Multiple Determinants of Health in the Workplace

Melissa Evans  

Introduction

Occupational Health is a two-way relationship between health and work. According to Occupation Health (2007), “Occupational Health is as much related to the effects of the working environment on the health of workers as to the influence of the workers’ state of health on their ability to perform the tasks for which they were employed. Its main aim is to prevent, rather than cure, ill health from wherever it arises in the workplace. A person’s health can impact on their work and their work can impact on their health.”

Approaching the impacts on work health holistically, we can look at the determinants of health within the workplace through the use of various models; however we are going to focus on the Dahlgren-Whitehead “Rainbow Model”.

In essence the “Dahlgren-Whitehead model highlights a causal relationship between individual lifestyle ‘choices’, social networks, working and living conditions and economic, political and environmental factors, globally, nationally and locally. While the configuration of these different layers and factors can have both positive and protective influences on our lives, they can also undermine health and wellbeing, both for individuals and communities. For example, adverse economic conditions have implications for employment and training opportunities, public services such as health, social care, education, the wide range of services provided by local authorities, as well as the funding they provide to support local voluntary sector services. Where adverse conditions persist, they can have a significant and negative impact on social attitudes, social cohesion and social mobility(NHS Education for Scotland).”

Developed in 1991 by Goran Dahlgren and Margaret Whitehead the Dahlgren Whitehead Rainbow maps the relationship between the individual, their environment and health. The rainbow looks at five main areas. These areas include:

• Age, Sex and Constitutional Factors – This is the core of the Dahlgren-Whitehead model and it focuses on the key areas of age, sex, ethnicity and genetic/biological constitutional factors. A workers age, sex or constitutional factors can reveal if the worker brings with them a pre-existent health status to the workplace such as inheritance and genetic susceptibility. Other factors in the extended layers can also be influenced by this component of the model.

• Individual Lifestyle Factors – This layer focuses on a person’s lifestyle ‘choices’. Behaviours such as alcohol and other drug misuse, poor diet, smoking, lack of physical activity, the number of jobs they do or if they play a sport can have an impact on a workers’ health and in turn could affect their ability to complete certain tasks in the workplace. Injuries caused by lifestyle choices such as sport could impact on a workers ability to carry out certain tasks or could put them at a higher risk of aggravation within the workplace which could lead to more serious injuries.

• Social and Community Networks – This layer focuses on family support, friends and wider social circles. In this layer we can look at things like different cultural backgrounds, communication, community support groups and interpretation services. Quality not quantity should be taken into consideration.

• Living and Working Conditions – This layer focuses on access to opportunities such as work, unemployment, training, health care services, housing, public transport and amenities. It also includes items such as water, sanitation and access to essential items such as food, fuel and clothing. When we focus on work we need to focus on the type of work to see if there is a potential for occupational disease or stress. Financial instability and access to health services could be a result of unemployment.

• General Socio-Economic, Cultural and Environmental Conditions – This layer factors that impact on health and wellbeing such as social, economic, cultural and environmental. Items include availability of work, wages and taxation, prices of essential items such as food, clothing, transport and fuel. Cultural factors could include health being affected by traditions and beliefs of the family community. These conditions get reported on through to the government and in turn can influence the priorities of health policy and spending by the government.

Whilst there is extensive documentation and evidence prior to the development of the Dahlgren-Whitehead with respect to Occupational Health, the model has been widely used to assist with research of the vast array of factors that can impact our workers from both a health and work level. The development of the model now allows us to look into reviews and research papers, and including qualitative and quantitative evidence in a more in-depth way. When using this information it should be supplemented with local and expert knowledge, policy information, and proposal specific information.

According to the Declaration on Occupational Health for All by the World Health Organisation (1994) “by affecting the health of the working population, occupational injuries and diseases have profound effects on work productivity and on economic and social well-being of workers, their families and dependants.”

Depending on the type of occupational injury or disease its effects can be far reaching. Whilst a majority of occupational injuries and diseases are minor there are also those that are more severe that the outcome could be long term, for example, could result in ongoing hospital treatment for an extended period, may need extended rehabilitation, permanent disability or even death. Let’s look at the potential outcome of a worker who sustains a permanent disability and is wheelchair bound for the remainder of their life, it is not just the worker who is effected but their family, friends, their wider community, the costs that it generates, the loss of productivity at the workplace and the impact on social security systems.

The World Health Organisation (1994) states that “health and safety problems at work are, in principle, preventable and should be prevented by using all available tools – legislative, technical, research, training and education, information, and economic instruments.” In order to achieve this outline a workplace needs to consult Federal, National and State Legislation such as the Work Health and Safety Act 2011 as well as Australian Standards and Codes of Practice to assist with the development of a Safety and Health Policy in the first instance. From the policy a workplace then needs to delve further and design and implement Safety Management Systems, work instructions, job descriptions, job dictionaries, etc. Once the documentation has been researched, designed and implemented they then need to look at training and education. As part of this phase they need to identify hazards, conduct risk assessments and look at controls and interventions for prevention and control.

Reference List

1. Aw, T.C., Gardiner, K. and Harrington, J.M. (2007) Occupational Health.

2. NHS Education for Scotland. Retrieves March 20, 2017 from http://www.bridgingthegap.scot.nhs.uk/understanding-health-inequalities/introducing-the-wider-determinants-of-health.aspx

3. Dahlgren, G. and Whitehead, M. (1991). The Dahlgren Whitehead Rainbow. Retrieved March 18, 2017 from http://www.esrc.ac.uk/about-us/50-years-of-esrc/50-achievements/the-dahlgren-whitehead-rainbow/

4. World Health Organisation (1994). Declaration on Health for All.

< >