OH Today Volume 31 Issue 4 - 2024

A Day in the Life of an Occupational Health Nurse in Rural America

Also in this issue : Coaching in Spirometry | Incapacity Epidemic | Bias ESG | Managing Risk | Coaching Skills | Research at IOSH

iOH Partners

s

Editor LYNN PRATT Assistant Editor JANET O’NEILL Production Editor IAN GARNER

Copyright © iOH 2023 Registered Charity No. 1205635 Published by iOH, The Association of Occupational Health and Wellbeing Professionals

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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.

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

Fro

CONTENTS

Lynn

From the President A Day in the Life of an Occupational Health Nurse in Rural America

5 6

A

s 2024

been re

opportu

challenges faced

Health (OH) pro

political, econom

The benefits of enthusiastic coaching in Spirometry

11

changes with th The Get Britain

Paper - GOV.UK

governments vis

What can Occupational Health do to stop the incapacity epidemic.

16

curb the signific

being underutili

economic inacti

What is Occupational Health in a world of false narratives and bias towards disadvantaged people?

Occupational Health Meets ESG: A New Paradigm for Workplace Wellness

22

outlines how hig

and sickness ben

by hiring 8,500 n

staff, expanding

26

Placement Supp

Talking Therapi

illness. It will be

observe how thi

Are coaching skills the new superpower for Occupational Health?

35

Why managing risk and health surveillance is important as an occupational health practitioner

41

us in OH. You ca

and perspectives

and other relate edition.

As we look ahea

been exploring w members based

feedback. Here a

Driving Improvement in Workplace Safety and Health: The Role of Research at IOSH

46

we've been work

• Our new cale

displays “wha world”.

om the President Pratt draws to a close, I've

• We’ve been collaborating with

As usual we will be holding the Ruth

eflecting on the

other organisation’s associated

Alston Memorial Lecture and Dinner

unities and

with OH. Explore this resource.

on 11 March 2025 at 7pm, Hilton

d by Occupational

ofessionals amidst

mic, and social

he new government.

Working White

K outlines the

sion for reform to

cant amount of talent

ised due to increasing

ivity. The white paper

gh unemployment

nefits will be tackled

new mental health

g Individual

port and providing

ies for severe mental

e intriguing to

• 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 multi-

disciplinary webinars with recordings to watch at your leisure.

is vision unfolds for

• Sharing our partners resources.

an find information

This week Croner-i offered all

es on "work inactivity"

iOH members access to their

ed topics in this

Croner-i lite platform.

• Coming soon! Peer support

ad to 2025, we have

sessions.

ways to support

We have started the planning again

on our recent

for exhibiting at the Health &

are some initiatives

Wellbing at Work Conference on

king on!

11th & 12th March, at the NEC.

endar of events

at’s on in the OH

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

Early bird tickets with a

member discount are now available using code IOH10.

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A Day in the Life of an Occupational Health Nurse in Rural America

By Barbara Chandler

I

f 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

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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

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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

serve. It’s about meeting people where

how small, on the long-term health of

they are, whether that’s with a K-taping

our workers.

treatment for a sore shoulder or

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

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.

cultural and logistical challenges daily,

I am proud to work for a company that

but there’s nothing more fulfilling than

values its employees enough to invest in

seeing the positive effect we can have on

their health and well-being. As we

our workers’ lives, knowing that they

continue to grow, innovate, and feed the

leave work healthier and happier than

world, we also strive to ensure that the

when they arrived.

individuals behind the protein are cared

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

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.

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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.

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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

Table 1. Testing sequence for an SVC

spirometry is important to ensure

Have the subject assume the correct posture

technically acceptable and repeatable results are obtained. The steps recommended by the 2019 ATS/ERS guidelines are highlighted tables 1 and

Correct posture with head slightly elevated Provide nose-clip and bacterial viral filter Breathe normally

2. The aim of this sequence is to allow

Inspire to TLC

the subject to breathe in as deeply as

Expire gently with maximal effort

possible to total lung capacity and

Breathe normally

breathe out for as long as possible to reach residual volume. The operator should have a view of both the display

Table 2. Testing sequence for an FVC manoeuvre Have the subject assume the correct posture

screen and the subject throughout the

Provide nose-clip and bacterial viral filter

test. Maximal inhalation is visible on the

Breathe normally

graph during testing however, it is

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

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.

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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

Coaching tip Blow out gently all the way until you are empty

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.

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

Coaching suggestion Synchronize command to ‘blast’ exhalation to the end of inspiration

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”.

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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

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.

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.

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Charlene Mhangami, Senior Clinical Application Specialist, Vitalograph

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What can Occupationa 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?

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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

al Health do to y epidemic.

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

l Medicine Consultant

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

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 ioh.org.uk

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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

instead. But in fact, there is no correlation

of those claiming incapacity benefit increased

between the two. Incapacity rates have

5.5-fold. There has been a further 10% rise in

increased 6-fold since the late 1970s. The

recent years, which has generated a lot of hoo-

situation has worsened in the years following

hahs. But we must ask the question: what is

this graph (figure 3 & 4) .

going on?

Perhaps we think we know it is a lack of moral

We might assume that rates of incapacity

fibre. Many want to believe that disabled and

follow rates of unemployment: when times are

unemployed people are shirkers, looking for an

hard, people are out of work because they

easy way out, happy to sit at home, claiming

cannot find work, or claim incapacity benefit

benefits whilst the rest of us work. The

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problem is that, when the DWP investigated

In 2002, 17% were, 50% of which involved

fraudulent incapacity claims, they found 0.7%:

mental health problems. Is this a surprise?

fewer than 1:100.

Perhaps we think it is the yellow flags: catastrophic thinking, low mood, avoidance

Political and Economic Changes

behaviour or having an external locus of

What has driven this change in the working

control, (where the person feels that events

environment? It is the rise of a new variant of

are in charge of their life, rather than them

capitalism, championed by Thatcher and

feeling in control). Perhaps Henry Ford’s

Reagan. The idea is to release the wealthy to

aphorism applies: “whether you think you can

make money, and this money will trickle down

or whether you think you can’t, you’re

to the rest of us. The tax burden should be

probably right.”

reduced, and we will all be better off.

Or perhaps we’re looking in the wrong

But it has not worked: the wage gap between

direction. We are trying to identify individual

the richest and poorest has a 35-fold

factors when the problem is at a national level.

difference in the 1980s, to a 180-fold gap now.

For example, the EU introduced the 48-hour

The money never trickled down. And

working week due to the evidence that

inequality in a society correlates with a

overwork was associated with ill health. But if

considerable number of social problems, such

you’re in the bottom 10% of earners in the

as life expectancy, literacy, infant mortality,

USA, you now must work 60 hours per week, to

teenage births, homicide rates, obesity, and

earn the same as you would have earned

mental illness, amongst others.

working 40 hours a generation ago.

Another myth within this model is that the

We all know about the National Living Wage,

private sector will do it better, but the scandal

currently set at £11.44 per hour. But did you

of the water companies and others shows this

know about the NLW Foundation (https://

simply isn’t true.

www.livingwage.org.uk), which does the research to identify how much we need to

What this means for Us?

earn? They show that the figure should be £12.

Firstly, I believe we need a reset. We as

This does not sound much but amounts to a

individual practitioners, and as an entire

shortfall of £1,092 in a year. Bear in mind that

speciality, have focused our efforts on

for most households living in poverty,

individuals, and organisations. We must

someone is working. This shortfall means they

broaden our gaze and recognise that wider

are struggling to balance the cost of food and

social factors are much more important.

heating, that ‘luxuries’ of one holiday a year or

Otherwise, we will remain impotent. That is

buying a TV are beyond them. I wonder what

why occupational health is ineffective in

it’s like, watching endless adverts of holidays

reducing incapacity.

abroad, knowing you will never be able to afford them?

Secondly, we need to be better informed.

Please watch my presentation delivered to the

And we know that job insecurity is a major risk

SOM (https://www.youtube.com/watch?

factor for stress. Whole swathes of the

v=Gx3ueQWxUdA).

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.

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. ioh.org.uk

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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.

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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 Oc Health in reducing incapacity.

T

he belief that economic

spread more rapidly than information,

disadvantage is a choice is not

creating a challenging environment for

widely supported among health

truth and accountability.

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.

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 –

However, in today’s media landscape,

all of which fall nicely within the remit

false or misleading narratives and biases

of Occupational Health (OH) and

can significantly affect disadvantaged

Wellbeing.

and vulnerable members of society.

These narratives often perpetuate stereotypes, misrepresent facts, and contribute to systemic inequalities.

22

Addressing these issues requires an

Disadvantaged communities, including low-income groups and marginalised populations, are often misrepresented, or underrepresented in the media. This

False narratives can mislead the public,

misrepresentation can lead to a lack of

distort perceptions, and influence policy

trust in news sources and further

decisions that affect vulnerable

marginalise these groups (Reuters

populations. These narratives often

Institute) . Constantly facing public

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Volume 31 Issue 4

In today landscap misle narrati biase significan disadvan vulne members

ccupational

y’s media pe, false or eading ives and es can ntly affect ntaged and erable s of society

mistrust and the consequential

Countries that invest in OH tend to have

behaviours, e.g. microaggressions, can

higher GDP per capita. This is because a

cause significant emotional and

healthy workforce contributes more

psychological stress. Over time, this can

effectively to economic activities

lead to burnout, affecting both personal

through:

well-being and professional performance.

• Engagement with occupational health and risk-reduction methods

Mistrust hinders effective

build and encourage innovation in

communication and collaboration

workplace practices and

within teams and increases the risk of a

technologies, leading to more

toxic work environment, leading to

efficient and effective business

decreased productivity and an

operations.

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

• 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.

prioritise investment.

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Sources

News and False Narratives: An

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/health-

disparities-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

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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://

Lucy Kenyon

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 is a Specialis Consultant and d entrepreneur.

She is an Honorar Lecturer at the Un Chester and has b and mentoring in Health since 1996 Universities of Bir Chester, Coventry West of Scotland.

She delivers profe development cou National Perform Group, Cordell He employers, for wh researches and de -based practice.

She has been a m iOH board since 2 from 2017 - 2020 a Executive Directo

She has a Master Science and the In Certificate in Occ Hygiene from Birm she has taught an research projects

n | Linkedin

st OH Nurse digital health

ry Senior niversity of been teaching n Occupational 6 for the RCN, rmingham, y, Derby and .

essional urses for the mance Advisory ealth and hom she evelops evidence

member of the 2014, President and a Nonor since 2021.

of Medical nternational cupational mingham, where nd worked on s.

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Occupational Health Mee A New Paradigm for Workplac

By Cameron Jackson 26

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Volume 31 Issue 4

ets ESG: ce Wellness

O

ccupational 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.

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Talking about the big ‘S’ for OH

diversity and inclusion standards but

The social pillar of ESG is where

employees feel valued and supported.

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 28

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actively champions them, helping to build a culture of equity where all 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

infectious diseases or managing chronic

Occupational Health (OH) plays a

risk management not only reduces

pivotal yet often underappreciated role in reinforcing the Governance pillar of ESG. While governance is typically associated with corporate structures,

health conditions, OH teams proactively mitigate risks that could disrupt business operations. Effective health absenteeism and enhances employee productivity but also ensures continuity and workforce stability, which are critical to a company’s long-term

financial oversight, and accountability,

governance and sustainability.

the integration of OH into governance

Compliance with legal requirements is

frameworks strengthens a company’s

another cornerstone of governance, and

ethical commitment to its workforce.

OH departments play a vital role in

OH companies contribute significantly

helping businesses adhere to industry

by driving policy development, risk

health standards and government

management, and compliance with legal

regulations. This includes complying

standards, ensuring that organizations

with occupational health and safety

uphold not only regulatory obligations

laws, managing employee health records

but also the ethical treatment of

in accordance with data privacy rules,

employees—key components of robust

and ensuring proper procedures for

corporate governance.

workplace hazards, illness prevention,

OH professionals are essential in

and disability accommodations. By

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

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

environments to safeguarding workers’

among stakeholders.

rights. By collaborating with senior

By embedding OH into their governance

leadership and human resources teams,

frameworks, companies can ensure that

OH helps shape policies that go beyond

their health-related policies, risk

regulatory compliance, focusing on fair

management processes, and compliance

and ethical employee treatment. This

efforts are in full alignment with

integration ensures that health and

broader ESG goals. OH companies, with

safety initiatives are not just an

their focus on employee well-being and

operational necessity but a strategic

ethical responsibility, are uniquely

part of the company’s governance

positioned to strengthen governance

structure, enhancing both

structures. In doing so, they help create

accountability and transparency.

organizations that are not only healthier

A key contribution of OH to the

but also more accountable, transparent,

governance pillar is its role in

Occupational Health is instrumental in promoting both the physical and mental wellbeing of employees, a cornerstone of any company’s social responsibility efforts.

and sustainable in the long term.

identifying, assessing, and managing health-related risks in the workplace.

Whether it's controlling the spread of

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A Hidden Catalyst for Environmental Sustainability

align their personal habits with the

While Occupational Health (OH) may

promoting employee health in the face

not seem directly tied to environmental

of environmental stressors. For

sustainability, it can play a meaningful

example, preparing workers for heat-

role in driving environmentally

related illnesses or air quality concerns

responsible practices within

can help organizations mitigate the

organizations. OH providers, through

impacts of climate change on workforce

their operations and influence, have the

productivity. By focusing on both

potential to promote sustainability both

individual well-being and

internally and across the workforce.

environmental sustainability, OH can

One key way OH contributes to

help bridge the gap between employee

environmental goals is by adopting ecofriendly practices in their own operations. For instance, digitizing

resilience to climate change by

health and corporate environmental goals, making it an indirect but significant driver of positive environmental impact.

not only streamlines administrative

While traditionally Occupational Health

tasks but also minimizes waste and

may not be viewed as a driver of

resource consumption. Additionally, the

environmental sustainability, its

rise of telemedicine offers a dual

influence within organizations positions

benefit: improving access to health

it as a valuable contributor to broader

services while significantly cutting down

sustainability efforts. By adopting eco-

on travel-related carbon emissions, as

friendly practices and fostering a culture

employees no longer need to commute

of environmental responsibility OH

for appointments. These shifts not only

providers can reduce their

enhance efficiency but also align OH

environmental footprint while

providers with broader sustainability

simultaneously enhancing efficiency

efforts.

and accessibility. As climate change and

Beyond internal operations, OH can act

environmental concerns become

behaviours across the workforce. By leveraging their position in employee health and wellness programs, OH professionals can encourage practices

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

such as energy conservation in the

sustainable and responsible workplace.

workplace, responsible use of resources,

Fusing Health and Sustainability

and the adoption of eco-friendly commuting options like cycling,

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OH can support companies in building

health records and reducing paper usage

as a catalyst for fostering sustainable

30

organization’s sustainability goals.

carpooling, or using public transport.

As this article has gone on to

These small but impactful changes help

demonstrate, there is an incredibly large

cultivate a culture of environmental

cross section on the Ven diagram

awareness, encouraging employees to

between Occupational Health and ESG.

Volume 31 Issue 4

The integration of Occupational Health

initiatives.

(OH) with Environmental, Social, and

The convergence of OH and ESG

Governance (ESG) principles underscores its vital role in shaping healthier, more sustainable workplaces.

As organizations increasingly prioritize employee well-being, ethical

businesses to enhance their operational resilience, maintain regulatory compliance, and cultivate a culture of accountability and responsibility.

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

presents a unique opportunity for

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.

References 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.

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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

O

ccupational Health (OH) is yet again

treatment, managing conditions and avoiding

at a pivotal place as the new labour

complications (NHS England 2014).

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.

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

In its ‘Five Year Forward Review,’ NHS

dwindling) resource with often heavy

England acknowledges more is needed to

workloads as we spread ourselves across all

support people in managing their health.

aspects of the role.

Staying healthy, making informed choices of

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Coaching skills are not just another

number of people with three or more long-

intervention. My heart sinks when I look at the

term conditions continues to rise.

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

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

workload.

widely. It is delivered by a range of providers

If instead, we look at developing coaching

increase patient activation, and wellness, aid

skills as a mindset and a way of being in our everyday conversations, the impact

as part of health programmes and systems to uptake of interventions, reduce risk and support decision-making. Most of the research

becomes a game changer. Used in

into the effectiveness of health coaching,

combination with core clinical skills,

unsurprisingly, comes from the US.

health coaching could have a greater

In the UK, health coaching was introduced in

impact on return-to-work outcomes and

2013 and is still an innovation in most sectors.

health management by empowering the

It was originally selected for an accelerated

patient/client to be more in control of

NHS England-funded programme to

their health condition, improving their

contribute to its Five Year Forward View,

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

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: -

managing long-term conditions like

efforts to achieve those goals. It is a person-

reduction in BMI and improvement in

centred approach when the clinician partners

blood pressure and cholesterol levels.

with the patient to establish goals and the patient is equal in decision-making about their

Clinical outcomes improved in self-

-

Health behaviours improved particularly

care. They are the expert in their own

around physical activity and improved

circumstances, needs, and preferences.

medication adherence.

The sustainability of the NHS depends upon

-

Patient activation and Self-Efficacy where

patients and communities playing a greater

motivation to manage own health

role in their health and care. The impact of

improved.

long-term conditions (LTCs) on quality of life and NHS costs continues to escalate and the

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-

A reduction was seen in hospital readmission rates and some evidence of

reduced emergency department visits and

healthcare moves towards more

GP appointments.

personalised, preventive approaches,

Overall, while there are promising results, more research is needed to definitively

coaching skills become increasingly relevant.

establish the effectiveness and cost-

More research is needed to understand the

effectiveness of health coaching

impact these skills have in OH, on the

interventions. Not least we need to establish

practitioner, their workload and the wider

research in Occupational Health, of which

influence in their team and community.

there is little. If the evidence suggests patients

However, from what we currently know and

are more engaged and better able to self-

see, the potential is great.

manage their health condition, are they less

The coaching mindset

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

-

-

-

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

they feel heard and involved in decision-

the person in front of you has the potential and

making.

resources within themselves to solve their

Professional development, with improved development

-

supported self-management intervention.

follow through with treatment plans when

communication and leadership

-

NHS England refers to health coaching as a

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

Improved job satisfaction as coaching

coaching mindset involves all the human

approaches help practitioners to find more

qualities we already possess, good listening,

fulfilment in their work, potentially

holding a safe space for others, having

reducing burnout. Building better rapport

curiosity, empathy and challenging someone to

with more meaningful interactions,

stretch that little bit further so they can see

increasing job satisfaction.

beyond their limitations.

Coaching leads to enhanced self-awareness

And doesn’t this transcend our lives too? Are

which improves personal development,

we a better person, a better friend, father,

stress management and work-life balance

mother, partner if we have this mindset and are

with better relationships in and outside

believers in one another? And would it reduce

work.

the feeling or need to rescue others all the

Reducing workload: Empowered patients

time?

are likely to require less frequent

Having a coaching mindset is not as easy as

interventions, potentially easing workload

one might think. When we talk about the skills

in the longer term.

required for good coaching conversations, such

Alignment with healthcare trends: As

as active listening, powerful questioning, ioh.org.uk

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enabling a space for the person to ‘think,’

Ways to check in and build on your coaching

building trust and rapport, you may be

mindset in everyday conversations:

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 Practice active listening by being curious about the other person’s experience and thoughts and listening to their response.

-

-

-

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 – 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

why it is important to them.

conversation or interfered with enabling

Prepare for your conversation, reducing

the other person to think at their best.

distractions and planning how to have the

Reflecting on these points and integrating

conversation.

coaching skills and mindset, could be a

Encourage reflection by using open

notable change for occupational health

hand.

Encourage ownership by inviting the

patient to generate their ideas about what can be done.

Encourage the person to take small actions

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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

in their chosen direction.

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other’s expectations and set the parameters

exploring what they want to achieve and

broaden their perspective on the issues at

-

call this contracting. Understand each

Set goals in partnership with the patient,

questions to help the person explore and

-

do in that consultation. In coaching we

being able to sufficiently stand back from

conversations: -

1. Be clear on what you are both there to

Volume 31 Issue 4

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.

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The HSE put the cost of workplace injury

conditions) and prevent conditions from

and illness at c. £20.7bn for the last year

worsening and creating long-term

of reported data from 2023. This is made

health problems.

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?

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

Occupational health: Promoting a safe and healthy work environment

recognise the commitment to their well-

As an employer it’s important to

to fewer workplace illnesses and

understand the hazards in the

injuries, reducing absenteeism. What’s

workplace, be able to undertake a robust

more, occupational health can identify

risk assessment and put in place

the adjustments needed that help

meaningful control measures in order to

employees return to the workplace

manage risks to the workforce. Where a

which in turn bring further health

residual risk to health is likely, an

benefits.

effective health surveillance programme

Building a culture of health and

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.

being.

Fewer injuries and illnesses reduce

absenteeism: It’s another productivity benefit. Managing risks effectively leads

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

Here are just a few of the benefits to

practices which can have a lasting

both employees and employers.

impact on overall workplace culture.

Early detection: Through health

Workplace Health Surveillance

surveillance programmes, occupational health can monitor employees for early signs of work-related health issues (like

Health surveillance in the workplace

hearing loss, respiratory problems,

isn't just a box-ticking exercise; it's an

musculoskeletal disorders or skin

important way to protect employees' health. Employers need to make sure

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there is a clear link between work tasks

Personal protective equipment

and possible health risks before they

(PPE): Protect the worker with

start any kind of surveillance program.

equipment

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

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

consent from workers isn't just a good

The Management of Health and Safety

idea; it's necessary for trust and

at Work Regulations 1999 say that

compliance.

health surveillance is often required by

The ‘Hierarchy of Controls’ of managing risk at work

law in the UK. It's not just a choice that

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.

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

Elimination: Physically remove the

others who may be affected by the

hazard

organisation's work. Further details

Substitution: Replace the hazard

from the Health and Safety Executive

Engineering controls: Isolate people

(HSE).

from the hazard Administrative controls: Change the way people work

ioh.org.uk

OH TODAY

43

For the occupational health practitioner,

Improve your health surveillance skill sets

health surveillance knowledge is key to

The EOPH conference ‘Putting Health

In conclusion

the prevention of work related ill health and the promotion of a fitter and healthier workplace.

back into Health Surveillance’ takes place on the 14th of February 2025 in Birmingham. A range of speaker

These practices ensure both the physical

sessions will include experts in health

safety of employees and the operational

surveillance topics inc. respiratory, skin

resilience of the organisation. All of

surveillance, HAVS, hearing and how to

which makes health surveillance one of

monitor the effectiveness of risk

the most dynamic areas of occupational

management controls. See more details

health impacting on safety, productivity

in our advert and visit our website to

and ultimately helping to create a

book: https://eoph.co.uk/training/

culture that priorities workplace health and that saves lives.

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

44

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Volume 31 Issue 4

The relevance of research in occupational health and safety

Bernardino Ramazzini (1633-1714) had

asking why workers do n

adopted this attitude as a physician. As

medical surveillance ap

a result of his studies into the

more complex approach

relationship between work and disease

understanding what fac

What is research? Polit and Beck define

Ramazzini is credited as being the

workers’ experience of b

Father of Occupational Medicine, or if

sedentary occupations.

Florence Nightingale (1820-1910) had

in a systematic approac

not seen the need to demonstrate

the problem. In research

through statistics how improvements in

achieved through differ

hospital sanitation reduced disease in

which produce varying l

soldiers (pg. 2). The reality is that

evidence. A hierarchy o

research forms part of our everyday lives

way to rank the study ba

and as healthcare professionals we are

strength and precision o

either consumers (utilising the

methods used. This hier

outcomes to enhance service delivery)

in Figure 1 is usually rep

or producers (investigating problems so

pyramid with the strong

we can create the evidence used by

(e.g. systematic reviews

indifference and the belief that it is not

consumers).

evidence with decreasin

relevant to them. I am often advised

For the producers, research in the

that OHPs are clinicians, not academics,

occupational health and safety (OHS)

and therefore have no need to engage in

environment is a disciplined process

research, which is reflected in the often-

tailored to provide answers or evidence

poor response rates when they are

to questions specific to the workplace.

invited to participate in surveys and

Questions arising from the workplace

other data collection methods(2). That

may require a simple approach such as

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,

leads us to ask where we would be if 46

OH TODAY

Volume 31 Issue 4

(3)

positioned below this (e 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

ppointments or a

h to

ctors influence

back pain in The solution lies

ch to exploring

h, this is

rent methods

levels of

of evidence is a

ased on the

of the research

rarchy as shown

presented as a

gest methods

s) at the top and

ng 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) ioh.org.uk

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47

The findings or outcomes to these

practice on a wide range of OHS topics.

investigations should provide reliable

Given that IOSH is a global occupational

data that influences practice and/or

health and safety (OHS) professional

service delivery through the

body, the aim is for our research to

development of new policies, identifying

benefit various OHS stakeholders, e.g.,

what works and what does not work,

occupational safety and health

identifying emerging trends that are

practitioners and policy makers.

therefore relevant to those working in the field of OHS as consumers.

The research team, with its diverse OHS background, engages in specific projects

Research evidence should guide

in various capacities, such as project

decisions about the health, safety and

managers, research consultants,

wellbeing of our workers leading to what

advisors, and partners. Therefore, our

is referred to as evidence-based practice.

role involves representation on the

As OHS professionals we should be

steering groups of IOSH-funded

reflecting and asking the question ‘Is the

projects, as well as non-IOSH-funded

service that I deliver based on sound

projects. Given the broad range of OHS

evidence, does it allow me to provide my

topics, both our funded research and

client with the best level of service I

external representation on projects

can?’ Now if you are not interested in

must align with IOSH priority areas and

offering quality services then of course

contribute to our Corporate Strategy,

this would not apply to you – but we

Activate 2028.

believe that all OHPs are concerned with delivering a quality service that ensures the health, safety and wellbeing of their workers.

We recognise that, while we have a Research for Public Benefit fund reserved for commissioning research, it is a limited financial resource.

At IOSH one of our core research values

Therefore, connecting and partnering

is that we engage with research that

with like-minded organisations is

seeks to explore solutions to

critical for maximising our impact. We

occupational based problems that

primarily achieve this through

provide for a safer and healthier world of

membership in research consortiums

work. We do this through various levels

(e.g., Affinity Health at Work and

of the research hierarchy.

SAF€RA) and by jointly funding projects.

How is IOSH involved in research?

What research projects are IOSH involved in?

The Institution of Occupational Safety

IOSH-funded research was paused

and Health (IOSH) activity in research

during the COVID-19 pandemic and

developed significantly in the 2000s,

resumed in the 2022/2023 period, with

primarily through commissioning

our first post-COVID project launching

studies on an annual basis. On an almost

in February 2024. This jointly funded

yearly basis, through calls, IOSH

project is a collaboration between

considers proposals and funds projects

Lancaster University and the

to establish evidence, and ultimately

International Commission of

improve health and safety policies and

Occupational Health (ICOH), titled

48

OH TODAY

Volume 31 Issue 4

Research e should gui decisions a health, saf wellbeing workers le what is ref as evidenc practice.

evidence ide about the fety and of our eading to ferred to ce-based

‘Effective Delivery of Occupational Safety

Our 2024/2025 call is currently open

and Health Services: Promoting

until 13 January and can be explored on

Occupational Safety and Health as a

the IOSH website. This year, there are

Universal Fundamental Right at Work.’ As

four research topics, all based on

a mixed-methods project, it aims to

identified research needs within the

investigate global access to and

OHS community.

coverage of OSH services through a specific case studies, key stakeholder

What types of research does IOSH commission?

interviews, and a global roundtable. The

We recognise the value of different

purposive survey, selected country-

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.

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

The 2023/2024 call process culminated

by providing useful knowledge but also

in a funded project through Solent

by offering practical strategies that end-

University entitled ‘A toolbox for

users can implement in their

recording and analysing work related

workplaces. For this reason, although we

adverse health outcomes for workers in UK

primarily commission empirical

ports and onboard UK registered ships’.

research, even in the case of systematic

Evidence shows that health-related

reviews, we typically produce summary

issues represent 80% of the global

reports and other accessible outputs,

burden of work-related disease and

such as checklists, case studies, and

injury(4). This project aims to develop a

guides, to support the non-academic

toolbox featuring best-practice guidance

community in applying the findings

for data collection and analysis of work-

effectively.

related adverse health events,

To support the function and the wider

addressing gaps in the investigation of these incidents.

business, the team actively seeks relevant information from a range of

As a research consultant, IOSH

authoritative sources, including

representatives have contributed to the

academic publications and grey

European Union (EU)-funded MENTUPP

literature. This horizon-scanning

project (Mental Health Promotion and

activity helps us stay informed about

Intervention in Occupational Settings) and

emerging and prevalent OHS-related

now serve on the five-year EU-funded

issues, ensuring we remain responsive

PROSPERH project (Promoting Positive

to the evolving needs of the field.

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. ioh.org.uk

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49

Conclusion Our mission is to draw on diverse sources of

Dr Karen Michell | Linkedin

academic, scientific, and authoritative knowledge to drive OHS thought leadership

Karen is a distinguished

and deliver relevant content to OHS

Occupational Health and

professionals and the profession as a whole.

Safety (OHS)

Ultimately, the programme exists to make a

professional with over

difference in OHS policy and practice—an

25 years of global

impact that is not always easy to measure.

experience in

However, studies such as Getting the Best from

occupational health nursing, health and safety

the Fit Note, where over 60 recommendations

management, research, and education. She

were shared with the Department of Health’s

currently works as the Research programme lead for

fit note review working party and led to

Occupational Health at IOSH, driving advancements

changes, demonstrate that significant impact

in workplace health and safety. Recognised for her

can be achieved, even at national or

academic and practical excellence, she is a Fellow of

international levels.

the Academy of Nursing in South Africa and a

References

Chartered IOSH Member. A published author and

1. Polit DF, Beck CT. Nursing research:

occupational health service delivery, quality

Generating and assessing evidence for nursing

assurance, governance, and legislative compliance.

practice. 9th ed. Philadelphia: Lippincott

Her expertise and dedication to worker health and

Williams and Wilkins; 2012.

safety have earned her a reputation as a global OHS

recognised speaker, Karen specializes in

2. Michell K, Rispel L. Views of frontline service providers on the accreditation of occupational health services in South Africa.

authority.

Mary Ogungbeje | Linkedin

Occupational Health Southern Africa. 2022;28 (3):86-94.

With a 20-year career at the

3. Ehrlich R, Katzenellenbogen J, Tollman S,

Institution of Occupational

Gear J. Why do epidemiological research? A

Safety and Health and 18

South African perspective. In: Joubert G,

years’ of experience at a sen-

Ehrlich R, editors. Epidemiology: A research

ior board level in two UK

manual for South Africa. Cape Town, South

charities, Mary is a dynamic,

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.

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 50

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