On April 29, the III CiSAL (Occupational Health Research Centre) and Park Salut Mar Health Service meeting took place in the PRBB Auditorium, a meeting that filled the room from wall to wall. These annual meetings consist of an open conference, a round table, and a poster session for students. Fernando Benavides, coordinator of the Public Health and Education in Health Sciences programme at the CEXS-UPF and organiser of the meeting, tells us about it.
What was the topic of the meeting?
The meeting centred around seeing work as a source of health, physical, psychological and social welfare. The job has traditionally been seen as a source of accidents and disease, but it should not be seen as a ‘punishment’: it is a source of wellbeing. Not only because it provides income, but because it gives you identity, civic responsibility and personal satisfaction.
If work is health, we’re going wrong …
A society like ours, with 27% unemployment, is a sick society. In Spain today there are 2 million households with no income. And unemployment affects health – there are studies that show that the unemployed have a 15-20% higher risk of premature death, especially because of cardiovascular and mental problems. Therefore it is important to help the sick so that, as soon as possible, they can get back to work.
And this is what was presented at the conference by the speaker.
Ewan B. Macdonald, professor of occupational medicine at Glasgow University, has a programme to improve the physical and mental health of unemployed and increase their odds of finding a job. Because, for example, if you go to a job interview and you are sick you are less likely to succeed.
Tell us about the model this programme is based on.
The biopsychosocial model says that, in addition to biological and biomedical aspects, psychological and social issues are also important in health and disease. They can influence depression, but also cancer and other non-mental illnesses, not only etiology, but also prognosis. Today, for cancer, treatment followed by return to work has a better prognosis than being treated and not going back to work!
Give us an example of what can be done from the workplace.
The Hospital del Mar is becoming a reference model in the healthcare environment with regard to occupational health. Among other challenges, it has managed to reduce sick leave from 6 to 4%. How? By offering individual treatment of cases, introducing flexible hours, flexible types of job, and so on, to encourage the staff to keep working whilst caring for their health. They are also working on prevention, making ergonomic design changes to prevent musculoskeletal problems, the primary cause of absence from work, and which greatly affect quality of life.
How has the perception of occupational health changed over recent years and what do you think the future is?
Companies have become more interested, partly due to ‘obligation’, as there are European regulations to comply with, but also because they see the benefits and have realised that their workers are more efficient and productive. We have to reinvent occupational health, not only to prevent the negative aspects of work, but to enhance the positive aspects, creating healthy environments. The participation of workers is a key element in achieving this goal.
In the context of the current global economic crisis, it escapes nobody how important it is to have a job and the effect of a country’s welfare system on those who don’t have one. But perhaps one doesn’t always think on the effect this can have, specifically, on one’s health. A recent review published in Health Policy shows how country-level welfare regimes may be an important determinant of employment-related health.
The authors analysed 104 original articles published between 1988 and 2010 on job insecurity and precarious employment. They classified each study according to a six-regime welfare state typology: Scandinavian, Bismarckian (which includes countries such as Germany, France, Italy, Spain, Austria, Switzerland, the Czech Republic, Slovakia, Hungary and Poland), Southern European, Anglo-Saxon, Eastern European, and East Asian.
Their results show how, for example, precarious workers in Scandinavian welfare states report equal or even better health status when compared to their permanent counterparts. By contrast, precarious work in the remaining welfare state regimes is found to be associated with adverse health outcomes, including poor self-rated health, musculoskeletal disorders, injuries, and mental health problems.
The review was led by Joan Benach, head of the Health Inequalities Research Group (GREDS-EMCONET) of the UPF and also a member of the Spanish CIBERESP. Colleagues at the Bloomberg School of Nursing, University of Toronto, in Canada, collaborated. The authors state that future research on how macro-economic processes, country-level welfare factors, and individual employment histories and environments relate to employment-related health inequalities should be conducted.
Kim IH, Muntaner C, Vahid Shahidi F, Vives A, Vanroelen C, & Benach J (2011). Welfare states, flexible employment, and health: A critical review. Health policy (Amsterdam, Netherlands) PMID: 22137444