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don't add up
Britain is facing an occupational disease epidemic, but you wouldn’t know it from the official statistics. Whether it is cancer or heart disease, strain injuries or neurological disorders, work is claiming a massive, deadly and largely ignored workplace toll. And if you don’t count the bodies, the bodies don’t count.
A headcount of 2.2m sick as a result of their work with 600,000 new cases in a single year might sound like a lot (1). But research shows conclusively this best available Health and Safety Executive (HSE) estimate is a gross under-estimate of the real incidence of many common workplace diseases and utterly misses many others. The end result is that occupational ill-health has become Britain’s biggest, most easily prevented, public health disaster.
Ignoring Britain’s occupational health calamity is nothing new. There are people in their 50s who joined the job market before noise was accepted by the government in 1963 to be a work-related problem.
Many more, workers in their 40s, started work before vibration white finger was recognised in 1976. In the 1980s it was repetitive strain injuries that got the denial treatment; in the 1990s, stress. Some common conditions, like work-related neurological disorders, don’t even appear on the UK work disease scoresheet.
The government’s new occupational health flagship project, Workplace Health Direct, has one major underlying assumption – new cases of occupational disease are a rarity (2). It is not a view shared by all.
Dr Joe LaDou, editor of the International Journal of Occupational and Environmental Health, has warned: “Never in history has there been as much occupational disease as exists in the world today” (3).
Much of the growth is in developing countries, but some of it is because of population growth in developed nations, coupled with the hazardous legacy of old industries and the emerging problems of new jobs and new work methods – work intensification and increasing job insecurity, relatively new industries like microelectronics where serious problems are only just becoming evident and the unprecedented quickfire introduction of more hazardous substances and new substances to workplaces.
Dr LaDou concludes occupational illnesses and injuries are among the five leading causes of sickness and death in the United States.
The top causes of death in the UK are the most common work-related health conditions - cancer, chronic respiratory disease, and circulatory disease - and the workplace is a substantial contributor to the overall mortality from these conditions (4).
Working it out
HSE figures suggest work-related ill-health is a relatively minor contributor to overall sickness and early deaths in the UK. However, research suggests otherwise. Hazards believes more realistic estimates of the work contribution could be:
And whereas LFS figures for 2003/04 suggested there were 160,000 workplace accidents, about four times this many people (over 600,000) became aware they had an occupational health condition in that year.
The European Foundation’s 2000 survey (4) found 7 per cent of UK workers – well over a million workers - reported they had been off work in the last 12 months as a result of occupational health problems.
However, just 23,000 new cases of occupational disease – just one per cent of those estimated to be suffering work-related ill-health in any given year and less than five per cent of new cases – were referred to specialist doctors, according to The Health and Occupation Reporting Network (THOR) (5).
This, combined with the UK’s notoriously poor occupational health service provision, means most people never get near a medical professional who might be qualified to make the link between their ill-health and their job. Where work is a contributory factor to ill-health, but not necessarily the sole contributor, the problem is worse still. Most statistical approaches fail to count accurately or at all these “related to” rather than “100 per cent caused by” cases.
This leads to an under-estimate of the contribution of work to many common conditions, including chronic respiratory disease, cancer and heart disease. Other work-related conditions, including a wide-range of potentially fatal health conditions, are omitted entirely from HSE’s reckoning.
HSE’s headline figure for the number of people suffering work-related ill-health, 2.2 million, indicates about 5 per cent of UK adults who have ever worked are suffering a work-related health problem as a result.
But the HSE figures, gleaned from the Labour Force Survey, suggest a figure a fraction of that found by the European Survey of Working Conditions. The findings, published in 2003, indicated 60 per cent of workers had work-related health problems (5). Community and other studies suggest the LFS figures frequently fall a long way short of the mark.
HSE’s statistical report for 2003/04 notes: “The estimated prevalence of stress and related (mainly heart) conditions increased during the 1990s and appears to have levelled off since 1998/99, at around double the level of 1990.” Even by HSE’s LFS estimates, work-related “heart disease/attack circulatory” conditions are almost as common as work-related deafness and significantly more common that work-related skin disease.
Work-related stress is one of the UK’s top work related health problem, trailing only musculoskeletal disorders, with 557,000 people in 2003/04 reporting levels of work-related stress that were making them ill, 66,000 reporting work-related heart disease.
But the real extent of work-related heart disease is certainly much higher than these figures suggest (Hazards 83). Thirty years ago, a study of compensation systems funded by the UK government found that 12 per cent of people reporting health problems causes by work were reporting heart disease (7).
In 1991, Danish statisticians calculated that work factors could account for 16 per cent of early deaths from heart disease in men and 22 per cent in women (8). More recently other studies reached a similar conclusion, with one 2002 British Medical Journal study showing workers in stressful jobs are more than twice as likely to die from heart disease (9).
A 2005 report put the number of heart disease deaths due to workplace passive smoking alone at 274 in 2003 (10). Workplace chemicals, noise, biological hazards (Hazards 28) and work overload (Hazards 83) and problems including excessive standing (Hazards 91) all cause work-related heart disease.
A work contribution of 20 per cent to overall heart disease mortality in people of working age, would indicate 3,200 work related heart disease deaths each year in people under the age of 65. For all heart disease deaths, the work contribution could be over 20,000 deaths per year.
HSE continues to insist a 1981 paper, ‘Causes of cancer’ by Richard Doll and Richard Peto (11), which put workplace cancer mortality at 4 per cent of all cancer deaths, is the “best available estimate” (See: Burying the evidence). This would suggest 6,000 occupational cancer deaths a year, with HSE saying the figure falls between a lower limit of 3,000 cases a year and an upper limit of 12,000 cases.
Evidence suggests, however, the real annual toll could be more than twice even the larger figure. Dr Richard Clapp, author of a September 2005 review of causes of occupational and environmental cancer (12), estimates the Doll/Peto figures under-estimate the true cancer incidence by between two and four times, putting the probable occupational cancer range between 8 and 16 per cent of all cancer deaths.
Death statistics, including HSE’s own figures, would seem to contradict HSE’s cancer death estimate. UK deaths from the asbestos cancer mesothelioma are approaching 2,000 a year. Asbestos related lung cancers are likely to be of a similar magnitude or more. HSE’s own registry of skin diseases recorded over 600 work-related cases of skin cancer in 2004. The total work-related lung cancer incidence is thought to be 10 per cent of all cases, which would equate to 3,500 deaths a year. A 2005 British Medical Journal paper put the number of work-related passive smoking lung cancer deaths alone at 160 in just one year (10).
A wide range of other cancers are clearly linked to workplace exposures, including cancers of the bladder, nose and breast. And studies have demonstrated links between jobs and brain, blood, lymphatic and other cancers (13).
A 12 per cent contribution of work-related cancers to overall cancer mortality would suggest in the order of 18,000 occupational cancer deaths a year, and 32,000 new cases.
Other groups, like construction workers and steel workers, face a high risk of the condition too, but their numbers remain invisible because there is no comparable compensation scheme.
A 2005 paper in the journal Occupational and Environmental Medicine concluded 15-20 per cent of UK cases of chronic obstructive lung disease were caused by workplace exposures, suggesting over one per cent of the UK adult population could be affected as a result of their jobs, causing about 6,000 deaths a year (15).
The SWORD reporting database, based on cases reported by occupational physicians and hospital consultants, records just 650 new cases a year (1).
The American Thoracic Society, in an estimate thought to be conservative by many, puts the workplace contribution at 15 per cent of all asthmas (16). The European Community Respiratory Health Survey put the proportion of asthmas caused by work in the UK at 11.6 per cent, but this only considered cases in adults under the age of 44.
Only a couple of hundred of people get DWP benefits for occupational asthma each year.
Over 5 million people in the UK have asthma, suggesting upwards of 750,000 could have work-related asthma. Asthma UK estimates a further 750,000 have their pre-existing asthma aggravated by work.
However, because few workplace strain injuries are compensated or reportable under official schemes and physicians are notorious reluctant to attribute musculoskeletal disorders to work - often because they fear their opinion will be used in a compensation claim - this is likely to be a significant under-estimate.
A study of hospital admissions for musculoskeletal problems in Denmark suggested between 10 and 20 per cent of all cases were work-related.
A Medical Research Council study in 1997-98, backed by HSE, gave a prevalence
estimate of 509,000 people in Great Britain suffering from hearing difficulties
as a result of exposure to noise at work, and 370,000 suffered noise-related
tinnitus (17). Association
of British Insurers figures indicated around 500,000 workers have been
compensated for noise-induced hearing loss since 1963.
HSE estimates two million workers are exposed to “levels of vibration where there are clear risks of developing disease.” It adds that each year about 3,000 claims are made for DWP industrial injuries benefit for vibration white finger and vibration-related carpal tunnel syndrome.
The DTI compensation scheme for ex-miners had 170,000 claims on behalf of workers who had suffered hand-arm vibration syndrome between 1998 and 2005, 147,000 of whom were still alive in September 2005 (14) – and suffering from a condition not appearing at all in HSE’s LFS figures.
LFS figures for 2003/04 suggest 38,000 people in the UK currently have work-related skin problems. Unpublished HSE figures in 1992 suggested 42 per cent of cases of hand dermatitis are related to work.
A cautious estimate for the overall work-related contribution to skin disease would be 25 per cent.
Chemical neurotoxicity, for example, appeared in the US top 10 work-related health problems, but is nowhere to be seen in HSE’s estimates (Hazards 41).
Conditions not caught by official reporting but known to be caused by work from workplace studies – Parkinson’s, Alzheimers, Motor Neurone Disease (19), autoimmune conditions like schleroderma and rheumatoid arthritis (20), reproductive disorders and a number of cancers – fall entirely off the radar.
Conditions that are hard to slot into a traditional medical diagnostic model, including multiple chemical sensitivity (21) and sick building syndrome, are for all practical purposes invisible in the UK.
This is catastrophic enough, but work-related ill-health is not spread evenly across the workforce. Males in manual jobs are more than twice as likely to get occupational lung cancer. Perhaps a quarter of all bladder cancers are work-related, concentrated in workers in industrial jobs.
For conditions from occupational heart disease and cancer, to strain injuries and skin disease, the risk is greatly higher in those lower down the workplace pecking order. Knowing this means it should be easier to target preventive efforts. Failing to act amounts to aiding and abetting a working class killer.
1. Self-reported work-related illness in 2003/04: Results from the Labour Force Survey, HSE, 2005 [pdf].
Health and Safety Statistics Highlights 2003/04, HSE, 2004. [pdf]
Occupational Health Statistics Bulletin 2004/05.
3. Joe LaDou. Occupational health in industrializing countries.
Occupational Medicine: State of the Art Reviews, volume 17, number 3,
pages 349-354, 2002.
4. J Paul Leigh and John A Robbins. Occupational disease and workers’ compensation: Coverage, costs, and consequences, Milbank Quarterly, volume 82, issue 4, pages 689-721, December 2004 [abstract].
6. The Health and Occupation Reporting Network (THOR).
7. Royal Commission on the Civil Liability and Compensation for Personal Injury. Report Chapter 20. Chairman: Lord Pearson. Cmnd 7054-1, 1978.
8. O Olsen and TS Kristensen. Impact of work environment on cardiovascular diseases in Denmark, Journal of Epidemiology and Community Health, volume 45, pages 4-10, 1991.
10. Doll R and Peto R. The causes of cancer: Quantitative estimates of avoidable risks of cancer in the United States today. Journal of the National Cancer Institute, volume 66, number 6, pages 1191-1308, 1981.
11. Richard Clapp, Genevieve Howe, Molly Jacobs Lefevre. Environmental
and cccupational causes of cancer: A review of recent Scientific literature.
12. Konrad Jamrozik. Estimate of deaths attributable to passive smoking among UK adults: database analysis , BMJ, doi:10.1136/bmj.38370.496632.8F, published 2 March 2005.
13. Workplace roulette: Gambling with cancer, ISBN 1-896357-09-1. Between the Lines, Canada. 1997.
14. Department for Trade and Industry. Miners’ Compensation. Headline statistics as at 25 September 2005 [pdf].
15. M Meldrum and others. The role of occupation in the development of chronic obstructive pulmonary disease (COPD). Occupational and Environmental Medicine, volume 62, pages 212-214, 2005. [Extract] [Full text]
16. Ki Moon Bang and others. Prevalence of asthma by industry in the US population: A study of 2001 NHIS data, American Journal of Public Health, volume 47, issue 6, pages 500-508, 2005.
exposure to noise and hearing difficulties in Great Britain,
HSE Contract Research Report 361, 2001.
18. KT Palmer and others. Prevalence of Raynaud's phenomenon in Great Britain and its relation to hand transmitted vibration: a national postal survey, Occupational and Environmental Medicine, volume 57, number 7, pages 448-452, 2000 [abstract]
19. Robert M Park and others. Potential occupational risks for neurodegenerative diseases, American Journal of Industrial Medicine, volume 48, issue 1, pages 63–77, 2005 [abstract].
20. Berit Sverdrup and others. Association between occupational exposure to mineral oil and rheumatoid arthritis: results from the Swedish EIRA case–control study, Arthritis Research & Therapy, volume 7, pages 1296-1303, 2005. doi:10.1186/ar1824
21. Multiple Chemical Sensitivity, MCS, Environmental Project no. 988, 2005 (in English).
Noise-induced hearing loss statistics
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