Communicating occupational and environmental issues

Effective health risk communication is an important tool that can prevent or modify the inappropriate public reactions that often accompany occupational and environmental health issues and allegations. The public perception of the magnitude or significance of risk is influenced by factors other than scientific data. The goal of risk communication therefore is more than just imparting scientific facts. It is about ensuring that the public fully understand risk and that they are enabled to make informed decisions under conditions of uncertainty. How people perceive risk, and their values and feelings toward occupational and environmental health issues, are as important considerations for risk communication as are numerical or factual scientific data. Occupational and environmental health scares often occur because of complexities such as the multidimensionality of risk, trust or mistrust in sources of information, technological revolution, the reliance of the public on the media for health information and the public desire for information and the truth. If, as health professionals, we are to address effectively both real and perceived occupational and environmental health issues, we need to be aware of the major advances that have been made in the use of risk communication in recent years.     

Auditing stress

Stress is now recognized as an occupational hazard and it is incumbent on all employers to carry out an assessment in order to assess the risk to health. A stress audit would be an appropriate tool to use. An audit should concentrate on organizational issues. Most audits use a questionnaire and it is sensible to use one which has already been validated. Results should be fed back to the employer in a form which is easily understandable and which contains clear recommendations for action. A repeat audit after one year is advised.     

Major chemical incidents: bridging the occupational--public health gap

Increasing awareness and concern about possible long-term health effects of exposure to chemicals after major chemical incidents has opened up a new area of public health activity. However, progress is hampered by a lack of low level exposures in potentially highly susceptible subgroups of the populations, and by a lack of expertise in public health. The challenge is to extend the toxicological and epidemiological experience developed in the occupational setting to the community level. To better define the problem population surveillance of acute chemical hazards, first set up in Wales, has been extended throughout the UK, and is also being piloted internationally. Further work is needed to address specific problems of the epidemiological follow-up of populations exposed, the assessment of the psychological consequences at the community level, and risk perception and communication. Organisational arrangements for the public health management of incidents and their sequelae must move beyond short-term funding and market competition and must incorporate the expertise of the occupational disciplines.     

Are Australians concerned about nanoparticles? A comparative analysis with established and emerging environmental health issues

Objective: Introducing new technologies into society raises considerable public concern. We determine the public concern about nanoparticles, and compare this concern to other environmental health issues such as wind farms and coal seam gas production. Methods: A repeat cross sectional survey examining views on environmental health issues, risk, chemicals and trust was undertaken in more than 1,300 Australian residents in 2000 and 2013. Logistic regression and principal component analysis was used to investigate predictors of nanoparticle concern and identify a component structure for environmental health issues that could explain a trend of future nanoparticle concern. Results: Australians have a relatively low level of concern about the risks of nanoparticles to health when compared to their concerns about other environmental health issues. Items associated with concern included gender, a general wish to avoid chemicals and possibly trust in politicians. Concern over nanoparticles clustered with similar views on technological risks. Conclusions: Current public concern over the risks of nanoparticles is low. However, a reframing of the issue towards ‘chemicals’ is likely to have a negative effect on risk perceptions. This paper raises questions about appropriate channels for the effective communication of risk.     

Chronic lead poisoning in an adult battery worker

BACKGROUND: Lead poisoning is a common environmental health hazard in developing countries. Incidences of lead poisoning are seen in all age groups, especially in adults working in lead-based industries, where many still remain unaware of the adverse effects of exposure to unusually high levels of lead. METHODS: We report the case of an adult battery worker, who initially received symptomatic treatment because of clinical misdiagnosis. Later, he was treated with appropriate chelators, which helped to decrease blood lead levels drastically. However, being unable to change his occupation, he continues to be exposed to potentially lethal doses of lead. CONCLUSIONS: A key role for health agencies, besides providing opportunities for diagnosis and therapy, should be to increase public awareness about this widespread environmental hazard through education, documentation and communication.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Risk communication: identifying the importance of social context1

This editorial uses articles published in recent issues of Health, Risk and Society to critically review current approaches to risk communication. The effective communication of risk forms a key component of public health measures designed to improve the health of populations in countries such as the UK. These approaches assume that the recipients of the risk information are rational actors who will use the information to minimize their exposure to health hazards, and this will reduce the collective level of harm. However, a recent article in Health, Risk and Society indicated that individuals are not passive recipients of information and do not respond to risk information ‘rationally’. Individuals actively engage in looking for and using information but may also make conscious decisions to avoid certain forms of information. Their response to information is shaped by social context, their own needs for personal security and the extent to which they trust the source of specific items of information. As a result, there is little evidence that risk communication based on the rational actor model shapes an understanding or behaviour in ways in which health-policy makers and public health experts want.     

The reliability of personal alcohol consumption estimates in a working population

Health and safety problems related to alcohol consumption represent a major concern in many businesses and consequently pre-employment questionnaires and workplace health promotion packages frequently contain questions seeking basic estimates of alcohol consumption. Although individuals with very heavy drinking patterns often attract much attention, on a population basis most morbidity is likely to arise from drinkers consuming above the recommended limits but not sufficient to result in gross occupational or social effects. This study reviews the research on the reliability of questionnaire techniques used to quantify alcohol consumption and compares the most valid retrospective interview based estimate of consumption, the time line follow-back (TLFB), with a prospective daily diary (DD) method in a working population. The DD method was acceptable and produced significantly higher estimates of consumption and for 'normal' subjects gave consistent estimates of +/- 10 units/week over several weeks. Appropriate questionnaire design is discussed and the use of a DD method in health promotion activities recommended.     

Improved communication between doctors and with managers would benefit professional integrity and reduce the occupational medicine workload

BACKGROUND: Professional expectations for communication skills are explicit. These skills are needed for professional integrity and personal morale. Nevertheless, occupational physicians see doctors as patients for whom communication among between doctors and with their managers are the principal cause of their presenting health problems. AIM: To describe the frameworks of professionalism in medicine and the duty to care for good communication; present issues surrounding competency in communication skills; identify health problems among doctors associated with poor communication; and consider roles of economic appraisal and preventive strategies. METHOD: A literature review identified key publications of professional expectations and requirements of doctors for their communication skills. Health problems among doctors associated with poor communication and presenting at least twice in a National Health Service (NHS) occupational health (OH) department during January-December 2002, were sought by manual retrieval of all doctor-patient records. The categories of communication difficulty were agreed in the focus group discussion of the presenting problems with occupational physicians. RESULTS: Nine categories of communication difficulties among doctors resulting in their presentation in OH departments with health problems were identified. CONCLUSIONS: Personal health problems caused by poor communication involve considerable time and potential litigation costs. Doctors need to be reminded of their responsibilities. Opportunity cost studies would help to strengthen an evidence base for the need of doctors to adhere to the professional requirements of good communication skills.     

Recommendations to improve health risk communication: lessons learned from the U.S. Public Health Service

The growth in the public's concern over a variety of environmental health risks has placed new requirements and demands on U.S. Public Health Service (PHS) agencies for information that describes and explains the nature of risk in clear and comprehensible terms. Experience has shown, however, that merely disseminating information without reliance on communication principles can lead to ineffective health messages and public health actions. This article presents the findings of a study conducted by the Subcommittee on Risk Communication and Education of the Environmental Health Policy Committee (EHPC), PHS, on how PHS agencies are communicating information about health risk; how effective these communications have been; and what specific principles, strategies, and practices best promote effective health risk communication. The purpose of the Subcommittee's study was to develop specific recommendations that would help PHS decision makers and health risk communicators improve the effectiveness of health information provided to, and received from, the public. The study suggests fundamental principles drawn from a series of case studies from PHS agencies about how best to plan and carry out risk communication activities.     

Recommendations to Improve Health Risk Communication: Lessons Learned from the U.S. Public Health Service

The growth in the public's concern over a variety of environmental health risks has placed new requirements and demands on U.S. Public Health Service (PHS) agencies for information that describes and explains the nature of risk in clear and comprehensible terms. Experience has shown, however, that merely disseminating information without reliance on communication principles can lead to ineffective health messages and public health actions. This article presents the findings of a study conducted by the Subcommittee on Risk Communication and Education of the Environmental Health Policy Committee (EHPC), PHS, on how PHS agencies are communicating information about health risk; how effective these communications have been; and what specific principles, strategies, and practices best promote effective health risk communication. The purpose of the Subcommittee's study was to develop specific recommendations that would help PHS decision makers and health risk communicators improve the effectiveness of health information provided to, and received from, the public. The study suggests fundamental principles drawn from a series of case studies from PHS agencies abouthow bestto plan and carry outrisk communication activities.     

Health and safety practices among farmers and other workers: a needs assessment.

The development of appropriate health and safety interventions for farmers and agri-workers is important world-wide but data on present practices and attitudes to change are lacking. A representative quota sample (n = 1,938) of the Irish population was surveyed on lifestyle practices and workplace risk assessment and control measures, in relation to chemical exposure, manual handling and machinery. Focus group discussions were conducted also with 47 representatives of national farming organizations. As compared with the general workforce, farmers had a significantly (p < 0.01) lower level of assessment of risk hazards associated with manual handling and machinery. Both farmers and employees in workplaces with less than 20 employees reported a significantly lower level of safety training. Male farmers had a particularly negative health profile with only 18% reporting regular dental checks, 26% practising skin protection and 29% taking regular exercise. Discussions indicated that barriers to change included low perceived susceptibility, lack of time and resources. Mental health issues were particularly highlighted. We conclude farmers differ significantly in many instances from the rest of the workforce in regard to occupational health and safety issues and specific interventions in key areas are required for the agri-sector.     

Occupational toxicology and the control of exposure to pharmaceutical agents at work

BACKGROUND: The pharmaceutical industry employs >350 000 people worldwide in operations including research and development (R&D), manufacturing, sales and marketing. Workers employed in R&D and manufacturing sectors are potentially exposed to drug substances in the workplace that are designed to modify physiology and also to chemical precursors that are potentially hazardous to health. Pharmaceutical workers are at risk from adverse health effects, including occupational asthma, pharmacological effects, adverse reproductive outcomes and dermatitis. AIM: This study aimed to describe the approaches taken by pharmaceutical companies for identifying and communicating potential adverse health effects that may result from workplace exposures and in setting 'in-house' exposure control limits and to highlight the challenges in controlling workplace exposures to increasingly potent compounds. METHOD: The literature was reviewed by searching the Medline and HSELine databases. RESULTS: The findings are presented in five sections, covering: test methods and approaches to occupational toxicology; hazard communication; approaches to setting health-based occupational exposure limits for pharmaceutically active agents; recent approaches to risk control; and occupational hygiene and exposure controls. CONCLUSION: Significant efforts have been directed at predicting and evaluating potential occupational health hazards in the pharmaceutical industry. The pharmaceutical industry has provided leadership in controlling exposure to hazardous substances. Much of this work has been driven by a real need to control occupational exposures to substances that can have profound adverse health effects in exposed employees and that are becoming increasingly more potent.     

Factors influencing uptake of influenza vaccination among hospital-based health care workers

BACKGROUND: Vaccination of health care workers against influenza has been shown to lower mortality among elderly patients, but uptake of voluntary vaccination among health care workers remains low. AIMS: Factors influencing uptake of vaccination were examined among a cross-section of health care workers based in an NHS Trust. METHODS: A structured, self-administered questionnaire was mailed to a random sample of health care workers based in the acute services sector of a UK National Health Service Trust, 6 months following a voluntary immunization programme implemented as part of the Scottish Executive Health Department winter planning arrangements for 2000-2001. The programme was promoted using posters in clinical areas and a single leaflet given to all staff through a paycheck advice note. RESULTS: Five hundred and fifty-one health care workers (53%) responded to the questionnaire and influenza vaccination was accepted by 150 (28%). The occupational health poster strongly influenced the decision to accept vaccination [odds ratio (OR) = 11.01; 95% confidence interval (CI) = 2.13-56.80; P < 0.0001]. Other significant influences included female sex (OR = 9.11; 95% CI = 1.26-65.72) and perceived risk of contracting flu without the vaccine (OR = 7.70; 95% CI = 1.44-41.05). Misconceptions regarding the purpose of the vaccination campaign were common and concern regarding possible side-effects was a deterring factor for vaccination uptake. CONCLUSION: Our study showed that visual material displayed throughout the workplace strongly influenced the acceptance of influenza vaccination. Future campaigns should also emphasize the positive benefits to patients of health care worker immunization, with readily accessible information regarding side-effects available from all sources.     

Implementation of statutory occupational respiratory health surveillance

Health surveillance is required by UK regulations in certain circumstances, and is usually provided through an occupational health organization. Although there are studies assessing the provision of health surveillance across the country, there are no published studies addressing the practical application of legislation, guidelines and medical research to respiratory health surveillance programmes. An audit of a multidisciplinary health surveillance programme was carried out, using review of occupational health records, occupational hygiene reports and managers' risk assessments, to compare the implementation of health surveillance in different organizations and under different contractual relationships. Sixty-six per cent of National Health Service (NHS) and 56% of industrial workplaces were able to provide risk assessments but were unable to link these with appropriate health surveillance. Twenty-seven per cent of NHS employees potentially exposed to respiratory sensitizers had baseline surveillance, compared with 87% in industry. Fifty-five per cent of Medical Research Council questionnaires were inappropriately administered by the employee themselves, rather than an interviewer as recommended. Other follow-up questionnaires in use had not been formally validated. Non-regular lung function assessment using spirometry was the predominant tool used for follow-up surveillance. There was no overall strategic approach to respiratory health surveillance in the organization studied. Health surveillance programmes should focus on disease prevention without becoming a repetitious application of unvalidated tools. Clinical governance demands quality assurance standards that will effectively implement a coordinated approach to health surveillance.     

Healthy workplace indicators: costing reasons for sickness absence within the UK National Health Service

Sandwell Healthcare NHS Trust has been developing a tool for monitoring the reasons and costs of long-term sick leave (> 7 days). The data obtained from this process has been used to modify the type of occupational health and safety services provided for the Trust. Adoption of more standardized tools of this nature throughout the National Health Service (NHS) would help trusts to compare, and where appropriate enhance, the services provided by occupational health. Musculo-skeletal and mental health problems, account for the greatest costs arising from long-term sickness absence. It may therefore be prudent for NHS employers and their occupational health services to target their efforts on these particular problems.     

Needlestick injury in clothing industry workers and the risks of blood-borne infection.

This paper identifies the hazard of a hollow needle device used extensively in the clothing industry and assesses the risk of transmission for HIV, Hepatitis B and Hepatitis C. A substantial risk of transmission is suggested and measures have been advised for its control. Occupational Health Physicians are advised to be aware of hollow needles in other industrial processes and where risks of cross-infection exist, the same safety considerations should be applied as in clinical medicine and veterinary work to avoid needlestick injuries. Needle sharing must be avoided.     

Investigation of eye splash and needlestick incidents from an HIV-positive donor on an intensive care unit using root cause analysis

BACKGROUND: Two doctors working on a busy intensive care unit sustained injuries whilst removing a chest drain from an HIV-positive patient. One doctor had a needlestick injury into his finger whilst the other sustained an eyesplash when the chest drain was pulled out. METHODS: Following Department of Health format 'Doing less harm', a root cause and human factor analysis of the incident was carried out. The aim was to explore the underlying issues. RESULTS AND CONCLUSIONS: Training, cultural and organizational issues were exposed, and are now being addressed. This approach has led to a far more effective dialogue with the National Health Trust concerned than was previously experienced, and there is early evidence of progress on important aspects of health and safety management at organizational level. Lack of health and safety training of doctors at undergraduate and postgraduate level needs to be addressed.     

Nevada's academic-practice collaboration: public health preparedness possibilities outside an academic center

The Nevada State Health Division developed a local academic-practice partnership with the University of Nevada Reno's Master of Public Health Program to assess the bioterrorism risk communication, information, response, and training needs of professional and public stakeholder groups throughout Nevada. Between October 16, 2002, and April 13, 2004, 22 needs assessment focus groups and 125 key informant interviews were conducted to gather information on the diverse needs of the stakeholders. The themes that emerged from these activities included the need for effective pre-event education and training; a coordinated and responsive public health preparedness infrastructure; honest, accurate, and timely communication in the event of a bioterrorism situation; and appropriate information dissemination methods and technology. The data collected through this needs assessment gave the Nevada State Health Division vital information to plan public health preparedness initiatives. The establishment of local academic-practice partnerships for states without a Centers for Disease Control and Prevention-funded Academic Center for Public Health Preparedness is an effective way for health departments to develop their public health preparedness infrastructure while simultaneously training the future public health workforce.     

Cluster management and the role of concerned communities and the media

Public health services often have to deal with reported clusters of adverse health events. An important characteristic of disease clusters is that the involved community often is concerned about environmental factors influencing health. To facilitate cluster investigations, a stepwise protocol was developed in the Netherlands, based on international literature. Essential is the two-way approach, consisting of a disease-track and an environment-track. Attention to potential environmental exposures is as important as attention to the reported diseases, not only because environmental pollution often is the reason of public concern and thus relevant for risk communication, but also for deciding about the boundaries of the population at risk. Moreover, environmental information is necessary for judgement of the plausibility of a causal relation and for advising measures to prevent exposure. Within this two-way approach, three stages are distinguished: orientation stage, verification stage and quantification stage. Only if an increased risk as well as an elevated exposure is verified, under certain conditions a case–control study may be useful to study causality between exposure and adverse health events. During all stages of the investigation, good risk communication strategies have to be taken into account. However, even then it might be difficult to prevent conflicts, because of the differing interests between experts and the community involved. One of the most important aspects that determine judgements about risks by threatened people, is controllability; that is why community participation is essential. Therefore it can be concluded that cluster management is a mutual endeavour for experts, public and media, where experts are judged on three characteristics: expertise, credibility and empathy.