Feature

Prevention is better than cure

Simon Pickvance takes a radical look at occupational health

For peope involved in healthcare teams, primary prevention has come to mean identifying and advising individuals who are at risk, rather than identifying and eliminating the primary causes of ill-health. Real prevention should involve tackling the underlying causes effectively. Without such action, the undiminishing demands on the health service can bring disillusion and undermine our ability to defend the NHS.

Over the last 200 years social pressure for better working conditions has been instrumental in forcing legislation onto the statute books. But the 1974 Health and Safety at Work Act brought health and safety into the collective bargaining system.

Since 1974 innumerable small improvements have been won in every workplace and major restrictions have been placed on employers — especially on their use of asbestos and pesticides at work. There have also been controls placed on noise. In the long term these changes will result in a vase reduction in the demands placed on the NHS.

If the nature of work — the lack of control we have over it as workers and the conflicting demands of health and profit — is the underlying cause of much ill-health, what has the health and safety movement found to be an effective means of change?

The 1974 Health and Safety at Work Act made sufferers from occupational ill-health the agents of change; they were able to take up issues through their safety representatives at work.

Training given to Britain’s 100,000 or so safety representatives has frequently enabled them to challenge the scientific arguments used to set exposure limits to chemicals, noise and other hazards. A network of advice centres, area-based trade union safety committees, and a miriad of campaigns and broad networks, from the TUC to Hazard 88, have co-ordinated struggles.

But the movement has had its setbacks. In many workplaces there are no trade union or safety representatives.

The economic recession has sometimes forced a deterioration in conditions. New hazards have replaced old ones. While workers’ concern with conditions has increased, state regulations through the Health and Safety Executive has actually decreased.

The experience of the Sheffield Occupational Health Project (OHP) has stimulated projects in several parts of Britain to try to bridge the gap between prevention at work and the healthcare system.

The approach of the OHP workers is to first speak to patients in practice and health centre waiting rooms about their individual health problems, then look for the possibilities of their workmates or other sufferers tackling the cause together.

Because most people use the doctor’s surgery at least once a year OHPs have made surgeries their base, thus involving not only active safety representatives and trade unionists in health and safety issues, but retired and unemployed workers, or workers in poorly organised workplaces.

Careful record keeping has allowed OHP workers to pick up new patterns of ill-health related to patients’ work which had not been suspected before. In a recent survey Sheffield OHP found that one third of patients 16 years or over, visiting their doctor, had work-related health problems. For many these problems were the reason they were visiting the doctor on the occasion they were interviewed.

The experience of OHPs could form the basis for a new, radical, social prevention integrated into the health service but separate from and of equal standing to healthcare. The OHP approach could be applied to other health problems — caused by the food industry and social patterns of eating; housing provision and the building industry; environmental and domestic hazards (living near factories, incinerators or main roads and exposure to hazardous products like the pesticide Lindane).

The new preventers will have different skills from carers. They will need a knowledge of their field to challenge received ideas and to decode what they are told, as well as experience in organising for change at work or in the community. They should pass on skills to people they work with, rather than accumulate skills to defend their role. They will need to start by working with individuals in order to support groups at work or in the community. They should use the patterns of illness in groups of patients to inform these groups and other people of the experience they share.

Preventers and carers in health terms need to work together. Preventing a problem from recurring adds satisfactor to a carer’s work. The alternative - colluding with a system that prioritises care over prevention when resources are short — is being cruel by trying to be kind.