Introduction to Occupational Health

Original Editor - Jess Bell

Top Contributors - Jess Bell, Kim Jackson, Lucinda hampton and Tarina van der Stockt

Introduction

Occupational Health (OH) refers to the relationship between work and health.

The World Health Organization defines occupational health as: "an area of work in public health to promote and maintain highest degree of physical, mental and social well-being of workers in all occupations."

Iavicoli et al. describe occupational health professionals [OHPs] as individuals "who, in their professional capacity, carry out occupational health and safety tasks, provide occupational health services or are involved in an occupational health practice. OHPs therefore include occupational health physicians and nurses, factory inspectors, occupational hygienists and occupational psychologists, ergonomists, specialists in rehabilitation therapy, in accident prevention and in the improvement of the working environment, as well as those developing occupational health and safety research."

In essence, occupational health specialists aim to enhance a worker’s health status, increase the productivity of a workforce, improve business performance and the economy.

Various terms are used to denote this area of rehabilitation. Occupational Health is typically used to refer to individuals in work whereas Vocational Rehabilitation tends to be used when referring to those outside paid employment, but these terms vary across the world.

Occupational health specialists have specific training and experience to understand the link between health and work. This enables them to support both workers and employers. Occupational health focuses on three main objectives:

• Maintenance and promotion of workers’ health and working capacity
• Improvement of working environments to ensure that they are conducive to health and safety
• The development of work organisations/cultures in ways which support health and safety at work, promote positive social interactions and improve productivity

While many multidisciplinary professionals work within specialist roles within occupational health and vocational rehabilitation, more emphasis is needed by all physiotherapists and rehabilitation professionals on the importance of work factors to provide universal support to the working-age population.

"This is particularly important when you consider that many people will now be working well into their sixties or even seventies, so the likelihood of experiencing some health issues when working is high." -- Katherine Roberts

Why is Occupational Health Important?

"Economic, social, technical, and political drivers are fundamentally changing the nature of work and work environments, with profound implications for the field of occupational health."

Work is said to increase physical and mental health, enhance a worker’s sense of purpose, confidence, self-worth, independence and fulfilment. There is evidence to suggest that 'good work' is beneficial for health and that, for the majority of people, health can be enhanced by working.

Return to work post illness or injury should, therefore, be considered as an important outcome measure when exploring treatment options and the support of working age people.

The following facts highlight important trends in relation to work and injury / sickness.

• Five percent of all sickness absence will become long term (ie it will last more than 4 weeks) and this accounts for almost half of the total working days lost each year
• The longer a person is absent from work, the greater the chance that they will not return to work. eg. if an individual is absent from work for six months, there is an 80% chance that they will be out of work for five years, which comes at significant cost to the individual and society

• When poor work ability (physical or mental) is combined with one or more chronic diseases, there is an increased risk of long-term sickness absence in the working population
• The risk of long-term sickness absence gradually increases based on factors associated with work that has high physical demands

Of particular importance to physiotherapists is that alongside “stress, depression and anxiety”, “other musculoskeletal problems” are some of the most commonly reported reasons for long-term absence from work.

• Low back pain is associated with increased absenteeism from work
• Neck pain has high socioeconomic costs which are related to work absenteeism and medical expenses
• Long-duration neck / back pain which is activity-limiting may decrease work performance and lead to absenteeism and early retirement
• Persistent shoulder pain in adults aged 20 to 55 years has been found to impact work participation and productivity

There is also evidence that demonstrates connections between workplace health and well-being, the engagement of workers, resilience, and productivity. Seen in this light, it can be suggested that occupational health contributes "much more than the prevention of occupational diseases and illnesses; there is a strong business case to be made in terms of the productivity of organizations as well as the public health of communities."

What does an Occupational Health Specialist Do?

The occupational health specialist is involved in performing impartial and objective assessments that consider not only what is best for the employee, but also what is best for the employer.

• Important as an organisation’s success is strongly affected by the health and wellbeing of its workforce.
• Effectively managing the requirements of both parties is essential to ensure a productive outcome for all.
• This focus on both the patient and their employer sets occupational health apart from other areas of physiotherapy, where the focus is usually on the individual.

Not all employees have equal access to occupational health services. Employees working for larger organisations will be more likely to be able to access these supports, as will those working in the public sector versus those in the private sector, thus it seems important that all physiotherapists consider this area when creating treatment or rehabilitation plans.

Biopsychosocial Model

Occupational health uses the biopsychosocial (or bio-occupational-psycho-social) model rather than the biomedical model. It is widely agreed that health and illness are due to the interaction between biological, psychological, and social factors:

• Bio - a focus on the physiological pathology, levels of physical health or disability
• Psycho  - a focus on thoughts, emotions, and behaviours such as psychological distress, fear avoidance/beliefs and current coping mechanisms
• Social  - a focus on the social economical, social environmental and cultural factors such as work issues, family circumstances and economy based factors

All these areas are related and must be considered together for effective occupational health assessment and support.

More information on the biopsychosocial model is available here.

The Occupational Health Team

The occupational health team includes health professionals from a variety of backgrounds who work together to enable workers to return/remain in the workplace.

1. Occupational Health Physicians promote and protect the health and workability of workers. They focus on preventative medicine and management of illness, injury and disability related to the workplace.
2. Occupational Health Advisors are nurses with specialist training in occupational health. They often take on a case management role and will perform duties such as new starter health assessments, health surveillance and screening programmes such as audiometry, spirometry, vision screening, hand/arm vibration assessment and shift worker assessment.
3. Occupational Health Psychologists care for psychological well being of the individual. They are involved in supporting job satisfaction and the effectiveness of the organisation. Their role is diverse and can focus on education and training or one-to-one support and therapy. Similarly they may be involved in advising managers and decision makers on how best to support the mental health and well-being of employees.
4. Occupational Therapists in the workplace help employees overcome barriers that prevent them from participating in work. These barriers are varied and include issues such as illness, disability, social/institutional or physical environmental issues.
5. Occupational Health Physiotherapists are often involved in the assessment of return to work, functional rehabilitation, and other clinical treatment services. They may take on health promotion and education roles, risk assessment and training, health promotion activities, as well as being involved in managing long term conditions in the workplace. Physiotherapists working in occupational health have the scope to develop their own practice in different directions from risk management and interventions through to case management of long term conditions in the work place.

The roles of these professions often overlap and all may be first contact practitioners. They may also be supported by ergonomists, occupational hygienists, health and safety consultants, human resources and senior managers.

Relationship of Occupational Health to Physiotherapy

Physiotherapy has been found to be clinically and cost-effective in getting people back to work. While not all physiotherapists will become occupational health specialists, there is a need for all physiotherapists to consider the importance of work factors when assessing patients.

"If you are a physiotherapist for the working-age population, do you feel comfortable asking work questions relating to their health issue ...?" -- Katherine Roberts

Physiotherapists are well placed to ask these questions about work and to set goals focused on return to work. Examples of questions to guide you to assess the impact of an injury on work could include:

• What work duties are difficult as a result of your injury/condition/disability?
• What do you feel could be done to help resolve this issue?
• Which of your work tasks are you currently still able to undertake?

With careful questioning, physiotherapists can develop a picture of how work conditions may be aggravating a patient’s condition. Patients can also provide photos or videos of their work station to enable the physiotherapist to better understand the workplace. Many office workers spend prolonged periods in front of computers/laptops, so physiotherapists can provide information on stands, the use of an external mouse and keyboard, as well as providing postural advice and a simple exercise programme to do at work.

Physiotherapists can also consider blue flags (the worker's’ perception of work-related factors that impact disability) or yellow flags (psychological, behavioural and emotional health risk factors) that may be affecting a worker’s condition or engagement in the workplace. If unable to address all the relevant issues, a physiotherapist can then consider referring on for more specialist occupational health management.

Relevant Resources

The Association of Chartered Physiotherapists in Occupational Health and Ergonomics. Available from www.ACPOHE.csp.org.uk (accessed 13 April 2020).

International Federation of Physical Therapists working in Occupational Health and Ergonomics. Available from www.wcpt.org/IFPTOHE (accessed 13 April 2020).