Compensation for change
Professor Niki Ellis
Professor Niki Ellis, CEO, Institute for Safety, Compensation and Recovery Research (ISCRR)
Illnesses, not injuries, are the compensated conditions responsible for the highest number of days lost in workers compensation schemes, with musculo-skeletal disorders and psychological conditions leading the way.
This reflects the changing nature of employment, with a reduction in jobs in the manufacturing industries and an increase in knowledge economies. We are part of an ageing population and our workforce is ageing too. Illnesses arising from chronic diseases occur more often in older people.
Technology has changed work as well. By introducing more automated processes, the mining industry, for instance, has engineered out many of the traditional hazards for miners. Now some of the big occupational health and safety issues concerning this industry are the social stressors of fly-in-and-fly-out operations, fatigue from extended shifts and whether the muscle and joints of the ageing, overweight workforce can cope with the uneven terrain.
This is making things complicated for workers compensation. Legislation is based on the obligation of employers to provide a safe and healthy workplace for their workforce – workers compensation is for injury and illness which arises from exposures to hazardous work.
With illness, as compared to injury, it is not so easy to isolate what has been caused by work. For a long time we have pretended that some illnesses are work-related and some are not, but have been pretty arbitrary with which illness falls into which category.
For example, noise-induced hearing loss is a frequently accepted workers compensation claim, but we know that degeneration of the acoustic nerves associated with ageing contributes significantly. Coronary heart disease is a common (although declining) condition in our society, which is relatively rarely compensated, yet we know that occupational stress is an important risk factor.
The fact is that illnesses arise from a mixture of environmental (both work and outside work) and individual genetic and behavioural factors. If someone has a fork lift crash at work and breaks a leg it is pretty clear this is due to their job. If someone working in a warehouse for a long period of time develops pain in their knee, sorting out causation between overuse at work, playing football, genetics and ageing is like throwing darts in a fog.
The rise and rise of mental health is adding further complexity. Workplaces are only just coming to terms with long-standing evidence that poor job design and bad management can manifest in mental illness in workers, such as anxiety and depression, as well as physical illness such as musculo-skeletal disorders and coronary heart disease.
To most people, it is common sense that personality, previous experiences, problems outside work, or the lack of support from family and friends affects how well people cope with pressure at work. Increasingly it is apparent that these factors also play a role in how people respond to being in a compensation system.
Studies of the recovery times of people who are receiving compensation show they recover more slowly than people with the same condition who are not receiving compensation. For a long time it has been assumed this is because the compensation gives people incentives to remain ill, but this simplistic theory is now receiving more critical examination, and not holding up well under the spot light.
Traditional boundaries are now blurring. Some employers have reasonably asked where their responsibilities will stop. Paul Litchfield, head of health and safety at British Telecom, answers this by saying, “almost every business that I know of in the UK will tell you that mental health stress, mental illness is the commonest cause of absence that they face. Now if you choose to do nothing about your commonest cause of sickness absence then I would suggest you are not managing your business very well.”
These are significant challenges and a research plan that will drive further improvements to Victorian compensation systems will be launched by the Institute for Safety, Compensation and Recovery Research (ISCRR) this week. But this is a plan with a difference.
It has been estimated that only 10 per cent of health research is translated into policy or practice change. Research on research has shown that barriers to the utilisation of research by policy makers include that the research topic is not relevant, the research is not timely, and that the output of the research does not lend itself to action.
To overcome this, ISCRR developed its plan for research through conversations with WorkSafe and TAC program managers, research experts, employer and union groups and health and care service providers. There will also be opportunities for those interested amongst these groups to be involved in conducting the research itself.
Significant effort will be made to the translation of research into prevention in workplaces, improved health and care delivery, reduction of anxiety and depression which can accompany recovery and improved experience of scheme clients so they can get back to their daily activities and return to work.
The Productivity Commission report on disability care and support was released on 10 August and is indicative of a growing expectation that disability support should be offered to more people, not just those who have disabilities arising from work or road crashes. This will require us to find ways to make health, compensation and employment systems work together more efficiently and effectively. There is much to be done.