A Day in the Life of an Occupational Health Nurse in Rural America
iOH Partners
Lynn
s 2024 been reflecting opportunities challenges faced Health (OH) professionals political, economic, changes with the The Get Britain Paper - GOV.UK governments vision curb the significant being underutilised economic inactivity. outlines how high and sickness benefits by hiring 8,500 new staff, expanding Placement Support Talking Therapies illness. It will be observe how this us in OH. You can and perspectives and other related edition. As we look ahead been exploring ways members based feedback. Here are we've been working • Our new calendar displays “what world”.
From the President
Pratt
draws to a close, I've reflecting on the opportunities and faced by Occupational professionals amidst economic, and social the new government.
Working White GOV.UK outlines the vision for reform to significant amount of talent underutilised due to increasing inactivity. The white paper high unemployment benefits will be tackled new mental health expanding Individual Support and providing Therapies for severe mental be intriguing to this vision unfolds for can find information perspectives on "work inactivity" related topics in this ahead to 2025, we have ways to support on our recent are some initiatives working on! calendar of events what’s on in the OH
• We’ve been collaborating with other organisation’s associated with OH. Explore this resource
• An AI group in OH, including iOH and other OH representatives, has been established. Your views are welcome to help shape their strategy.
• Assisting members to choose educational providers if they are looking to study.
• Helping members with small grants for short courses or study days to help relief some financial burden. T&C apply.
• Running regular multidisciplinary webinars with recordings to watch at your leisure.
• Sharing our partners resources. This week Croner-i offered all iOH members access to their Croner-i lite platform.
• Coming soon! Peer support sessions.
We have started the planning again for exhibiting at the Health & Wellbing at Work Conference on 11th & 12th March, at the NEC. Early bird tickets with a member discount are now available using code IOH10.
As usual we will be holding the Ruth Alston Memorial Lecture and Dinner on 11 March 2025 at 7pm, Hilton Metropole Hotel, NEC. It is guaranteed to be an exciting evening of networking, learning and entertainment. This year’s lecture will be delivered by Kevin Bampton, entitled- Occupational Health: Time for a 21st Century Upgrade? Member tickets £46 including 3 course dinner and drinks. You can bring a friend or colleague; non-members are welcome.
Finally, I extend my sincere gratitude to all the volunteer board members, trustees, supporters, and our members for their unwavering support of iOH charity initiatives throughout 2024. In addition, an enormous thank you to iOH partners who have provided financial support to enable development of new initiatives. Wishing you all a restful holiday break and look forward to reconnecting in 2025.
Lynn Pratt, President iOH
A Day in the Life of an Occupational Health Nurse in Rural America
By Barbara Chandler
If I could share with the world what I do as an occupational health nurse in rural America, I would talk endlessly about my passion for promoting health and wellness in the workplace. My role goes far beyond bandaging cuts and conducting health screenings it's about making a tangible difference in the lives of hardworking individuals who keep the wheels of our community turning.
I live in Enid, Oklahoma, a charming town of roughly 50,000 people nestled in the heart of rural America. Life here is simple, but the work we do is anything but. I work for one of the world’s largest international protein companies, the second-largest employer in the county. The plants under my care operate around the clock, with 1,600 people working tirelessly to produce high-quality protein that feeds the world. The hustle and bustle of these plants are palpable, and as the nurse manager, I oversee the occupational health department, ensuring that safety and wellness are always a top priority.
Our role begins with ensuring compliance with OSHA standards through programs such as hearing screenings, respiratory programs, post-offer health assessments, and drug testing. On top of these programs, we provide immediate care for day-to-day injuries slip and falls, lacerations, smashed fingers, and musculoskeletal complaints that come with the territory of physical labor. We offer a variety of treatments, including ice, heat, muscle rubs, K-taping, and over-the-counter medications. The joy in my job comes not only from treating these injuries but from the satisfaction of knowing that we’re creating a safe and supportive environment for our workers.
However, not all injuries can be treated in-house. In cases where the injury or illness requires more advanced care, I have the privilege of managing the workers’ compensation process. Oklahoma is an employer-choice state, meaning I have the ability to select the best physician and appointment times for our team members, ensuring they receive timely and top-notch
care. We also pride ourselves on our robust light-duty program, which allows us to accommodate nearly any restriction or accommodation a worker may need, helping them return to work sooner and recover more quickly.
But my favorite part of my job what truly gets me out of bed each morning is health promotion. A healthy worker is a happy and productive worker, and promoting health and wellness is key to retention and job satisfaction. We have an incredibly diverse workforce, with many of our workers hailing from Pacific Islander and Hispanic cultures. While our backgrounds may differ, our need for love, acceptance, and healthcare is universal.
Access to healthcare can be a challenge in rural Oklahoma. While we’re fortunate to have an onsite clinic available free of charge for our team members, access to specialists is a different story. The nearest specialists are located in Oklahoma City or Tulsa, a 90-minute to two-hour drive away an impossible journey for some, particularly those without cars or driver’s licenses. For many of our workers, taking time off work to attend a doctor’s appointment can mean a significant financial hit. Preventive care, while crucial, often takes a backseat when workers are more focused on putting food on the table.
This is where our onsite wellness programs come into play. I’m incredibly proud of our annual mammogram events, where we bring a mammogram bus to the plant for two days, offering screenings to around 75-80 team members without requiring them to take time off work. Preventive care is crucial, and by bringing services to the workplace, we’re removing barriers that might otherwise prevent workers from getting these life-saving screenings.
Our health fairs are another hit, especially when we focus on areas like dental care, which many of our workers were unfamiliar with. We’ve even had workers who didn’t realize that dentists are doctors for teeth! Our fairs provide an opportunity to teach them about oral hygiene, flossing, and brushing, and everyone loves the prizes we give out. These events aren’t just about health they’re about empowerment, teaching our workers that taking care of their bodies will allow them to take care of their families for years to come.
Diabetes and high blood pressure are two of the biggest health concerns we tackle regularly. We offer screenings, educational sessions on nutrition, and medication management especially important in a workforce where cultural differences often affect how people view and manage their health. It’s an incredible
My favorite part of my job - what truly gets me out of bed each morning - is health promotion.
feeling to make an impact, no matter how small, on the long-term health of our workers.
Working in occupational health in rural America is as rewarding as it is challenging. We’re not just dealing with sprained ankles or bruised egos we’re working to ensure the safety, health, and overall well-being of a diverse and hardworking population. We deal with cultural and logistical challenges daily, but there’s nothing more fulfilling than seeing the positive effect we can have on our workers’ lives, knowing that they leave work healthier and happier than when they arrived.
As an occupational health nurse in rural America, my job is not confined to treating injuries. It’s about advocating for the health and wellness of those I
serve. It’s about meeting people where they are, whether that’s with a K-taping treatment for a sore shoulder or bringing a mammogram bus to the plant to catch early signs of breast cancer. And at the heart of it all is the understanding that health and wellness are fundamental to a worker’s productivity, satisfaction, and quality of life.
I am proud to work for a company that values its employees enough to invest in their health and well-being. As we continue to grow, innovate, and feed the world, we also strive to ensure that the individuals behind the protein are cared for mind, body, and spirit. That’s the heartbeat of my job, and it’s why I wake up every day excited to do what I do.
Barbara Chandler, BSN, RN,
Barbara Chandler | Linkedin
Barbara is the Nurse Manager for Tyson Foods in Enid, OKlahoma, US, where she leads a dedicated team of Occupational Health Nurses focused on the health and wellness of over 1,600 team members. She holds a Bachelor's Degree in Nursing from The University of Oklahoma and will complete her MSN/MBA at Purdue University in 2025. Barbara is an active member of the American Association of Occupational Health Nurses (AAOHN) and serves on its Practice Committee.
The benefits of enthusiastic coaching in Spirometry
By Charlene Mhangami, Senior Clinical Application Specialist, Vitalograph
Spirometry is a common physiological test used to measure the maximal volume of air that can be inspired and expired with maximal effort. This definition of spirometry is important as it instantly highlights how the test needs to be performed by the mention of ‘maximal effort’. In occupational health, spirometry can be used in various areas as part of the health surveillance. The results can be obtained at the start of employment by obtaining a baseline value for the worker, or the spirometry results are obtained and observed annually, or at specific intervals depending on requirements of the employee, work environment or company. Spirometry results should be technically acceptable and repeatable as abnormal values may require referral to further intervention. Obtaining technically acceptable results requires accurate equipment, an enthusiastic operator and subject cooperation and coordination. It is suggested that inconsistent effort can be due to inadequate instruction and coaching by the operator as well as other factors. This article will focus on the importance of good coaching and clear instructions before and during, the slow vital capacity (SVC) and forced vital capacity (FVC) measurements.
Preparing for a spirometry test
Achieving a technically acceptable spirometry session begins with the preparation of the test. Ensure height and weight measurements are taken accurately e.g. no shoes or heavy jackets to be worn. Once the person is sat down, check the relative contraindications, and ask about activities that should be avoided before the test according to the ATS/ERS 2019 Spirometry guidelines.
Ensure the subject is sat on a comfortable chair with no wheels and arms on each side. Before testing begins, it is important to explain what the tests measures and what is required of the subject during the test. If the subject has a good understanding of the test, they are likely to perform the manoeuvres to a higher standard. In 2018, an online survey was conducted by the European Lung Foundation involving 1,760 patients from 52 countries. The aim of the survey was to improve spirometry testing by understanding the patient experience. The survey showed patients want clear information before, during and after the test. Operators should ensure they have fully explained the test in a clear and concise manner and provide feedback during the manoeuvres.
What is the correct test sequence?
Confidence in the test sequence used in spirometry is important to ensure technically acceptable and repeatable results are obtained. The steps recommended by the 2019 ATS/ERS guidelines are highlighted tables 1 and 2. The aim of this sequence is to allow the subject to breathe in as deeply as possible to total lung capacity and breathe out for as long as possible to reach residual volume. The operator should have a view of both the display screen and the subject throughout the test. Maximal inhalation is visible on the graph during testing however, it is mainly important to observe the subject not only for safety reasons, but because maximum inspiration will also be visible by looking at the subject as they may show raised shoulders and widened eyes.
Table 1. Testing sequence for an SVC
Have the subject assume the correct posture
Correct posture with head slightly elevated
Provide nose-clip and bacterial viral filter
Breathe normally
Inspire to TLC
Expire gently with maximal effort
Breathe normally
Table 2. Testing sequence for an FVC manoeuvre
Have the subject assume the correct posture
Provide nose-clip and bacterial viral filter
Breathe normally
Inspire completely and rapidly with a pause ≤ 2 seconds at TLC
Expire with maximal effort until no more air can be expelled while maintaining an upright posture
Inspire with maximal effort until completely full
Breathe normally
Coaching during an SVC
Variation between coaching during an SVC and a FVC is important as they require different techniques. Good coaching involves focusing on each of the testing stages and making sure they are executed fully before progressing to the next step. The SVC measurement is obtained during a slow, gentle, maximal expiration after maximal inspiration. The subject should be instructed to breathe normally initially to obtain the stable tidal breathing trace, then they should be instructed to inhale until the lungs feel full, and then exhale gently until they feel empty. The air should not be released too slow as it could underestimate the VC. The manoeuvre should be a gentle, steady expiration alongside coaching to guide the subject to achieve a constant flow rate.
Coaching during an FVC
For an FVC manoeuvre the subject must first be instructed to breathe normally, the first maximum inhalation is important, and instruction should be given for the subject to “inhale as deeply as possible” (not just “take in a deep breath”). During the inspiration, the operator should coach the subject using phrases such as “ more, more, more.“ and encouraging body language can also assist. Body language can be particularly useful where there may be a language barrier present. Indicators that show maximal inspiration has been achieved include eyebrows raising, eyes widening or raised shoulders. A subject who looks comfortable and hunched over is unlikely to be at full inhalation. The instruction should match the testing stages, if the focus is solely on instruction without matching the testing stages, then maximal inhalation might be missed which will underestimate the FVC.
Coaching tip
Blow out gently all the way until you are empty
Coaching suggestion
Synchronize command to ‘blast’ exhalation to the end of inspiration
The next step is the expiration. During the expiratory portion of the FVC manoeuvre, the subject should be instructed to blast the air out, not simply blow the air from the lungs. Continuous enthusiastic encouragement should be shown by the operator using body language and phrases such as “keep going”. It is important to note that although we want to achieve technically acceptable results, the safety of the subject should be a priority. The operator needs to be alert to any indications of discomfort where testing should stop and the manoeuvre be terminated if a subject is uncomfortable or approaching syncope. Once the end of forced expiration criteria has been met the subject must take maximal breath back into total lung capacity, during which, use phrases such as “ more, more, more” or “right to the top”.
What are the benefits of coaching?
Little research has been done in investigating the effects of encouragement in Spirometry There is one study carried out by AL Zhranei et al., 2021 at a university in Saudi Arabia, they looked to determine whether general repetition or verbal encouragement influenced the vital capacity.136 healthy adults were split into two groups, both performing baseline spirometry and then repeated the spirometry test three times. On the second and third occasion one group received encouragement and the other group had repetition without encouragement. In the group who only repeated the test there was no difference in VC from baseline on the second and third attempt. In the group that had encouragement there was a difference in VC compared to baseline, based on statistical analysis of the data. This study highlights the important of verbal encouragement during spirometry testing.
Be a coach and a cheerleader
Enthusiastic coaching is beneficial in helping to achieve technically acceptable and repeatable results which may affect the workers job role. Good rapport with the subject and gaining their trust is crucial in obtaining maximal efforts. Finding the midground between being a coach by providing feedback, and being a cheerleader by offering active encouragement, is vital. Operators should be open to adapting their approach as some subjects may require more assistance than others.
References
AL Zhranei, R. et al. (2021) ‘The impact of verbal encouragement and repeating on the measurement of spirometry in healthy adult’, Cureus [Preprint]. doi:10.7759/ cureus.18714.
Cheung HJ, Cheung L. Coaching patients during pulmonary function testing: A practical guide. Can J Respir Ther. 2015 Summer;51(3):65-8. PMID: 26283871; PMCID: PMC4530837.
Graham, B.L. et al. (2019) ‘Standardization of spirometry 2019 update. an official American Thoracic Society and European Respiratory Society Technical Statement’, American Journal of Respiratory and Critical Care Medicine, 200(8). doi:10.1164/rccm.201908-1590st.
Enright PL. How to make sure your spirometry tests are of good quality. Respir Care. 2003 Aug;48(8):773-6. PMID: 12890297.
Johnson, B. et al. (2020) ‘Improving spirometry testing by understanding patient preferences’, ERJ Open Research, 7 (1), pp. 00712–02020. doi:10.1183/23120541.00712-2020.
Charlene Mhangami, Senior Clinical Application Specialist, Vitalograph
What can Occupational stop the incapacity
By Dr Charlie Vivian, Occupational
We OH practitioners are passionate about our work. We want to help our patients, employees of the organisations we work for, to be well, both physically and psychologically. But there is compelling evidence that we are having little or no meaningful impact, probably because we are looking in the wrong direction to find solutions.
This article will explore the core principles of modern medical practice, (which directly influences OH practice), social determinants of health, changes in incapacity, how changes at a national level may be driving the incapacity epidemic, and finally what this means for us: what can WE do?
Occupational Health do to
epidemic.
Medicine Consultant
The Medical Model
Modern medicine is based on a biomedical model. This is reductionist and dualist. It is reductionist because all physical symptoms can be traced back to a physical change. It is dualist, because if there is no physical cause, it is all in your head.
But it has become increasingly obvious that this model is too simplistic and does not work. Since the 1970s, there has been a move towards a biopsychosocial model, where we recognise that illness is made up of physical changes, our psychological reactions to these changes, and the social context. Simply focusing on physical conditions does not unlock the
complexity of health problems. Therefore, we are much more willing to explore the individuals’ response to their illness. We encourage counselling, to help the person gain a better understanding of their predicament, and what they could do to improve it. We recognise that factors in the individuals’ home life can affect how well they cope at work and encourage adjustments to reduce the impact.
But even this isn’t enough. We need to broaden our gaze further and consider whether factors at a societal level may be having more of an influence than we realise.
Social Determinants of Health
We all know that there are things we can do to improve our health. Eat healthy food, exercise, rest, manage stress, not smoke, and drink sensibly. Repeated public health proclamations remind us of this.
But social factors are much more than this. Decades ago, there was a large study of civil servants working in Whitehall. What they discovered was that job grade was predictive of your cholesterol levels. The higher up the food chain you were, the better your cholesterol levels were, (figure 1). In a OH context, doctors on average will have the best levels, then nurses, then OH technicians, and lastly the cleaners. In other words, the most effective
way to improve your cholesterol is to change from being a cleaner to a doctor.
But it is not just cholesterol level: It is the overall mortality risk. The better off live longer than the poor. It is a straight gradient, so the more you can push yourself towards the top, the better(Figure 2). This improvement is only partially influenced by the traditional risk factors of smoking, drinking and obesity: it is a risk factor on its own.
Changes in Incapacity
Why is this of interest to us in occupational health? Because there is compelling evidence that changes at a societal level have driven the explosion in incapacity. We all know that unemployment rates vary according to the economic climate: in downturns, more are unemployed, and at good times, employment rates improve. We may assume that the same applies to incapacity, but there is no correlation between the two graphs.
From the late 1970s to the early 2000s, the rate of those claiming incapacity benefit increased 5.5-fold. There has been a further 10% rise in recent years, which has generated a lot of hoohahs. But we must ask the question: what is going on?
We might assume that rates of incapacity follow rates of unemployment: when times are hard, people are out of work because they cannot find work, or claim incapacity benefit
instead. But in fact, there is no correlation between the two. Incapacity rates have increased 6-fold since the late 1970s. The situation has worsened in the years following this graph (figure 3 & 4) .
Perhaps we think we know it is a lack of moral fibre. Many want to believe that disabled and unemployed people are shirkers, looking for an easy way out, happy to sit at home, claiming benefits whilst the rest of us work. The
problem is that, when the DWP investigated fraudulent incapacity claims, they found 0.7%: fewer than 1:100.
Perhaps we think it is the yellow flags: catastrophic thinking, low mood, avoidance behaviour or having an external locus of control, (where the person feels that events are in charge of their life, rather than them feeling in control). Perhaps Henry Ford’s aphorism applies: “whether you think you can or whether you think you can’t, you’re probably right.”
Or perhaps we’re looking in the wrong direction. We are trying to identify individual factors when the problem is at a national level. For example, the EU introduced the 48-hour working week due to the evidence that overwork was associated with ill health. But if you’re in the bottom 10% of earners in the USA, you now must work 60 hours per week, to earn the same as you would have earned working 40 hours a generation ago.
We all know about the National Living Wage, currently set at £11.44 per hour. But did you know about the NLW Foundation (https:// www.livingwage.org.uk), which does the research to identify how much we need to earn? They show that the figure should be £12. This does not sound much but amounts to a shortfall of £1,092 in a year. Bear in mind that for most households living in poverty, someone is working. This shortfall means they are struggling to balance the cost of food and heating, that ‘luxuries’ of one holiday a year or buying a TV are beyond them. I wonder what it’s like, watching endless adverts of holidays abroad, knowing you will never be able to afford them?
And we know that job insecurity is a major risk factor for stress. Whole swathes of the population have lost stable jobs and are forced to work in jobs with no security and uncertain hours.
In 1979, 3% of working age males were off sick.
In 2002, 17% were, 50% of which involved mental health problems. Is this a surprise?
Political and Economic Changes
What has driven this change in the working environment? It is the rise of a new variant of capitalism, championed by Thatcher and Reagan. The idea is to release the wealthy to make money, and this money will trickle down to the rest of us. The tax burden should be reduced, and we will all be better off.
But it has not worked: the wage gap between the richest and poorest has a 35-fold difference in the 1980s, to a 180-fold gap now. The money never trickled down. And inequality in a society correlates with a considerable number of social problems, such as life expectancy, literacy, infant mortality, teenage births, homicide rates, obesity, and mental illness, amongst others.
Another myth within this model is that the private sector will do it better, but the scandal of the water companies and others shows this simply isn’t true.
What this means for Us?
Firstly, I believe we need a reset. We as individual practitioners, and as an entire speciality, have focused our efforts on individuals, and organisations. We must broaden our gaze and recognise that wider social factors are much more important. Otherwise, we will remain impotent. That is why occupational health is ineffective in reducing incapacity.
Secondly, we need to be better informed. Please watch my presentation delivered to the SOM (https://www.youtube.com/watch? v=Gx3ueQWxUdA).
Thirdly, please start speaking out. Contact your leaders, telling them you are worried this issue has been neglected. Encourage them to read this article or watch the presentation.
Fourthly, we need to build a task force of OH professionals who are willing to take this agenda forward. Are you willing to join?
As Thomas Legge, the father of UK Occupational Medicine said, unless and until the employer has done everything to protect the worker, and everything means a great deal, there is little the worker can do. Today, we need our focus to be on what society needs to change.
Dr Charlie Vivian
Consultant Occupational Physician
Selected Bibliography
Social Determinants of Health. Michael Marmot. OUP 2005.
The State We’re In. Will Hutton. Vintage Digital 2011
The Spirit Level. Richard Wilkinson and Kate Pickett. Penguin 2010
This article is a summary of a presentation delivered to the SOM in 2022. Please watch here (https://www.youtube.com/watch?v=Gx3ueQWxUdA).
Dr Charlie Vivian | Linkedin
Charlie Vivian is a consultant occupational physician. He set up Icarus Health Solutions in January 2012 and delivers contracted OH services to a variety of organisations.
Most of his clinical work focuses on complex cases. He has undertaken hundreds of independent medical examinations for income protection and total and permanent disability. He also provides ill health retirement assessments for several police forces, private organisations and the NHS.
For over 10 years, his key interest has been building his understanding of whether individual reactions to illness are more important than the medical diagnosis itself. However, he is increasingly convinced that wider social and political changes are the key factors for the explosion of incapacity rates in the last 30 years. This applies to both physical and psychological illness.
What is Occupational Health in a world of false narratives and bias towards disadvantaged people?
By Lucy Kenyon
This article was inspired by Charlie Vivian’s article about the effectiveness of Occupational Health in reducing incapacity.
The belief that economic disadvantage is a choice is not widely supported among health professionals. Most health professionals recognise that economic disadvantage is influenced by a complex interplay of factors, including social, economic, and environmental determinants. These factors can include access to employment opportunities.
However, in today’s media landscape, false or misleading narratives and biases can significantly affect disadvantaged and vulnerable members of society. These narratives often perpetuate stereotypes, misrepresent facts, and contribute to systemic inequalities. False narratives can mislead the public, distort perceptions, and influence policy decisions that affect vulnerable populations. These narratives often
spread more rapidly than information, creating a challenging environment for truth and accountability.
Addressing these issues requires an initiative-taking approach, including promoting diversity, equity, and inclusion (DEI), providing training on unconscious bias, and creating a supportive environment where all employees feel valued and respected –all of which fall nicely within the remit of Occupational Health (OH) and Wellbeing.
Disadvantaged communities, including low-income groups and marginalised populations, are often misrepresented, or underrepresented in the media. This misrepresentation can lead to a lack of trust in news sources and further marginalise these groups (Reuters Institute) . Constantly facing public
In today landscape, misleading narratives biases significantly disadvantaged vulnerable members
today’s media landscape, false or misleading narratives and biases can significantly affect disadvantaged and vulnerable members of society
mistrust and the consequential behaviours, e.g. microaggressions, can cause significant emotional and psychological stress. Over time, this can lead to burnout, affecting both personal well-being and professional performance.
Mistrust hinders effective communication and collaboration within teams and increases the risk of a toxic work environment, leading to decreased productivity and an environment where teams themselves may not perform to their full potential. Within marginalised groups in the workplace mistrust is more significant, due to its consequences affecting both individuals and the organisation. When employees from marginalised groups feel mistrusted or experience microaggressions, their overall job satisfaction can decline, leading to lack of motivation and engagement in their work, which in turn reinforces negative stereotypes.
Where is the opportunity?
OH professionals are uniquely positioned to understand and address these issues, crucial for fostering a more inclusive and equitable society. An ethical approach that supports disadvantaged groups and challenges false narratives can rebuild public trust in the community, dismiss harmful stereotypes, contribute to social and economic equality, and highlight these issues to media organisations, policymakers, and the public to promote accurate and fair representation (Navigating the ethical terrain 2024 ) to prioritise investment.
Countries that invest in OH tend to have higher GDP per capita. This is because a healthy workforce contributes more effectively to economic activities through:
• Engagement with occupational health and risk-reduction methods build and encourage innovation in workplace practices and technologies, leading to more efficient and effective business operations.
• Preventing workplace injuries and illnesses reduces healthcare costs and compensation claims, leading to significant savings for businesses and the economy.
After all, we know that a healthy workforce is more productive and efficient. By preventing work-related illnesses and injuries, occupational health services support elevated levels of productivity. Occupational health initiatives improve the overall quality of life for workers, leading to greater job satisfaction and stability. Equity and inclusion ensure safe and healthy working conditions promotes equity and inclusion in the workplace, helping disadvantaged and vulnerable groups.
In summary, occupational health is integral to economic growth and development. It not only enhances productivity and reduces costs but also promotes social well-being and sustainable economic practices. By prioritising worker health, businesses can achieve sustainable growth. Healthy workers are more likely to stay in the workforce longer, contributing to longterm economic stability.
Occupational
Sources
Broda, 2024. Misinformation, disinformation, and fake news: lessons from an interdisciplinary, systematic literature review, Annals of the International Communication Association, 48:2, 139-166. Accessed 20241016. To link to this article: https:// doi.org/10.1080/23808985
Guidotti (Ed), 2011. Occupational Health and Economic Development
Accessed 20241016. To link to this article: https://doi.org/10.1093/ acprof:oso/9780195380002.003.0025
HMG, 2022. Health disparities and health inequalities: applying All Our Health. Accessed 20241016. To link to this article: https://www.gov.uk/ government/publications/healthdisparities-and-health-inequalitiesapplying-all-our-health/healthdisparities-and-health-inequalitiesapplying-all-our-health
ILO, Occupational Health Trends in Development. Accessed 20241016. To link to this article: https:// iloencyclopaedia.org/part-iii-48230/ development-technology-and-trade/ item/338-occupational-health-trends-in -development
Job, 2022. Health professional’s implicit bias of adult patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review protocol. BMJ Open 2022;12: e059837. Accessed 20241016. To link to this article: https:// bmjopen.bmj.com/content/12/12/ e059837
Krishnan, 2024. Navigating the Ethical Terrain Around the Challenges of Fake
News and False Narratives: An Integrative Literature Review and a Proposed Agenda for Future Research. J Bus Ethics. Accessed 20241016. To link to this article: https://doi.org/10.1007/ s10551-024-05686-z
NHS, 2023. Growing occupational health and wellbeing together: our roadmap for the future. Accessed 20241016. To link to this article: https:// www.england.nhs.uk/long-read/growing -occupational-health-and-wellbeingtogether-our-roadmap-for-the-future/
ONS, 2010; Accessed 20241016. To link to this report: http://www.ons.gov.uk/ methodology/ classificationsandstandards/ otherclassifications/ thenationalstatisticssocioeconomicclass ificationnssecrebasedonsoc2010
Reuters, 2024. News for the powerful and privileged: How misrepresentation and underrepresentation of disadvantaged communities undermine their trust in news. Accessed 20241016. To link to this article: https:// reutersinstitute.politics.ox.ac.uk/newspowerful-and-privileged-howmisrepresentation-andunderrepresentation-disadvantaged
Steinbach, 2017. Medical Sociology, Social Policy and Health Economics. Inequalities in health. FPH. Accessed 20241016. To link to this article: https:// www.healthknowledge.org.uk/publichealth-textbook/medical-sociologypolicy-economics/4c-equality-equitypolicy/inequalities-distribution
WHO, 2024. Occupational Health. Accessed 20241016. To link to this article: https://www.who.int/india/ health-topics/occupational-health
Lucy Kenyon
Lucy is a Specialist Consultant and digital entrepreneur.
She is an Honorary Lecturer at the University Chester and has been and mentoring in Health since 1996 Universities of Birmingham, Chester, Coventry, West of Scotland.
She delivers professional development courses National Performance Group, Cordell Health employers, for whom researches and develops -based practice.
She has been a member iOH board since 2014, from 2017 - 2020 and Executive Director
She has a Master Science and the International Certificate in Occupational Hygiene from Birmingham, she has taught and research projects.
Specialist OH Nurse digital health
Honorary Senior University of been teaching in Occupational for the RCN, Birmingham, Coventry, Derby and Scotland. professional courses for the Performance Advisory Health and whom she develops evidence
member of the 2014, President and a NonDirector since 2021. of Medical International Occupational Birmingham, where and worked on projects.
Occupational Health Meets A New Paradigm for Workplace
By Cameron Jackson
Occupational Health (OH) and Environmental, Social, and Governance (ESG) have become increasingly vital in both corporate and public sectors. The launch of the NHS Occupational Health Strategy for 2023 underscores the growing awareness of OH’s essential role in promoting employee well-being throughout the UK. As businesses continue to face postpandemic challenges, the demand for robust OH services is expanding beyond healthcare, touching virtually every industry.
At the same time, ESG has shifted from a voluntary initiative to a critical business obligation. Companies are now under greater pressure from clients, employees, investors, and other stakeholders to demonstrate accountability in their environmental impact, social practices, and governance. Although ESG regulations remain fragmented, 2024 is seeing a distinct trend toward stronger mandates and compulsory ESG reporting, further driving the need for businesses to integrate ESG into their core strategies to remain compliant and competitive.
The intersection of these two fields presents a significant opportunity. Occupational Health plays a key role in advancing both the social and governance aspects of ESG, ensuring employee wellbeing, ethical management, and regulatory compliance. While often overlooked in environmental discussions, OH can also contribute to broader environmental goals by encouraging sustainable workplace practices. This convergence offers businesses the chance not only to meet regulatory expectations but also to lead by example in fostering healthier, more equitable, and sustainable work environments.
Talking about the big ‘S’ for OH
The social pillar of ESG is where Occupational Health (OH) has the most direct influence, playing a critical role in advancing social responsibility within organizations. OH providers contribute significantly to this pillar by focusing on four key areas: workforce well-being, health and safety, mental health and well-being programs, and fostering inclusive workplaces. These contributions are vital to upholding a company’s commitment to social responsibility and creating a healthier, more productive, and equitable work environment.
Occupational Health is instrumental in promoting both the physical and mental well-being of employees, a cornerstone of any company’s social responsibility efforts. By addressing both immediate health needs and long-term wellness, OH ensures that employees are supported throughout their careers, not just in moments of crisis. This focus on health and safety demonstrates a company’s dedication to its people, leading to increased employee morale, reduced absenteeism, and higher productivity. A strong OH program reflects an organization's recognition of its workforce as its most valuable asset.
OH also plays a pivotal role in fostering more inclusive and diverse workplaces, which is central to the social pillar of ESG. By providing tailored health services such as mental health resources, disability accommodations, and support for age-related health issues, OH ensures that all employees regardless of their individual circumstances have access to the care they need. This approach not only meets
diversity and inclusion standards but actively champions them, helping to build a culture of equity where all employees feel valued and supported.
Health and safety compliance is another critical aspect of a company’s social responsibility, and OH is essential in ensuring that businesses not only meet but exceed regulatory requirements. Through injury prevention programs, management of work-related illnesses, and other safety initiatives, OH helps create safer, healthier working environments. This proactive approach not only protects employees but also strengthens a company’s ethical accountability by safeguarding its human capital and reducing workplace risks.
Mental health has become an increasingly important focus in today’s workplace, and OH departments are at the forefront of delivering mental health and well-being programs. By addressing issues such as stress, anxiety, and burnout, OH helps foster a culture of mental health awareness and support. These programs not only enhance the well-being of individual employees but also contribute to overall organizational success by reducing absenteeism, improving productivity, and creating a more resilient workforce.
By integrating these four key areas into the broader ESG framework, companies can fully embrace social responsibility as part of their core operations. With its holistic approach to employee health and well-being, Occupational Health enables businesses to not only meet ESG expectations but also take a leadership role in creating healthier, more inclusive, and socially responsible workplaces.
Strengthening Governance Through Occupational Health
Occupational Health (OH) plays a pivotal yet often underappreciated role in reinforcing the Governance pillar of ESG. While governance is typically associated with corporate structures, financial oversight, and accountability, the integration of OH into governance frameworks strengthens a company’s ethical commitment to its workforce. OH companies contribute significantly by driving policy development, risk management, and compliance with legal standards, ensuring that organizations uphold not only regulatory obligations but also the ethical treatment of employees key components of robust corporate governance.
OH professionals are essential in creating and refining workplace health policies that align with a company’s overarching ESG objectives. These policies address a wide range of areas, from promoting safe and healthy work environments to safeguarding workers’ rights. By collaborating with senior leadership and human resources teams, OH helps shape policies that go beyond regulatory compliance, focusing on fair and ethical employee treatment. This integration ensures that health and safety initiatives are not just an operational necessity but a strategic part of the company’s governance structure, enhancing both accountability and transparency.
A key contribution of OH to the governance pillar is its role in identifying, assessing, and managing health-related risks in the workplace. Whether it's controlling the spread of
infectious diseases or managing chronic health conditions, OH teams proactively mitigate risks that could disrupt business operations. Effective health risk management not only reduces absenteeism and enhances employee productivity but also ensures continuity and workforce stability, which are critical to a company’s long-term governance and sustainability.
Compliance with legal requirements is another cornerstone of governance, and OH departments play a vital role in helping businesses adhere to industry health standards and government regulations. This includes complying with occupational health and safety laws, managing employee health records in accordance with data privacy rules, and ensuring proper procedures for workplace hazards, illness prevention, and disability accommodations. By ensuring that companies meet these regulatory demands, OH not only helps avoid legal penalties but also promotes ethical practices in employee care, which bolsters trust and credibility among stakeholders.
By embedding OH into their governance frameworks, companies can ensure that their health-related policies, risk management processes, and compliance efforts are in full alignment with broader ESG goals. OH companies, with their focus on employee well-being and ethical responsibility, are uniquely positioned to strengthen governance structures. In doing so, they help create organizations that are not only healthier but also more accountable, transparent, and sustainable in the long term.
Occupational Health is instrumental in promoting both the physical and mental wellbeing of employees, a cornerstone of any company’s social responsibility efforts.
A Hidden Catalyst for Environmental Sustainability
While Occupational Health (OH) may not seem directly tied to environmental sustainability, it can play a meaningful role in driving environmentally responsible practices within organizations. OH providers, through their operations and influence, have the potential to promote sustainability both internally and across the workforce.
One key way OH contributes to environmental goals is by adopting ecofriendly practices in their own operations. For instance, digitizing health records and reducing paper usage not only streamlines administrative tasks but also minimizes waste and resource consumption. Additionally, the rise of telemedicine offers a dual benefit: improving access to health services while significantly cutting down on travel-related carbon emissions, as employees no longer need to commute for appointments. These shifts not only enhance efficiency but also align OH providers with broader sustainability efforts.
Beyond internal operations, OH can act as a catalyst for fostering sustainable behaviours across the workforce. By leveraging their position in employee health and wellness programs, OH professionals can encourage practices such as energy conservation in the workplace, responsible use of resources, and the adoption of eco-friendly commuting options like cycling, carpooling, or using public transport. These small but impactful changes help cultivate a culture of environmental awareness, encouraging employees to
align their personal habits with the organization’s sustainability goals.
OH can support companies in building resilience to climate change by promoting employee health in the face of environmental stressors. For example, preparing workers for heatrelated illnesses or air quality concerns can help organizations mitigate the impacts of climate change on workforce productivity. By focusing on both individual well-being and environmental sustainability, OH can help bridge the gap between employee health and corporate environmental goals, making it an indirect but significant driver of positive environmental impact.
While traditionally Occupational Health may not be viewed as a driver of environmental sustainability, its influence within organizations positions it as a valuable contributor to broader sustainability efforts. By adopting ecofriendly practices and fostering a culture of environmental responsibility OH providers can reduce their environmental footprint while simultaneously enhancing efficiency and accessibility. As climate change and environmental concerns become increasingly central to corporate strategy, the role of OH in supporting both employee well-being and environmental resilience underscores its importance in advancing a more sustainable and responsible workplace.
Fusing Health and Sustainability
As this article has gone on to demonstrate, there is an incredibly large cross section on the Ven diagram between Occupational Health and ESG.
The integration of Occupational Health (OH) with Environmental, Social, and Governance (ESG) principles underscores its vital role in shaping healthier, more sustainable workplaces. As organizations increasingly prioritize employee well-being, ethical governance, and environmental responsibility, OH emerges as a key player in meeting these demands. By enhancing workforce health, fostering inclusivity, and adopting eco-friendly practices, OH providers not only contribute to social responsibility but also drive broader sustainability
References
initiatives.
The convergence of OH and ESG presents a unique opportunity for businesses to enhance their operational resilience, maintain regulatory compliance, and cultivate a culture of accountability and responsibility. Ultimately, the proactive involvement of Occupational Health in these areas will lead to healthier employees, more ethical corporate practices, and a significant positive impact on the environment, paving the way for a more sustainable future.
NHS England » Growing occupational health and wellbeing together: our roadmap for the future
Cameron Jackson | Linkedin
Cameron joined PAM Group in June 2023 as ESG Manager, leading the integration of sustainability initiatives aligned with the company’s goals. With degrees in Environmental Science (BSc) and Environmental Governance (MSc), he previously developed Net Zero and Social Value strategies across various sectors. At PAM, Cameron built the Carbon Auditing program from the ground up and now drives social value initiatives focused on physical and mental wellbeing, community engagement, and fundraising.
Are coaching skills the new superpower for Occupational Health?
By Mandy Murphy
Note: to discuss health coaching in its widest clinical context, “employees,” and “clients,” will be referred to as patients
Occupational Health (OH) is yet again at a pivotal place as the new labour government spotlights the health of the working-age population. The Department for Work and Pensions (DWP) will return attention to ‘work as a health outcome’ and the workforce emerging to deliver on this programme. There are many challenges: Working-aged people who have left the labour market due to ill health, lost productivity from absence and presenteeism and supporting people with work-limiting conditions. Working-age people with long-term health conditions are predicted to rise by 600,000 in the next six years (Atwell S et al, Health Foundation 2024) compounding the challenge.
There is no magic pill to resolve all these challenges. A series of ambitious initiatives across healthcare is required to address and impact, return-to-work barriers.
In its ‘Five Year Forward Review,’ NHS England acknowledges more is needed to support people in managing their health. Staying healthy, making informed choices of
treatment, managing conditions and avoiding complications (NHS England 2014).
Patient activation and self-efficacy through health coaching is a vital element to behavioural change and enables people to selfmanage their health. But above this, it is vital to train healthcare professionals with coaching skills to support this shift. Indeed, health coaching skills have been identified as one of the five key interventions by NHS England in their 2016 ‘Substantial Self-care programme’.
I, as an experienced Occupational Health professional, have been coaching professionally for 10 years. I can see the value of coaching skills for healthcare professionals through my own work and believe OH professionals can adopt this skill to increase the impact of what they already do. I am, however, mindful of how much is asked of OH professionals these days. We are a finite (and dwindling) resource with often heavy workloads as we spread ourselves across all aspects of the role.
Coaching skills are not just another intervention. My heart sinks when I look at the research and literature on health coaching and the focus on it as an intervention, a separate tool or a specific style of conversation and potential referral pathway. Focusing on coaching skills in this way will limit the value and sustainable impact this can have on patient self-efficacy and the clinician’s workload.
If instead, we look at developing coaching skills as a mindset and a way of being in our everyday conversations, the impact becomes a game changer. Used in combination with core clinical skills, health coaching could have a greater impact on return-to-work outcomes and health management by empowering the patient/client to be more in control of their health condition, improving their confidence and motivation to selfmanage.
Why coaching in Occupational Health or clinical setting?
Health coaching helps people gain the knowledge, skills, and confidence to participate actively in their own care. A coaching approach in a clinical consultation can empower people to set their own selfidentified health goals and support their efforts to achieve those goals. It is a personcentred approach when the clinician partners with the patient to establish goals and the patient is equal in decision-making about their care. They are the expert in their own circumstances, needs, and preferences. The sustainability of the NHS depends upon patients and communities playing a greater role in their health and care. The impact of long-term conditions (LTCs) on quality of life and NHS costs continues to escalate and the
number of people with three or more longterm conditions continues to rise
Part of this challenge is the role played at the centre, by the patient and the healthcare professional and the impact these roles have on successful return to work or meaningful activities.
The United States (US) uses Health Coaching widely. It is delivered by a range of providers as part of health programmes and systems to increase patient activation, and wellness, aid uptake of interventions, reduce risk and support decision-making. Most of the research into the effectiveness of health coaching, unsurprisingly, comes from the US.
In the UK, health coaching was introduced in 2013 and is still an innovation in most sectors. It was originally selected for an accelerated NHS England-funded programme to contribute to its Five Year Forward View, following extensive piloting and rollout across the East of England. The evidence reviews of this is documented here: (Does_Health_Coaching_Work.pdf)
What do we know about the benefits of health coaching?
Research and evaluation studies have shown that there is compelling evidence that health coaching can have a positive impact on patient outcomes and healthcare utilisation:
- Clinical outcomes improved in selfmanaging long-term conditions like reduction in BMI and improvement in blood pressure and cholesterol levels.
- Health behaviours improved particularly around physical activity and improved medication adherence.
- Patient activation and Self-Efficacy where motivation to manage own health improved.
- A reduction was seen in hospital readmission rates and some evidence of
reduced emergency department visits and GP appointments.
Overall, while there are promising results, more research is needed to definitively establish the effectiveness and costeffectiveness of health coaching interventions. Not least we need to establish research in Occupational Health, of which there is little. If the evidence suggests patients are more engaged and better able to selfmanage their health condition, are they less likely to take time off for sickness absence which could result in higher productivity?
The benefit of health coaching has an impact on the trained professional in many ways, as identified in the research:
- Enhanced patient care through improved patient engagement. Coaching skills help practitioners to empower people to take an active role in their health management, resulting in them being more likely to follow through with treatment plans when they feel heard and involved in decisionmaking.
- Professional development, with improved communication and leadership development
- Improved job satisfaction as coaching approaches help practitioners to find more fulfilment in their work, potentially reducing burnout. Building better rapport with more meaningful interactions, increasing job satisfaction.
- Coaching leads to enhanced self-awareness which improves personal development, stress management and work-life balance with better relationships in and outside work.
- Reducing workload: Empowered patients are likely to require less frequent interventions, potentially easing workload in the longer term.
- Alignment with healthcare trends: As
healthcare moves towards more personalised, preventive approaches, coaching skills become increasingly relevant.
More research is needed to understand the impact these skills have in OH, on the practitioner, their workload and the wider influence in their team and community. However, from what we currently know and see, the potential is great.
The coaching mindset
NHS England refers to health coaching as a supported self-management intervention. However, I do not see it as an intervention at all. It is a mindset, a way of being with your patient, as Jenny Rogers reminds us:
“Coaching is a lot more than just a ‘technique’ you switch on and off. It is a radical and allencompassing new set of assumptions about people “. Jenny Rogers
A coaching mindset means having a belief that the person in front of you has the potential and resources within themselves to solve their challenges and live a full and happy life. It is a way of being with someone and does not require healthcare workers to have a separate type of conversation about their health. A coaching mindset involves all the human qualities we already possess, good listening, holding a safe space for others, having curiosity, empathy and challenging someone to stretch that little bit further so they can see beyond their limitations.
And doesn’t this transcend our lives too? Are we a better person, a better friend, father, mother, partner if we have this mindset and are believers in one another? And would it reduce the feeling or need to rescue others all the time?
Having a coaching mindset is not as easy as one might think. When we talk about the skills required for good coaching conversations, such as active listening, powerful questioning,
enabling a space for the person to ‘think,’ building trust and rapport, you may be thinking, well I do all that already. And in some cases, you may well be. However, it is also about having a keen sense of self-awareness and noticing (promptly) when you are getting in the way of the person’s ability to own and self-manage their health. Have you noticed moments when you advise early when your listening is interfered with or distracted, and not fully present with the patient when your questions are misdirected and not in service of empowering the patient? Being self-aware requires honesty and vulnerability and owning those moments when you got in the way of a patient’s self-efficacy, and when you got in your way of being your best in that conversation.
Develop your coaching mindset in everyday conversations
Here are a few ways you can make a start with adopting a coaching style in everyday conversations:
- Practice active listening by being curious about the other person’s experience and thoughts and listening to their response.
- Set goals in partnership with the patient, exploring what they want to achieve and why it is important to them.
- Prepare for your conversation, reducing distractions and planning how to have the conversation.
- Encourage reflection by using open questions to help the person explore and broaden their perspective on the issues at hand.
- Encourage ownership by inviting the patient to generate their ideas about what can be done.
- Encourage the person to take small actions in their chosen direction.
Ways to check in and build on your coaching mindset in everyday conversations:
1. Be clear on what you are both there to do in that consultation. In coaching we call this contracting. Understand each other’s expectations and set the parameters of what you want to achieve in this consultation. There may be an overarching goal that is achieved across more than one session but the key focus for today will be what you both want to achieve before the end of the session time.
2. With every interaction, know your intention with it. Stay out of the weeds when asking questions. Do not ask for detail that does not service the purpose of the goal for the conversation and the desired outcome of your time together.
3. Ask yourself, have I allowed the patient sufficient space to do their thinking, or did I work harder and do the thinking for them?
4. Be self-aware and understand yourself –being able to sufficiently stand back from what is in front of you so you can notice your own emotions before it interferes with the quality of your session. Know what you bring to the room and if you project it. A good exercise in reflection is to spot the impact that your interferences have on the conversation or interfered with enabling the other person to think at their best.
Reflecting on these points and integrating coaching skills and mindset, could be a notable change for occupational health practitioners. I honestly believe this. I question if we can sustainably do this for the longer term, not just at the time of a training session, so it truly becomes part of everyday conversations in our practice without overloading ourselves with yet another thing to do or another intervention to pull from the toolbox on occasion.
Mandy Murphy | Linkedin
Mandy is a board director for the Council for Work and Health and provides consultancy to Occupational Health services and teams. Mandy’s coaching work focuses on career change and transitions, including returning to work following absences (parental leave, career breaks and long-term absences) and transitions for new managers and leaders. Mandy also provides training for peer groups in coaching skills, and emotional intelligence (resilience) and offers group coaching programmes. Mandy offers discounted coaching sessions to occupational health practitioners and solo-preneurs and can be contacted via Linkedin or email: mandy@coachmandy.co.uk.
Mandy delivers bi-annual health coaching in Occupational Health workshops for the National School of Occupational Health which are advertised in advance. She is also available for direct booking at mandy@coachmandy.co.uk
Why managing risk and health surveillance is important as an occupational health practitioner
By Dr Finola Ryan
The UK’s workplaces are becoming increasingly impacted by workrelated illness and injury. As a result, employers are facing decreased productivity due to the absence caused. For those of us working in occupational health, this presents a challenge and an opportunity.
The challenge lies in turning this declining state of health around. The opportunity comes through our ability to advise employers on how to manage and control the risks that affect health.
This article describes some of the ways that occupational health practitioners are able to do this through health surveillance, promoting a safe and healthy work environment. We also cover some of the legal requirements you should be familiar with.
How costly is illness and injury?
In 2022/23, the Health and Safety Executive (HSE) estimated that 35.2 million working days were lost in the UK due to work-related illness and injury. 31.5 million days were lost through illness, with stress, depression, or anxiety accounting for 17.1 million days and musculoskeletal disorders
accounting for 6.6 million days. 3.7 million days were lost through injury. The average number of days lost per person was 15.8 days, with 6.6 days for injuries, 17.8 days for ill health, 19.6 days for stress, depression, or anxiety, and 13.9 days for musculoskeletal disorders. Even before the pandemic, these numbers were increasing and post -pandemic, they are even higher.
The HSE put the cost of workplace injury and illness at c. £20.7bn for the last year of reported data from 2023. This is made up of £7.7bn costs for workplace injuries and £13.1bn for sickness. The reasoning suggested for ill health to cost more than injury is it generally leads to more absence days off work, costing more to employers, businesses, and the government. The same report estimated £7.2bn is lost in productivity costs to businesses for days lost to sickness and injury.
These costs really highlight why delivering a healthier workforce is of huge organisational value. So, how can occupational health help?
Occupational health: Promoting a safe and healthy work environment
As an employer it’s important to understand the hazards in the workplace, be able to undertake a robust risk assessment and put in place meaningful control measures in order to manage risks to the workforce. Where a residual risk to health is likely, an effective health surveillance programme acts as a back stop to tell you when to review your risk assessment and controls. And that’s where occupational health and the specialty of health surveillance come in.
Here are just a few of the benefits to both employees and employers.
Early detection: Through health surveillance programmes, occupational health can monitor employees for early signs of work-related health issues (like hearing loss, respiratory problems, musculoskeletal disorders or skin
conditions) and prevent conditions from worsening and creating long-term health problems.
Prevention of illness and injury: Risk management helps to proactively identify, assess, and control hazards that could cause injuries or illnesses among employees. Occupational health practitioners can identify and mitigate risks associated with physical, chemical, biological, and ergonomic factors.
Increased productivity and employee engagement: Employees who see the value of workplace health initiatives tend to feel more valued. This can improve morale and foster a culture of trust and engagement, as employees recognise the commitment to their wellbeing.
Fewer injuries and illnesses reduce absenteeism: It’s another productivity benefit. Managing risks effectively leads to fewer workplace illnesses and injuries, reducing absenteeism. What’s more, occupational health can identify the adjustments needed that help employees return to the workplace which in turn bring further health benefits.
Building a culture of health and safety: Occupational health practitioners contribute to a positive safety culture by encouraging employees to be proactive about their health and safety. They help embed safe work practices which can have a lasting impact on overall workplace culture.
Workplace Health Surveillance
Health surveillance in the workplace isn't just a box-ticking exercise; it's an important way to protect employees' health. Employers need to make sure
there is a clear link between work tasks and possible health risks before they start any kind of surveillance program. The good news? This is a much easier process than it sounds. Health surveillance programmes only need a few important things: tried-and-tested detection methods, a reasonable likelihood of health effects, and the potential to actually protect workers' health.
The key to success lies in having a solid policy that everyone agrees on. This means that workers and management need to agree on who is in charge of what, how results will be handled, and what will happen if health problems are found. And here's something that many businesses forget: getting informed consent from workers isn't just a good idea; it's necessary for trust and compliance.
The ‘Hierarchy of Controls’ of managing risk at work
One of the ways that occupational health professionals can manage risk is through the hierarchy of controls. This is a widely used systematic approach based on prioritising the most effective methods to protect workers from hazards. It consists of five levels, ranked from the most effective to the least effective in terms of long-term risk reduction.
Elimination: Physically remove the hazard
Substitution: Replace the hazard
Engineering controls: Isolate people from the hazard
Administrative controls: Change the way people work
Personal protective equipment (PPE): Protect the worker with equipment
Often, you’ll need to combine control methods to best protect workers. This link will take you to a paper that gives practical examples of how these controls apply to the workplace. It’s a collaborative process and successful implementation happens when occupational health identify hazards and control risks in collaboration with the workers themselves.
The Management of Health and Safety at Work Regulations 1999
The Management of Health and Safety at Work Regulations 1999 say that health surveillance is often required by law in the UK. It's not just a choice that employers make. Statutory health surveillance starts when people at work are exposed to noise, vibration, ionising radiation, solvents, fumes, dusts, biological agents, or other dangerous substances. Occupational health practitioners help organisations meet these requirements, ensuring legal adherence and reducing liability. This includes supporting employers in undertaking suitable risk assessment and implementing effective control measures through the consideration of the health and safety of employees and others who may be affected by the organisation's work. Further details from the Health and Safety Executive (HSE).
In conclusion
For the occupational health practitioner, health surveillance knowledge is key to the prevention of work related ill health and the promotion of a fitter and healthier workplace.
These practices ensure both the physical safety of employees and the operational resilience of the organisation. All of which makes health surveillance one of the most dynamic areas of occupational health impacting on safety, productivity and ultimately helping to create a culture that priorities workplace health and that saves lives.
Improve your health surveillance skill sets
The EOPH conference ‘Putting Health back into Health Surveillance’ takes place on the 14th of February 2025 in Birmingham. A range of speaker sessions will include experts in health surveillance topics inc. respiratory, skin surveillance, HAVS, hearing and how to monitor the effectiveness of risk management controls. See more details in our advert and visit our website to book: https://eoph.co.uk/training/
Dr Finola Ryan | Linkedin
Finola Ryan is Consultant Occupational Physician at Cordell Health, a member of the EOPH Teaching Faculty and Executive Medical Director at the British Association for Performing Arts Medicine
The relevance of research in occupational health and safety
What is research? Polit and Beck define research as a systematic inquiry that uses disciplined methods to answer questions or solve problems, the ultimate goal of which is to develop, refine and expand knowledge(1) (pg. 3). In both my (KM) professional and academic experience I have noticed a mixed response when engaging occupational health professionals (OHPs) (both nurses and doctors) regarding research, with responses ranging through anxiety, avoidance, indifference and the belief that it is not relevant to them. I am often advised that OHPs are clinicians, not academics, and therefore have no need to engage in research, which is reflected in the oftenpoor response rates when they are invited to participate in surveys and other data collection methods(2). That leads us to ask where we would be if
Bernardino Ramazzini (1633-1714) had adopted this attitude as a physician. As a result of his studies into the relationship between work and disease Ramazzini is credited as being the Father of Occupational Medicine, or if Florence Nightingale (1820-1910) had not seen the need to demonstrate through statistics how improvements in hospital sanitation reduced disease in soldiers(3) (pg. 2). The reality is that research forms part of our everyday lives and as healthcare professionals we are either consumers (utilising the outcomes to enhance service delivery) or producers (investigating problems so we can create the evidence used by consumers).
For the producers, research in the occupational health and safety (OHS) environment is a disciplined process tailored to provide answers or evidence to questions specific to the workplace. Questions arising from the workplace may require a simple approach such as
asking why workers do not medical surveillance appointments more complex approach understanding what factors workers’ experience of back sedentary occupations. in a systematic approach the problem. In research, achieved through different which produce varying evidence. A hierarchy of way to rank the study based strength and precision of methods used. This hierarchy in Figure 1 is usually represented pyramid with the strongest (e.g. systematic reviews) evidence with decreasing positioned below this (e.g. descriptive studies).
Driving Improvement in Workplace Safety and Health: The Role of Research at IOSH
Karen E Michell (PhD, OHNP, FANSA, CMIOSH)
Mary Ogungbeje (MSc, CMIOSH)
not attend their appointments or a approach to factors influence back pain in The solution lies approach to exploring research, this is different methods levels of of evidence is a based on the of the research hierarchy as shown represented as a strongest methods reviews) at the top and decreasing strength (e.g. single
Figure 1
Quick guide to an evidence hierarchy of designs for cause-probing questions
Source: Polit and Beck. 2012. Nursing research: Generating and assessing evidence for nursing practice (pg iii)
The findings or outcomes to these investigations should provide reliable data that influences practice and/or service delivery through the development of new policies, identifying what works and what does not work, identifying emerging trends that are therefore relevant to those working in the field of OHS as consumers.
Research evidence should guide decisions about the health, safety and wellbeing of our workers leading to what is referred to as evidence-based practice. As OHS professionals we should be reflecting and asking the question ‘Is the service that I deliver based on sound evidence, does it allow me to provide my client with the best level of service I can?’ Now if you are not interested in offering quality services then of course this would not apply to you – but we believe that all OHPs are concerned with delivering a quality service that ensures the health, safety and wellbeing of their workers.
At IOSH one of our core research values is that we engage with research that seeks to explore solutions to occupational based problems that provide for a safer and healthier world of work. We do this through various levels of the research hierarchy.
How is IOSH involved in research?
The Institution of Occupational Safety and Health (IOSH) activity in research developed significantly in the 2000s, primarily through commissioning studies on an annual basis. On an almost yearly basis, through calls, IOSH considers proposals and funds projects to establish evidence, and ultimately improve health and safety policies and
practice on a wide range of OHS topics. Given that IOSH is a global occupational health and safety (OHS) professional body, the aim is for our research to benefit various OHS stakeholders, e.g., occupational safety and health practitioners and policy makers.
The research team, with its diverse OHS background, engages in specific projects in various capacities, such as project managers, research consultants, advisors, and partners. Therefore, our role involves representation on the steering groups of IOSH-funded projects, as well as non-IOSH-funded projects. Given the broad range of OHS topics, both our funded research and external representation on projects must align with IOSH priority areas and contribute to our Corporate Strategy, Activate 2028.
We recognise that, while we have a Research for Public Benefit fund reserved for commissioning research, it is a limited financial resource. Therefore, connecting and partnering with like-minded organisations is critical for maximising our impact. We primarily achieve this through membership in research consortiums (e.g., Affinity Health at Work and SAF€RA) and by jointly funding projects.
What research projects are IOSH involved in?
IOSH-funded research was paused during the COVID-19 pandemic and resumed in the 2022/2023 period, with our first post-COVID project launching in February 2024. This jointly funded project is a collaboration between Lancaster University and the International Commission of Occupational Health (ICOH), titled
Research evidence should guide decisions about health, safety wellbeing workers leading what is referred as evidence practice.
‘Effective Delivery of Occupational Safety and Health Services: Promoting Occupational Safety and Health as a Universal Fundamental Right at Work.’ As a mixed-methods project, it aims to investigate global access to and coverage of OSH services through a purposive survey, selected countryspecific case studies, key stakeholder interviews, and a global roundtable. The research outputs will provide deeper insights into the facilitators and barriers to OSH delivery in high-, middle-, and low-income countries, offering a truly global understanding of OHS service delivery.
The 2023/2024 call process culminated in a funded project through Solent University entitled ‘A toolbox for recording and analysing work related adverse health outcomes for workers in UK ports and onboard UK registered ships’. Evidence shows that health-related issues represent 80% of the global burden of work-related disease and injury(4). This project aims to develop a toolbox featuring best-practice guidance for data collection and analysis of workrelated adverse health events, addressing gaps in the investigation of these incidents.
Our 2024/2025 call is currently open until 13 January and can be explored on the IOSH website. This year, there are four research topics, all based on identified research needs within the OHS community.
What types of research does IOSH commission?
We recognise the value of different types of research and have commissioned a variety of studies, using diverse research methods. However, we are particularly focused on applied research, where findings can assist OHS professionals or policymakers not only by providing useful knowledge but also by offering practical strategies that endusers can implement in their workplaces. For this reason, although we primarily commission empirical research, even in the case of systematic reviews, we typically produce summary reports and other accessible outputs, such as checklists, case studies, and guides, to support the non-academic community in applying the findings effectively.
To support the function and the wider business, the team actively seeks relevant information from a range of authoritative sources, including academic publications and grey literature. This horizon-scanning activity helps us stay informed about emerging and prevalent OHS-related issues, ensuring we remain responsive to the evolving needs of the field. evidence guide about the safety and of our leading to referred to evidence-based
As a research consultant, IOSH representatives have contributed to the European Union (EU)-funded MENTUPP project (Mental Health Promotion and Intervention in Occupational Settings) and now serve on the five-year EU-funded PROSPERH project (Promoting Positive Mental and Physical Health at Work in a Changing Environment). Through IOSH’s involvement in these projects, we help disseminate high-level, evidence-based research findings to OHS practitioners, supporting improvements in workers’ experiences.
Conclusion
Our mission is to draw on diverse sources of academic, scientific, and authoritative knowledge to drive OHS thought leadership and deliver relevant content to OHS professionals and the profession as a whole. Ultimately, the programme exists to make a difference in OHS policy and practice an impact that is not always easy to measure. However, studies such as Getting the Best from the Fit Note, where over 60 recommendations were shared with the Department of Health’s fit note review working party and led to changes, demonstrate that significant impact can be achieved, even at national or international levels.
References
1. Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice. 9th ed. Philadelphia: Lippincott Williams and Wilkins; 2012.
2. Michell K, Rispel L. Views of frontline service providers on the accreditation of occupational health services in South Africa. Occupational Health Southern Africa. 2022;28 (3):86-94.
3. Ehrlich R, Katzenellenbogen J, Tollman S, Gear J. Why do epidemiological research? A South African perspective. In: Joubert G, Ehrlich R, editors. Epidemiology: A research manual for South Africa. Cape Town, South Africa: Oxford University Press; 2008.
4. World Health Organization, International Labour Organization. WHO/ILO joint estimates of the work-related burden of disease and injury, 2000-2016: global monitoring report. Geneva: World Health Organization and the International Labour Organization; 2021.
Dr Karen Michell | Linkedin
Karen is a distinguished Occupational Health and Safety (OHS) professional with over 25 years of global experience in occupational health nursing, health and safety management, research, and education. She currently works as the Research programme lead for Occupational Health at IOSH, driving advancements in workplace health and safety. Recognised for her academic and practical excellence, she is a Fellow of the Academy of Nursing in South Africa and a Chartered IOSH Member. A published author and recognised speaker, Karen specializes in occupational health service delivery, quality assurance, governance, and legislative compliance. Her expertise and dedication to worker health and safety have earned her a reputation as a global OHS authority.
Mary Ogungbeje | Linkedin
With a 20-year career at the Institution of Occupational Safety and Health and 18 years’ of experience at a senior board level in two UK charities, Mary is a dynamic, dedicated and forward-thinking professional. At the forefront of IOSH Research and Development Fund management and grant applications, she has diversified her experience to become a pioneer in identifying and implementing innovative ideas, advocating sound practices and delivering over 80 evidence -based publications.
The Institution of Occupational Safety and Health
