Sedentary occupations may still be classified as low risk, but the growing reality is that more and more people are cracking up, reports Anne Montague in London
WORK is a dangerous business. Every year, millions of people suffer ill health that is directly caused by, or made worse by, their jobs. And although hazardous occupations still carry the highest risk of injury, there is now growing evidence that even apparently safe, sedentary occupations may present a significant threat to health.
Traditional work hazards certainly haven’t disappeared. Construction remains a high-risk occupation. Many men are still dying as a result of cancers and other illnesses related to coal dust or asbestos – individuals paying the price for the poor safety standards of the past.
The number of people developing debilitating allergies, such as occupational dermatitis and asthma, seems to be increasing. Occupational asthma now affects up to 600 000 people both in high-risk industries like chemicals, plastics and pharmaceuticals. A recent Health and Safety Executive (HSE) investigation in Britain found that one in 10 of the underground construction workers on the new Jubilee Line extension in London is suffering from occupational dermatitis.
But as physical work dangers are reduced – there has been a dramatic drop in the rate of work-related injuries and fatalities over the past two decades – they are more than matched by a growing and more subtle threat: to people’s mental health. The European Community’s 1992 report on European health and safety at work identified stress and back pain as the most common health problems. After last year’s landmark case, when social worker John Walker successfully sued his employers for his nervous breakdown brought on by stress, the HSE emphasised employers’ legal responsibility for the mental as well as the physical health of their staff.
At the root of all this is a changing workplace. Between 1973 and 1993, employment in service sector occupations increased by nearly four million. “Workplace pressures have increased,” says Malcolm Harrington, professor of occupational health at the Institute of Occupational Health, Birmingham University. “There are fewer people doing more work and longer hours – there is this macho idea that if you’ve left the company carpark by 7.30pm you’re a wimp. We are living in a short-term contract world and people have a greater sense of job insecurity.”
Hi-tech offices pile on the pressure. “It used to take a day or two for a memo to reach you – now we have instant e-mail, which demands an instant response,” says organisational psychologist Dr Stephen Williams.
These pressures manifest themselves in any number of ways: depression, anxiety, panic attacks, irritable bowel syndrome, fatigue and headaches. Last month the Institute of Management reported that every day 270 000 people take time off work owing to job- related stress – at an annual cost of $10,9- billion. Some industries seem particularly vulnerable. Social services staff and, ironically, health workers, have higher than average sickness rates.
Increasing client and patient violence – in a recent Unison survey 40% of health service staff reported that they suffered violence at work – intensifies the pressure.
Andrew Thomas, formerly a medical liaison scientific officer in the haematology department of a Swansea hospital, recognised the dangers and got out. “In 16 years in the health service, I never worked less than 100 hours a week,” he says. “The pressure increased, with fewer people to do more work, and I realised I was becoming depressed.”
By January 1992, when he decided to leave, he says he would have taken any job, just to get out. He has now retrained as a solicitor.
The shifting pattern of job-related risk is being recognised by the insurance industry. Sedentary occupations are still classified as low risk, while jobs in industries like construction carry the heaviest weighting; but work pressures are affecting premiums.
“Stress-related disorders are increasingly a feature of disability claims,” says Alex Isted, underwriting manager for Munich Reinsurance in the UK. “It’s happening across a range of occupations – teachers are a good example. It’s not just the increasing physical hazards of the job. Additional mental strains on teachers bring their risk level closer to that of the light manual worker.”
Colin Foster (not his real name) knows all about those stresses. A late entrant to teaching, having given up a career in the insurance industry to retrain, he has retired after 20 years because of ill health. “I was totally committed to the children and loved my job,” says Foster, now 53. It was in the early Nineties that the strain started to show. “It was a constant battle with the system. There was intense pressure on resources – there was no management support and morale was very low,” he says. Foster started visiting his GP regularly. His blood pressure went up, he developed stomach problems, vomiting and insomnia.
At first he didn’t link his ill health with work. “Then in October 1994, my doctor asked me if I’d consider leaving teaching because it was badly affecting my health.” At first Foster resisted, but as he became more ill, he realised that he had to get out. He retired earlier this year.
It is becoming a familiar story. Within the last eight years, the numbers of teachers retiring as a result of ill health has more than doubled. Dr Albert Ferrante is a family doctor in London; his patients are traders, bankers and other professionals.
`People come in here complaining of irritable bowel syndrome, concentration difficulties, depression, fatigue, palpitations, chest pain and low back pain. What they’re exhibiting are the physical manifestations of stress,” Ferrante says.
“The old coping mechanisms – the drinking, the collegiate atmosphere where Bill helped Fred who wasn’t managing very well – have gone. Companies have trimmed down, there’s no one to take your problems to. The global market means that some people have to be in a high arousal state 24 hours a day.”
What makes the current situation so alarming, according to Harrington, is that there is virtually no area of work that is unaffected. “It is getting worse,” he says. “And the quick-fix reaction – send the employees on a stress-management course or to see counsellor – will no longer do.” The answer, according to Williams, lies in good job design, improved management and a work culture that enables people to admit to, and deal with, stress.
It is starting to happen. Seven years ago, telecommunications giant Cable & Wireless (C&W) developed an integrated occupational health programme, which encourages every employee to complete a pressure management indicator once a year. This provides information about how people are coping.
The result, says Dr Robert Wilcox (C&W’s occupational physician), is a work culture where people are not afraid to admit problems, feel a responsibility for the solution and, importantly, have a real sense of control. The programme has cut both sickness rates and stress levels. “I would say that we have actively prevented about 1% of our employees from cracking up,” Wilcox says.
18