Book extract
Supporting health at work: international perspectives on
occupational health services
edited by Peter Westerholm and David Walters
£35 softback
ISBN
978 0901357 39 7
Providing relevant and effective occupational health (OH)
services in the changing world of work is widely recognised as a
major challenge in most advanced market economies. Economic changes
that are occurring on a world scale and the efforts of states to
achieve or maintain competitiveness in global markets create new
environments in which traditional approaches to requiring or
supporting service provision for OH are no longer seen as
appropriate. In many countries, the shift away from the regulatory
state to one in which the state is a facilitator of free market
initiatives has produced many contradictions, some of which are
directly relevant to the provision and role of OH services. Change
in the structure of work and the labour market offers further
significant challenges to the coverage and operation of traditional
provision. In addition, the nature of the relationship between work
and health is increasingly regarded as considerably more complex
than in the past. Negative health outcomes have changed as
employment has shifted away from heavy industry towards services;
this has led, for example, to a reduction in cases of traditional
occupational diseases but parallel increases in stress-related
conditions. At the same time, greater attention is being paid to
providing support for keeping people in work and returning to
productive employment those who have left work for health reasons.
In these latter scenarios, traditional views of the negative
effects of work on health are to some extent being reoriented to
accommodate notions of positive effects that productive economic
activities have on the health and wellbeing of individuals in
modern societies.
Clearly all these changes have significant implications for the
nature of support for maintaining the health and wellbeing of
people at work. They affect the aims of such support, its targets
and priorities, the way in which it is delivered and its coverage.
They also concern the roles and expected contributions of health
professionals and the meaning of OH prevention, as distinct from OH
curative or reparative programmes or activities. It is to examine
these implications for OH service provision in a range of countries
that this volume has been compiled. But we hope to offer something
more than a description of service provision. There are critical
matters of evaluation, quality and scale of service provision that
need to be addressed in order to understand the issues involved in
providing professional health services to companies and
organisations in production and services in the modern world of
work. These matters further include the challenges involved in
interacting with management and executives of client organisations,
the staff they employ and the trade unions to which the staff may
belong.
A shift has occurred in some countries away from
state-subsidised services to market-based provision. It is
important to know what the impact of this change has been on the
nature of the services now offered and their quality. In this
context, there are important issues of evaluation to address, as
well as strategic approaches to ensuring quality in changed
circumstances of delivery in which, for example, it cannot be
assumed that client satisfaction will necessarily always be the
best measure of how OH services support the health needs of
workers.
Equally important is the question of support for health
professionals engaged in service provision. Beginning with the
nature of education and training of professionals and the adequacy
with which it reflects current issues, concerns are also evident in
relation to continuing training and professional development as
well as to changes in the qualities and competences that are
relevant and required to provide support for OH in the modern
economy. How or to what extent these issues are addressed in
different countries is therefore of considerable
interest.
More generally, there are questions that can be asked about the
nature of evaluation of provisions and practices in different
countries and the evidence base for policy development in OH.
Changes that have taken place in the organisation of provision are
partly dictated by markets, but the state obviously has not been a
passive player in this process. There are therefore important
questions for macro-level analysis of state policies on health
services and the role of support for health at work within these
policies. Rhetorical links between workplace health support, work
retention, return to work and rehabilitation have been made in
recent governmental policies in some countries. But what is the
reality of practice at the workplace level? Here too, major
questions should be addressed to micro-level evidence and
evaluation in each country as well as to questions of regulation
and market liberalisation in OH. While there is little dispute that
productive and paid work is overall a more healthy situation than
unemployment, the quality of such work and the support that makes
it safe and without risks to health for all workers are important
aspects in which there is a central role to be played by preventive
services. Significant issues about practice also concern, for
example, relationships between the preventive work environment
functions of OH services and those needed to support rehabilitation
and return to work, and the extent to which these functions are
integrated or separated at the level of the workplace and service
provider.
A further related but relatively unexplored area concerns the
role of workplace health promotion (WPHP) in ensuring improving
health at work. The evaluations in this book allow a degree of
comparative analysis of a number of important questions, such as
the extent to which approaches to WPHP exist in different
countries, how they are linked to other means of support for health
improvement at work, and what the roles and responsibilities of
employers are in such essentially public health issues.
Linked to all these questions, of course, is the challenge of
coverage of OH services in the modern economy. It is widely
recognised that the trend away from work in large stable
organisations in which the employment relationship is legally
defined creates major challenges to traditional approaches to the
management of health and safety in general. In terms of OH service
provision, it is important to review what is known about support of
this kind for workers who are employed in small enterprises, or in
other contingent and peripheral forms of employment, since it is
clear that in many respects the health of these workers is
particularly vulnerable.
This book is devoted to consideration of these issues in OH
service provision across a range of countries, representing a
variety of different responses to challenges presented by modern
economic change in advanced market economies. In each case, the
authors have provided a rich source of description and analysis of
the national situations with which they are familiar in their
respective countries. Not all changes or their consequences are
evident to the same extent in all countries. At a descriptive
level, one clear feature that emerges from the accounts is that of
variation in national approaches. At the same time, however, there
are strong signs of convergence. Generally, research on all the
issues outlined above is relatively underdeveloped. Therefore
contributions often raise more questions than answers. This is
inevitable and, indeed, to be welcomed, if such questions help to
give a clear pointer to future needs.
As a result, we have a unique contribution to the literature on
OH service provision, in which the role of the state and the
market, professional standards and competences, the position of OH
services in public health support more generally, and issues of
quality and effectiveness are addressed. For British readers, such
a contribution is particularly timely since policy development and
the changing focus of support for work and health has been
especially prominent in recent times. The international nature of
the content of the present volume therefore provides an important
source of comparison and contrast that is relevant to current
debates in the UK. However, such relevance is by no means
restricted to British experiences. Indeed, the issues covered in
the following pages have widespread international application and
provide a firm bedrock for future analysis of the quality and
development of OH service provision in all modern economies.
This book consists of a series of contributions describing and
analysing developments in OH service provision in Austria, the
Czech Republic, Denmark, Finland, France, Germany, the Netherlands,
Norway, Sweden and the UK (where separate accounts are given for
experiences in England and Scotland). We have also included a
contribution from Japan, which offers some interesting comparisons
from outside Europe. There are two comparative and analytical
chapters. In the first of these, Laurent Vogel presents some
thoughts on the state of OH service provision in Europe and on the
wider implications of the national contributions. The volume
concludes with an overview from Peter Westerholm, who played a
major role in selecting and editing the national contributions,
which offers further reflections on the range of issues
addressed.
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