Musculoskeletal Disorders: a Fatality?

1. Musculoskeletal Disorders: a Fatality? Roland Gauthy, Eur.Erg. Research Officer @ ETUI-REHS

2. Agenda • An “old” problem, • with huge consequences (costs / impacts) • caused by classical & newer risk factors • Confrontation with new challenges: demography, global economy, technological changes • What to do from a worker’s point of view?

3. An old problem • Paleopathologists show that MSDs already existed since antique times • MSDs remain a problem although efforts have been made to better understand & control them • Clear link between different activities, working conditions & MSDs… 1000 of publications • Legislative instruments: directive, standards • Measure of impacts & costs

4. Impacts • Economical impacts at several levels • Individual (1) • Company • Societal • EU (global impacts) • Human impacts (2) -------------------------------------------------------------  (1) + (2) ~ ‘worker’s costs’

5. Workers’ costs (not only €) • Loss of wages • Out- and inpatient costs, orthopaedic equipment and rehabilitation costs, home care costs • Time spent in health care and rehabilitation facilities (lost opportunities to do… ) • Transportation • Altered way of life (autonomy) • Lost of opportunities: living projects, working projects, leisure, pension... • Deteriorated quality of life with impacts on the family and the social network

6. Classical vs newer risk factors • We have the classical combination of physical factors triggering MSDs Force / Posture / Repetition / Vibration but • Other factors and contexts shall be considered  even in ‘lighter jobs’ are MSDs observed:

7. Newer contexts & risk factors • The work content has changed: lighter (less physical), more intense, enlarged (combo of several tasks) but (paradox) with restricted room to manoeuvre • The working conditions are different: more flexible, high tech, just-on-time, lean…precarious • The socio-economical context has changed = globalized, international, extremely competitive • The way of living is different: commuting time, intensity, garbage producing society // garbage’s added value (re-usable, sustainable development, …)

8. Combination of risk factors & of loads • Stressors, emotional loads, sensorial ones, etc.: working with people, violence, specialization • Use of ICT: ‘ping pong’ ~ extremely reduced response time is the rule, proactivity is required, emotional intelligence is must… • Quasi absence of variations in posture + sedentary way of life (use of cars / transportation) • Suppression of ‘non added value’ time ~ suppression of recovery periods

9. Examples • Supermarket’s cashiers enlarged role • scanning (goes quicker)  repetitive handling (tons/day) • money / credit cards / coupons • promotion / hostess • control • Dentist’s restricted role • pure dentistry (more €) • other tasks allocated to dental assistants • Selected sorting of valuable waste packing  unpacking  sorting

10. Stressors in the workplace (often combined with mechanical factors) could explain the development of MSD although actions have been taken to combat physical/mechanical factors: • work organisation, • psychosocial burdens, • degree of latitude – room to manoeuvre • social support …

11. Facing New Challenges… Such as: • Declining demography, • Aging • Longer working life, • Globalised economy, • Energy costs

12.  Cumulated Health Impacts • Unless speaking of an accident, the isolated impact of a MSD is totally uninteresting! “Unfortunately” MSDs do not kill but are slowly “gnawing” • It is in the long run, through repetitions that the (bio) mechanical part of the body erodes… like your intervertebral disks while seating constantly… • It is in the duration, from our birth, and all along our career (inclusive the excursions out of the tracks) that health is either constructed or destructed 

13. or the cumulative impacts of MSD’s risk factors

14. Younger & “50+” Workers’Exposures vs. Complaints…?! Younger workers = heavier jobs / less complaints 50+ = lighter jobs / more complaints Even consider the “forgotten MSDs” !!!

15. Demographic challenge ! working up to 67 years ? What about the preventive approach at work for everybody & everywhere? Here should Ethics & Intelligence (prevention) work together... At least for those willing to look ahead

16. Precariousness & prevention • The weakest way to prevent is to provide training… because training does not • Address potential causes • Tend to influence the weakest link (that is why training is so essentially weak!)‏ • Although it is the most popular preventive tool in companies… (lack of vision or cupidity ?) • Access to training is usually limited: few precarious workers are incorporated in OSH training programs… one could imagine to which level they are involved in participatory design and hazard inventory (stocktaking)!…

17. The “forgotten” MSDs ? • MSD’s history started with tile setters’ hygroma • Its continues with “salami” chopped workers = • a lumbar area • a neck • upper-limbs • Where are the other body parts ? It seems that they do not have • Brain & CNSno cognitive, emotional or sensorial loads, no feelings • Lower-limbsno “feet-ankles, knees or hips” disorders • A real body with its interrelated and interconnected physiological functions 

18. The following may not exist !?

19. What do workers need? • Adequate legislation (directive) “asap” • Useful and “in-use” legislation: principle = “pedagogic-control-sanction” • Participatory hazard reduction from design to implementation of tools & work systems • Increased knowledge and awareness at all levels (workers and representatives, preventionists, labour inspection & employers)‏ • Job retention / return to work (rehabilitation) • Systematic compensation for the victims • Updated list of occupational diseases (even to allow better EU comparisons)

20. More information Topics (e.g. MSD) http://hesa.etui-rehs.org Bibliography http://www.labourline.org ETUC’s positions http://www.etuc.org