditions should

arthritis, diabetes, hearing impairment,

not be made as all individuals are

Crohn’s disease, colitis, blood disorders

different and their condition and its

and cancer.

treatment is individual to them.

Disclosure

These workshops were undertaken to

One interesting theme that arose was

get common views of the effects on

non-disclosure, i.e., not declaring a

individuals and work. Galen of

health condition within the workplace.

Pergamon 172 AD, a Greek physician,

It is estimated that one in three

surgeon, and philosopher, stated that

employees with a long-term health

employment is nature’s physician, and

condition has not discussed it with their

is essential to human happiness. Whilst

employer. The reasons a person may

we may not all agree with this entirely,

decide not to disclose to their manager

most would accept that work is good for

are multifactorial. They may feel that

our mental wellbeing, giving us a sense

they can cope and will disclose if they

of purpose and connection. Taking into

need to, they may have had frequent

account that all individuals that took

changes of manager and the opportunity

part in this study were in active

hadn’t arisen, feelings of

employment, it was useful to

embarrassment, feeling they won’t be

understand what impact conditions had

believed and fear of the consequences,

and what support would enable

may be some of the reasons for non-

individuals to remain in work optimally.

disclosure. Without disclosing, the

Disclosure in this study was voluntary

employer is unable to make adjustments

and confidentiality was maintained.

or provide support potentially leading to

Examples of hidden disabilities declared

Of those people who reported a disability:

48% have mobility difficulties (1 in 2) 36% experience stamina/breathing/fatigue difficulties (1 in 3) 27% experience mental health difficulties (1 in 4) 6% experience memory problems (1 in 6) 13% experience hearing loss (1 in 8) 12% have a sight impairment (1 in 8) 14% have learning difficulties (1 in 7)

Figure 1

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individuals working when ill and

struggling to cope. This can cause presenteeism, described by Roberston Cooper as not performing effectively, and ultimately result in sickness absence. Sadly, disclosure often occurs when people can’t cope anymore and have no reserves left.

The effects of hidden disabilities on an individual in work • Work-life balance due to resting when not working, to be fit for work • Work satisfaction by trying to maintain workability • Social isolation, with reduced interaction at work because of the perception that colleagues don’t understand • Skills development from a loss of confidence, low self-esteem, and self

-worth in some people •

Attitudes and perceptions of disability are changing with increased knowledge

and awareness and legislation exists to

Career development and the

ensure support is provided wherever this

promotion process can be daunting,

is feasible. The outlook is not all

affecting the perception of job

negative for those with hidden

prospects and job security

disabilities.

All of the above can influence health

Common themes Several common themes arose from the

and wellbeing.

On a positive note, Occupational Health

workshops.

can make a significant difference with

A minority noted negative aspects of

their knowledge of workplace health,

working from home due to feeling

health care services and supportive

isolated and missing social contact,

measures in advising both managers and

having distractions such as children or

employees. Improvements in technology

being a carer, and lack of privacy. Many

in the last 30 years have helped enable

felt that their prospects of promotion

many to continue working, particularly

were reduced because they found the

those with neurodiverse conditions.

interview process stressful and felt that

Medical advancements continue, even

they would not be able to demonstrate

during the pandemic to improve the

their skills. Some found their colleagues

management of health conditions.

were dismissive of their condition and

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Episodic absence adjusted target re and not proactiv manage to heigh anxiety a

reported as being the most beneficial

solution to managing health conditions.

Productivity due to fewer distractions, no commute to work and less fatigue were seen as major benefits. Many reported having no absences in over a year due to home working and an improved work/life balance. Most

The iceberg metaphor is a good analogy for coping with a hidden disability at work as much of what people do to cope with a health condition goes unnoticed and is managed at home with a reduction in activities to conserve energy for work. We need to change this profile to increase awareness and reduce work challenges so that the employee not only copes with work but thrives.

c es only d for after eached

vely ed leading htened and fear

admitted being able to manage their health better when working from home as they had the flexibility to rest and exercise when required, felt less pressured and could control the environment. Individuals with autism reported that they were better able to control their environment at home as noise levels in the office can be most distracting. Also, they felt more confident participating in virtual meetings rather than face to face.

Improved confidence and fewer symptoms of anxiety were reported by

they lacked understanding. Others

many who worked from home. It was

reported difficulty starting conversations

acknowledged that regular team calls

with their manager and feared that

helped keep them connected to

confidentiality would not be maintained.

colleagues and regular one to one

Many viewed attendance policies and processes negatively and felt that hidden disabilities were not accounted for. They noted that adjustments were often made only after the absence target had been breached and no proactive measures were in place for episodic attendances.

This led to a heightened level of anxiety and a negative impact on health. Lack of consistency across an organisation contributed to a lack of confidence in the provision of support.

Supportive solutions Having a supportive manager as long as this was consistent across the organisation was seen as helpful, however, working from home was

conversations with managers were beneficial as long as they were meaningful and included an enquiry about wellbeing, coping and the offer of support if appropriate. However, this and adjustments such as home working would not be feasible without disclosure. Therefore, trust needs to be built and openness encouraged.

Learning points • Awareness sessions on hidden disabilities for managers as part of their training, and for managers to have Human Resource (HR) support.

• Awareness sessions for colleagues • Peer support groups for certain disabilities

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• A disability passport that documents

adjustments specific to that individual

those with disabilities and if not,

employees may wish to set one up.

Various charities will assist

• Should individuals need to return to

organisations with education and

the office after home working, then a

training, and some provide financial

phased return to ease them back in

support. The hidden disability

Further considerations Occupational health services are well placed to offer support to employees with a hidden disability and referrals should be made where adjustments at

work could enable an employee. Under the Equality Act, employers have to make reasonable adjustments for those considered to have a disability.

Occupational health advisers (OHA) can give professional advice on appropriate adjustments to managers which enable employees to remain at work.

During the pandemic, many people have been unable to access treatment for symptoms, surgery may have been

delayed and this impacts on workability.

Occupational health services such as those offered by PAM Group provide psychological services, physiotherapy and have a team who are specialists in providing services and equipment for neurodiverse conditions. Access to such services may enable an employee to continue working. Access to a health coach to help with fitness, wellbeing, diet, and lifestyle would also be a great

benefit in enabling people to manage their health at work.

sunflower scheme was set up a few years ago at Gatwick airport as it was recognised that additional assistance was required for people with hidden disabilities. They issued green lanyards with the yellow sunflower for people

who needed assistance and large retail stores now issue these and have trained their staff to aid those wearing them.

Access to work may provide special equipment, assist with adaptations and adjustment or support a worker getting to and from work, Remploy or Able Futures for long term mental health support.

Conclusion Attitudes and perceptions regarding disability are changing and knowledge and awareness through the media have increased. However, the insights gained indicate more can be done to assist employees with hidden disabilities. To meet the needs of workers with diverse episodic conditions, there is a need for fairness and transparency in the workplace concerning how hidden disabilities are managed. Work is an important health outcome and work challenges need reducing so that the

Ensuring that appropriate display screen

employee is no longer impacted by their

equipment (DSE) is accessed as well as

disability.

regular eye tests for those who work with computers.

Many workplaces have Mental Health First Aiders who can support and signpost employees, but wellbeing Support Groups can be set up to support 44

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Focus on skills and abilities, rather on performance deficit. additional evidence-based tools, resources, and training are required.

References Sources: Steadman et al, 2016; NHS,

HSE: Developing an intervention

2012; Labour Force Survey, 2012;

toolbox for common health problems in

Vaughan-Jones & Barham, 2009

the workplace

‘Improving Lives: The Future of Work,

Research: Disclosure, Privacy

Health and Disability’ Government

and Workplace Accommodation

paper 2017

of Episodic Disabilities: Organizational

Health warning for employers

Perspectives on Disability

Supporting older workers with health conditions.

Communication-Support Processes to Sustain Employment. Monique A. M. Gignac et al

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T

he recently published new

and improving an OH&S management

global standard for

system (and) highlights that the

psychological health and safety

organization is responsible for the

in the workplace aims to provide clear

OH&S of workers and others who can be

guidance to employers on managing

affected by its activities. This

mental health at work. Whilst it is a

responsibility includes promoting and

voluntary standard to implement it will

protecting their physical and

help organisations to ensure that they

psychological health”.

are complying with legislation. This new standard “is intended to be used together with ISO 45001, which contains requirements and guidance on planning, implementing, reviewing, evaluating,

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There are ten sections within the standard, the first three of which are shorter, give context and define the scope, references, terms and definitions found within the standard. The

ISO 4

Mana

Psychosoc

An ove

By Libby

45003

aging

cial Risks

stand-out in section 5 refers to it being

essential that there is worker “consultation and participation” in order to develop, plan, implement, maintain, evaluate and continually improve by leading to an “increase (in) a worker’s motivation and commitment to contribute to psychologically healthy and safe workplaces”.

Section six, planning, is where things start to get meaty regarding the identification of potential psychosocial

hazards and has familiar overlaps with the HSE Management Standards for Stress (see tables1-3 in the standard).

Section seven covers support and lists competency, awareness, communication, documentation and confidentiality as resources to achieve the objectives of the standard.

Section eight guides on operational planning and control and covers risk assessment and control measures. It

includes guidance on eliminating hazards, reducing OH&S risks and promoting well-being at work and usefully states signs/symptoms that a worker has been exposed to psychosocial risk. This section continues to be far-reaching as it also guides organisations to include statement in section 3.2 stands out as it states that “wellbeing at work can also contribute to the quality of life outside

procurement, contracting and outsourcing, and emergency preparedness and response and

of work”. This is important as it

rehabilitation and return to work.

confirms the importance of good work

The ninth section, as would be expected

as a health outcome that if not well managed can have a personal and

erview

societal cost.

y Morley

planning and offers a detailed checklist

Sections four and five focuses on preto consider in order to gain a thorough understanding of the organisation prior to section six, the planning stage. The

following the planning stage, covers evaluating performance via both quantitative and qualitative means plus inclusion of senior management to indicate continued buy-in from the top.

It clearly states within this section that “appropriate documented information” should be retained as evidence.

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The final section refers to continuous

health and safety management —

improvement and corrective actions in

Psychological health and safety at work

the case of and incident non-

— Guidelines for managing psychosocial

conformance. It is pleasing to note that

risks and at a cost of £118.00 can be

the standard states that organisations

downloaded in PDF format.

should, in relation to incident or noncompliance “encourage and support reporting to reduce fear of reprisals”.

A useful overview via e-learning can also be accessed for free at ISO 45003:2021 Psychological health and

A full copy of the standard can found at

safety at work FREE resources training

ISO 45003:2021(en), Occupational

pdf

Libby is iOH Director of Mental Health and Wellbeing, Owner of Mindshift Consultancy

Mindshift Consultancy is a training provider that can support your organisation regarding stress and mental distress. Leverage our expertise and passion for educating, awareness-raising and stigma reduction by getting in touch!

Discount available* for our latest IOSH licensed course for managers & team leaders on “Individual Stress Risk Assessment: what, why, when and how”. *valid until 31.12.21 libby@mindshiftconsultancy.co.uk Mindshift Consultancy | Occupational Health & Wellbeing Specialists Feedback from recent delegates at Smyths Toys: “Our trainer was very clear, knowledgeable and relatable” “Libby kept our focus throughout! Very personable and totally awesome!”

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