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LONDON -- Employers in Britain have until Dec. 11 to make their voices heard in setting the occupational health agenda for the next 10 years.

A discussion document published by the government-funded Health and Safety Executive urges employers and other interested parties to submit comments and suggestions on how to help the agency develop a 10-year occupational health strategy that "will make a real impact on preventing work-related ill health."

The strategy will link with government plans to boost the public health in general in the United Kingdom. Green papers, or consultative documents, published earlier this year included one titled "Our Healthier Nation," which looks at all aspects of public health, including health in the workplace. A pre-legislative white paper on public health is expected to be published later this year.

The HSE says its discussion document, "Developing an Occupational Health Strategy for Great Britain," is "about preparing a 10-year occupational health strategy that will help all those involved in preventing ill health caused by work to work together toward common aims and targets."

Although employers and the HSE have made considerable strides in improving health and safety at work during the last two decades, "many people are still made ill at work. A recent HSE survey suggests that over 2 million people (in the United Kingdom) are suffering from illness they thought was caused by work," the discussion document points out.

The main categories of illness reported were musculoskeletal conditions -- with an estimated 1.2 million people affected -- and stress, with an estimated 500,000 people affected.

Among the factors identified by the HSE contributing to people still being made ill by work was a lack of management accountability. "Although there is a clear focus on prevention of risk via management, real progress will only be achieved if managers are held accountable," the document said. It notes that small employers, in particular, do not recognize their role in managing health and safety and controlling health risks.

Meanwhile, occupational health issues such as back pain and stress often lack the immediacy of safety issues because the illnesses have long latency periods and often have no agreed-upon diagnostic criteria, as well as possible additional causes related to home or leisure.

And where employers do make risk assessments, many "still fail to identify important health risks and expend energy on lesser issues," the document says, adding that "employers spread their efforts too thinly without really resolving any particular issue."

The HSE proposes seven goals to improve occupational health in the next decade. The goals, designed for the HSE, employers, insurers and any other parties that have an interest in health and safety, aim to:

* Put in place suitable procedures, systems and campaigns to address occupational health issues both now and in the future. For employers, this would mean ensuring that occupational health is recognized as an integral part of management and that managers are held accountable for preventing ill health caused by work.

* Decide which occupational health issues should be targeted for action.

* Develop relevant advice on occupational health to help employers control the targeted health risks.

* Collect and make available essential occupational health information, which may involve employers, insurers and other organizations sharing data and working together.

* Raise awareness of occupational health and make training and education on occupational health available to everyone.

* Provide systems to assess the effectiveness of actions taken.

* Gain commitment from all interested parties. This could be done, for example, by providing financial or other incentives to companies that showed improved occupational health.

Setting a 10-year strategy also must take into account changes that will inevitably occur in the workplace and that will affect occupational health, the document notes.

For example, in the last two decades, there "has been a large decrease in the number of people employed in manufacturing, and in the future the number of manufacturing jobs is likely to continue falling," the HSE predicts.

Also, "considerable downsizing in some organizations" may lead to an increase in uncertainty and longer working hours for the remaining employees, it notes.

The number of people in part-time work and in self-employment is likely to continue to increase in the next 10 years, along with the number of small companies. The HSE's data suggests that "the self-employed are more likely to have accidents than employees (and) the risk of fatal or serious injury is greater in small workplaces"; this could mean that these are high-risk groups if a similar trend exists for work-related ill health, according to the document.

Labor market changes, such as an older workforce; more women, including more pregnant women and mothers; and "multiskilling," with people changing jobs more often, also will affect occupational health, the HSE points out.

The rate at which new technologies reach the market also could affect whether health risks can be identified early enough.

Meanwhile, public concern and expectations of health and safety standards will continue to grow, while increasing litigation likely will raise the profile of many occupational health risks, the HSE observes.

Copies of the discussion document, which includes a questionnaire for employers and other interested parties to complete, can be obtained from Dr. Elizabeth Gibby, Health and Safety Executive, Room 717 Rose Court, 2 Southwark Bridge, London SE1 9HS. Comments should be returned by Dec. 11