Feature

Just part of the job?

Pam Wagstaff looks back on the first year’s work of a project aimed at improving workplace health

The Camden Occupational Health Project (COHP) started in January 1990 and the first patient interviews took place in March. COHP was developed by representatives from trades unions, health promotion, environmental health, community work and general practice. Its management committee still reflects these interests and provides the project with the kind of contacts it needs to implement appropriate preventative and remedial action on work-related ill health.

Initial reactions to the project were frequently sceptical: occupational health was not regarded as a serious issue in an area without traditional heavy industries. Most people in Camden are employed in the service sector or in small workplaces. But that’s the case everywhere — and small workplaces have high rates of occupational disease and accidents. They are frequently not registered and therefore unlikely to receive a visit from an enforcement agency. The likelihood of registered workplaces being inspected is small in any case, as staffing levels are too low to ensure adequate rates of inspection. Nor are small workplaces likely to have recognised trade unions, so there will be no safety representatives with rights under the Health and Safety at Work Act.

Occupational medicine is given low priority in medical education. Few GPs see it as their role to refer patients to appropriate agencies if they suspect that work is at the root of the problem. Project workers have the time to talk in detail with patients about health and safety issues and to complete an occupational history which stays in their medical records. This data can help GPs make a better diagnosis and provide the most appropriate treatment. For most patients, this is the only chance they have to reflect on the possible effects their job may have on their health. It is usually the only time they have been approached in a doctor’s waiting room by someone who wants to interview them — and at first they may be rather wary that the ‘authorities’ are checking up on them.

Although a few people do refuse to go ahead with the interview, this is often because — understandably — they feel too ill.

Initially, patients tend to say that they have no health problems as a result of their work. Almost as frequently it becomes obvious that they take for granted a range of ill effects as ‘part of the job’. Patients often believe these problems are their own fault and put them down to having an ‘allergic skin’ or ‘weak back’.

When patients mention particularly hazardous workplaces, they are encouraged to contact the local environmental health department, or the Health and Safety Executive These agencies may be contacted on the patient’s behalf and inspections carried out. Quite a small proportion — about 25% — belong to trade unions and these patients are urged to speak to their health and safety representative or shop steward about the problem. Once project workers have established that a particular hazard exists for an occupational group, they contact the relevant union to alert them to the problem or find out what action has already been taken. COHP is pursuing the possibility of training on hazard prevention for specific groups, including home helps, cleaners, caretakers, office workers and postal workers.

Additional ways of following up the concerns of patients who are not union members need to be explored. These may include meetings or courses for women and for minority ethnic groups who are already in contact with community health workers.

COHP has been aware from the start that there are large numbers of people from minority ethnic groups in Camden and that they often face poor working conditions. Many attend the small number of GP surgeries or community health facilities where their mother tongue is spoken and there is less chance of health problems being compounded by language barriers.

If our activities are limited to a small number of surgeries these communities will not necessarily be served, so other ways of working with ethnic minority groups are being explored. Our success in this area will be independently assessed in the 3-year review of the pilot period, by Dr. Anne Cockcroft, professor of occupational medicine at the Royal Free Hospital.

COHP also plans to educate health workers about the effects of workplace hazards. A data base is currently being developed by COHP to build up a profile of work-related ill health in Camden — which can then be brought to public attention.

During the first six months of the project, over 650 patients have been interviewed in three GP surgeries — and at least half had suffered ill health as a result of their work. They reported many different hazards, including a wide variety of chemicals, dust, noise, unsafe machinery and equipment and a working environment which was uncomfortable and possibly unhealthy. A number of people said they were at risk of assault or harassment in their work, and many worked long or unsocial hours.

The project has already achieved one notable success: following an interview with a local authority worker about the hazards of solvent-based paints, COHP advised workers that the paints could cause damage to the nervous system and were known to increase the risk of cancer. As a result of action taken on this advice, the painters gained an agreement that solvent-based paints would be phased out in favour of water-based ones recommended by a recent Health and Safety Executive leaflet.