Suggestions for a national health strategy for construction

HSE Programmes

Despite a great deal of activity at corporate level, and specific campaigns, the UK still suffers from a lack of co-ordinated research into occupational health outcomes from construction work. The HSE Construction NIG has made some efforts to collate information from other sources, but this has been undertaken without adequate resources. A formal programme to develop a library resource, to evaluate published papers and produce an update to the industry as a whole as to findings from around the world would be more cost-effective than simply seeking to finance and repeat this worldwide research effort. For example, studies have been published on solvent exposures for painters (Fidler amp; Baker 1987), silica exposure of concrete workers (Torning et al. 1992), handling mineral wool (Linblad 1988), and many other specific construction industry risks from arsenic on contaminated sites to zoonoses - yet the information is only available to specialist workers prepared to browse journals, databases and the Internet. The HSE needs to be resourced to make the early indications of problems, and most importantly solutions, available to the industry as a whole.

The Employment Medical Advisory Service (EMAS) should properly resourced and encouraged into a more activist role, but not by simply sending more medical staff out to meet with employers and discuss occupational health. EMAS has become the invisible arm of the HSE, and apart from the most general guidelines, which for the reasons discussed earlier are barely applicable to construction, has issued only local advice to an industry deeply uncertain as to what it should do and increasingly demonstrating a willingness to act. One positive suggestion would be for EMAS in a wholly non-enforcement role (with assurances about the style of approach to be adopted) to provide staff to work on and evaluate pilot studies running or being established within companies, such as those discussed above. EMAS could then develop and provide some very practical guidance material on how to take a range of initiatives from simple skin checks to establishing a major occupational health presence on a difficult contaminated land site. If HSEs occupational health staff develop and publish a professional synthesis of good practice and theoretical integrity it will move the issue up the management agenda of many companies which simply do not know what to do.

Government Programmes

There must be political recognition that occupational health provision for construction workers requires national intervention and a national scheme - the workers are too mobile, their employers too many and too small individually, the compensation claims too few, the bad publicity for accidents too significant compared with that for ill health, for private industry to properly take this on without a national framework. The HSE campaign argues that 'Good health is good business' - but what if it is not, if turning a blind eye to a particular health risk is actually cheaper than properly managing it? The answer is that good health is always good business for UK plc - for many of the costs of ill health are picked up as social expenditure in terms of health care, social services, loss of productive workers, family dependency when the main breadwinner is incapable of further productive work. That is why the recent developments, such as and in particular the Green Paper 'Our Healthier Nation' and the appointment of a Minister of Public Health (Tessa Jowell), and her immediate and vocal support for occupational health as a key element of public health programmes, is so welcome. Now the HSE is seeking to develop an overall strategy for occupational health, but construction needs to fight for its place at the decision-making forums - we are in a special industry, with special needs and that has not always been recognised. The HSC is working on a strategic vision of health, looking 10 years beyond the Millennium, and this creates an unusual opportunity to develop new approaches to this issue.

Recognition that the Government does not have to be a provider of service, but it may function as definer of the necessary service, and may use regulations to create a framework in which for example a national capitation fee for workers (a sort of payroll tax) pays for a mixture of National Health Service and private healthcare provision. Or perhaps to work on a construction site a worker needs to carry a smart card similar to that developed and launched by CITB which details his/her training, competency in using machinery and plant, and health records from an annual or biannual health check.

Government intervention is required to establish a network of skilled occupational health providers - again as facilitator rather than employer. Visiting GPs with an interest in occupational health is not always satisfactory for manufacturing plants, but for construction sites it is next to useless as a strategic response. The sites move, the problems vary, and only by developing a cohort of physicians, nurses, occupational hygienists and others who really understand construction will the industry receive the occupational health support it needs.

Corporate programmes - a model of occupational health in a company

'Health' must begin to appear on the health and safety agenda, in a coherent and systematic manner. The days of the hard hat and safety boot inspection are not over, but simple safety reviews of sites should be a small element in the overall campaign to make construction a healthier and safer industry to work in. But no company can afford to address everything at once, so priorities need to be set, and what follows from this can only be a rough draft as the debate on occupational health services i

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Suggestions for a national health strategy for construction

关于国家建筑健康战略的建议

HSE Programmes

HSE计划

Despite a great deal of activity at corporate level, and specific campaigns, the UK still suffers from a lack of co-ordinated research into occupational health outcomes from construction work. The HSE Construction NIG has made some efforts to collate information from other sources, but this has been undertaken without adequate resources. A formal programme to develop a library resource, to evaluate published papers and produce an update to the industry as a whole as to findings from around the world would be more cost-effective than simply seeking to finance and repeat this worldwide research effort. For example, studies have been published on solvent exposures for painters (Fidler amp; Baker 1987), silica exposure of concrete workers (Torning et al. 1992), handling mineral wool (Linblad 1988), and many other specific construction industry risks from arsenic on contaminated sites to zoonoses - yet the information is only available to specialist workers prepared to browse journals, databases and the Internet. The HSE needs to be resourced to make the early indications of problems, and most importantly solutions, available to the industry as a whole.

尽管在企业层面开展了大量的活动和具体的运动，英国仍然缺乏对建筑工作的职业健康结果的协调研究。HSE建筑业NIG已经做出了一些努力来整理其他来源的信息，但这是在没有足够资源的情况下进行的。制定一个正式的计划来开发图书馆资源，评估已发表的论文，并向整个行业提供关于世界各地研究结果的最新信息，将比简单地寻求资助和重复这种世界性的研究工作更具成本效益。例如，关于油漆工的溶剂暴露（Fidler amp; Baker 1987）、混凝土工人的二氧化硅暴露（Toring et al. 1992）、处理矿棉（Linblad 1988）以及许多其他具体的建筑业风险（从受污染场地的砷到人畜共患病）的研究已经发表，但这些信息只有准备浏览期刊、数据库和互联网的专业工人才能获得。HSE需要获得资源，以便向整个行业提供问题的早期征兆，以及最重要的解决方案。

The Employment Medical Advisory Service (EMAS) should properly resourced and encouraged into a more activist role, but not by simply sending more medical staff out to meet with employers and discuss occupational health. EMAS has become the invisible arm of the HSE, and apart from the most general guidelines, which for the reasons discussed earlier are barely applicable to construction, has issued only local advice to an industry deeply uncertain as to what it should do and increasingly demonstrating a willingness to act. One positive suggestion would be for EMAS in a wholly non-enforcement role (with assurances about the style of approach to be adopted) to provide staff to work on and evaluate pilot studies running or being established within companies, such as those discussed above. EMAS could then develop and provide some very practical guidance material on how to take a range of initiatives from simple skin checks to establishing a major occupational health presence on a difficult contaminated land site. If HSEs occupational health staff develop and publish a professional synthesis of good practice and theoretical integrity it will move the issue up the management agenda of many companies which simply do not know what to do.

就业医疗咨询服务（EMAS）应该提供适当的资源，并鼓励其发挥更积极的作用，但不是简单地派出更多的医务人员与雇主见面并讨论职业健康问题。EMAS已经成为HSE的隐形部门，除了最一般的指导方针（由于前面讨论的原因，这些指导方针几乎不适用于建筑业），只向一个对自己应该做什么深感不确定的行业发出了局部建议，而且越来越显示出行动的意愿。一个积极的建议是，EMAS以完全非执法的角色（保证所采取的方法的风格）提供工作人员，以工作和评估公司内部正在进行或正在建立的试点研究，如上面讨论的那些。然后，EMAS可以开发并提供一些非常实用的指导材料，说明如何采取一系列的举措，从简单的皮肤检查到在难以污染的土地站点上建立一个主要的职业健康机构。如果HSE的职业健康工作人员开发并出版了一份有良好实践和完整理论的专业综合报告，它将使这个问题上升到许多根本不知道该怎么做的公司的管理议程上。

Government Programmes

政府方案

There must be political recognition that occupational health provision for construction workers requires national intervention and a national scheme - the workers are too mobile, their employers too many and too small individually, the compensation claims too few, the bad publicity for accidents too significant compared with that for ill health, for private industry to properly take this on without a national framework. The HSE campaign argues that 'Good health is good business' - but what if it is not, if turning a blind eye to a particular health risk is actually cheaper than properly managing it? The answer is that good health is always good business for UK plc - for many of the costs of ill health are picked up as social expenditure in terms of health care, social services, loss of productive workers, family dependency when the main breadwinner is incapable of further productive work. That is why the recent developments, such as and in particular the Green Paper 'Our Healthier Nation' and the appointment of a Minister of Public Health (Tessa Jowell), and her immediate and vocal support for occupational health as a key element of public health programmes, is so welcome. Now the HSE is seeking to develop an overall strategy for occupational health, but construction needs to fight for its place at the decision-making forums - we are in a special industry, with special needs and that has not always been recognised. The HSC is working on a strategic vision of health, looking 10 years beyond the Millennium, and this creates an unusual opportunity to develop new approaches to this issue.

必须在政治上承认，为建筑工人提供职业健康服务需要国家干预和国家计划--工人流动性太大，他们的雇主太多，个人规模太小，赔偿要求太少，与健康不良相比，事故的坏消息太多，如果没有国家框架，私营企业就无法适当承担这个责任。HSE运动认为，'良好的健康是良好的生意'--但如果不是这样，如果对一个特定的健康风险视而不见实际上比适当管理它更便宜呢？答案是，对英国公司来说，良好的健康总是好的生意--因为许多健康不良的成本被作为社会支出，包括医疗保健、社会服务、生产工人的损失、主要养家糊口的人不能再从事生产工作时的家庭依赖。这就是为什么最近的发展，例如，特别是绿皮书 '我们更健康的国家 '和公共卫生部长（Tessa Jowell）的任命，以及她对职业健康作为公共卫生计划的一个关键因素的立即和明确的支持，是如此受欢迎。现在，HSE正在寻求制定职业健康的整体战略，但建筑业需要在决策论坛上争取自己的位置--我们是一个特殊的行业，有特殊的需求，这一点一直没有得到承认。HSC正在制定健康的战略远景，着眼于千禧年后的10年，这为制定解决这一问题的新方法创造了不寻常的机会。

Recognition that the Government does not have to be a provider of service, but it may function as definer of the necessary service, and may use regulations to create a framework in which for example a national capitation fee for workers (a sort of payroll tax) pays for a mixture of National Health Service and private healthcare provision. Or perhaps to work on a construction site a worker needs to carry a smart card similar to that develop

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