| PATTERNS
OF ILL-HEALTH IN IRISH CONSTRUCTION WORKERS 1997-2004 |
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| PREFACE |
The
Construction Workers Health Trust was founded in 1994
by the Construction Group of Trade Unions affiliated
to the ICTU. |
The
Trust aims to promote a healthy lifestyle among construction
workers. Research in other countries has shown conclusively,
that the blue collar worker succumbs to serious illness
up to twenty years earlier than white collar workers,
and in Ireland, construction workers are a particularly
vulnerable group. |
The
Trust is funded by a small levy, paid by workers,
who are members of the Construction Workers Pension
Fund. |
We
are a registered charity, and operate as a stand alone
unit with our own board of Trustees, and a small dedicated
staff. |
The
primary activities of the Trust are: |
|
Providing
free Health Screening to building workers on site.
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Conducting
research into conditions which affects the health
of building workers. |
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Running
regular campaigns of testing for conditions such as
Prostate Cancer, Colon Cancer and Diabetes. |
|
Giving
support, financial or otherwise, to other national
organizations engaged in the treatment of, or research
into, serious illness. |
This
second report on patterns of ill health amongst Irish
construction workers, which includes the reasons for
sickness absence from work, highlights the hazards
which building workers face in their everyday lives. |
It
is particularly disappointing to note that the primary
causes of absence from work continues to be injury
and musculo-skeletal disorders, both of which are
largely preventable. In this regard we feel the time
has come for the Health & Safety Authority to
establish, as a matter of urgency, a task force, to
examine the nature and extent of occupational illnesses
that afflicts construction workers, and based on our
extensive knowledge and experience, we would be happy
to participate in such a venture. |
Finally,
I would like to thank Dr Harold Brenner for his thorough
and dedicated work in trawling through the records
of the Sick Pay Scheme, and I hope that this report
proves useful, not only to medical decision makers
in Ireland, but to students, observers and critics
of our national healthcare services. |
| Michael
Brennan |
| Chariman,
Construction Workers Health Trust. |
|
 Michael
Brennan
Chairman, Board of Trustees
Construction Workers Health Trust |
| |
| |
In
1997, the Construction Workers Health Trust investigated
patterns of ill-health amongst Irish construction
workers. From the archives of the Construction Federation
Operatives Pension and Sick Pay Scheme (CFOPS), over
29,000 records of absences of its members in the period
1981 to 1996 were examined, as were over 3,000 records
of early retirements of members on health grounds
from 1965 to 1996. |
The
report was distributed to interested bodies, and subsequently
published in the international journal. Occupational
and Environmental Medicine. |
The information gained was used to help develop a
health promotion strategy for use not only by the
Trust but also by the construction industry as a whole. |
The
range of health disorders among industrial workers
resulting in absence from work is well documented,
and it is recognised that construction workers are
at greater risk of developing certain health disorders
than are the general population and workers in other
industries. However, prior to this work, patterns
of ill-health and injury giving rise to sick leave
or early retirement in the Irish construction industry
were not known. |
| In
2001, the Trust undertook a mortality study of construction
workers and ex-construction workers who had contributed
to CFOPS. Death certificates of over 1,650 men who
died from 1995 to 2000 were examined, and the principal
causes compared to those in the general Irish male
population. The results reflected findings of the
2001 report, Inequalities and Health in Ireland, which
confirmed the broad international experience of significantly
higher mortality rates for people from lower socio-economic
groups. |
| Since
1997 the construction industry in Ireland has greatly
expanded. During this period there have been significant
socio-economic changes in the country, general health
services are under review and men continue to be reluctant
to avail of health checks. Initiatives of the Trust
during the last several years have attempted to improve
the health of construction workers, with all members
given the opportunity for health checks by their general
practitioners, and those in the appropriate age group
encouraged to attend their GPs in a campaign of early
detection of prostate cancer, both campaigns at no
cost to members themselves. Current initiatives include
colon cancer screening in association with Tallaght
Hospital, detection of unrecognised diabetes mellitus
in association with St. James’ Hospital, development
of ergonomic techniques for brick and block layers
in association with NUI Galway and FAS, and the development
of a stop-smoking strategy in association with the
Research Institute for a Tobacco Free Society. |
In
2004, with the aims of further assessing the health
status of construction workers and of improving ways
in which its health promotion programme is delivered
on construction sites (its core activity), the Trust
decided to re-visit its earlier areas of research.
The objectives were to review sickness absence and
early retirement on health grounds since 1996 and
to examine mortality in construction workers since
2000. |
|
 Dr
Harold Brenner
MB, FFPHMI. |
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| METHOD
|
The
population base for the absence and early retirement parts
of the study consisted of construction workers who were members
of CFOPS, and thus eligible to receive benefits, between 1997
and 2004. The population base for the mortality study consisted
of eligible construction workers and ex-construction workers
who died between 2001 and 2004 and whose kin had applied for
any type of death benefit from CFOPS. It is conservatively
estimated that members form only one third of those eligible
for membership of the scheme by virtue of working in the construction
industry. In July 2006, CFOPS was re-organised as the industry-wide
pension scheme and is now known as the Construction Workers’
Pension Scheme (CWPS).
Pertinent records were made available by
kind permission of the trustees and the administrator of
CWPS. Information on sickness absence, early retirements
and deaths was extracted from its databases, transferred
to an epidemiological statistics computer programme, and
appropriately analysed.
|
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| RESULTS |
Where
comparisons can be made with the earlier study covering the
period 1981 to 1996, the figures for that earlier study are
shown in red.
|
| SICKNESS
ABSENCE |
| Population
base |
The
number of eligible workers, mostly male, increased each year
from 1997 onwards as shown in Figure 1, continuing the trend
started in 1996. This trend reflects the recovery and sustained
expansion in the industry after a period of recession between
1985 and 1993. |
|
| The
10-year age group distribution of the population remained
essentially the same for each year of the study (Table 1). |
|
ABSENCES |
| An
absence from work due to illness was recognised by CWPS if
it entailed more than three working days and a sick certificate
was received. There were 26,660 absences recorded over the
eight-year period of the study, mostly (99.4%) involving male
workers. A total of 15,408 individual workers were involved
(155 were female). Table 2 shows the frequency of absences
by these workers. Just over 60% were absent on one occasion
only. The extreme case was a worker who was absent on 23 occasions
during the eight-year period of the study. |
 |
Figure
2 shows absences as percentages of the study population for
each year. There was little variation around the annual average
of 6.9 absences per 100 workers (7.8
per 100 workers). |
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Table
3 shows, for each year of the study, the age-specific rates
of absence; the rate of absence rising with age is clearly
illustrated. |
|
| AGE
AT TIME OF ABSENCE |
| The
mean age at time of absence was 39.4 years (38.7
years), the median was 38 years (37
years). Reflecting the larger proportion of younger
workers in the study population, 75% of absences (78%)
were among workers aged below 50 years. |
| DURATION
OF ABSENCE |
| For
the purpose of this study, the number of working days involved
in each absence (calculated as three days added to the days
for which sick pay was paid) is used as the duration of absence.
The mean duration of absence was similar for each year of
the study, varying from 21.6 to 22.7 days. Overall the mean
duration of absence was 22.2 days (23.5
days): the median duration was 15 days
(17 days). As in the earlier study, the mean duration
of absence increased linearly with age (Figure 3).
|
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Regional
variations in mean duration of absence and mean age at absence
(for counties with more than 500 absences in the eight-year
period) are shown in Table 4. |
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| The
mean duration of absence varied from 20.7 days (Kerry) to
24.0 days (Limerick). The mean age at absence varied from
37.6 years (Louth) to 41.6 years Kerry). |
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| WORKING
DAYS LOST |
| During
the period of the study, absence due to illness totalled 592,592
days, an annual mean of 74,074 days (42,340
days). The mean days lost per absence was 22.2 days
(23.5 days). Recognising that
these figures do not include the number of days where absences
were less than 4 days duration, and using 230 days as the
number of working days in a year, the annual percentage working
days lost through sickness absence was calculated; they are
shown in Table 5. Working days lost due to selected diagnostic
categories are shown later (Table 8). |
 |
In
the previous study the annual percentages days lost varied
from 0.6% to 1.1%. |
| REASONS
FOR ABSENCE |
Reasons
for sickness absence were available for analysis in most (99.8%)
cases. In the few remaining cases, no medical certificate
was on file or no specific diagnosis was given on the certificate.
|
Available
information suggests that all diagnoses in this study refer
to the individual workers and not to sickness or injury to
family members. It was not possible to identify work-related
sickness or injury, nor was it a purpose of the study. |
Table
6 shows the percentage distribution of the diagnostic categories
of sickness reported in the medical certificates that were
available for analysis, and numbers in categories grouped
by age at the time of absence. The relatively few cases (120)
under the age of 20 are included in the 20 to 29 year age
group. |
 |
*Due
to a change in the data input system since the previous study,
cases of bronchitis and emphysema were inadvertently classified
as respiratory infection and included in the infectious disease
category. This number (342) is an estimate based on data from
the previous study; the infectious disease number has been
appropriately amended. |
njury
is the most frequent reason for sickness absence, comprising
31.4% of all reasons (30.2%).
Table 7 shows the types of injury. |
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|
 |
Musculoskeletal
disorders accounted for 22.8% of absences
(13.1%); back pain accounted for 67% (60%)
of these. The percentage of these disorders is markedly higher
than the percentage in the previous study |
Infectious disease accounted for 15.6% of
absences (25.4%). Lung infections
comprised 20% (17%) of these
and upper respiratory infections/flu 27% (48%).
The percentage of infectious disease is markedly smaller than
in the previous study. |
| Cardiovascular
disease accounted for 4.1% of absences (3.6%).
Hypertension comprised 27% (27%)
of these. |
Cancer
(40 cases) accounted for 0.15% of absences (0.1%).
No information is available about the cancer types associated
with sickness absence. |
Bronchitis,
emphysema and asthma together accounted for 1.3% (4.4%).
However 1.3% is an estimated figure (see note under Table
6). |
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| WORKING
DAYS LOST |
| Working
days lost due to selected diagnostic categories are shown in
Table 8. |
 |
| As
in the previous study, the greatest number of working days
lost was due to injury. However musculoskeletal disorder replaces
infectious disease as the next highest number of days lost.
Cardiovascular disease was fourth highest in terms of total
number of days lost, but ranked second highest in mean days
lost (32.3), while cancer was ranked highest in mean days
lost despite the low total number of days lost. |
Although
hospital-related reasons accounted for a high number of days
lost, it included investigations, surgery and post-operative
care not easily sub-classified. |
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| RETIREMENT
ON THE GROUNDS OF ILL-HEALTH |
From
1997 to 2004, 649 workers were granted early retirement based
on health grounds; of these, records of 571 were available
for the purpose of this study. The number and rate of these
retirements in each year of the study are shown in Table 9. |
 |
Since
the age structure of the population was essentially the same
for each year, the annual rates of early retirement can be
compared. The rates varied from 0.45 per 1,000 workers in
1999 to 1.97 in 1998 (the low rate in 1999 is due to most
of the unavailable records being of retirements in this year).
The mean annual rate was 1.46 per 1,000 workers
(5.3 per 1,000, but this was due in large part to high rates
of retirement, between 9 and 13 per thousand, in the years
1983 to 1988). |
Table
10 shows the age of workers at the time of being granted early
retirement. The mean retirement age was 55.6 years, the median
59 years (56.2, 58 years). The
age at which the largest number of these retirements took
place was 64 years (63 years).
|
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As
expected, most early retirements on health grounds occurred
in the later years of working life, 42.9%
(43%) aged 60 years and over. However 11.4%
(8%) were of workers under the age of 45 years. Early
retirement on grounds of ill-health from the industry is based
on certification of permanent disability by an independent
occupational physician. Categories of medical diagnoses on
the certificates are shown in Table 11. |
 |
*
includes 3 cases of silicosis and 1 case of asbestosis **
all cases of diabetes mellitus |
Disability
based on a diagnosis of cardiovascular disease accounted for
26% of the retirements (31%)
of which coronary heart disease accounted for 61% (56%);
hypertension accounted for 12% (16%)
and stroke for 14% (15%) of this
category. Musculoskeletal disorders comprised 28% (30%)
of diagnoses, of which degenerative disc disease accounted
for 16% (20%) and all other forms
of arthritis accounted for 84% (70%).
Of the 43 cases of cancer, cancer of the larynx and lung accounted
for 28% (31%) and cancer of the
digestive tract 28% (20%). Injury
formed 17% (8%) of the diagnostic
categories of which limb and back injuries contributed 49%
(63%). Psychiatric disorder comprised a small proportion
(4.2%) of the grounds for early
retirement (3.7%) corresponding
to the low proportion (2.8%)
of mental disorders as a reason for sickness absence (1.8%).
A further breakdown of selected categories is contained in
the following tables: |
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Although
the specific occupations/trades of most of the workers granted
early retirement was established, insufficient baseline information
was available to compare risks of early retirement on health
grounds between occupations. |
During
the period of the study, a potential 5,351 years of working
lives were lost due to early retirement on health grounds
from the industry, an annual mean potential loss of 669 years
(977 years) on health grounds. Table 18 indicates, for each
occupation, the potential years of working life lost, the
number of retirees and the percentage of retirees under the
age of 50 years. |
 |
Potential
years of working lives lost in each occupation (PYWLL),
number of retirees (No.) and percentage of retirees
under
the age of 50 (% < 50yrs) |
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|
Electrician
is the occupation in which workers under the age of 50 years
form a high proportion (44.4%) of those retiring on health
grounds, 34.9% in the previous
study. The numbers of sheet metal workers and floor layers
(occupations also with high proportions retiring under the
age of 50 in the previous study) is too small in the present
study to calculate a meaningful percentage. Overall, those
retiring before the age of 50 years (21.2%) accounted for
51.4% of the total potential working years lost. In the previous
study the 17% retiring under
50 accounted for 45% of these
years lost. |
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| DEATHS
IN THE CONSTRUCTION INDUSTRY |
Death
certificates of members of CWPS who died in the years 2001
to 2004 and whose kin had applied for any type of death benefit
were examined. In addition, deaths which occurred in 2000,
information on which was not available at the time of the
previous study, were included. |
|
In order to obtain a more comprehensive picture of deaths
in the industry, data from this four-year period have been
associated with the data in the previous study. The following
analysis, then, refers to deaths in the 10-year period 1995
to 2004. |
There were 3185 recorded deaths including one female, in this
period; however death certificates were only available for
scrutiny in 3114 (97.8%) of these, and the following data
refers to these 3114 deaths (971 under the age of 65 years). |
| TYPES
OF BENEFIT |
Types
of benefit associated with the deaths, mortality benefit (MB),
widows pension including widows pension commuted (WP), funeral
expenses (FE) and refund of contributions including two discretionary
payments (RD), are shown in Table 19. |
|
TRADE
OR OCCUPATION |
The
trade or occupation of the deceased members was established
in 75% of cases (2,347 cases). These are shown, for those
dying under the age of 65 and for those aged 65 and over,
in Table 20. The table is for descriptive purposes only and
cannot be used for comparisons of deaths between trades/occupations. |
|
AGE
AT DEATH |
|
Table 21 compares the annual mean age of death in the study
population with the mean age of death in the corresponding
year for Irish males aged 20 years and over in the general
population. |
|
The
mean age at death in each year is less for construction workers,
and except for three years, the difference is statistically
significant. For the whole of the study period, the difference
is statistically significant. The mean age of death for workers
aged 20 to 64 is 50.7 years; in a large mortality study of
construction workers in the UK, the mean age of death in this
age group was 53.1 years. |
CAUSES
OF DEATH |
| Cause
of death was established by examination of copies of death
certificates, 2,898 held in CWPS records and 216 in the General
Register Office records. |
| The
causes of death were grouped according to the ICD-9 classification
and are shown in Table 22. |
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|
The
following Tables 23 to 26 show the three principal causes
of death; circulatory disease, malignant cancer and respiratory
disease, as well as deaths from injury and poisoning, sub-grouped
into the commoner causes, for those under the age of 65 and
for those aged 65 and over. |
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A
standardized mortality ratio (SMR) was calculated to compare
all-cause deaths in the age group 20 to 64 years in the study
population with those in the general population. Mortality
from particular causes among the study population was compared
with those of the general population using proportional mortality
ratios (PMRs). |
Using
the average age-specific death rates for men in the general
population in the 10-year period as a standard, the SMR for
men in the age group 20 to 64 years was calculated. An SMR
over or under 100 indicates a higher or lower than expected
mortality in the construction worker population. For this
age group the SMR was 86 (C.I. 80 - 91), in line with findings
of studies in other countries. |
|
For the purpose of this report, PMRs were calculated for malignant
cancer, circulatory disease, injury and poisoning and respiratory
disease, as well as for selected causes within these major
groupings; they are shown in the following Tables 27 and 28.
The ratios were obtained both for deaths in the age group
20 to 64 and for all deaths in the study population. Mean
deaths in the four even years from 1996 to 2002 in the Irish
male population for the appropriate age groups and causes
were used in the calculations. |
| A
PMR over or under 100 indicates a higher or lower than expected
mortality in the study population from a particular cause.
The confidence intervals (C.I.s) for the PMRs have been computed
at the 95% level. Statistically significant findings are indicated
with an asterisk. |
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The
review of the literature undertaken for the Trust’s
previous investigation of patterns of ill-health in Irish
construction workers clearly showed that construction workers
are more at risk than those in other occupations to injury
and to the development of certain diseases. The work is intrinsically
dangerous; workers are exposed to potentially dangerous substances,
to noise, vibration and to changes in the weather. They are
also exposed to a “bystander effect” in which
a worker may not only encounter the hazards of his own job,
but may also be exposed as a bystander to hazards associated
with the work of a different tradesman because of shared work
spaces. Additionally it is known that many construction workers
have unhealthy lifestyles and are obese or overweight. |
| Sickness
absence has been defined as absence from work which
employees attribute to sickness or injury and which the employer
accepts as such; within this definition, sickness of other
family members may be included as a reason for employee absence.
However in this study all sickness or injury referred to employees.
It was not possible to identify work-related sickness or injury,
nor was it a purpose of the study; data on occupational injury
and occupational disease in the building and construction
industry are available in publications of the Irish Central
Statistics Office. |
| Over
the eight year period of the study, 15,408 absences were recognised
by CWPS for sick pay, mostly (99.4%) involving male members.
The mean age at time of absence was 39.4 years (median 38
years). Reflecting the larger proportion of younger workers
in the study, 75% of absences were by men under the age of
50 years. The rate of absence each year varied little from
between six and eight absences per 100 workers. Analysis of
the age-specific rates of absence clearly showed for each
year the rate of absence rising with age, with the rate of
absence approximately three times higher in those aged 60
to 64 than those in the 20-29 age group. The mean duration
of absence was 22.2 days (median 15 days) and was shown to
increase with age. Small regional variations in the mean duration
of absence, as well as mean age at absence, were noted, possibly
due to ill-defined local factors. |
The
reasons for sickness absence were determined in nearly all
cases. Injuries (31.4% of all absences), musculoskeletal disorders
(22.8% of which more than three-quarters was due to back pain)
and infectious disease (15.6%) accounted for most cases of
sickness absence. Cardiovascular disease accounted for 4.1%.
Hospital-related reasons, including hospital investigations,
surgery for a variety of conditions and post-operative care,
accounted for 14% of absences. Although the reasons for sickness
absence were all categorised in terms of medical diagnoses,
it is recognised that psychosocial factors both at home and
the workplace can play a part in, and be predictive of, sickness
absence. |
| The
annual number of working days lost due to sickness absence
totalled 592,592 days (an average of 74,074 days per year).
As expected, the greatest number of working days lost was
due to injury followed by musculoskeletal disorders and infectious
diseases. Despite the comparatively low total number of days
lost due to cancer it was ranked highest in mean days lost
per absence. |
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Early
retirement on grounds of ill-health is not only about
the permanent disability suffered by the individual; the loss
of expected productive years and the unprepared entry into
retirement may have psychological and social consequences
for the individual and the family. For the industry, it means
the loss of experienced workers and the implications of employing
and training new personnel. In the present study, the mean
annual rate of such retirement was 1.45 per 1000 workers and
the mean annual age was 55.6 years.
|
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The identification of cardiovascular disease, musculoskeletal
disorders and injury as the major causes of permanent disabilities
leading to early retirement on the grounds of ill-health is
a reflection not only of the prevalence of these conditions
in the general population but of the environment and type
of work involved in the construction industry. Psychiatric
disorder comprised a small proportion of the grounds for early
retirement corresponding to the low proportion of mental disorders
as a reason for sickness absence. |
The
many potential years of working lives lost due to early retirement
on health grounds (5,351 years) is an indication of the large
impact of permanent disability on both individual workers
and the industry. The impact is greater when such retirement
occurs at a relatively young age; the study showed that 21.2%
were under the age of 50 years, accounting for 51.4% of the
potential years lost. |
The
mortality study is subject to certain limitations and as such
the findings must be interpreted with care. It is recognised
that death certificates may contain considerable inaccuracies
in certifying causes of death. The study is limited to deaths
for which death benefits are claimed, however there is no
reason to think there is any difference in age or causes of
deaths among eligible construction workers whose kin do not
claim such benefits; nor would there be any reason to believe
that the findings would be different for construction workers
who were not members of the pension scheme. |
|
The mean age at death was 68.6 years compared to 71.8 years
in the general Irish male population aged 20 years and over.
This difference is statistically significant and supports
a generally held belief that “construction workers die
younger.” |
|
For descriptive purposes only, the trade or occupation of
the men in the study was established. The categories of general
operative, carpenter, bricklayer and painter accounted for
58% of the total deaths. |
The standardized mortality ratio which compared all-cause
deaths in the age group 20 to 64 years in the study population
with those in the general population, although somewhat surprisingly
low (86) given the working conditions and lifestyle factors
of construction workers, is supported by findings in other
studies in Sweden and Germany which also find lower all-cause
mortality in construction workers in this age group. This
all-cause low mortality is possibly due to the "healthy
worker survival effect", a selection process in which
those who remain employed tend to be healthier than those
who leave employment. However, the long term effects of work
in the construction industry are reflected in the mean age
at death described above. Proportional mortality ratios (PMRs)
were used for comparison of particular causes between the
study population and the Irish male population aged 20 years
and above; although widely used in studies of occupational
mortality, PMRs need to be interpreted with care especially
when mortality is low in a particular group. |
| |
|
The
study shows that construction workers experience an increased
mortality from injury and poisoning, statistically significant
in the working age group of 20 to 64 years. It also shows
that construction workers experience a significantly increased
mortality from malignant cancer. Lung cancer is significantly
increased in both age groups and stomach cancer, although
not reaching significance, is also increased in both groups.
This is consistent with studies of construction worker mortality
in other countries. Occupational hazards encountered at work
as well as certain behavioural and socio-economic factors
almost certainly contribute to this excess in mortality in
comparison to the general population. An example of behavioural
factors is that of cancers of the oropharynx and oesophagus
which are known to be cause-related to the combined effect
of smoking and alcohol intake; in the present study there
was a high PMR (139) for these cancers which is statistically
significant. A total of 16 deaths from mesothelioma (cancer
of the pleural lining of the lung) was recorded in the present
study; during the same six-year period as the study there
were 108 deaths in the general male population, which figure
includes the 16 deaths in the study. It should be noted that
mesothelioma occurs mainly as a result of exposure to asbestos
in several job groups not necessarily confined to the construction
industry – it is known that vehicle body builders, boiler
operators, chemical workers and upholsterers have significantly
high PMRs for mesothelioma. There was a highly significant
PMR (244) for mesothelioma in a U.K., and a mortality study
of electrical workers in the construction industry in the
U.S.A. showed a PMR of 356 for mesothelioma. |
|
It would appear that work in the construction industry does
not contribute to excess deaths from ischaemic heart disease
and this reflects the findings in other similar studies. This
may appear surprising given the high level of smoking and
the degree of obesity among construction workers. However
in this study, there was a significant PMR (121) for deaths
from cerebrovascular disease in the whole study population.
There was also a low PMR for respiratory disease, especially
in those under the age of 65, again reflecting the experience
in other studies. |
|
Although there is concern over anecdotal reports of suicide
in the industry, the study shows significantly less suicides
proportional to those in the general population. Explanations
may include the fact that unemployment is a contributory factor
to suicide in the general population, while in the period
under study there was a high demand for workers in the construction
industry, and that in the main construction workers derive
satisfaction and pride from the results of their work. The
finding of decreased suicide compared to men in the general
population was also found in large mortality studies of construction
workers in the U.K. and in Germany. However the 60 cases of
suicide, on average one occurring every nine weeks in the
study population over the 10 years, warrant studies of the
causes of suicide and methods of intervention into the psychosocial
circumstances which lead to these events. |
| Although
the number of deaths is small in this study compared to similar
studies in the U.K. (15,000 death certificates examined in
one study), in Japan (17,000 in one study) and the U.S.A.
(31,000 in one study), it is sufficiently large that the findings
can be extrapolated with a high degree of certainty to all
construction workers and ex-construction workers in Ireland. |
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The
three modules of this study have identified a number of major
causes of morbidity and mortality among construction workers.
It is generally accepted that much morbidity leading to sickness
absence, early retirement on grounds of ill-health and premature
death is preventable. Informed by the results of this study,
CWHT pursues an aggressive on-site health promotion strategy
which, if effective in the high-risk population of construction
workers, can modify lifestyle, particularly relating to diet,
smoking and exercise which are recognised risk factors in
the development of cardiovascular disease, many cancers and
diabetes. Legislation on Health and Safety at Work, together
with voluntary codes of practice in the industry, should lead
to a reduction of occupational hazards to health, particularly
in relation death, injury and musculoskeletal disorders. |
| |
CWHT
acknowledges with thanks the Trustees of the Construction
Worker’s Pay Scheme in making the relevant records available
for this research; particular appreciation is due to Mr. Pat
Ferguson, Administrator of the Scheme, to Ms. Doreen Molloy,
Assistant Administrator, and to Ms Clare Mulligan, Executive
Officer, for their support and advice. Origin technologies
were most helpful in developing a programme to extract the
relevant records from the vast CWPS database. Thanks are due
to Mr. Eddie Flood at the Office of the Registrar General
for permission to view a number of death certificates and
to Mr. Declan Roche for guidance in accessing them. The author
is indebted to Mr. Brian Daly (CEO, CWHT) who gave invaluable
advice during the period of the research, and together with
Ms Móirlin McGuire (Executive Officer, CWHT) guided
the work through to the final printed report. |
REFERENCES |
|
References to other studies mentioned in the text may be obtained
from Dr. Harold Brenner, CWHT. |
|
| ON-SITE
QUESTIONNAIRE AND HEALTH SCREENING
|
QUESTIONNAIRES |
|
As part of the on-site health promotion and health screening
by the CWHT occupational nurses, each worker completes a questionnaire
which is designed both to help the nurse evaluate the worker’s
lifestyle in order to advise appropriately on health matters
and issues that might arise, and in the longer term to help
the Trust in its evolving health promotion strategies. The
questionnaire results are analysed periodically without any
possibility of individual identification. |
| From
March 2005 to March 2007, 10,324 questionnaires completed
by construction workers (including 87 females) were analysed,
and a selection of the results are presented here; a further
2,000 questionnaires were completed by white collar workers,
but are not included in this analysis. |
SELECTED
RESULTS FROM QUESTIONNAIRE ANALYSIS |
|
(note: not all respondents answered all the questions) |
|
|
| Health
screening |
| A
selection of the results of the on-site health screening
of workers from March 2005 to March 2007 is presented
here. |
|
Blood pressure |
1,528 workers out of 10,078 tested (15%) were found
to have blood pressure above the accepted normal range |
|
Cholesterol |
2,121
workers out of 10,125 tested (21%) were found to have
a total cholesterol higher than the accepted healthy
upper limit |
| Body
mass index (an indication of body weight taking height
into consideration) |
Out
of 10,205 tested, 4,139 (41%) were within the healthy
weight range, 4,453 (44%) were overweight, 1,585 (15%)
were obese, 28 (0.3%) were underweight |
| CO
level (smokers) |
Tests
were performed on 3,434 smokers – all had detectable
levels of carbon monoxide in expired lung air, illustrating
one of the toxic effects of smoking |
| Spirometry |
Lung
function tests were performed on 5,490 selected workers.
491 (9%) were found to have some degree of impaired
lung function. |
|
Referred to General Practitioner |
Following
screening tests, 3,464 workers (33%) were referred
to their GPs for further evaluation. |
| Referred
for counselling |
Following
upon the health promotion discussion with the occupational
nurse, 104 workers were referred for counselling,
initially to the Trust’s counselling supervisor. |
|
| |
|
|
