News on the Radio
I listened aghast at the news from my car radio—one of my company’s lorries was in an accident, and there were fatalities in the other vehicle. No more details were given, but immediately I started thinking about all the lorry drivers and who it might be, and why. The devastation an incident like this causes is just awful, not only for the victim and family but also for the driver and company, also a full review of everything was now on the cards as part of the full investigation.
At the time, I worked for a large distribution company and managed a sizable occupational health team, which included occupational health doctors, nurses, and technicians working in hubs around the country. Health surveillance, health screening, fitness for work, and absence management took most of their time.
Drivers belonged to a business unit within the larger company that delivered groceries across the United Kingdom with a hub-and-spoke type of service. The drivers were well paid, and many had been in the jobs for most of their working lives. They took pride in making sure that groceries got through whatever weather, and in one particularly bad winter when roads were almost impassable, received an award for keeping the shop shelves stocked with food.
We had never had one of our lorries involved in a fatal accident before.
Medical Standards for Lorry Drivers
The Driver Vehicle Licensing Authority specifies that lorry drivers (class two) have a medical check-up every five years (after the age forty-five) by a registered doctor. These higher medical standards for vocational drivers focus on coordination, sight, heart health and so on. Click here for more details of what the medical examination entails and frequency of medical tests.
Long ago we had a discussion within the company about how occupational health should be involved in this.
A class two medical and renewal of licence (necessary to continue driving) can cost anything from fifty to two hundred pounds, depending on the doctor, and tended to get more costly the nearer to London or the South. It was suggested, as a way of saving money, that the occupational health doctors do the medical tests. As they were our doctors, we already paid for them, and they would have the best interests of the company at heart.
I disagreed with this not for economic reasons but for medical reasons.
A GP who did the class two medicals for the lorries had full access to the individuals’ health records. Occupational health did not have this access to the full medical history and neither, for that matter, did companies who set themselves up just to do these medicals. Drivers who may have had a health scare or a medical incident in the past, are aware of this, so prefer to go to a new doctor (without the background history) and not their own surgery.
I argued successfully that we would continue to outsource the medicals to a driver’s own GP; it might be more expensive, but it would be safer.
Health on the Road
The UK transport business is a male-dominated sector (83 per cent of workers in the sector are men) with workers sitting in tiring or painful positions; long working hours (average more than forty-eight hours a week); and non-standard working hours (night and evening work, weekend work, and more than ten hours worked per day). Unsurprisingly, this sector scores badly on work-life balance.
Drivers find it difficult to eat healthy meals and take exercise breaks while on the road.
Think how you might park a heavy goods vehicle outside your local co-op or even in some supermarkets?
Drivers have to plan their breaks and eating before setting out on long-distance drives to keep within the law of working hours and for their personal needs such as toilet breaks, snacks, and so on. They also have to carry plenty of drinks with them, especially in the summer.
In the transport sector, occupational risk factors are usually:
Health Risks from Driving
Whole-body vibration; noise; prolonged sitting; tiring and painful postures; strict timetables; shift work and overnight driving; insufficient breaks and sleep; repetitive tasks and monotonous routine; unorganised meals; road accidents; transport of flammable; explosive, and toxic substances; air conditioning; difficulty getting in or out of the lorry cabin Health Risks from Environment Carbon monoxide (CO), sulphur dioxide (SO2), nitrogen monoxide (NOx), asbestos, polycyclic aromatic hydrocarbon (PAH), benzene, particulate matter, climate conditions, pollen, physical violence
Gender; age; ethnicity; education; personality; attitudes; risk perception; experience and earlier motor vehicle accidents; private life events; fatigue; pre-existing diseases (allergies, asthma, diabetes, heart problems, etc.); medicine consumption (antihistamines, tranquillisers); lifestyle (physical inactivity and unhealthy eating); and hazardous behaviours (tobacco smoking, alcohol abuse, use of hard or soft drugs)
Lower back pain, being overweight, sleep apnoea, cardiovascular and respiratory diseases, and work-related stress. These problems being linked to the working environment (such as poor work organisation) and working conditions (static work), and to personal risk factors (such as lack of exercise, unhealthy diet, alcohol abuse, smoking, age, and pre-existing diseases).
To address these health issues and motivate the people to change behaviour, many large employers of vocational drivers have developed programmes to encourage a healthier lifestyle.
There were many issues that came from the lorry accident investigation over the year. One of which was that the company would start its own health promotion programme. Who better to ask on how to do this than occupational health, also known as me?
Setting up a Suitable Health Promotion Programme for Class 2 Drivers
Shortly after, and as part of the investigation, the divisional director asked my opinion.
I told him that good occupational health promotion campaigns in the workplace need a holistic approach, and the workforce needs to own them. Any initiatives must consider the worker’s private life, working life, and the interaction between the two. I explained how working conditions influence a driver’s general health and gave examples of how sedentary work can lead to obesity. Similarly, workers’ personal habits, attitudes, and lifestyle choices affect their health and well-being and impact their work performances. A knock-on effect of the health promotion project is that there is also a positive effect on the employer.
The director listened carefully to my explanation and agreed to get back to me with his decision about what to do.
Before I go any further though, I should like to point out, we started other initiatives as a result of the investigation of the accident, but these were not health related.
Health Promotion at Work
Workplace health promotion combines the efforts of employers, employees, and society to improve the health and well-being of people at work. It includes measures supporting health-enhancing behaviours and attitudes; promotion of mental health and well-being; promotion of work-life balance; and the addressing of issues related to work-related stress, ageing, and staff development.
A review of research on workplace health promotion interventions found that several factors were key to the success of any health promotion campaign:
1. Organisational commitment to improving the health of the workforce (tick)
2. Appropriate information and comprehensive communication strategies to employees (half a tick)
3. Employees’ involvement throughout the process (tick)
4. Organisation of work tasks and processes contributing to health, and not damaging it
5. Implementation of practices which enhance healthy choices as the easiest choices (tick)
Looking at the list above, I worked out that my team could help with all but point 4 and was keen to start. My occupational health team also gave me some good ideas to work with and suggestions of how we could help. It was a great day to be asked to help with such an important project, as health promotion and education could have a huge positive impact in the logistics department.
But I was surprised and impressed by the final programme we agreed upon.
Workplace Health Promotion Group
The group consisted of occupational health, management, union representatives, and three drivers, plus a representative from the administration part of the division.
Discussions about which health initiative would be best were lively. A couple of times I overruled, but generally, the suggestions were good and, more importantly, would be accepted by the teams.
We eventually decided on the following:
- A printed company calendar with health messages (the illustrations drawn by drivers’ children)
- Healthy food options being available on each site
- Ice boxes for each driver to put in their cabs
- Eyesight test charts on each site with instructions on how drivers could test their own eyesight
- Displaying a series of posters on each site with key health messages throughout the year
- A voluntary health check from occupational health for each driver to check blood pressure, urine for diabetes, waist measurement, body mass index, and eyesight
- Individual advice from occupational health on any health matter
- Other initiatives, including reviewing the risk assessments and training for drivers on safe driving
The programme was starting as I left the company.
A keen member of my occupational health team took up the challenge. The success of the programme over the year following meant many others adopted the initiative too.
As for the driver of the lorry, he returned to work and continues to drive.
A number of issues arose from this incident, but the most enlightening issue for me was the astonishing programme that came out of the working group. The focus was specific and highly relevant to the workers, therefore, more likely to work. So often I see health promotion programmes that bear little relevance to the workers or consider minorities in the workforce, such as smokers and the stressed, instead of those who might truly need help with health. Our overweight drivers found it difficult to eat healthy while they were on the road, therefore they stocked up with sweets and processed foods.
Men are particularly difficult to reach. So we considered those who would not engage in the traditional one-to-one health assessments done by nurses. We chose a poster campaign giving the opportunity for workers’ children to become involved.
We also realised that driving is a job, and if you lose your job, you lose your livelihood. Health checks are scary in that respect, so each worker could test their own eyesight if they had concerns.
It may not have been the answer, but it was a start.
Chapter from Jane Coombs book: ‘The Good, The Bad, and the Smugly: Behind the Scenes in Occupational Health’
Available on the Kindle Store for £4:18