Workplace health programmes are increasingly threatened by changes in employment practice, Dr Kenneth Calman warned, with a shift to short- term contracts and part-time work, the growth of small businesses and the downsizing of larger companies.
The increasing use of short-term contracts served only to heighten insecurity and stress, he said. Minor psychiatric illness - including stress - is the second most common cause of absenteeism lasting three weeks or more. However, many people continued to work when they were not fit to do so, Dr Calman added. "People are concerned about their work, and all therefore wish to work at all costs.''
Speaking at the launch of his annual report on the state of public health, Dr Calman said managers should recognise that "the workforce is the most important resource that [they] have ... in the end the solution lies with managers". But he warned that it was "more and more difficult" for employers, other than large companies, to deliver an adequate occupational health service.
The report singles out health in the workplace as an area of concern. There are 1.6 million accidents at work annually, according to government statistics, and 2.2 million cases of work-related illness. Each year, 30 million work days are lost and 20,000 people forced to give up work. The total cost is between pounds 11bn and 16bn - 2 to 3 per cent of GDP.
Occupational health programmes aim to protect and maintain the well-being of workers, but although the number of doctors and nurses employed by private firms rose from 5.5 per cent to 14 per cent between 1977 and 1992, the percentage of the workforce covered had fallen from 52 per cent to 34 per cent because of the change in employment structure. Dr Calman urged smaller companies to join together to provide workplace health care, and said that NHS occupational health services could be expanded to serve private firms.
The report draws together statistics from the industrial injuries scheme, medical professions, the Labour Force Survey and national mortality data. It shows that cancer-causing chemicals (other than asbestos) may be responsible for 6,000 premature deaths. Asbestos is killing up to 3,500 people a year and the number is rising - expected to peak at 5,000-10,000 - because of the long latency of related illness.
Musculo-skeletal disorders, including repetitive strain injury, form the largest category of work-related illness. Figures suggest about 5.5 million working days are lost each year and 880,000 people suffer annually. Some 20,000 people say they have asthma caused by work and a further 50,000 say the condition is made worse by their working conditions.
t On the State of the Public Health 1994; HMSO; pounds 16.50.Reuse content