OPINION: Where does the "Workplace" fit into "Public Health"?

As a nursing student my community health nursing course, kind of, sort of covered Occupational Health. In an astonishing half a page of an entire textbook the entire concept of Occupational Health was “mentioned” (I am obviously being sarcastic). It wasn’t really until I accidentally landed in the field of Occupational Health and Safety where I understood the impact the workplace had on human health.

So let me first start with this, it’s funny to me because when I was in my undergraduate program I never thought I would ever have to refer to this ever in my life but here I am, writing a blog post in my own blog about it.

Health Canada elaborates quite nicely on the definition of “population health”:

Population health builds on a long tradition of public health and health promotion. In 1974, the federal government's White Paper, A New Perspective on the Health of Canadians (Lalonde Report), proposed that changes in lifestyles or social and physical environments would likely lead to more improvements in health than would be achieved by spending more money on existing health care delivery systems. The Lalonde Report gave rise to a number of highly successful, proactive health promotion programs which increased awareness of the health risks associated with certain personal behaviors and lifestyles (e.g., smoking, alcohol, nutrition, fitness). A population health approach takes action based on analyses and understandings of the entire range of the determinants of health. A population health approach recognizes the complex interplay between the determinants of health. (https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach/what-population-health-approach.html#health )

Determinants of health are the broad range of personal, social, economic and environmental factors that determine individual and population health. The main determinants of health include:

  1. Income and social status

  2. Employment and working conditions

  3. Education and literacy

  4. Childhood experiences

  5. Physical environments

  6. Social supports and coping skills

  7. Healthy behaviors

  8. Access to health services

  9. Biology and genetic endowment

  10. Gender

  11. Culture

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We can clearly see that one of the determinants is employment and working conditions yet hardly any focus from a broader perspective is placed on “working conditions” other than preventing safety hazards and occupational incidents. In Ontario and probably the rest of Canada, we have two different ministries dealing with an issue that has everything to do with one another. The ministry of health deals with healthcare and the ministry of labor deals with labor and safety but who bridges the gap between the two of them and the concept of “HEALTH”? Majority of the Canadian population WORKS for long periods of their lives meaning alot of their life is spent at the workplace.

I certainly have seen joint ministry initiatives but I personally don’t feel like it is enough because we continue to see increases in both occupational and non/occupational illnesses, increase in mental health issues/suicides, and an increase in health issues as a whole, in general.

Lets do some simple math using Ontario as an example:

According to the January 2018 Ontario Labour Market Report:

Current working population in Ontario: 11.8 Million

1 average persons life spent at work: 1950 hours/year (37.5 hours x 52 weeks)

Lets say,

The average person starts full time work at 21 and retires at 65 = 44 years of work

44 years of work x 1950 hours = 85,800 hours

So,

85,800 hours x 11.8 millions = 1, 012, 440, 000, 000

That’s 1 trillion, 12 billion, 440 million hours spent working.

So I go back to my original question, why doesn’t population health have more of a focus on the workplace?

We’re seeing that emergency rooms are overloaded, the Canadian healthcare system is loaded, patients are on the wait list for unacceptable periods of times for diagnostics, testing and treatment. There isn’t funding or enough resources to respond to health issues fast enough. People are dying, the government is making more cuts and the outcome isn’t changing.

Let’s think for a second, the approach to healthcare changed with the Lalonde report to a more upstream preventative approach. Hoping that it impacts the end result being a healthier population, decrease in illnesses and in turn reducing the populations need to access healthcare because they are WELL and not sick.

With that being said, It is important to keep workers well because they spend most of their lives there. It impacts every aspect of literally everything, injured/ill workers means that businesses suffer impacting the Canadian economy, businesses lose profitability because they are losing a crucial component of their operations - the manpower, employees who are ill are impacted because now they aren’t making wages or their disability benefits don’t cover enough for them to survive which can also mean their families are impacted and at the end of the day their basic needs aren’t being met resulting in a catastrophic cycle of continued sickness, an overloaded healthcare system and death.

So I ask, why isn’t there more being done at the level of the workforce to keep the population healthy?

At the current times, employers commit out of their own pockets to try to keep their workers well and it clearly is not enough.

Why isn’t the government doing more to include workplaces in their focus of “population health”. ?

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References:

https://www.ontario.ca/page/labour-market-report-january-2018

https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach/what-population-health-approach.html#health

https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html