Feature

Bringing the world stage a little nearer home

The government is a signatory to the World Health Organisation’s Health for All strategy. Trade unions should capitalise on this to consolidate their health promotion role, say Frances O’Grady and Belinda Pratten

In 1978-9 the World Health Organisation (WHO) launched its strategy for Health For All by the year 2000. It is a strategy that should become a focus for all trade unionists with a concern for healthcare. The principles of Health For All (HFA) call for a reduction in health inequalities and for public participation in the design and implementation of local health targets.

As a Member State of the WHO, and a signatory to Health For All, the UK government is committed to this strategy. This commitment offers trade unions an international — and more specifically a European — stage to press for action by government and employers to improve the health of working class people. Trade unions have long been involved in campaigning on health issues. In recent year such campaigning has focused on defending the NHS, tackling hazards at work, taking up public health issues and pressing for workplace health services such as on-site cancer screening.

HFA provides a framework for trade union to build on the popularity of a collective approach to securing these aims and can impress upon public opinion the role of trade unions as health promoting organisations.

In its evidence to the Thatcher review of the NHS, the TUC used the government’s commitment to Health For All to argue for more resources for the NHS and for the extension of universal health services based on need. NHS trade unions have used research on local health needs and Health For All targets to argue successfully against cuts in jobs and NHS service provision, (eg the submissions of health service trade unions to health boards in the north of Ireland).

HFA can also provide a focus for work-related health problems. The true extent of work-related health damage in Britain is unknown. But it is estimated that between 8,000 and 20,000 people die each year due to occupational causes, and even this does not take into account the large amount of chronic health damage that drastically effects the quality of life of hundreds of thousands of workers.

WHO has long recognised the direct and indirect relationship between the organisation of work, the nature of the work process and health. The HFA strategy provides a practical confirmation of the preventive approach and may prove to be a useful lever in the campaign for the extension of occupational health services. In Britain most of these services are private and up to a half of the workforce have no occupational health cover. Those working in small establishments (mostly women) and workers in the private sector enjoy least protection.

Moreover, health and safety at work is one of the few remaining elements of contract compliance that remains lawful in the awarding of tenders by local and health authorities. The importance of developing a health perspective for campaigns on privatisation and contracting out is widely recognised.

Ealing council, in Middlesex, has pioneered a training package jointly with the general workers union GMB, aimed at equipping cleaning workers with skills necessary to win a tender for the councils cleaning contract. The GMB and environmental health department have made inputs into the training course, focusing particularly on health and safety and job specifications. The course also serves to raise the health promoting value of (mainly black) women’s low paid, domestic work. This training model has been adopted by Haringey and Sheffield council in relation to school meals workers, and could also be usefully adopted elsewhere.

Public health action in the workplace is an effective means of contracting and providing health services to those who bear the brunt of health inequalities. From on-site cancer screening services to training programmes, research shows that the workplace can be an effective vehicle for health promotion work.

In Oxford the city council health unit is planning an on-site cancer screening programme for employees and is negotiating with the health authority to ensure testing and back-up support is provided by the NHS.

In Leeds, a joint initiative between trade unions, the council’s health unit and its equal opportunities unit secured local authority funding for training for women lay officials to contact and encourage take-up cancer screening services. Hundreds of women were screened and four required treatment. The project also strengthened the position of women trade unionists.

These are just some examples of the way in which trade unions have been able to work within the Health For All strategy to improve the health of their members.

Through this strategy they have been able to consolidate their role in promoting health and reducing inequalities and to work with other agencies to achieve such exciting, positive and innovative initiatives.