tag:theconversation.com,2011:/es/topics/worksafe-2942/articlesWorksafe – The Conversation2019-11-07T19:03:31Ztag:theconversation.com,2011:article/1264892019-11-07T19:03:31Z2019-11-07T19:03:31ZEngineered stone benchtops are killing our tradies. Here’s why a ban’s the only answer<figure><img src="https://images.theconversation.com/files/300381/original/file-20191106-88403-1i4frk7.jpg?ixlib=rb-1.1.0&rect=6%2C7%2C1016%2C674&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If we can't afford natural stone, like marble, it's tempting to choose engineered or artificial stone instead. But at what cost to those who breathe in the silica dust when cutting it?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-smiling-caucasian-family-kitchen-preparing-347647706">from www.shutterstock.com</a></span></figcaption></figure><p>The <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-nat-dust-disease-taskforce.htm">National Dust Disease Taskforce</a> is preparing to read submissions next week on how best to handle the resurgence of the fatal lung disease silicosis. This can develop after breathing in silica dust when cutting artificial stone — also known as engineered, composite or manufactured stone — the type used for kitchen benchtops.</p>
<p>But this is not the first time we’ve been alerted to the long-term effects of exposure to hazardous dust. Think asbestos.</p>
<p>So what lessons can Australia learn from tackling asbestos to manage this latest preventable occupational hazard?</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-silicosis-and-why-is-this-old-lung-disease-making-a-comeback-80465">Explainer: what is silicosis and why is this old lung disease making a comeback?</a>
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<h2>We’ve known about hazardous dust at work for centuries</h2>
<p>Centuries ago, we recognised dust in mines badly damaged workers’ lungs. In 1713, Italian physician Bernardino Ramazzini <a href="https://www.ajconline.org/article/0002-9149(59)90174-2/pdf">wrote</a> how miners’ bodies:</p>
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<p>[…] are badly affected, the lungs especially since they take in with the air mineral spirits.</p>
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<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1002/ajim.22528">More evidence</a> led to a 1930 conference in South Africa agreeing the lung disease silicosis was caused by silica dust. A few years later, the International Labour Organisation included silicosis in a list of diseases workers could be compensated for.</p>
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Read more:
<a href="https://theconversation.com/black-lungs-back-how-we-became-complacent-with-coal-miners-pneumoconiosis-57718">Black lung's back? How we became complacent with coal miners' pneumoconiosis</a>
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<p>Control measures to reduce the risk of silicosis were well-recognised even in the mid-1930s; <a href="https://www.amazon.com/Hawks-Nest-Incident-Americas-Industrial/dp/0300035225">lawsuits were filed</a> against the Union Carbide company for not protecting construction workers. </p>
<p>At that time, breathing protection was fairly basic. But in the decades since then, <a href="https://www.safeworkaustralia.gov.au/silica">we established</a> that any activity generating silica dust (such as cutting, blasting or grinding concrete or rock) needed water spray systems, extraction fans and respirators.</p>
<h2>The dangers of cutting engineered stone</h2>
<p>So how, in a country like Australia, do we suddenly see young workers dying of this completely preventable disease? </p>
<p>The cases seem to be arising from cutting artificial stone. This can contain up to 95% silica, <a href="https://www.worksafe.qld.gov.au/injury-prevention-safety/alerts/whsq/2018/prevent-exposure-to-silica-for-engineered-stone-benchtop-workers">compared with</a> less than 40% silica in natural stone.</p>
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<a href="https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Cutting engineered stone exposes workers to higher levels of silica dust than cutting natural stone.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stone-cutting-tool-evening-1232151553">from www.shutterstock.com</a></span>
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<p>Cutting artificial stone has emerged as a major hazard. <a href="https://www.abc.net.au/news/2019-09-16/silicosis-surge-prompts-call-for-ban-on-engineered-stone-product/11516138">The ABC reports</a> there have been 260 cases of silicosis in Australia, mostly in Queensland. </p>
<p>And there are likely to be more cases developing. <a href="https://www.commerce.wa.gov.au/announcements/spotlight-silica-proactive-inspection-program">Regulators’</a> <a href="https://www.finance.nsw.gov.au/about-us/media-releases/nation-leading-program-fight-silicosis-0">responses</a> — proactively inspecting workplaces to see if they comply with safe work practices and issuing prohibition notices and fines to individual workplaces if not — are very welcome.</p>
<p>But these responses come too late for those hundreds of young workers who have lost their health, some of whom may die without a lung transplant.</p>
<h2>What can we learn from asbestos?</h2>
<p>We have been here before. Asbestos mining and manufacturing and the importation of asbestos products into Australia started in the 1880s. Over the next century, it developed into a major industry, peaking in the decades after the second world war.</p>
<p>Over the same time, medical knowledge about the diseases caused by asbestos was growing. The first recorded case of asbestosis (a progressive lung disease) was <a href="https://catalog.hathitrust.org/Record/100760626">described in London in 1906</a> (although, reports of ill health in asbestos workers had been reported <a href="https://catalog.hathitrust.org/Record/002130771">from as early as 1899</a>). </p>
<p>In 1928 the Journal of the American Medical Association <a href="https://jamanetwork.com/journals/jama/article-abstract/253232">published an editorial</a> on asbestosis. And, in Australia from 1945, standards for exposure to asbestos <a href="https://publishing.monash.edu/books/aa-9781925835618.html">were introduced</a> as controlling dust levels was thought the best way to prevent disease. </p>
<p>If Australia had stopped the use of asbestos in 1928, the ill health and death associated with asbestos would not be at levels we’ve seen since.</p>
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Read more:
<a href="https://theconversation.com/health-harms-of-asbestos-wont-be-known-for-decades-14845">Health harms of asbestos won't be known for decades </a>
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<p>Instead, <a href="https://www.safeworkaustralia.gov.au/system/files/documents/1702/literaturereview_airborneasbestosfibres_2008_pdf.pdf">Australia only stopped using</a> blue asbestos (the most carcinogenic form) in the late 1960s, brown asbestos (the next most carcinogenic) in the 1980s, and all asbestos in 2003.</p>
<p>By 2020, there will have been an estimated <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/ajim.10047">18,000 cases of mesothelioma</a>, <a href="https://www.nature.com/articles/bjc2011563">108,000 cases of lung cancer</a> and <a href="https://www.safeworkaustralia.gov.au/doc/asbestos-related-disease-indicators-2014">an unknown</a> but substantial number of cases of asbestosis in Australia.</p>
<h2>How best to protect workers?</h2>
<p>The standard response to the silicosis epidemic is that workers should use control measures and personal protection. However, there is <a href="https://academic.oup.com/annweh/article/59/1/122/2464381">increasing</a> <a href="https://oeh.tandfonline.com/doi/abs/10.1080/15459624.2013.789706">evidence</a> dust control measures do not reduce the levels of silica to non-hazardous levels. </p>
<p>Many companies also use a mixture of dry and wet cutting, particularly when installing the products. As with asbestos, there simply is no way to safely use this material.</p>
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Read more:
<a href="https://theconversation.com/dying-for-work-the-changing-face-of-work-related-injuries-40328">Dying for work: the changing face of work-related injuries</a>
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<p>We need to go back to the basics of occupational health — <a href="https://en.wikipedia.org/wiki/Hierarchy_of_hazard_controls">the hierarchy of control</a>. This means, if there is a hazard, we first see if we can eliminate it by banning the dangerous product.</p>
<p>This basic principle, taught to all occupational health and safety professionals, seems to have been forgotten for silica. For example, SafeWork Australia does not mention elimination in its online information on controlling <a href="https://www.safeworkaustralia.gov.au/silica">silica</a>, although it does mention substitution with products containing lower levels of silica.</p>
<p>The <a href="https://www.breathefreelyaustralia.org.au/">Breathe Freely Australia</a> public health campaign, <a href="https://www.breathefreelyaustralia.org.au/wp-content/uploads/2019/10/bf-cmt-Hiearchy-of-Control.pdf">notes</a> elimination:</p>
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<p>[…] is the preferred method of control as it completely eliminates the hazard, but unfortunately it is not often feasible. </p>
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<h2>Yes, a ban is feasible</h2>
<p>We argue it is feasible to ban artificial stone, which is not made in Australia but imported. There are many alternatives, such as natural stone, or <a href="https://www.bettastone.com.au/">Betta Stone</a> made from recycled glass.</p>
<p>The National Dust Disease Taskforce is <a href="https://consultations.health.gov.au/ohp-regulatory-policy-branch/national-dust-disease-taskforce/">taking submissions</a> until November 11, 2019.</p>
<p>We suggest:</p>
<ul>
<li><p>a total ban on importing, making and using engineered stone with a crystalline silica content of more than 80%</p></li>
<li><p>immediate regulation (in every jurisdiction) banning dry cutting, grinding or polishing of all artificial stone</p></li>
<li><p>a reduction of the workplace exposure standard for respiratory crystalline silica to half current levels by January 2020 (from 0.10mg/m³ to 0.05mg/m³). Disappointingly, a recent SafeWork Australia meeting rejected the opportunity to reduce the level to 0.02mg/m³.</p></li>
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<p>It took 70 years for Australia to ban all forms of asbestos. We need to learn from that disaster and immediately ban artificial stone. We just can’t continue to let young Australian workers die just so we can have cheap, fashionable kitchens.</p><img src="https://counter.theconversation.com/content/126489/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lin Fritschi is a member of the Occupational and Environmental Cancer Subcommittee for Cancer Council Australia. She is also an expert member on the Western Australian Commission for Occupational Safety and Health. She has made a submission to the National Dust Disease Taskforce. The opinions expressed are her own.</span></em></p><p class="fine-print"><em><span>Alison Reid will be making a submission to the National Dust Disease Taskforce.
</span></em></p>What lessons can Australia learn from tackling asbestos to manage this latest preventable occupational hazard?Lin Fritschi, Professor of Epidemiology, Curtin UniversityAlison Reid, Associate Professor, Epidemiology and Biostatistics, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/804652017-08-07T02:09:55Z2017-08-07T02:09:55ZExplainer: what is silicosis and why is this old lung disease making a comeback?<figure><img src="https://images.theconversation.com/files/179579/original/file-20170725-6656-edt7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You can barely see this construction worker for dust. His lack of protective face mask puts him at risk of silicosis and other lung diseases.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/Category:Silicosis#/media/File:DustWorker.jpg">Lamiot/Wikimedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Silicosis is a group of occupational lung diseases caused by breathing in silica dust. It has been described since ancient times, when miners and stone cutters were exposed to dust containing this crystalline mineral.</p>
<p>Silicosis was more common in Australia in the 1940s to 60s, particularly in construction and demolition workers. Growing awareness of the disease and the importance of reducing exposure to dust – for instance, wearing masks at work, wetting the dust and other safe work practices – has reduced the number of cases.</p>
<p>However, there has been a worrying resurgence of cases recently, as a recent New South Wales parliamentary committee <a href="https://www.parliament.nsw.gov.au/committees/DBAssets/InquiryEventTranscript/Transcript/9950/Transcript%20-%2028%20June%202017%20-%20UNCORRECTED.pdf">has heard</a>. Now one of the fastest growing occupational groups we’re seeing with silicosis are people who <a href="https://www.mja.com.au/journal/2017/206/9/complicated-silicosis-resulting-occupational-exposure-engineered-stone-products">make and install engineered stone products</a>, the type of benchtops and tiles you might find in your kitchen or bathroom. </p>
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Read more:
<a href="https://theconversation.com/australias-occupational-health-and-safety-regime-needs-first-aid-12794">Australia's occupational health and safety regime needs first aid </a>
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<p>This resurgence in cases is likely related to a poor understanding of the risks involved in working with engineered stone, and a <a href="https://www.parliament.nsw.gov.au/committees/DBAssets/InquiryEventTranscript/Transcript/9950/Transcript%20-%2028%20June%202017%20-%20UNCORRECTED.pdf">lack of adherence to safety regulations and surveillance requirements</a>.</p>
<h2>What is silica and how are people exposed?</h2>
<p>Silica is in quartz, sand, stone, soil, granite, brick, cement, grout, mortar, bitumen and engineered stone products.</p>
<p>Any occupation disturbing the earth’s crust increases the risk of silicosis. That includes sand blasting, cutting, excavating, building on sandstone, demolition work, tunnelling, quarry work and mining. Air-polishing concrete, foundry work, bricklaying, stone masonry, and making glass and ceramics also increase the risk.</p>
<p><a href="https://academic.oup.com/annweh/article-abstract/60/5/631/2196173">About 6.6% of Australian workers</a> are exposed to crystalline silica dust that can be breathed in, and 3.7% are heavily exposed.</p>
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<a href="https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Stone masons are also at risk from silicosis if they don’t take precautions against breathing in silica dust.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/341489507?src=kqnbp-yH_j46iZGl762w8g-1-48&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>While not all of these will go on to develop silicosis a significant proportion will, with symptoms appearing between months and many years after exposure, depending on the type of silicosis. </p>
<p>The likelihood of developing severe silicosis increases depending on how much dust people are exposed to and for how long. Genetics may also play a role in susceptibility, with some groups, <a href="https://academic.oup.com/aje/article/144/9/890/95225/Silicosis-among-Foundry-Workers-Implication-for">like African Americans</a>, having a higher risk.</p>
<p>Symptoms of silicosis include a cough, breathlessness and tiredness. But in the early stages of the disease, there may be no symptoms.</p>
<p>As silicosis can progress long after exposure at work, people should report any troublesome symptoms to their GP, even after they have left the industry. If silicosis is suspected, they should be referred to a respiratory physician.</p>
<h2>Different types of silicosis</h2>
<p>There are three different types of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1637684/">silicosis </a>:</p>
<ul>
<li>acute silicosis can develop within weeks of very heavy exposure to silica. The lungs are filled with a fluid containing a lot of protein, which causes severe breathlessness</li>
<li>accelerated silicosis is also associated with high exposures (the type currently being seen in people working with engineered stone products), where there’s a rapid increase of scarring in the lung (fibrosis) within 10 years of first exposure, and</li>
<li>chronic silicosis, the most common form of silicosis, where fibrosis occurs more slowly over 10-30 years after first being exposed.</li>
</ul>
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<img alt="" src="https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=584&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=584&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=584&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=734&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=734&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=734&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Chest x-ray of complicated silicosis, showing large areas of scarring.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<p>Then there’s simple and complicated silicosis. Simple silicosis results in many small white spots (nodules) that you can see on a chest x-ray or CT scan. With complicated silicosis there are large areas of scarring called progressive massive fibrosis.</p>
<p>In general, the more scarring and the more widespread it is, the more trouble people have breathing as their lungs lose their capacity to expand and contract with each breath. Silicosis also increases people’s susceptibility to <a href="https://theconversation.com/explainer-what-is-tb-and-am-i-at-risk-of-getting-it-in-australia-75290">tuberculosis</a>.</p>
<h2>How is silicosis treated and what are the outcomes?</h2>
<p>Diseases due to silica exposure are serious and potentially lethal, and there is no specific treatment other than supportive care. This can include stopping smoking, using inhalers, vaccination against infections, and antibiotics. In the late stages, oxygen treatment or a lung transplant may be needed.</p>
<p>Once diagnosed, the disease generally progresses over time. Patients with accelerated silicosis may progress to progressive massive fibrosis over a period of four to five years. Overall, people diagnosed with silicosis lose an average 11.6 years of life. So, prevention is vital.</p>
<h2>How can we prevent silicosis?</h2>
<p>Diseases due to silica exposure – for instance silicosis, <a href="https://monographs.iarc.fr/ENG/Monograph">lung cancer</a>, connective tissue disorders like <a href="http://www.sclerodermaaustralia.com.au/about/about-scleroderma">scleroderma</a>, kidney disease and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/lung-conditions-chronic-obstructive-pulmonary-disease-copd">chronic obstructive lung disease</a> – are entirely preventable.</p>
<p>Wetting of silica dust, using appropriate exhaust ventilation and extraction hoods, and wearing the right dust masks and air filters all reduce the chances of someone breathing in silica dust at work.</p>
<p>There are also <a href="https://www.safeworkaustralia.gov.au/system/files/documents/1705/workplace-exposure-standards-airborne-contaminants-v2.pdf">workplace standards</a> on exposure to silica dust. And workplace screening for lung disease is <a href="https://www.safeworkaustralia.gov.au/system/files/documents/1702/guide-pcbu-health-monitoring-exposure-hazardous-chemicals.pdf">mandatory</a> for those at significant risk, which can include a physical examination as well as x-rays and lung function tests.</p>
<h2>How can we keep track of silicosis?</h2>
<p>Silicosis carries a high <a href="https://www.safeworkaustralia.gov.au/system/files/documents/1702/occupational_respiratory_disease_australia.pdf">social and economic cost</a>. And workers can receive compensation for silica-related disease in some states. In NSW, for instance, <a href="https://www.safeworkaustralia.gov.au/system/files/documents/1702/occupational_respiratory_disease_australia.pdf">186 workers</a> received compensation payments through the Dust Diseases Board in 2002-2003.</p>
<p>Yet, we don’t know the true number of new cases in Australia. While there are voluntary reporting systems in Victoria, Tasmania and NSW, these are likely to have underestimated the true incidence of disease.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-black-lung-and-why-do-miners-get-it-51649">Explainer: what is black lung and why do miners get it?</a>
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<p>So specialist doctors concerned about the resurgence of silicosis <a href="https://www.parliament.nsw.gov.au/committees/DBAssets/InquiryEventTranscript/Transcript/9950/Transcript%20-%2028%20June%202017%20-%20UNCORRECTED.pdf">have called for</a> mandatory reporting of occupational lung disease to a centralised registry, as occurs in Europe and America.</p>
<p>Australia is seeing the re-emergence of diseases like silicosis and coal worker’s lung (also known as black lung) that were previously believed to have disappeared. So, workers, employers, doctors, public health officials, and legislators need to work together to prevent more cases of these deadly, but preventable, lung diseases.</p><img src="https://counter.theconversation.com/content/80465/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Miles is a Staff Specialist at Calvary Mater Newcastle, and a Member of the Occupational and Environmental Lung Disease Special Interest Group of the Thoracic Society of Australia and New Zealand.</span></em></p>We’re seeing the resurgence of an old lung disease in people who make and install the type of engineered stone product you might find in your kitchen or bathroom.Susan Miles, Respiratory, sleep and general physician and conjoint lecturer in medicine, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/655402016-11-13T19:05:30Z2016-11-13T19:05:30ZWe need more support systems for people who want to work during and after cancer treatment<figure><img src="https://images.theconversation.com/files/143010/original/image-20161025-28405-1oy34yp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cancer and its treatment can have a profound impact on the patient's ability to work.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Work is good for your health. Not only because it provides income but because it preserves a sense of identity and purpose if you are going through a hard time. It provides social interaction and, especially in the case of someone battling through cancer, a sense of normality. </p>
<p>But coming back to work after cancer treatment, or working during, will not come as easy as before diagnosis. And in Australia, there is no system to support people returning to work after cancer treatment – or to provide advice to their doctors or employers on how to help them.</p>
<h2>Work and cancer</h2>
<p>Cancer and its treatment can have a profound impact on the patient’s ability to work. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/27364149">recent Australian study</a> of 255 cancer patients showed 67% changed their employment after cancer and for 63%, the household income had reduced since diagnosis. </p>
<p>People who have, or are, undergoing cancer treatment, <a href="https://www.ncbi.nlm.nih.gov/pubmed/25066834">experience physical changes</a> such as fatigue or nausea; emotional issues including self-consciousness about hair loss; and practical issues such as fitting in medical appointments around work responsibilities.</p>
<p>The cancer diagnosis itself can lead to a change in life priorities, and work may drop down the list. Equally though, despite not being fully able to manage work demands, cancer patients <a href="https://www.ncbi.nlm.nih.gov/pubmed/23695927">may feel pressured to work</a> to meet their financial needs.</p>
<p>Cancer patients are at greater risk of unemployment than the general population. That risk is higher for those with few work skills, blue collar workers who are <a href="https://www.ncbi.nlm.nih.gov/pubmed/22422040">already more financially vulnerable</a> and those who live in areas of limited employment opportunities. </p>
<p>The ability to work after cancer treatment is <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00577-8/abstract">further impacted</a> by the economic environment and job market. Some countries like the Netherlands and Germany consider <a href="https://www.ncbi.nlm.nih.gov/pubmed/21231779">rehabilitation after cancer</a>, including work rehabilitation, part of the standard management of cancer patients. But this approach is not currently adopted in Australia.</p>
<h2>Financial toxicity</h2>
<p>Being unable to work during cancer can make it difficult for the patient to meet the costs of treatment. The so called “financial toxicity”, or difficulty paying for cancer treatment, <a href="http://jco.ascopubs.org/content/34/9/980.abstract">has been associated</a> with distress, bankruptcy and in some cases, earlier death. </p>
<p>The impact of cancer treatment costs on patients and their families is increasingly recognised in Australia and the world. But the indirect effect of a patient being unable to work as a contributor to financial toxicity, has attracted much less attention.</p>
<p>A recent study in the <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00577-8/abstract">Lancet medical journal</a> found during the global economic downturn, cancer patients who were unemployed had lower survival rates. This was especially the case in countries where patients have to pay full price for treatment, which authors suggested could be due to being less able to afford cancer treatments.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/145004/original/image-20161108-4718-1y81qc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/145004/original/image-20161108-4718-1y81qc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/145004/original/image-20161108-4718-1y81qc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145004/original/image-20161108-4718-1y81qc8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145004/original/image-20161108-4718-1y81qc8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145004/original/image-20161108-4718-1y81qc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145004/original/image-20161108-4718-1y81qc8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145004/original/image-20161108-4718-1y81qc8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1127&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Impacts of cancer treatment depend on many factors, individual tolerance to treatment and the nature of the patient’s job.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>More cancer treatments in Australia require some form of user-pay arrangements; from self-funded chemotherapy and higher co-payments, to escalating parking and travel costs. </p>
<p>There have been calls in Australia for doctors to openly disclose the extent of financial toxicity associated with the patient’s treatment, as <a href="https://www.mja.com.au/journal/2016/204/11/financial-toxicity-clinical-care-today-menu-without-prices-1">part of the informed consent</a> process. </p>
<p>But although doctors can tell patients what their treatment will cost, most health professionals don’t routinely provide advice about the impact of cancer and its treatment on work; nor are they trained in assessing a patient’s work ability. </p>
<p>It’s not routine practice to refer patients to an occupational physician for this kind of assessment.</p>
<p>Australian state-based schemes, such as WorkCover and WorkSafe, offer support when a work injury prevents people from working. But neither of these have a scheme for those who can’t work as a result of cancer.</p>
<h2>How we can help</h2>
<p>Doctors routinely recommend short-term absences from work to allow for recovery from surgery. But similar discussions and advice relating to the long-term impact of cancer treatments like chemo and radiation therapy are often lacking.</p>
<p>This is partly because, unlike the well documented surgery recovery time, the impacts of the other treatments are hard to predict and quantify. They depend on many factors including individual tolerance to treatment and the nature of the patient’s job. </p>
<p>Further, those undergoing treatment may be too focused on getting through their cancer ordeal to be aware of the risks of impaired work ability. And employers may not know how to support someone going through cancer treatment. They may be more comfortable getting with the employee not working at all.</p>
<p>Patients, health professionals and employers, need support to help people return to work after cancer. We have <a href="http://workaftercancer.com.au/">developed a web resource</a> to help with various needs in this area. </p>
<p>The website includes links to informative Australian and international resources. It also has a list of questions patients should ask their doctors and employers, assessments on their ability to work, resources on legal rights and obligations, and personal perspectives of cancer survivors. </p>
<p>It aims to provide information on not just what to expect but what could be done and by whom. For instance, it provides a template for a return-to-work plan and a checklist – developed by an occupational physician – for doctors of items to examine to assess a patient’s ability to work.</p>
<p>Researchers need to start measuring the impact of cancer on employment at both the individual and social level and develop strategies to manage it. We shouldn’t forget the more than a million cancer survivors in Australia, many of whom are young enough to continue working after cancer. </p>
<hr>
<p><em>The author is presenting the web resource workaftercancer.com.au at the Clinical Oncology Society of Australia’s <a href="http://cosa2016.org/program/">Annual General Meeting</a> this week.</em></p><img src="https://counter.theconversation.com/content/65540/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Supporting People with Cancer to Return to Work Focusing on Disadvantaged Communities project is a Cancer Australia Supporting people with cancer Grant Initiative, funded by the Australian Government.</span></em></p>In Australia, there is no system in place to support people returning to work after cancer treatment – or to provide advice to their employers on how to help them.Bogda Koczwara, Senior Staff Specialist, Medical Oncology, National Breast Cancer Foundation Practitioner Fellow, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/555772016-03-16T03:55:55Z2016-03-16T03:55:55ZThe two-year wait for Hazelwood mine fire charges shows the system needs to change<p>Victoria’s Environmental Protection Authority has <a href="http://www.epa.vic.gov.au/about-us/news-centre/news-and-updates/news/2016/march/15/charges-laid-following-epa-investigation-into-hazelwood-mine-fire">brought charges against four companies</a> over the <a href="https://theconversation.com/victorias-coal-fire-poses-a-rare-challenge-for-firefighting-23698">Hazelwood coal mine fire</a>, which burned for 45 days in February and March 2014, blanketing the nearby town of Morwell in smoke.</p>
<p>The charges allege that the pollution from the fire broke environmental laws by making the air:</p>
<blockquote>
<ul>
<li>noxious or poisonous or offensive to the senses of human beings;</li>
<li>harmful or potentially harmful to the health, welfare, safety or property of human beings;</li>
<li>detrimental to any beneficial use made of the atmosphere.</li>
</ul>
</blockquote>
<p>The charges follow a two-year investigation featuring <a href="http://hazelwoodinquiry.vic.gov.au/">several inquiries</a> into the fire, including a <a href="http://www.parliament.vic.gov.au/file_uploads/10826_HAZ_Hazelwood_Mine_Fire_Inquiry_Report_2015_16_Volume_II_____Term_of_Reference_6_LoRes_58CA_4NfZvjW2.pdf">report</a> which concluded that the blaze probably contributed to deaths in the community. </p>
<p>The mine’s owner is already facing <a href="http://www.worksafenews.com.au/component/k2/item/473-hazelwood-power-corporation-charged.html">charges from Worksafe Victoria</a>, which it says it <a href="http://www.abc.net.au/news/2016-02-04/hazelwood-mine-operator-charged-over-devastating-2014-blaze/7138378">will defend</a>. It is majority-owned by the power multinational GDF Suez (known internationally as <a href="http://www.engie.com/en/journalists/press-releases/gdf-suez-becomes-engie/">Engie</a>). </p>
<p>Some, including Victoria’s environment minister Lisa Neville, have <a href="http://www.smh.com.au/environment/victorian-environment-minister-lisa-neville-hits-out-at-epa-over-hazelwood-charges-delay-20160204-gmli2v.html">raised questions</a> over why it has taken so long for the EPA to lay its own charges. This chimes with our ongoing research, which indicates that Australian citizens and campaign groups have less power to bring environmental prosecutions than in other comparable countries.</p>
<h2>Compare and contrast</h2>
<p>We compared the situation in Australia with an Italian case involving another Engie subsidiary, Tirreno Power. In 2014, while Hazelwood was burning, Tirreno’s coal-fired power plant in Vado Ligure, Italy, was <a href="http://reneweconomy.com.au/2014/hazelwood-owner-told-to-shut-italian-coal-plant-blamed-for-deaths-18375">seized and shut down</a> in response to <a href="http://www.penalecontemporaneo.it/upload/1399222800Trib.%20Savona%20-%20decreto%20sequestro%20Tirreno%20Power.pdf">judicial findings</a> that the company had violated its environmental conditions, causing hundreds of deaths and thousands of illnesses as a result of the facility’s emissions.</p>
<p>Unlike at Hazelwood, there was no single disaster such as a fire, but rather a realisation of the damage being done by chronic pollution.</p>
<p>In Italy, not only is environmental protection improving under the guidance of the European Union, but citizens also have their own systems to report potential violations, balancing to some degree the rights of corporations against those of other parties. In the Tirreno case, the campaign group <a href="http://www.internazionale.it/reportage/2015/11/07/vado-ligure-carbone-inquinamento">Rete Savonese Fermiamo il Carbone</a> (Savonese Stop the Coal Network) was instrumental in raising the issue and ultimately securing a victory for local citizens.</p>
<p>Victorian state laws have some similar provisions, particularly under the <a href="http://www.legislation.vic.gov.au/domino/web_notes/ldms/pubstatbook.nsf/f932b66241ecf1b7ca256e92000e23be/750e0d9e0b2b387fca256f71001fa7be/$file/04-107a.pdf">Occupational Health and Safety Act</a>. If a citizen feels that an incident has breached health and safety laws and authorities do not prosecute within six months, they can make a written request to <a href="http://www.worksafe.vic.gov.au/">Worksafe Victoria</a> to prosecute. </p>
<p>This is probably how Worksafe’s recent action against GDF Suez came about about. Acting on behalf of campaign group <a href="http://www.votv.org.au/">Voices of the Valley</a>, Environmental Justice Australia <a href="https://envirojustice.org.au/blog/worksafe-to-prosecute-hazelwood-power-corp-over-mine-fire">asked Worksafe to pursue legal action</a>.</p>
<p>But similar provisions do not exist under Victoria’s <a href="http://www.epa.vic.gov.au/about-us/legislation/acts-administered-by-epa">environmental laws</a>, which date back to 1970. Only the EPA can bring charges, but if it chooses not to, there is no way for citizens to ask the authority to reconsider.</p>
<h2>Citizens’ rights</h2>
<p>In some ways this is rather startling. It begs the question of who will uphold environmental standards if the regulator chooses to look the other way. It is little wonder that citizens are resorting to <a href="https://newmatilda.com/2016/02/09/climate-angels-santos-csg/">protest</a> and <a href="http://www.smh.com.au/comment/coal-marketing-should-come-with-a-health-warning-20160309-gnegkv.html">media pressure</a> to be heard.</p>
<p>Meanwhile, there are worrying signs that corporations are being given special privilege on account of their role as drivers of economic development. This includes mining companies who, for example, have until recently been relatively free simply to <a href="http://www.abc.net.au/news/2015-09-19/taxpayers-may-foot-bill-for-mine-rehabilitation/6787954">abandon mines</a> once extraction has finished. Even now they only have to pay nominal rehabilitation bonds, with the result that Hazelwood is one of roughly <a href="https://theconversation.com/what-should-we-do-with-australias-50-000-abandoned-mines-18197">50,000 abandoned mine sites</a> across the country, many of which pose serious risks. The current Hazelwood Mine Fire Inquiry report on mine rehabilitation at the site was due March 15, but <a href="http://hazelwoodinquiry.vic.gov.au/">this has been delayed for an unspecified period or reason</a>.</p>
<p>Society’s capacity to call on governments to prosecute is clearly mediated by how the law defines <a href="http://phg.sagepub.com/content/39/1/96.short">who can take legal action</a>. The federal government’s <a href="https://theconversation.com/brandis-changes-to-environmental-laws-will-defang-the-watchdogs-46267">ongoing bid to strip green groups of the right to challenge environmental approvals</a> is case in point.</p>
<p>The Hazelwood fire has exposed many environmental issues. But the slow pace of the investigation also highlights a real weakness in our legal system. Making this system more just and democratic is vital – not just to increase our capacity to respond to catastrophic events like the Hazelwood fire, but also to begin tipping the balance of power back towards society and away from corporations who must always be fully accountable.</p>
<p><em>This article was co-authored with Melanie Birkbeck, who has researched these issues as an intern at the <a href="http://sustainable.unimelb.edu.au/">Melbourne Sustainable Society Institute</a> and as a postgraduate student at the University of Melbourne’s <a href="http://environment.unimelb.edu.au/">Office for Environmental Programs</a>. It is based on research supported by the Melbourne Sustainable Society Institute and RMIT Centre for Urban Research.</em></p><img src="https://counter.theconversation.com/content/55577/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Rickards does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Two years after Morwell was blanketed in smoke from the Hazelwood fire, environmental charges have been laid against the mine’s operators. But the process should be more open and democratic - and quicker.Lauren Rickards, Senior Lecturer, Sustainability and Urban Planning, School of Global Urban and Social Studies; Co-leader, Climate Change and Resilience research program, Centre for Urban Studies, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/537322016-03-07T01:23:02Z2016-03-07T01:23:02ZGPs struggle to manage patients with work-related mental health problems<figure><img src="https://images.theconversation.com/files/111725/original/image-20160217-19260-1f2tqin.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">GPs are finding the compensation process for work related mental health claims onerous and in some cases bad for their patient's health, a study has found. </span> <span class="attribution"><span class="source">From www.shutterstock.com</span></span></figcaption></figure><p>Doctors face many challenges when managing work-related mental health problems, leading some to counsel patients against pursuing basic labour rights because it may prove detrimental to their mental health, the General Practitioner (GP) <a href="http://bmjopen.bmj.com/content/6/1/e009423.full">Return to Work study</a> has found. </p>
<p>The study examined the GP’s role in facilitating return to work after injury, arguing that some GPs find dealing with the workers compensation system so onerous and difficult that they are reluctant to follow through with some claims. </p>
<p>The study results are based on interviews with 93 GPs, injured patients, compensation scheme personnel and employers as well as an analysis of 125,000 compensation claims issued by around 10,000 GPs.</p>
<p>One doctor in the study said his instinctive response to the many patients who wanted to pursue worker’s compensation for stress, anxiety, depression and other work related sickness was to dissuade them. </p>
<blockquote>
<p>“When people come and ask me, that they perceive they’re being bullied at work and say, "I’m going to put in a Workcover claim,” I say, “Well just be careful because you have every right to, if you feel that you’ve been hard done by, but it’s going to be a dog fight.” </p>
</blockquote>
<p>This response was typical of the GPs interviewed.</p>
<p>GPs reported difficulties with the initial assessment and diagnosis of mental health injuries (as opposed to some easily diagnosable physical injuries such as fractures and lacerations). In 96% of initial sickness certificates issued for work-related mental health problems, GPs <a href="https://www.mja.com.au/journal/2013/199/7/sickness-certification-workers-compensation-claimants-general-practitioners">classified patients as “unfit for work”</a>. </p>
<p>GPs also reported conflicting medical opinions among clinicians about the difference between mental illnesses developed as a result of work-related stress and pre-existing mental illness secondary to work. This has a flow-on effect to workers compensation claims, as many schemes will only cover mental illness that arises as a consequence of work. </p>
<p>The strong stigma associated with making a work-related mental health claim also makes patients reluctant to seek help from psychiatrists and psychologists. They fear this health record will limit future employment prospects. GPs often have to juggle protecting their patients’ private health information alongside employers’ and insurance agents’ requests for further details.</p>
<p>The study also found, while patients might initially present with physical injuries, the complexity of the compensation system can create such a degree of stress that secondary mental illness may develop as a result of dealing with the system.</p>
<p>In other cases, chronic pain from physical injuries can lead to dependency on opioids and long periods of time off work, a vicious cycle that can also <a href="http://link.springer.com/article/10.1007%2Fs10926-014-9506-9">increase patient’s vulnerability to mental illness</a>. </p>
<p>GPs in the study reported insufficient remuneration for hours of overtime, reams of paperwork, the threat of legal subpoenas and lost income due to court appearances. It is therefore unsurprising that an increasing number of <a href="http://bmjopen.bmj.com/content/6/1/e009423.full">GPs are reluctant to treat</a> such patients and are more likely to refer them elsewhere.</p>
<p>Despite the problems uncovered in this study, over the past ten years there has been a <a href="http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/897/australian-workers-compensation-statistics-2012-13.pdf">22% rise in work-related mental health claims</a>. This is a worrying trend because strong evidence demonstrates that if a patient is off work for more than six months, their risk of depression and long-term disability <a href="https://eurpub.oxfordjournals.org/content/eurpub/18/3/232.full.pdf">is significantly increased</a>. The costs of this long-term ‘worklessness’ is to the <a href="http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/660/Cost%20of%20Work-related%20injury%20and%20disease.pdf">economic tune of approximately $5 billion per year</a> and the social discords of failed marriages, family conflict, increased suicide ideation, and financial crisis.</p>
<p>Compensation insurers have responded by providing GPs with specific and targeted information on how the compensation system works and clinical education and training on assessment and management for work-related mental health problems. But this is tackling only one side of the problem. Fundamental reforms within the compensation system is also urgently needed. </p>
<p>This study will inform the development of clinical guidelines to help GPs to look after patients with work-related mental health problems and help them return to work as soon as it is safe to do so.</p><img src="https://counter.theconversation.com/content/53732/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bianca Brijnath receives funding from WorkSafe Victoria, the Transport Accident Commission, Federal Department of Employment, ComCare, WorkCover Western Australia, Return to Work South Australia, WorkCover New South Wales, the National Health and Medical Research Council of Australia, the Royal Australian College of General Practitioners, and the Australian Primary Health Care Research Institute. </span></em></p><p class="fine-print"><em><span>Danielle Mazza receives funding from WorkSafe Victoria, the Transport Accident Commission, Federal Department of Employment, ComCare, WorkCover Western Australia, Return to Work South Australia, WorkCover New South Wales, the National Health and Medical Research Council of Australia, the Royal Australian College of General Practitioners, and the Australian Primary Health Care Research Institute. </span></em></p>GPs are worried that the WorkCover claims process worsens patients’ health and are encouraging them to not pursue it, a study has found.Bianca Brijnath, Senior Research Fellow, Monash UniversityDanielle Mazza, Professor, Department of General Practice, School of Primary Health Care, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/503962015-11-09T23:48:36Z2015-11-09T23:48:36ZIn charging Essendon, WorkSafe puts all sport on notice<figure><img src="https://images.theconversation.com/files/101332/original/image-20151109-29300-16dlena.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">By laying charges against the Essendon Football Club, WorkSafe Victoria has accepted that its mandate extends to professional sports.</span> <span class="attribution"><span class="source">AAP/Tracey Nearmy</span></span></figcaption></figure><p>WorkSafe Victoria’s decision to <a href="http://www.worksafe.vic.gov.au/news/news-article?result_42915_result_page=2">prosecute the Essendon Football Club</a> for occupational health and safety (OHS) breaches arising out of its 2011-12 supplements program has been a <a href="https://theconversation.com/time-for-ohs-regulators-to-get-off-the-bench-and-into-the-game-17039">long time coming</a>. On Monday, the club was charged with two breaches of the <a href="http://www.austlii.edu.au/au/legis/vic/consol_act/ohasa2004273/">OHS Act</a> for failing to provide a working environment that was “safe and without risks to health”. </p>
<p>That Essendon <a href="http://www.essendonfc.com.au/news/2015-11-09/club-statement">quickly agreed</a> to the charges as reflective of the club’s governance failings should not come as a surprise. It had effectively admitted a breach before the charges were laid. A club-commissioned <a href="http://www.essendonfc.com.au/news/2013-05-06/dr-ziggy-switskowski-report">review</a> from 2013 described:</p>
<blockquote>
<p>… a pharmacologically experimental environment never adequately controlled or challenged or documented.</p>
</blockquote>
<p>When accepting <a href="http://www.afl.com.au/news/2013-08-27/statement-from-afl-chairman-mike-fitzpatrick">AFL sanctions</a> in 2013, Essendon:</p>
<blockquote>
<p>… acknowledged it had established a supplements program that was experimental, inappropriate and inadequately vetted and controlled, and … failed to ensure it adequately protected the health, welfare and safety of the players.</p>
</blockquote>
<p>Essendon’s governance failures – especially its failure to maintain accurate documentation of the supplements given to its players – also forms part of the factual matrix from which its players are arguing the <a href="http://www.abc.net.au/news/2015-08-26/cas-confirms-november-date-for-wada27s-essendon-appeal/6725156">anti-doping case</a> against them cannot be proven to a “comfortable satisfaction”. </p>
<p>Essendon will now have the ignominy of a criminal conviction. It is at risk of having to pay yet another significant financial penalty. A court also could order the club to undertake a project for the improvement of OHS within the industry. </p>
<p>The implications of the bringing of OHS charges extend far beyond Essendon. For WorkSafe Victoria and professional sporting competitions, it is the equivalent of crossing the Rubicon. </p>
<h2>What now for OHS regulators?</h2>
<p>OHS regulators have <a href="http://epublications.bond.edu.au/slej/28/">long been reluctant</a> to intervene in the affairs of professional sporting competitions. They rightfully have been cautious when called upon to enter the sporting arena. The arena is complex, and their presence is contentious and contested.</p>
<p>By laying charges against Essendon, WorkSafe Victoria has accepted that its mandate extends to professional sports. In doing so, it has passed a point of no return.</p>
<p>WorkSafe Victoria now needs to act consistently with this expanded mandate. This does not mean that WorkSafe Victoria – and other OHS regulators – should be overzealous in their regulation of professional sports. OHS regulators should continue to exercise caution when entering what is for them still a new, complex and contentious field.</p>
<p>At the same time, however, they should not leave themselves open to criticism that they are inconsistently discharging their statutory responsibilities. All professional sports now need to be treated consistently with the precedent that has been set.</p>
<p>Greater transparency of the reasoning behind OHS regulators’ decisions to investigate or not to investigate professional sporting clubs for potential breaches of OHS law would increase public confidence in regulators and the decisions they make.</p>
<h2>What about professional sporting clubs?</h2>
<p>Professional sporting organisations always have been afforded a large degree of self-regulation. The AFL Commission already had penalised Essendon for its failure to adequately protect the health, welfare and safety of its players. </p>
<p>But in laying charges, WorkSafe Victoria sent two important messages to professional sporting organsations:</p>
<ul>
<li><p>That it – and not a sport’s governing body – is responsible for advancing the public interest served by OHS laws; and </p></li>
<li><p>Professional sport is not beyond the reach of OHS regulators. </p></li>
</ul>
<p>This is a development about which all professional sporting organisations should be alert, but not alarmed. They should be alert because the <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2654578">breadth and complexity</a> of OHS laws have not always been recognised by those involved with professional sporting competitions. </p>
<p>Multiple persons involved in professional sporting competitions owe broad, concurrent, overlapping and non-delegable duties. Duties are owed by a sport’s governing body, individual clubs and their officers, as well as by doctors, sports scientists, trainers and other persons whose acts or omissions are capable of affecting athletes’ health, safety and welfare. </p>
<p>These duties apply to activities undertaken by athletes participating in matches and training, and ensuring they are in the best physical and mental condition. They also apply to other activities undertaken by athletes at their club’s direction or encouragement, regardless of time or place. </p>
<p>However, sporting organisations should not necessarily be alarmed. OHS is already in sport – albeit by <a href="http://safetyatworkblog.com/2015/09/23/ohs-is-in-sports-but-by-another-name/">another name</a>. The Essendon supplements saga aside, most professional sporting clubs have a solid record in injury prevention and management. </p>
<p>There are few other activities in which an employer takes as much interest in an employee’s health, safety and welfare. The active involvement of OHS regulators should serve to reinforce this interest.</p><img src="https://counter.theconversation.com/content/50396/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eric Windholz worked with WorkSafe Victoria from 2001 to 2009, including as General Counsel and General Manager, Strategic Programs and Support.</span></em></p>The implications of the bringing of OHS charges extend far beyond Essendon. For WorkSafe Victoria and professional sporting competitions, it is the equivalent of crossing the rubicon.Eric Windholz, Lecturer in Law and Associate, Monash Centre for Commercial Law and Regulatory Studies, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/66532012-05-04T04:47:10Z2012-05-04T04:47:10ZShining a new light on bullying risk<figure><img src="https://images.theconversation.com/files/10322/original/hjmc2zgw-1336023870.jpg?ixlib=rb-1.1.0&rect=2%2C32%2C485%2C352&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Focussing on health and safety responsibilities is a key development in addressing workplace bullying.</span> <span class="attribution"><span class="source">AAP</span></span></figcaption></figure><p>Workplace bullying is one of the most contentious workplace issues. Against the backdrop of a forthcoming National Code of Practice on preventing workplace bullying, <a href="http://cdn.justice.act.gov.au/resources/uploads/Worksafe/Publications/Investigation_Reports/CIT_Report_Final_-_11_April_2012.pdf">a recent investigation</a> by Worksafe ACT represents a watershed moment in the treatment of this problem.</p>
<p>Worksafe ACT investigated actions of the Canberra Institute of Technology (CIT) regarding claims of workplace bullying by several staff. These claims were in the form of internal incident reports, compensation claims with supporting medical evidence, and complaints to the regulator. The claims were of a serious nature, and involved senior staff.</p>
<p>What was special about this investigation, apart from being publicly available, was that it was not at all concerned with the veracity of the bullying claims, nor what particular behaviours were alleged. By contrast, the regulator was focused on the processes that the employer had undertaken, or not undertaken, in executing its health and safety responsibilities. These responsibilities include providing a safe workplace and system of work, monitoring safety, and providing relevant information, training and supervision. </p>
<p>This is a key development. Despite their best efforts, safety regulators and inspectors can sometimes get weighed down by the complexity, and unpleasantness, of feeling that they have to mediate between interpersonal workplace issues. </p>
<p>The ACT report shines a light for regulators and employers: focus on whether the health and safety risks were controlled. It also shines a light for employees, because it shows what a proactive, forward thinking, and responsible organisation would be doing about psychological hazards.</p>
<p>The theme that unites the investigation report is that all actions taken in regard to bullying and other psychological hazards must be consistent with preventing the risks that they represent, as far as reasonably practicable. </p>
<p>There is sometimes reluctance in organisations to think about psychological hazards from within the risk management framework that they employ for all other hazards. Sometimes it is just a lack of awareness. </p>
<p>One example of how bullying was not considered as a risk issue in the CIT case involved how an employee appeared to be “paid to withdraw a complaint”. An employee who had complained about bullying was given a termination package, which was conditional the complaint being dropped. </p>
<p>After termination, the employer took no further action regarding the reported incident(s). The employer was then “puzzled as to why Worksafe ACT has continued to investigate…”. Even though the complaint had been “paid away”, and had physically left someone’s in-tray, the risk that was identified by that complaint was still present. Others in that workplace should have been protected from the identified and therefore foreseeable risk.</p>
<p>With other claims, CIT went through a process which concluded that the allegations were unsubstantiated. Accordingly, they took no action. However, the process in which they engaged was found by Worksafe ACT to be severely flawed on several bases. These flaws included that the internal “information gathering” exercises that were used to dismiss the substance of the complaints were likely to have been biased, given that senior staff were involved in the allegations. </p>
<p>It seems obviously inappropriate, but conflicts of interest in reporting lines and organisational “investigations” are regularly treated as though merely declaring the interest will make it go away. The Worksafe ACT report makes it clear that such biases mean that organisations have not done all that was reasonably practical to identify and address the problems.</p>
<p>However, external investigation of workplace issues, while always preferable, does not necessarily solve everything. According to the report, when some claims were sent for external review, the process was so constrained in scope by CIT that the review was essentially useless, and did not adhere to the principles of natural justice. </p>
<p>There are many examples where terms of reference constrain an investigator’s ability to draw valid conclusions about the events, and about what should be done by the organisation regarding its risk management duties. </p>
<p>The content of the complaints policy was also highlighted by the Worksafe report as limiting the extent to which risks were properly managed. The policy emphasised the responsibilities of the complainant, without similar focus on the respondent. </p>
<p>Thus it appeared biased in favour of respondents, and potentially discouraged complaints. Complaints actually constitute the identification of risk. Therefore, complaints procedures have to be robust in order for risk identification (which is part of an employers’ duty, under health and safety requirements) to be achieved.</p>
<p>Far from trite advice or simplistic checklists, the Worksafe ACT report discusses how the poor quality of policy, procedures and investigations undermines an organisation’s ability to demonstrate due diligence. This report has implications for all industries, across all Australian jurisdictions, with respect to what they should be doing to proactively manage psychological hazards.</p>
<p>The litany of problems in the CIT’s acts and omissions, as described in the investigation report, reflects how the real issues fell into the gulf between viewing bullying as a risk issue, and treating bullying as a traditional conduct or human resources issue. It’s a big gulf, and it’s pervasive in practice. </p>
<p>The Worksafe ACT report demonstrates how we need to move to a risk paradigm in managing this hazard, in order to minimise the costs to workers and businesses that it creates.</p><img src="https://counter.theconversation.com/content/6653/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carlo Caponecchia does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Workplace bullying is one of the most contentious workplace issues. Against the backdrop of a forthcoming National Code of Practice on preventing workplace bullying, a recent investigation by Worksafe…Carlo Caponecchia, Senior Lecturer, School of Aviation, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.