THE FOLLOWING THE FOLLOWING LECTURELECTURE HAS BEEN APPROVED FORHAS BEEN APPROVED FOR

ALL STUDENTSALL STUDENTSBY BIRMINGHAM CITY UNIVERSITYBY BIRMINGHAM CITY UNIVERSITY

health.bcu.ac.uk/craigjackson

This lecture may contain information, ideas, concepts and discursive anecdotes that may be

thought provoking and challenging

Any issues raised in the lecture may require the viewer to engage in further thought, insight, reflection or critical evaluation

Occupational Occupational ill-healthill-health

People are made sick People are made sick by the work they doby the work they do

Dr. Craig JacksonDr. Craig JacksonProf of Occupational Health PsychologyProf of Occupational Health Psychology

Education Law & Social SciencesEducation Law & Social SciencesBCUBCU

www.health.uce.ac.uk/craigjacksonwww.health.uce.ac.uk/craigjackson

““When you come to a patient’s house, you should ask him what sort When you come to a patient’s house, you should ask him what sort of pains he has, what caused them, how many days he has been ill, of pains he has, what caused them, how many days he has been ill, whether the bowels are working and what sort of food he eats. So whether the bowels are working and what sort of food he eats. So says Hippocrates. says Hippocrates.

I may venture to add one more question: what occupation does he I may venture to add one more question: what occupation does he follow? ” follow? ”

Bernard Ramazinni (1633-1714)Bernard Ramazinni (1633-1714)

The Godfather of Occupational DiseaseThe Godfather of Occupational Disease

Return to WorkReturn to Work

Longer off work = Less likely to return to workLonger off work = Less likely to return to work%

retu

rnin

g to

wor

k

10 2

0 3

0 4

0 5

0 6

0 7

0 8

0 9

0 10

0

months not working

<1 2 4 6 8 10 12 14 16 18 20 22 24

Waddell, 1994Waddell, 1994

Regional PictureRegional Picture

Self-reporting?Self-reporting?

Who’s best off?Who’s best off?

Who’s worse off?Who’s worse off?

Work Related Ill-Health in the UKWork Related Ill-Health in the UK

33 Million days lost per year33 Million days lost per year

Males lose more working days than femalesMales lose more working days than females

Days lost increase with ageDays lost increase with age

Low managerial / professionals had highest rate of absenceLow managerial / professionals had highest rate of absence

Most sickly occupations are health & social welfare, construction, teaching,Most sickly occupations are health & social welfare, construction, teaching,and researchand research

Work Related Ill-Health in the UKWork Related Ill-Health in the UK

Bakers appear highly with occupational asthmaBakers appear highly with occupational asthma

Metal workers appear highly with upper limb problemsMetal workers appear highly with upper limb problems

Mesothelioma deaths high in shipbuilders and asbestos workersMesothelioma deaths high in shipbuilders and asbestos workers

Stress, depression and anxiety highest in:Stress, depression and anxiety highest in:Public admin. Public admin. DefenceDefenceEducationEducationHealth workHealth workSocial workSocial work

China & EgyptChina & Egypt

History of Occupational IllnessHistory of Occupational Illness

Stone-age was first age of occupational riskStone-age was first age of occupational risk

Iron-age and smelting worsened thisIron-age and smelting worsened this

Mining in Egyptian period: worse job goingMining in Egyptian period: worse job going

Bernardino Ramazzini (1633-1714).Bernardino Ramazzini (1633-1714). DeMorbis Artificium DeMorbis Artificium

Industrial Revolution UK. Industrial Revolution UK.

Factory Act. 1802Factory Act. 1802

Annie Bessant. MatchworkersAnnie Bessant. Matchworkers

Sir Thomas Legge (1863 – 1932) 1Sir Thomas Legge (1863 – 1932) 1stst Inspector of Factories Inspector of Factories

1848 – Factory act1848 – Factory act

1848 – Factory act1848 – Factory act

1848 – Factory act1848 – Factory act

EnglandEngland

England: Black CountryEngland: Black Country

England: Black CountryEngland: Black Country

England: Black CountryEngland: Black Country

Photo courtesy of Institute of Rural Health Photo courtesy of Institute of Rural Health

England: Black CountryEngland: Black Country

Photo courtesy of Institute of Rural Health Photo courtesy of Institute of Rural Health

England: Black CountryEngland: Black Country

Photo courtesy of Institute of Rural Health Photo courtesy of Institute of Rural Health

England: Black Country – environmentally friendly?England: Black Country – environmentally friendly?

Photo courtesy of Laurie Leeming-Latham of MOHS Photo courtesy of Laurie Leeming-Latham of MOHS

England: Black Country – environmentally friendly?England: Black Country – environmentally friendly?

Photo courtesy of Alastair Robertson Photo courtesy of Alastair Robertson

Mystery Health Problems ?Mystery Health Problems ?

Mystery Health Problems ?Mystery Health Problems ?

Economics of Scale - Solway HarvesterEconomics of Scale - Solway Harvester

Photo courtesy of Dr Gordon Baird Photo courtesy of Dr Gordon Baird

Numerical %

Isle of Whithorn 7/300 2.3

Wigtownshire 7/20,000 0.03

London 7/6,000,000 0.00001

Solway HarvesterSolway Harvester

Equivalent to 7 people from WigtownshireEquivalent to 7 people from Wigtownshire

Equivalent to 120,000 people from LondonEquivalent to 120,000 people from London

Not just the crappy jobs. . .Not just the crappy jobs. . .

Pleural thickening Pleural thickening

Pleural thickening Pleural thickening

Testing Workers’ Lung FunctionTesting Workers’ Lung Function

Core Occupational Diseases (EU)Core Occupational Diseases (EU)

ChemicalChemical ChemicalChemical BiologicalBiological PhysicalPhysical PhysicalPhysicalInorganicInorganic OrganicOrganic DustsDusts OthersOthers

CadmiumCadmium CSCS55 ZoonosesZoonoses AsbestosAsbestos RadiationRadiation

ChromiumChromium BenzeneBenzene HepatitisHepatitis Silica(te)Silica(te) NIHLNIHL

MercuryMercury ChlorineChlorine TBTB MesotheliomaMesothelioma

CataractCataract

ManganeseManganese AromaticsAromatics VibrationVibration

NickelNickel P.aromaticsP.aromatics

DermatitisDermatitis

LeadLead IsocyanatesIsocyanates

2121stst Century Workplaces Century Workplaces

• Global companies and operationsGlobal companies and operations

• Leaner & Meaner managersLeaner & Meaner managers

• Gender issuesGender issues

• Disability issuesDisability issues

• Migrant issuesMigrant issues

• Longer & less fixed working hoursLonger & less fixed working hours

• Shorter contractsShorter contracts

• Dirty jobs out-sourced Dirty jobs out-sourced

2121stst Century Workplaces Century Workplaces

The World of Work and PeopleThe World of Work and People

• More complexMore complex

• Illness + Disease FocusedIllness + Disease Focused

• Health & Safety ObsessedHealth & Safety Obsessed

• Market-forces DominatedMarket-forces Dominated

• Quality Management DrivenQuality Management Driven

• SMEs PredominantSMEs Predominant

• Mass productionMass production

• Low Skills or Training required = low payLow Skills or Training required = low pay

2121stst Century Workplaces Century Workplaces

Current Sources of Occupational Ill-HealthCurrent Sources of Occupational Ill-Health

ChemicalsChemicals

GassesGasses

DustsDusts

ParticlesParticles

LightLight

HeatHeat

NoiseNoise

VibrationVibration

StressStress

RadiationRadiation

Slips, trips, fallsSlips, trips, falls

Working hoursWorking hours

ErgonomicsErgonomics

Troublesome OccupationsTroublesome Occupations

Top 5 Modern Day Occupational Health ProblemsTop 5 Modern Day Occupational Health Problems

Hearing Loss (NIHL, TTS)Hearing Loss (NIHL, TTS) Industry, Drivers, Emergency workIndustry, Drivers, Emergency work

Respiratory ProblemsRespiratory Problems Asbestos, Industry, RecyclingAsbestos, Industry, Recycling

Skin ProblemsSkin Problems Nurse, Hairdressers, IndustryNurse, Hairdressers, Industry

Mental Health / Stress / AnxietyMental Health / Stress / Anxiety Office workersOffice workers

Musculoskeletal problemsMusculoskeletal problems Office, Drivers, Industry, ConstructionOffice, Drivers, Industry, Construction

Work Related Ill-Health in the UKWork Related Ill-Health in the UK

MSDs and Stress show little change since 2002MSDs and Stress show little change since 2002

Mesothelioma deaths and Asbestosis slowly riseMesothelioma deaths and Asbestosis slowly rise

Asthma and Contact Dermatitis show little changeAsthma and Contact Dermatitis show little change

Occupational infections high in 2002 – diarrhoeal diseaseOccupational infections high in 2002 – diarrhoeal disease

Occupational Deafness slowly decliningOccupational Deafness slowly declining

Who is susceptible to stress ?Who is susceptible to stress ?

“ “Veal – Fattening Crate”Veal – Fattening Crate”

““Small, cramped office workstations built of fabric covered disassemblable Small, cramped office workstations built of fabric covered disassemblable wall partitions and inhabited by junior staff members. Named after the small wall partitions and inhabited by junior staff members. Named after the small pre-slaughter cubicles used by the cattle industry”pre-slaughter cubicles used by the cattle industry”

Douglas CouplandDouglas Coupland

The New Millennium – The Existential AgeThe New Millennium – The Existential Age

• StressStress

• Post Traumatic Stress DisorderPost Traumatic Stress Disorder

• Chronic Fatigue SyndromeChronic Fatigue Syndrome

• Multiple Chemical SensitivityMultiple Chemical Sensitivity

• Diffuse Pain Syndromes (RSI, MSD, WI)Diffuse Pain Syndromes (RSI, MSD, WI)

• Non-Specific Effect ModifiersNon-Specific Effect Modifiers

• Psycho-ImmunologyPsycho-Immunology

Professional MeddlingProfessional Meddling

Non-Specific SymptomsNon-Specific Symptoms

Often missed in assessmentOften missed in assessment

Prevalence of Non-Specific SymptomsPrevalence of Non-Specific Symptoms

Modern day complaintsModern day complaints

Multiple Chemical SensitivityMultiple Chemical SensitivityChronic Fatigue SyndromeChronic Fatigue SyndromeSick Building SyndromeSick Building SyndromeGulf War SyndromeGulf War SyndromeLow-level Chemical ExposureLow-level Chemical ExposureElectrical SensitivityElectrical Sensitivity

Historical complaintsHistorical complaints

Railway SpineRailway SpineNeurastheniaNeurastheniaCombat SyndromeCombat Syndrome

SymptomSymptom Prevalence % Prevalence %

Stuffy noseStuffy nose 46.246.2HeadachesHeadaches 33.033.0TirednessTiredness 29.829.8CoughCough 25.925.9Itchy eyesItchy eyes 24.724.7Sore throatSore throat 22.422.4Skin rashSkin rash 12.012.0WheezingWheezing 10.110.1RespiratoryRespiratory 10.010.0NauseaNausea 9.09.0DiarrhoeaDiarrhoea 5.75.7VomitingVomiting 4.04.0

Heyworth & McCaul, 2001Heyworth & McCaul, 2001

High EffortLow Reward

+High DemandLow Control

2x Substance abuse

2-3x Injuries

2-3x Infections

3x Back pain

5x Certain cancers

2-3x Conflicts

2-3xMental health problems

3xCardiovascular problems

Potential Health RisksPotential Health Risks

Shain 2001Shain 2001

What kids think of stressWhat kids think of stress

Stress Stress

Looks like a flaming deamon Looks like a flaming deamon Sounds like an eagle squaking Sounds like an eagle squaking Tastes like a burnt sausage Tastes like a burnt sausage Smells like sour milk Smells like sour milk Feels like stroking a hedgchog Feels like stroking a hedgchog Stress is when mum says NO!!!!! Stress is when mum says NO!!!!!

by Andrew (aged 10)by Andrew (aged 10)

Year 5Year 5

Potley Hill Primary SchoolPotley Hill Primary School

StressStress

Golden Age of StressGolden Age of Stress

Everyone is StressedEveryone is Stressed

BBCi - “Stress” = 16,000 findsBBCi - “Stress” = 16,000 finds

More people experiencing more stressMore people experiencing more stressGreater demands from employersGreater demands from employersPeople working longer hoursPeople working longer hours24 / 7 society24 / 7 society

World Wars I and IIWorld Wars I and IIWhere was stress?Where was stress?Possible evidence from dud shellsPossible evidence from dud shells

Karasek’s demand-control model of stress developmentKarasek’s demand-control model of stress development

lowlow high highjob demandsjob demands

job

co

ntr

ol

job

co

ntr

ol

low

low

hig

h h

igh

low strainlow strain

passivepassive

activeactive

high strainhigh strain

Risk of Risk of psychological psychological strain and strain and increased illnessincreased illness

Productive, Motivated

Karasek 1979

job

co

ntr

ol

job

co

ntr

ol

low

low

hig

h h

igh

Karasek 1979

job demands job demands

lowlow high high

activeactivelow strainlow strain

passivepassive high strainhigh strain

So what of Birmingham. . . ?So what of Birmingham. . . ?

• Local IndustriesLocal Industries

• Local populationsLocal populations

• Biggest Local Health ProblemsBiggest Local Health Problems

• Any Complicating / Confounding Factors?Any Complicating / Confounding Factors?

• What is Birmingham famous for?What is Birmingham famous for?

• What has Birmingham achieved?What has Birmingham achieved?

• Occ Ill-Health in your family?Occ Ill-Health in your family?

Occupational Alveolitis Occupational Alveolitis

Occupational Alveolitis Occupational Alveolitis

Not our problem anymore. . . . Not our problem anymore. . . .

““People who work sitting down get paid more People who work sitting down get paid more

than people who work standing up” than people who work standing up”

Ogden Nash (1902 - 1971)Ogden Nash (1902 - 1971)

A Final Truth A Final Truth