'Getting people healthy and back to work should be the measure of any successful health system'

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By Dr Chris Edmond

MY previous column was published in November. I missed writing the planned December instalment as I was suffering with the flu and, rather more seriously, I missed the column in January lying in hospital, suffering a prolapsed disc in my neck.

Before I continue, I would like to thank everyone who helped – particularly the consultant who so skilfully administered the epidural that started to take the pain away, which by then was unbearable.

The experience is certainly not one I would like to repeat, but it gave me a chance to reflect on issues related to my own work in occupational health, as well as the issues of inequality that have been highlighted in recent government reports and the JEP.

We often think, or are told, that we live in a meritocracy; where the most talented or the most hard-working reap the rewards. However, life isn’t nearly that simple – so often the outcome of life events depends on already having the resources or support necessary to overcome them.

In my case, I was able to recognise the symptoms of a prolapsed disc, was able to afford to see the GP, and I was able to access the right specialists and necessary tests to confirm the diagnosis and get the right treatment. I am also able to pay for private physiotherapy – another huge thanks to Paul Frankham from Performance Physiotherapy – which has allowed me to return to near full function far sooner than I would have been able to otherwise.

I was lucky, and I am back at work. Even so, like many, I don’t have the resources to sustain a lengthy period off work and as I lay in hospital I worried about how I would pay the bills just as much as I worried about my health.

So often in my work – in occupational health, as a disability benefit assessor, and previously as an A&E doctor – I have seen how luck or resources can change a life or career forever.

Take, as a theoretical example, someone suffering a similar disc prolapse who because of their financial situation might delay seeking an initial diagnosis, as they cannot afford either the GP fee or the time off to see the doctor. By the time they eventually get to the doctor, their condition has deteriorated and they might then face delays in getting scans and treatment.

They might need to take repeated sick days when the pain is too much, and lose their job as a result when their employer doesn’t show understanding. Perhaps they are in accommodation linked to their job, or employed on a licence, and all of a sudden they find themselves out of a job and homeless. Now imagine they have a family to support, as I do.

Take it one step even further, and because they cannot afford to see the doctor they buy strong painkillers or cannabis from a friend to ease the unbearable pain. And then they get caught, and now they have a criminal record as well.

These examples might seem far-fetched, but I have seen every single one on more than one occasion. And it can affect people working in all sorts of jobs, in all sectors, and at all levels – life is full of these ‘sliding doors’ moments.

In my work, I often talk about the positive impact that good work can have on health – work that pays a living wage, with good safe working conditions, supportive relationships, caring policies, and the necessary support available when employees do suffer health issues.

As well as good working conditions, employers can offer access to specialist occupational health services, to physiotherapy, counselling, and proactive health checks to keep their employees healthy and able to work. Employers can also offer the flexibility needed to support those with health conditions – adjustments in the workplace, flexible sickness policies and time off to access necessary healthcare.

Equally, getting people healthy and back to work as soon as possible should be a measure of any successful health system. Too often, the long-term impact of time away from work isn’t measured or highlighted when we consider long waits and other barriers to accessing healthcare – barriers that those with the necessary resources can jump. The health system needs to start seeing work as a health outcome otherwise such barriers can have huge, wide-ranging and long-term impacts on people’s lives far beyond the obvious impacts on their health.

Finally, it is well recognised that health inequalities tend to be reinforced over time – in the same way the example above quickly becomes a vicious circle, in the opposite direction access to good healthcare in childhood can lead to better employment in adulthood, leading to improved living conditions and a virtuous circle of good health and prosperity. The difference between the two can so often be luck, but we should invest in health equity to ensure everyone gets a fair chance.

  • Dr Edmond is the founder and medical director of WorkHealth (CI) Ltd, a dedicated Jersey-based occupational health provider. He is also a director at Jersey Sport and Jersey Recovery College, and adviser to the Jersey Community Foundation. He writes in a personal capacity.

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