The future of work-related health — beyond 2020

The impact of the coronavirus has been at the centre of almost every decision by the Government, employers, trade unions and workers themselves for most of the past year. As 2020 draws to a close, Vicky Powell looks at some early indicators for the future of health in the workplace.

A snapshot before the pandemic

In November 2020, the Health and Safety Executive (HSE) published its annual report on work-related injuries and ill-health in Great Britain for the period 2019/20. The figures cover the period at work from work between April 2019 and March 2020.

The first case of Covid-19 in Britain was confirmed on 31 January 2020 and the country entered the initial period of lockdown on 23 March 2020. Therefore, the latest HSE statistics fall largely outside the Covid-19 affected period.

Nevertheless, they are important in that they offer a crucial snapshot of what workplace health looked like, essentially before the pandemic started.

Even at this early stage at the time of writing, while the country remains in the midst of the pandemic and new lockdowns, it is probably fair to say that the world of work will never again be quite the same.

The lockdowns have introduced major disruption to businesses, in terms of financial losses but also with major impacts on the mental and physical health of the workforce.

Considering the very earliest impacts, disruption to the economy towards the end of 2019/20 due to the emergence of Covid-19 as a national health issue had some potential to have affected workplace injury and work-related ill health data in the last month or two of the 2019/20 period.

However, as it published the November 2020 figures, the HSE noted that the emergence of Covid-19 as a national health issue at the end of final quarter of 2019/20 did not appear to be the main driver of changes seen in the 2019/20 data, although the watchdog noted it was possible that the virus may be a contributory factor.

Within the 2019/20 period the following was noted.

  • There were 111 fatal injuries at work.

  • Around 693,000 workers sustained non-fatal injuries in 2019/2020.

  • A total of about 1.6 million working people were suffering from a work-related illness.

  • There were 38.8 million working days lost due to work-related illness and workplace injury.

  • A total of 325 cases were prosecuted and resulted in a conviction.

  • Fines from convictions totalled £35.8 million

  • In 2019/2020, the estimated economic cost to Great Britain totalled £16.2 billion with 38.8 million working days lost.

  • Ill health caused the biggest proportion of these costs ― at around 66% or £10.6 billion, with injury resulting in around 34% of total costs (£5.6 billion).

Each year the HSE estimates there are 12,000 deaths from lung disease linked to past exposures at work. The HSE has indicated that:

  • 33% of these are due to chronic obstructive pulmonary disease (COPD), which includes conditions such as chronic bronchitis and emphysema

  • 24% are caused by non-asbestos related lung cancer

  • 20% are down to asbestos-related lung cancer

  • 20% are caused by mesothelioma, a specific cancer caused by inhaled asbestos fibres, which forms malignant tumours in the lining of the lungs, abdomen or heart

  • 3% are related to other lung diseases.

Looking at the figures for ongoing work-related ill health, the HSE figures show that 1.6 million workers suffer from ill health which is related to their work and this is caused by:

  • stress, depression or anxiety (51% of cases)

  • musculoskeletal disorders (30%)

  • other types of illnesses (19%) such as occupational cancers, work-related skin diseases, hand-arm vibration syndrome and noise induced hearing loss for example.

A year of the Covid-19 virus

What remains to be seen at this point is the impact of the coronavirus on work-related safety and ill health in the year 2020/21.

Sarah Newton, the HSE’s Chair recently said, “The Covid pandemic has focussed attention on the health and safety issues people face in the workplace. The HSE remains committed to taking action where workers are not protected, to ensure the guidance and assistance we provide for employers in managing risks is the best available, based on the latest evidence and science”.

Despite the efforts of the regulator, there is almost no doubt there will be substantial impacts to be seen this time next year when the formal new figures become available.

Covid-19 during 2020 — the early figures

The BMJ has noted the HSE’s figure of 8666 notifications of Covid-19 in workers in England, Scotland, and Wales, including 125 deaths, from 10 April to 8 August 2020.

At least 3354 (nearly 40%) of these notified Covid-19 cases were in people working in residential care and other social work, including 52 (42% of this figure) of the deaths. A further 3382 cases (another 40% roughly) were among healthcare workers, including 50 (40% of this figure) deaths.

However, as the HSE has acknowledged, these figures misjudge the true scale of the problem because of widespread under-reporting by employers.

Figures from the Office for National Statistics (ONS) have shown that death rates for male security guards and related occupations were nearly four times higher than those for all men of working age, while for taxi, cab, bus, and coach drivers the age standardised mortalities were well over double.

In addition to cases of illness and deaths, the coronavirus has brought with it national lockdowns, large scale homeworking, the push for Covid-secure workplaces, Covid testing, job losses and in some cases the loss of entire industries in the case of the travel and entertainment sectors for example.

The early indications are that all of these factors will have significant impacts on Britain’s most important occupational ill health drivers. Worries related to job loss and insecurity as well as the fear of catching the virus at work and bringing it home to family members will likely drive up the figures for occupational stress, depression and anxiety. Early research surveys imply that hastily introduced homeworking, bringing with it working days centred around around sofas, dining room tables and kitchen counters, may well affect the figures for musculoskeletal disorders.

On the other hand, the lowered levels of economy activity associated with national and localised lockdowns will no doubt result in fewer work-related accidents.

Working towards sustainable workplace health

The British Occupational Hygiene Society (BOHS) has expressed its concerns that the current virus may be “sharpening and deepening” the impact of long-term health exposures.

Citing research evidence from the London School of Hygiene and Tropical Medicine released early in the pandemic, the Society has warned there are a number of diseases with strong occupational links to poorer outcomes for Covid-19 patients. These are yet to be explored in the depth they deserve.

However, the Chartered Society for Worker Health Protection is calling for a rethink of the current approach that invests heavily in trying to treat occupational illness and disproportionately focuses on safety.

Instead, the science-based Society believes that prevention of health risk as part of national strategies for “sustainable workplace health” is required.

Kelvin Williams, the Society’s President, says, “In every other environment, we have come to understand that prevention, long-term thinking and sustainability are key to effective measures. However, within the workplace, we are still thinking in a short-term way.

“It simply does not make sense to carry on with an investment in occupational health that ignores the vital importance of preventing risks to health in the first place. For example, in construction we think about the carbon footprint of building materials and even the welfare on site, yet we still plan to build in a way that generates cancer-causing construction dusts and then have to deal with the consequences. The figures speak for themselves.”

The Society’s President added, “There is so much focus on the immediate hazards that we miss the big dangers that are looming for us in the future and the huge opportunity we have to enable people to age well, not to be dependent on sickness benefits and work without fear.”

The Society is calling for a national dialogue and government focus on:

  • designing out health risks at work

  • research on prevention and control of workplace health hazards

  • using an understanding of human factors and their role in helping people manage their own health protection at work

  • targeting enhanced occupational health services to those who need it most

  • embedding occupational hygiene and occupational medicine in mainstream healthcare training and education

  • working with healthcare professionals to develop a whole life strategy for managing occupational health and occupational hygiene exposures.

Kevin Bampton, CEO of BOHS said, “People would be surprised that in the 21st century, we are still missing obvious opportunities to curb the risk of being exposed to common hazards. We can so easily avoid so many cruel illnesses that will rob thousands of the loved ones and cost the country billions in benefits, healthcare costs and lost work.

“At a time where the country’s finances are likely to be stretched for decades because of the cost of Covid-19, we need to be planning to avoid a continuing legacy of avoidable ill health. The measures don’t need to cost employers or the Government more. It just requires a different mindset. We find the case for sustainability in every aspect of our lives. It’s time it was a central feature of our workplace health strategies across the UK’s nations.”

BOHS is currently relaunching its industry partnership campaign on respiratory illness, Breathe Freely. It also plans to release a new White Paper, early in the new year, outlining the case for sustainable workplace health. The Society’s intention is to influence government and industry to plan for a healthy future for all workers.

Kelvin Williams who has led much of the Society’s response to coronavirus, said, “For many people, the workplace is the environment where we spend most of our waking lives. Lockdown has highlighted that how and where we work can be different.

“Covid-19 has demonstrated that this is the place in our lives where our exposure to health hazards can be most effectively regulated. It does not take a great amount of imagination to envisage UK becoming the global leader in sustainable workplace health technology and practice, based on what we have achieved over the period of the pandemic. That would be a worthwhile legacy of this painful time in our history.”

At the time of writing, HSE analysts are putting in place plans to assess the influence in 2020/21 which will cover the key impacts of Covid-19.

Inevitably, as with any major shock or change, the effects will become clearer with time.

However, there is a great deal employers and managers can do, now, to prevent avoidable cases of ill-health.

Employers will need to assess the major health risks and control them effectively, being scrupulously mindful of the hierarchy of the pillars of risk control.

It is with good reason that BOHS has highlighted designing out health risks at work as such a crucial part of worker health protection.

Complete elimination of risks ― by redesigning a job, for example ― should always come first in the hierarchy, while solutions such as personal protective equipment and clothing should be considered last of all. Other options of course will include substitution of materials or processes, engineering controls and administrative measures.

Equally, in the context of work-related stress, the HSE Management Standards can help employers to identify and manage six areas of work design which can affect stress levels: demands, control, support, relationships, role and change.

All of these factors can be worked into the health risk assessment process in large and small organisations.

Such an approach will certainly require an extended outlook, embracing complexity, rather than a stop-gap attitude but ― to reiterate the advice of the BOHS ― if managers and employers are prepared to change their mindset from a short-term view to a long-term preventative one, even in the face of the immense pressures of the coronavirus crisis, then the vision of sustainable workplace health may one day become a reality in the UK.