Glass, Sugar and Rising Sea Levels!

Another year draws to a close. What can we learn from the world to enhance workplace health and avoid adding insult to injury? Here is my philosophical take at year’s close.

A month ago Deborah Glass declared elements of the Victorian WorkCover system “Immoral and Unethical”  while Gary Fettke continued his crusade about the evils of Sugar and “Big Food” in relation to threats posed by diabetes  and obesity. Even a blog about health issues in the workplace can no longer ignore the emerging climate catastrophe and associated Rising Sea Levels.

GLASS

The Victorian Ombudsman, Deborah Glass recently released her second report into the Victorian WorkCover System declaring that her first report barely scratched the surface. With its focus on long term injured workers, the report –   WorkSafe 2: Follow-up investigation into the management of complex workers compensation claims highlighted the dysfunctional behaviour of WorkSafe Agents in a financially driven system to the detriment of the health and wellbeing of injured workers.

I don’t propose to rehash the findings, rather her most important conclusion about the inherent conflict generated by the way the system operates and what might be done about it. She states:

“…in the case of complex claims, financial reward and penalty measures in agents’ contracts with WorkSafe were driving a focus on terminating and rejecting claims to maximise profit, at the expense of sound decision making.”

My view about the most important aspect of this review is that it questions the very foundations of the Victorian health care system for injured workers.

Her recommendations include:

“……..an independent review of the agent model to determine how and by whom complex claims should be managed”

While the Glass report and many commentators focus negatively on the behaviour of the people administering claims within the system, I think that focus is misplaced and inappropriate.

It is hardly surprising that individual claims staff act the way they do, sometimes with apparent callous disregard for the wellbeing of workers, when the system isolates them from workers and measures their performance using financial outcomes and artificial RTW goals.

Such a system creates a WorkSafe Agent (or insurer) workplace culture that reinforces negative injured worker stereotypes and sucks out any empathy. While more senior management might express a claimant friendly narrative, usually there is tacit management approval for profit-friendly actions. With all these factors operating, it is surprising to me that as many decisions made by claims staff actually do support and assist with the recovery of injured workers, as they do.

The occasional exposure of inappropriate claims decisions by an Ombudsman’s Report is unlikely to change an entrenched culture reinforced by many factors.

Don’t blame claims officers – most inappropriate behaviour is the product of the system!

The development of attitudes by claims staff to injured workers might be an example of what Zimbardo tried to demonstrate with  The Stanford Prison Experiment.

SUGAR

Tasmanian Orthopaedic Surgeon, Gary Fettke has been vocal in a campaign that highlights  Big Food’s role in spreading misinformation about the role of dietary sugar in chronic disease, particularly its’ role in obesity and diabetes . Without analysing the details of this important issue, this example services to illustrate the potential for an entire generation of health professionals, advisory bodies and government authorities to become falsely convinced about health risks of certain food types with disastrous consequences for public health. Gary highlights how commercial interests can influence scientific conclusions and the systems in place.

RISING SEA LEVELS

While this blog does not normally provide commentary on the debate about environmental issues, it has become such a critical issue for mankind, I will reverse that policy, at least for this article. The science is clear – the effects of man-made rise in CO2 levels on our climate are uncontestable and present an existential threat to many species, including our own.

What is not known accurately is the speed of changes, at what point we reach a “tipping point” with acceleration of trends that become obvious to everyone, everywhere and perhaps most significantly the unanticipated social and political consequences of a changing climate and inundation of low lying areas by sea level rise – not only the direct health consequences. We can debate whether this is a climate “Emergency” in the medical sense, but it is obvious that immediate action is needed by those in control.

While I accept the need for all citizens to do their bit i.e.  to Think Globally – Act Locally the reality is that is that for meaningful change, the system, lead by governments around the world needs to be changed to achieve the necessary change. The Australian Government needs to more than pull its weight globally, given our relative wealth and our per capita contribution to global CO2 emissions.

LEADERSHIP, LEGISLATION AND CULTURAL CHANGE

Whether the objective is better outcomes for injured workers, downward trending national obesity rates or arresting atmospheric CO2 rise, the solution is not to blame individual behaviour.

It is not the primary responsibility of the claims officer, the person with diabetes or the average citizen of the Earth to reverse the trends. The solution is to change the system with a legislative framework that supports a culture that changes and supports individual behaviour that in turn reverses any adverse trend.

We need leaders in politics, government, community and business who understand the evidence and can act for the good of all with agendas for long-term change supported by legislation, irrespective of the issue. Only through changes to the system will cultural shift be achieved that can cause widespread change in individual behaviour.

The same applies to silicosis risk, but that is a topic for another day!

About Tasworkdoc

As an occupational physician in private medical practice in Hobart, Tasmania - the southernmost state of Australia, I see workers referred by their general practitioners with various types of work-related injuries and diseases. These are mostly musculoskeletal injuries, both of traumatic and gradual onset as well as various associated psychological disorders. With interaction with patients for treatment and providing advice about rehabilitation, I have the opportunity, first-hand, to observe interactions between individual patients and compensation systems. I also conduct independent medical assessments, including impairment assessments for musculoskeletal injuries and asbestos-related disease compensation. This provides another perspective of workers within compensation systems.
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1 Response to Glass, Sugar and Rising Sea Levels!

  1. jqu33431quintner says:

    Peter, I much prefer the model of Jeremy Bentham to describe WorkCover’s system of management of workers’ compensation claimants. Bentham conceived the Panopticon, where prisoners (in this case compensation claimants) would be observable at all times by unseen guards (in this case claims officers) and would behave accordingly, even when they were not being observed. What would motivate the government to change or to even fine tune a system that works perfectly well to contain costs?

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