The 1st May is usually an occasion for various political parties to organise meetings and rallies to demonstrate their level of support in the electorate. However, it is also celebrated as International Workers’ Day: it is opportune to reflect on one aspect of employment, how the health of workers needs to be a priority for employers, government and for society as a whole.

Working environment and health

Most readers are aware of how hazards at work can adversely impact on health. Recently, we had a laudable initiative of police officers having audiometric testing of their hearing. Indeed, workers exposed to excessive noise at work will, over time, have their hearing damaged until it affects their day to day life and they are effectively deaf. This is more common in industrial settings, e.g. sugar factories, stone crushers, heavy engineering plants, etc.

The recommended approach is for Noise levels to be measured regularly (e.g. annually), usually by a trained Occupational Health (OH) or Health and Safety (HS) practitioner. Depending on the noise levels, employees can be provided with appropriate hearing protection (as advised by the OH or HS practitioner) and have regular (annual) audiometric testing to ensure their hearing is not being affected.

Similarly, people working with hazardous chemicals at work may need to be provided with protective equipment (e.g. gloves, face masks, etc.) on the advice of the OH or HS practitioner. Workers who may be exposed to blood or blood products (hospital or clinic staff) will need to be protected by being immunised against Hepatitis B.

A more difficult area is when employees are stressed because of work issues, e.g. workload, pressure of work, excessive demands for employers, leading to long working hours, affecting work-life balance and mental health. In Mauritius, there is some awareness of how the working environment can affect health, largely as a result of HS Officers employed in industries, as required by the Occupational Safety, Health and Welfare Act, and as a result of campaigning by a few trade union leaders such as Reeaz Chuttoo (CTSP).

Fitness for work A lesser known area, but potentially critical for employers, is whether the worker is fit for the job, either at recruitment, or when an employed worker develops a medical condition. These issues are best addressed by a system when the organisation has access to Occupational Health expertise, either in-house (with a Nurse or Doctor trained in OH) or out-sourced (when the organisation has an arrangement with a separate OH provider).

At pre-employment, the potential recruit is invited to send to the designated OH team a pre-employment health questionnaire, duly completed, covering previous and current health issues. The OH clinician will then decide if a face-to-face medical examination is necessary and submit a report to the prospective employer about the applicant’s fitness for the role.

For workers already employed in the business, any existing or reported health concerns can trigger the Line Manager to refer the employee to be seen by OH. Following the assessment, a report to the Manager can be generated to cover such areas as: fitness for work, likelihood of future episodes of sickness absence, prognosis and eligibility for ill-health retirement.

The above process enables confidentiality of medical information to be preserved, with a report to management being issued with employee consent only, and to cover areas relating to fitness for work only, with no sensitive medical details divulged. Such organisational arrangements, which are the norm in industrialised countries, will enable managers to make informed decisions when faced with challenging situations such as:

Is an employee with epilepsy fit for work as a fork-lift operator in a warehouse?

■ My employee has developed Diabetes and injects four times a day with insulin: can he continue as a lorry driver?

■ A senior manager has had a mild stroke: can he return to his role with executive responsibilities?

 ■ How long before a baggage handler returns to work after a heart attack?

 ■ An employee starts exhibiting disturbed behaviour at work: does he or she have a mental health condition and how can this be managed in the workplace?

 ■ Can an employee return to adjusted or restricted duties after a period of illness?

■ How long should the employee remain restricted, before a return to full duties?

Absenteeism and Presenteeism

There are many ways in which ill health can affect work. The most common indicator is absenteeism, i.e. when the employee is absent from work on “sick leave”. Another outcome which is highly relevant is “presenteeism” when the employee is at work but has impaired functioning due to mental or physical ill health. The employee is “putting in face time” but has an impaired productivity due to wider health issues. The decision to attend work when “ill” may be due to psychosocial workplace factors as well as pressure from management to attend work.

Sir Cary Cooper, Professor of Organisational Psychology and Health at Manchester Business School, estimated that the annual cost of presenteeism is twice that of absenteeism in a presentation to the United Kingdom (UK) Chartered Institute of Personal and Development in 2015. Managers need to be aware of the issue of presenteeism when faced with an employee or an area of work with reduced productivity or work performance.

Stress at work

Many employees at work suffer from work-related stress, leading to anxiety and depression. In UK, a study found that in 2015-2016, almost 500,000 employees suffered from stress and this was attributable to work factors such as workload pressures, tight deadlines, too much responsibility and a lack of managerial support. 45 % of working days lost during the same time period (by employees taking “sick leave”) were due to stress.

A study in Australia has shown that, at any one point in time, 1/6 of working age people will suffer from a mental illness (most commonly depression and anxiety). Mental illness is one of the leading causes of sickness absence and longterm work incapacity in Australia and is also one of the main health related reasons for reduced work performance.

The UK Health and Safety Executive has recommended an approach to assess employees suffering from work-related stress to be assessed against six Management Standards, i.e. demands of the job; lack of control (conflicting work demands, no participation in decisions, lack of decision latitude…); poor relationships at work; changes (in responsibilities, job security); role (lack of role clarity, feeling undervalued); support (inadequate managerial support, lack of feedback and communication).

Using these “Management Standards” can be a constructive basis for discussion when a Manager discusses with an employee who is suffering from stress. To support workers who are suffering from psychological stress, anxiety or depression from work or home issues, most employers in developed countries have arrangements with employee assistance programs.

Typically, an affected employee can be referred to a Counsellor or Therapist (either by self-referral or after a referral by his/her Manager or OH) for a number of sessions of Counselling or other relevant therapy (e.g. Cognitive Behaviour Therapy). This arrangement is usually at no cost to the employee and often enables an earlier return to productive work, if there has been a period of absence.

However, this traditional approach of managing employees, known as a four D’s approach (damage, disease, disorder and dysfunction), is akin to “healing the wounded” and does not prevent poor performance, low motivation, unwell-being, ill health and disengagement.

Psychologically healthy workplaces

 There is growing evidence that employees can thrive and become more productive in a working environment which is supportive, with the right organisational culture and leadership. This has led to the concept of “psychologically healthy workplaces” which enhance the employee’s energy, enthusiasm, concentration, alertness and engagement, leading to increased performance of the team and the organisation.

Professor Derek Mowbray, in the Guide to the Wellbeing and Performance Agenda, advocates the framework for a Psychologically Healthy Workplace which includes the following four building blocks: an adaptive leadership which emphasises the shared responsibility of the workforce for the success of the organisation; an adaptive culture which prioritises teamwork, empowerment of staff, open communication; an adaptive, safe and healthy working environment which respects worklife balance; an adaptive and resilient employee who is mentally strong and equipped to respond to events and challenges. This approach recognises that employees’ attitudes are closely linked to organisational productivity and profitability.

An essential element of a psychologically heal- thy workplace is effective teamwork, which involves team members working together to produce a synchronized and collaborative output. It is an accepted view that, through combining the efforts within an effective team, the sum total of their contributions will be surpassed. Team leaders will have a central role and should display and develop enthusiasm, optimism and an inspiring vision in relation to team objectives.

Furthermore, organisational leaders are potent influencers on the well-being of their staff: positive perceptions of leaders’ transformational leadership are linked with increased trust in management, with an enhancement of employee well-being. In the words of Professor Mowbray: “Psychologically healthy workplaces… unleash energy, innovation and motivation and provide the seed-corn for sustained growth and development.”

The ultimate aim should be to develop a healthy and adaptive organisation, with a working environment that plays to the employees’ psychological well-being, ultimately making the workplace a fabulous place to work. In the United States, the American Psychological Association Center for Organisational Excellence has a Psychologically Healthy Workplace Program and nominates companies annually for Psychologically Healthy Workplace and Organisational Excellence Awards.

In Canada, in 2013, a National Standard of Canada for Psychological Health and Safety in the Workplace was published; the objective is to help organisations recognise psychological health as part of an ongoing process of continuous improvement. This initiative followed a survey by Ipsos Reid (a leader in canadian market research) in October 2012, which showed that 30 % of Canadian workers surveyed reported levels of concern with psychological health and safety, which they believed warranted serious attention.

In Australia, a Mentally Healthy Workplace Alliance (MHWA) was set up on 1 July 2013 as a national approach by business, community and government to encourage Australian work- places to become mentally healthy. Members of the MHWA include the Australian Chamber of Commerce and industry, the Australian Council of Trade Unions and the Australian Industry Group. The MHWA recognises that a mentally healthy workplace is not just good for people, it is also very good for business. It actively supports business by promoting the best available research evidence and good practice approaches to create mentally healthy workplaces.

Organisational health and productivity

 As far back as 1997, David Ulrich, Professor of Business at the Ross School of Business, University of Michigan, in his seminal book Human Resources Champions, wrote: “Employee contribution becomes a critical business issue because in trying to produce more output with less employee input, companies have no choice but to try and engage not only the body but the mind and soul of every employee.” The challenge is therefore to develop and implement an organisational approach which leads to higher employee engagement, enhancing employee health, well-being and productivity.

 In Mauritius, this can be driven centrally at a national level, with government initiatives similar to the canadian and australian models, involving both employers and trade unions. An ambitious aim, but achievable by a new Government who can provide the inspiring leadership necessary to energise the nation.