Report on Dr Adele Pilkington’s talk – Fostering Health in the Workplace: Physical health – 27 February 2007

To view Dr Pilkington’s PowerPoint presentation please click the icon at the foot of the page.

We are most grateful to Dundas & Wilson for hosting us.

True to the trailer she gave us, Dr Adele Pilkington painted a picture of health being more than the absence of disease: it is a “bio-psycho-social” phenomenon, but more of that later.

Dr Pilkington began by helping us see the reality of health at work today, or rather the high cost of its absence: more than £13bn in 2005 (a CBI 2006 figure).

What kind of major health issues exist in the world of work? To give us an idea, here are some stats about self-reported work-related illness. Any guesses as to the top two categories of illness and their relative importance? Well:

• 9.5m days lost due to a musculoskeletal disorder (“bad back”/back pain/and all the rest).
• 10.5m days lost due to stress, depression and anxiety.

In the former category were lots of healthcare workers, social care workers and construction workers, but also typists of various sorts. In the latter category were teachers, again healthcare workers, but this time also a large number of managerial roles.

Is work a blessing or a bind? The answer to that question can result in better health at work, or poorer health. Research as recently as September 2006 by Professors Waddell and Burton shows that work is generally good for health and wellbeing, always assuming that people are working in a supportive environment and not in physically hazardous conditions. A job can actually help people have better health than they would otherwise, and also give them greater control over their health. It really is good for you to earn an income and enjoy some economic stability.

A negative reading of the opening chapters of the Book of Genesis can give you a negative view of work. But there is in fact a positive message to be found there, namely that work is a gift, a way of participating in the stewarding of creation and the maintaining of life.

Dr Pilkington gave us an overview of health thinking. The 20th century saw an emphasis on occupational safety. The 21st century has already seen a major emphasis on creating the conditions whereby there can be a reduction in absenteeism. Scotland, thanks to its great innovative tradition in the world of medicine, has been leading the way on a lot of the thinking. Dr Pilkington cited several key Scottish Executive reports as well as a Health and Safety Executive (HSE) one and a couple from the Department of Health (DOH). There is a great awareness now of the negative effects on attendance, and hence productivity, of alcohol, obesity and STDs.

Our speaker then went on to show us an occupational health paradigm (her fifth PP slide). To take the upper section, occupational health practitioners have focused on the benefits of work. To take the lower right section, this portrays what was believed for long enough, namely that work was bad for your health (which we all know it can be in some circumstances or from time to time).The lower left section presents us with the new model – yes, that phrase, the “bio-psycho-social” model. To whet your appetite concerning the insights in this model: we know, do we not, of cases of people feeling ill when it is hard to know quite why they are ill, e.g. it is not simply a physical problem. Also, we are aware of people who may on the face of it look as if they are not capable of working but who very definitely show us that they are – the mind being determined to overcome e.g. physical or emotional hurdles.

Yes, health in this new model is about more than an absence of disease. There are physical considerations, hence “bio”; emotional considerations, hence “psycho”; and environmental considerations hence “social”. A psychiatrist called Engel was the first to propose this bio-psycho-social model, in 1977.  More and more, we are seeing that there is a relationship between spirit, soul and body. So much so, that it is often a mistake to “see” only a physical problem in the presenting person. This tie-up, this delicate interconnection of three distinct elements, is not entirely new.  For instance, the New Testament writer Paul refers to this tri-partite phenomenon (in the letter 1 Thessalonians ch 5 v 23).

In recent questionings of patients (2004), over 80% said they would appreciate medical experts taking an interest in their spirituality and incorporating in their care plan something tailored to their spiritual nature.

Adele Pilkington then went on to look more directly at office workers, i.e. people like her business matters audience.  She quoted first from the father of occupational health who had an insight into the state of wellbeing of sedentary workers as far back as 1700… (His name: Bernardino Ramazzini).

Then she quoted an up-to-date statement from the BCA, the British Chiropractors Association: “59% of the working population sits down all day at work and almost 50% refuse to leave their desks even for lunch. Those who are seated most of the day could be most prone to back problems.” (BCA, October 2006). How come? Well, one reason is that there can be a build-up of lactic acid in muscle tissues and this can lead to aches and pains / musculoskeletal problems.

How then to improve health at work?

• Adopt healthier lifestyles, e.g. healthy eating, exercise.
• Ensure a safe and supportive work environment.
• Maintain a good work-life balance, e.g. taking advantage of new flexible working policies.
• Foster / join supportive social networks (the business matters one being a good case in point, said Adele. She said moreover that it is no accident that members of religious communities on the whole enjoy better health than the rest of the population).
• Provide supportive rehabilitation after illness – especially for the aging working population, or there will be longer periods of absence!
• Adopt a holistic health policy and strategy, i.e. one which acknowledges the tie-up between spirit, soul and body, one which ministers to the whole person.

Our speaker then homed in on one instructive illustration of the bio-psycho-social model: the research conducted over decades on civil servants, called the Whitehall Studies. From the 1960s male civil servants were closely studied and followed-up. From the 1980s, scientists looked at female civil servants too. The big issue the scientists had in view was the occurrence of cardio-vascular diseases, i.e. the mortality of our civil servants and in particular why it was that the lowest grades had the highest mortality. What you might call common cardiac risk factors (the relative prosperity or deprivation in your background, diet, etc.) accounted for only 40% of the difference. What else was in play? Answer: it was found that lack of job control was a significant factor in loss of wellbeing and absence from work. In other words, chronic stress (as opposed to ordinary/common transient stress) was a killer. More about this later.

Adele then gave us several sources of information. See her PP slide (the penultimate one).

Finally, she suggested a health, work and wellbeing strategy for responsible employers:

• Engage the stakeholders (e.g. health practitioners as well as employees).
• Improve working lives (e.g. encourage healthy workplaces, improve occupational health (OH) provision).
• Focus on healthcare for working age people, notably in the early stages of their coming into the workforce.
• Lead by example.

Adele pointed out that the public sector is trying hard to follow all the above, including the last point. She informed us that public sector bodies have actually lagged behind private sector companies, and have set themselves the target of becoming exemplars, i.e. overtaking the private sector.

Q & A Time:

We asked our speaker about the prevalence of people “pulling a sickie.” Answer: It is estimated that this accounts for 13% of the £13 bn total cost of absence from work.

A member of the audience reminded us that the Gallup Organisation has found that having a “best friend” at work is hugely significant in terms of one’s enjoyment of work and loyalty to the employer/staff retention. We surmised that having such a friend in the workplace must also have a beneficial effect on one’s overall health – bearing out our speaker’s point that having a supportive social network in one’s office helps one’s health.

Picking up further on Gallup’s Q 12, we realised that getting to do each day what you are best at is a key factor in de-stressing your experience of work.

We then, with Adele’s help, discussed the link between stress and the absence of a sense of being in control. Reference was made to a study of baboons in Tanzania (!) which in turn fed into the Whitehall Studies mentioned in the talk.  Iain Archibald referred us to Professor Phil Hanlon’s treatment of this very topic of Fostering Health in the Workplace, a subject he recently covered in Glasgow. To read a report on the Professor’s talk click on the “Public Health” link on the right. Professor Hanlon is “Mr. Public Health – Scotland” and has a chair at the University of Glasgow.

That talk summary tells us why baboons and indeed humans lower down the pecking order/work hierarchy suffer from chronic stress and so enjoy less good health than those at the top.

Another de-stresser is of course receiving recognition and praise/affirmation when we do a good job. A Company that develops a true praise culture will do so much better than one where a blame culture prevails: absenteeism will be lower.

One comment from an insightful member of the audience was: going off work can be, in some cases, a means of trying to regain control where the person has felt their job/their workload/their duties were out of control.

Further suggestions to help staff in stressful situations were:

• Allow them to draw up their own rotas – this helps give a sense of being in control.
• Provide a contemplation room, as one of the big four accountancy firms does in each of its offices across the world; inside that place you are left in total peace – not even a pager can interrupt your regaining your composure there!
• Make available good resources like the one Adele Pilkington offered us: Work and Health Leaflet 1, just 8 pages long and available from HMSO.

Thoughts on combating a growing culture of “pulling sickies”:

• GPs should be asked to review matters with a patient more proactively before automatically agreeing to give them a sick note.
• An employer can put in place a procedure whereby a returning employee needs to sit down with a line manager on returning to work to talk over how the need for absence arose and how things went in the recovery period…(One person present said this worked well in his particular operation).

One of us asked Adele why it was that there is much higher absenteeism in the public sector than in the private. She offered two reasons:

• The public sector has a history of solving problems by offering more money to the embattled service/sector – which has had a tendency to cushion the service/sector from dealing directly with the cause of the problem.
• The public sector has in some quarters developed a “culture of entitlement” somewhat foreign to the private sector, as in “I am entitled to 10 days off sick a year and I can take them.”

Clearly, it is desirable to take a holistic approach to health and wellbeing at work, one which takes into account several factors, from providing a truly supportive physical environment to catering for people’s spiritual needs. Adele was kind enough to compliment business matters as an organisation that is particularly mindful of providing not only professional help but also social and spiritual help.

One long-standing friend of business matters said later that this was one of the best work lunchtime talks we have had in Edinburgh in the past 6/7 years.

Iain Archibald
Consultant to business matters