You big fat liars

Hazards 104, October - December 2008

Firefighter Kevin Ogilvie had worked for 22 years as a firefighter when he first failed an annual fitness test. The 46-year-old Grampian Fire and Rescue Service veteran went straight from fighting fires to fighting for his job.

His employer said it was forced to dismiss him in July 2008 after a “very long and arduous process of support and consideration.” Kevin was only reinstated after a threat of industrial action by his union, FBU, forced Grampian Fire and Rescue Service into negotiations at the arbitration service Acas. The union had argued that an alternative role could have been found within the service for Mr Ogilvie.

The case puts the spotlight on a potential flaw in the government’s welfare reform package, which aims to see more workers, including hundreds of thousands currently on disability-related benefits, move back into work. ‘No one written off: reforming welfare to reward responsibility,’ a welfare Green Paper [1] published in July 2008 by work and pensions secretary James Parnell, announced the government’s plans to scrap incapacity benefit and make those jobless for more than two years work full-time in the community.

But if employers aren’t interested in “good” jobs – ones providing decent pay and hours and satisfying, safe and sane work – or in “bad” employees the strategy hits a major stumbling block. Experts say if jobs are bad jobs or if employers are bad employers willing to fire less than perfect staff, the strategy is destined to fail.

The problems will be amplified if even large, public sector employers are, for example, willing to fire staff just for being overweight. But employers are getting increasingly picky – and many want to monitor more than your diet and your weight. Increasing numbers aim to keep tabs on your drug and alcohol use, exercise and other ‘lifestyle’ behaviours – and, they say, it’s all for your own good [2].

Personal problems?

“Health at work” initiatives, instead of addressing job insecurity, long hours, monotony, work hazards, staffing shortages, sedentary work and excessive workload, increasingly look instead at modifying workers own personal habits [3].

Well@Work, a two-year British Heart Foundation (BHF) project that concluded in summer 2008 and which was funded by £1.5m of government and lottery cash, introduced measures such as pedometers, health checks and fruit giveaways. It involved 32 workplaces employing 10,000 staff in public and private sector workplaces.

But the funding for the project has now ended. And although in some workplaces some workers took more exercise and ate more healthily, most didn’t. And to extend this project across the UK’s 28 million plus workers would cost in excess of £2bn a year – over seven times Health and Safety Executive's (HSE) annual budget.

Still, this is an industry set to grow. In the US, the American Heart Foundation this year handed out awards to more than 900 businesses across the country for their participation in its ‘Start! Fit-friendly companies’ programme, up 20 per cent on last year. The BHF pilot project was a close copy of the US programme.

'Working well: A global survey of health promotion and workplace wellness strategies', published in November 2008 by Buck Consultants, found in the UK 40 per cent of those surveyed now offer a 'workplace wellness strategy' - approximately double the percentage the preceding year, with 16.4 per cent of UK respondents now having a fully implemented a health promotion and wellness strategy and 34.5 per cent a partially implemented strategy. Only 3.6 per cent reported that that they had no plans at present for a wellness strategy.

There’s a whole awards industry dedicated to promoting lifestyle interventions at work – and those taking home the prizes are sometimes surprising. National Semiconductor in Scotland received a Gold Award in 2008 from the Healthy Working Lives Award programme for its efforts “to raise awareness of cancer among its workforce.” The company encourages its staff to exercise and provides health checks.

But unmentioned in the citation from the award body, the Scottish Centre for Healthy Working Lives, is the criticism the company has received for causing cancers in its staff.

And the hypocrisy award goes to…

There’s a whole awards industry dedicated to promoting lifestyle interventions at work – and those taking home the prizes are sometimes surprising.

National Semiconductor in Scotland received a Gold Award in 2008 from the publicly-funded Healthy Working Lives Award programme for its efforts “to raise awareness of cancer among its workforce.” The company encourages its staff to exercise and provides health checks. But unmentioned in the citation from the award body, the Scottish Centre for Healthy Working Lives, is the criticism the company has received for causing cancer in its staff.

Studies have linked occupational exposures at the Greenock plant to excesses of several cancers, including brain and breast tumours, which are four to five times higher than normal. It has been criticised in international journals for its cancer record and its failure to cooperate fully with cancer researchers.

Grace Mitchell (above left), like dozens of others, developed cancer while working at National Semiconductors Greenock microchip plant. Jim McCourt (right), who coordinates the Phase II campaign fighting for the firm’s cancer victims, commenting on the Gold Award from the Scottish Centre for Working Lives, said: “This is a company that has been under investigation for the last 12 years because of workplace health, miscarriage and cancer concerns. How can they receive such awards in light of this? It’s incredible and being done with taxpayers’ money.”

Studies have linked occupational exposures at the Greenock plant to excesses of several cancers, including brain and breast tumours, which are four to five times higher than normal. It has been criticised in international journals for its cancer record and its failure to cooperate fully with cancer studies at the plant.

And there is money to be made from a captive workforce. WeightWatchers UK is looking to sign up 500 companies whose staff do sedentary work to a programme of workplace weigh-ins, with classes by dieticians during the lunch hour or after work.

Strapping on a pedometer or signing up for a lunch-time diet programme will be of limited use if the worker is still spending 10 hours a day working frantically in front of a computer or a production line.

A University of North Carolina study this year found sedentary occupations carry a significant risk of workers gaining weight [4]. The investigation of 393 volunteers working at a call centre found 68 per cent gained weight averaging 0.9 kg per month for eight months. Only vigorous exercise - not walking and moderate exercise - was significantly associated with non-weight gain.

Better work

Unions argue the message from the workplace lifestyle evangelists would be more credible if more employers changed their bad habits and left workers with the time, money and hazard-free workplaces to have a healthy life. Or if they made the healthy and humane choice that sickness is not a disciplinary issue, an approach that makes the stressed more stressed and the sick more sick.

A 2008 paper published as part of the on-going Whitehall II research programme suggests workers taking long-term sick leave are not shirkers, but people with a genuinely increased chance of dropping dead [5]. And a 2003 paper [6] from the same study found taking short-term sick leave might stop you ending up on the long-term sick list – so far from being malingerers, the supposed shirkers are infact taking the responsible and low absence course of action.

But workload and punitive absence policies mean sick leave for some is a luxury they cannot afford. A poll published in September 2008 by medical insurance provider Axa PPP healthcare found nearly threequarters (72 per cent) of UK employees go to work despite feeling so ill they could legitimately stay at home. 

The poll of 2,000 workers indicated that the main reason for this “presenteeism” was people saying they didn't want to let down their colleagues. A quarter of respondents said they just had too much work to do to take time off. One in seven were worried their sick leave records could be used against them if their employer came to making people redundant. One in five also admitted to using some of their annual leave days to cover up sick days, for fear of not getting paid or losing their job.

We told you we were sick

People who have long spells of sick leave are at far greater risk of an early death than healthier employees, researchers have found [5]. The finding could help pick out at-risk groups, the University College London researchers reported in the British Medical Journal.

Taking extended sick leave more than once in three years, particularly if the absence is because of surgery or circulatory or psychiatric problems, is a red flag, according to the report. In fact, deaths increased as the medically certified absence rates (stretches of more than seven days) increased, according to the research team. The study of absence records for 6,478 British civil servants between 1985 and 1988, a part of the long running ‘Whitehall II’ research programme, showed that people who had one or more medically certified absences in three years had a 66 per cent increased risk of premature death compared to those with no such absence.

Workers who were absent because of circulatory disease were four times more likely to die prematurely than their colleagues with no absences. Those absent because of psychiatric illnesses were nearly twice as likely to die prematurely, while workers needing an operation were more than twice as likely to die early. Employees taking sick leave because of a musculoskeletal condition were an exception to the findings, and were at no additional risk.

Although it may seem unsurprising that sicker workers are more likely to die, earlier findings of the Whitehall II study, the UK's biggest ongoing occupational health study, concluded “short term absences may represent healthy coping behaviours,” with these workers less likely to end up on the long-term sick list [6].

Dealing with problems at an early stage might prevent them becoming a more serious – potentially deadly – condition later, requiring longer spells of sick leave. The suggests punitive sickness absence approaches encouraging “presenteeism” – the attendance at work of the working wounded - may have a seriously detrimental effect in the long run.

This phenomenon surfaced at Coventry City Council in August. UNISON’s Sarah Ferguson said workers at the council are scared to call in sick because of a “draconian” sickness and “health at work” policy. One union member even cancelled a medical appointment because she was too frightened to take time off to attend.

“We have had cases of people coming into work sick, because they are so frightened of coming into the sickness-at-work procedure. People are actually asking to take annual leave instead of sickness. It's frightening.” Ferguson said staff feared being caught up in the council's “promoting health at work” policy under which 75 people lost their jobs last year. Only 35 of those qualified for ill-health early retirement.

A September 2008 report from The Work Foundation [7] called for a new approach, based not on haranguing the sick, but on the creation of good jobs. Stephen Bevan, director of research at The Work Foundation, commented: “The right of the state to expect people to seek work in return for support needs to be balanced by a corresponding concern for the quality of work people do.

“If it’s bad work, as in short-term, insecure, low-paying, monotonous, and sometimes degrading, with no way to rise on merit, the plans are likely to fail and the revolving door between work and benefits will keep turning.”

The Foundation’s ‘Good work’ report says the quality of employment has an impact on health, life expectancy and life chances. It adds that the government cannot make serious progress towards the reduction of health inequalities unless it has policies to improve job quality for the most disadvantaged. The thinktank says work is better for health and life expectancy than worklessness, but it is only really good for us if it is “good work”. Too many people are trapped in a “revolving door” of bad, short-term jobs and joblessness, it says.

Lead author David Coats said: “The ‘rights and responsibilities’ rhetoric is fair enough, but what’s missing from politicians is any sense of what good, sustainable jobs are and how to go about creating them.”  He added: “The UK is not the worst performer on all measures of job quality in Europe. But we are still extraordinarily tolerant of the large numbers of jobs we have that are characterised by routine, monotonous work, tight managerial control, and excessive working hours. To allow this to continue is bad for business, bad for government and bad for people at work.”

Missing support

Government efforts to get the long-term sick off benefits and back to work risk are being further undermined by low levels of rehabilitation support in the workplace, according to the Chartered Institute of Personnel and Development’s (CIPD) Annual Absence Management Survey 2008.

It found over a third (36 per cent) of employers offer no rehabilitation support. Such services are most common in the public sector, where 84 per cent of employers offer them. The figure falls to 48 per cent in private sector services, and just 25 per cent in organisations employing fewer than 50 people.

Conditions in Britain’s workplaces are unlikely to improve anytime soon. As the government pares back the Health and Safety Executive (HSE), enforcement of healthy workplace conditions is eroded [8].

The changing nature of the modern job market – less job security, more contingent labour and the credit crunch – are adding to the strains facing workers. Job insecurity, like bad jobs, is already commonplace, and workers – particularly if they are turfed off benefits and compelled to work – will have little bargaining power or official support in the pursuit of “good work.” An August 2008 survey for the TUC found more than 3.3 million workers, 13 per cent of the workforce, were not confident they will still be in their job in a year’s time.

Job jitters are contagious and they are seriously bad for your health. Insecure work has been linked to higher rates of work-related accidents, sickness and chronic disorders including heart disease. Studies have linked all forms of “precarious” employment to higher rates of occupational accidents and ill-health and greater exposure to workplace risks.

This was confirmed in a September 2008 study [9] from the Centre for Addiction and Mental Health (CAMH) in Canada. It found workers who do not have job security develop more physical and mental health problems compared to their full-time counterparts. Researcher Dr Carles Muntaner concluded that job insecurity can lead to anxiety and depression, which can then cause cardiovascular and other physical ailments.

Mortality (death rate) is higher among temporary workers compared to permanent workers, the study found. Workers with precarious employment status are also three to four times more likely to develop some form of mental illness, the report said. It found workers who have high-demand but low-control jobs that offer few rewards are at greater risk for depression, anxiety disorders and substance abuse problems.

In September 2008, in response to a clamour from unions for information on the health promotion initiatives pushed in an increasing number of workplaces, TUC published its own guide [10]. It says “lifestyle” initiatives introduced by employers have their role, but says most of us spend most of our waking hours at work in conditions created by the employer, so employers should first make sure that work hazards are addressed.

The TUC guide, which covers issues including exercise classes, access to a gym, cycling, healthy eating and health surveillance, says: “Healthy working has to start with how we work. Unions know that the most effective way of promoting health at work is prevention, which is why we try to ensure that workers are protected from being made ill through overwork, stress, exposure to dangerous chemicals and unsafe working practices.”

It adds: “The biggest lifestyle gains can be made through reducing stress, long hours and introducing policies that promote 'work-life balance', but there are also other steps that employers can take to help support workers who want to live a healthier lifestyle.”

The Work Foundation’s ‘Good Work’ report points to simple measures that could make work better, all dealing with core workplace factors that affect health and well-being at work.

Recommendations in the report include the abolition of the individual opt-out from the Working Time Directive over a four year period and strengthening the information and consultation legislation to grant workers’ representatives the authority to address questions of work quality and work performance. The Foundation also calls for more widespread use of the Health and Safety Executive’s stress management standards.

And it says the government should impose new reporting requirements on publicly listed companies to include detailed information about health and safety performance, the incidence of illness, job satisfaction and autonomy and control data, within annual reports.

References

1. No one written off: reforming welfare to reward responsibility, DWP, July 2008.
2. Dame blast, Hazards, number 100, October/December 2007.
3. Futile exercise, Hazards, number 93, January/March 2006.
4. Robert Boyce and others. Physical activity, weight gain and occupational health among call centre employees, Occupational Medicine, volume 58, number 4, pages 238-244, 2008 [abstract].
5. Head J, Alexanderson K, Westerlund H, Vahtera J and Kivimäki M. Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study, BMJ Online First, 2 October 2008.  
6. Kivimäki M and others. Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study. BMJ, vol.327, pages 364-70, 2003.
7. ‘Good work’: Job quality in a changing economy, The Work Foundation, September 2008.
8. Where is the justice?, Hazards, number 104, October/December 2008.
9. Steady work and mental health – is there a connection?, Centre for Addiction and Mental Health news release, Canada, 15 September 2008. The research was a contribution to: Closing the gap in a generation: Health equity through action on the social determinants of health, WHO Commission on Social Determinants of Health (CSDH).
10. Promoting health at work: Guidance for safety representatives, TUC, September 2008.