This document discusses health loss and its causes in New Zealand. It uses the measure of disability-adjusted life years (DALYs) to estimate health loss. Mental disorders, injury, and chronic diseases are among the leading causes of health loss across different age groups. Projections estimate a 13% increase in DALYs from 2006 to 2016, with cancer, heart disease, and anxiety/depressive disorders as the top causes. Risk factors like tobacco use, high BMI, and injury risks are preventable contributors to health loss. The document advocates for occupational health programs to identify workplace hazards, monitor employee health, and manage risks to keep employees fit for work.

1. FIT & WELL FOR WORK – An integrated Approach for
Effective Management of Human Factors

2. HOW MUCH HEALTHY LIFE IS LOST DUE TO EARLY DEATH,
ILLNESS OR DISABILITY
•
Health Loss is estimated using a measure called DALY
DALY = Disability-adjusted life year
YLL – years of life lost
YLD = years lived with a disability
• THE GAP BETWEEN THE POPULATIONS CURRENT STAE OF
HEALTH AND THE IDEAL POPULATION (HEALTH
EXPECTANCY)= HEALTH LOSS

3. Health Loss is estimated using a measure called DALY
DALY = Disability-adjusted life year
YLL – years of life lost
YLD = years lived with a disability
Ministry of Health (2013) Report from NZ Burden of Disease, Injuries & Risk Factors 2006-2016

4. Causes of Health Loss
 In youth (15–24 years), the leading causes of health loss are mental disorders (31%) and
injury (27%), with reproductive disorders also important for females.
 In young adults (25–44 years), mental disorders (25%) and injury (15%) are the leading
causes of health loss, with reproductive disorders also important for females.
 In middle age (45–64 years), the well-known chronic diseases including cancers (24%) and
vascular disorders (16%) first come to prominence.
 In older adults aged 65–74 years, cancers (29%) and vascular disorders (24%) remain leading
causes of health loss, followed by musculoskeletal conditions (11%).

5. DALYs, by selected condition group, 2006, and projections for
2011 and 2016
Ministry of Health (2013) Report from NZ Burden of Disease, Injuries & Risk Factors 2006-2016

6. Projections for Health
• DALY 955.000 2006. 2016 1.085 million (13%) increase
• Cancer (17.5%)and Heart disease (17.5%) top killers then anxiety and depressive disorders (11.5%)
• MSK ((9%) – BACK (2.8%) OA ( 2.2% ) Chronic pain (1.3%) RA (1.1%)
• Health loss in Maori 1.8 times higher than non Maori with more than 50 % loss for Maori occurring before
middle age. Non Maori is middle age
• Leading risk factors lifestyle 13.7%) dietary (11.4%) substance abuse (13%). All preventable conditions
• Biggest Individual risk factor tobacco (9.6%) BMI( 7.9%)
• Injury risk factors 8%
• Do the results reflect current situation ? Yes projections to 2011 accurate then 2016 Tracking when
compared to other data (NZ Health Survey )
 We are living longer but not necessarily in good health - Morbidity rate
 Most of the morbidity factors are preventable
 We are getting fatter and have increasing mental disorders
Ministry of Health (2013) Report from NZ Burden of Disease, Injuries & Risk Factors 2006-2016

7. • Health Continuum – well – illness/injury -
disease/impairment
• Work versus non work What about the continuum
state – unsure ?

8. Managing Risks
Fit for Work versus Absenteeism / injury / injury
Fit for work – What are the issues that affect an organisation’s
Fitness for Work capacity
Traditional Health and Safety have focused on Injury as the key risk to
the health of an organisation but is also effected significantly by Illness
Absenteeism & presenteism
Risk Factors – What is the risk level of these factors for Fit for Work and
based on that what should be targeted to manage the issues

9. Models of health
intervention
• 1 in 3 employees seen by OM physician is absent for psychosocial
health complaints
• Identify predictors for this type of sickness absence to determine
interventions. (Duits S et el 2007)
• Chronic health problems associated with decreased work ability to a
much lesser extent lower productivity. MS & psychological health
issues main categories at risk. (Leijten et el sept 2014)
• Higher work engagement better physical health and mental health.
Lower control & higher job demands association with chronic health
problems (Leitjen june 2014)

10. Health consist of the following factors
Fit for Work
Well for Work
Working well
Wellbeing
Health & wellness aspects
to Manage
Pre employment
Post injury incident
Return to work
Functional assessment
Medically able to work
Occupational health
monitoring
General health fitness
Lifestyle Risk Factors
Behaviours e.g risk
taking
Interaction with other
Performance Factors
Emotional &
psychological wellness
stress, muscular
discomfort

12. Fit and well for work
Health & wellness
↓
Identify fit for work and wellness issues
Physical & capabilities requirements of work
↓
Risk assess health and wellness issues and determine targets
Workplace occupational health profile
Occupational health hazard assessment
Job task analysis
↓
Determine objective and outcomes
Set up strategies consistent with business core
↓
Set up Fit for Work programmes
↓
Report and evaluate
Database of information & Tracking system
Report back on Trends Indicators future effects of fit for work status
Privacy Act requirements
↓
Recommendations
Dealing with current and the future fit for work & wellness needs
↓
Report back on programme and outcomes
Strategies reviewed
Objectives & outcomes analysis

13. Fit & Well for Work Programmes
What are Fit & Well for Work programmes
 Fitness for job - able to do the job
 Healthy – Physical & mental
 Functional – physical /Functional/ cognitive
 Behaviour – attitude and expectation
How do Fit & well programmes relate to Work
Happy, fit, healthy people are able to function well (not to be confused with performance issues)
Strategy
Manage the ‘unwell’ effects by the correct programme e.g if you only have health programme you
will manage issues as health issue when that may not be the primary agent

14. Examples of Programme types
Fit Fit for work
Job task analysis
Pre employment
Annual health assessments
Wellness programmes
Health  Pre employment
 Annual health assessment
 ‘For cause’ health assessment e.g. absenteeism injury
 Wellness programmes
Capabilities • Fit for tasks assessment, pre employment, on going or For cause
assessments
• Training
• Matching person to job
Behaviour • Wellness – Individual/group/team health and fit targets.

15. OCCUPATIONAL HEALTH
HAZARD ASSESSMENT
PROGRAMME (HHAP)
Occupational health hazard screening is about ensuring that there is a safe
and healthy match between a person and the job they will do and preventing
any injury or harm being caused by the job, to the person.
Occupational health hazard assessment programme (HHAP) ensures that all
hazards that affect health are identified and the appropriate control
measures are put in place of which screening and assessment systems are a
part of this.

16. Source: W.H.O.

17. Step 5
Establish any Occupational Health policy, procedures and protocol for
management of Health Monitoring.
Establish Health Hazard Register
Determine implementation plan and schedule of monitoring
Establish benchmarks and measurement of outcomes

19. Occupational Health requires:
• Targeted health programmes focused on occupational
exposure detection based on hazard identification process
• Systematic approach
• Establishing objectives and expected outcomes.
Scheduling and planning occupational events.
• Based on health hazard identification
• Resources with expertise, qualification and practical
experience to implement programmes.
• Be consistent with continuous improvement process
• Audit process for compliance

20. Occupational Health Hazard Health Assessment will:
•Identify occupational health hazards in the workplace and enable
the appropriate monitoring to be established
•Assess for any workplace exposures, i.e. airborne monitoring, noise
levels
•Provide database of results for early detection and “comparison of
results” process for on-going monitoring
•Provide basis for identification of any trends or developments in
health affects from hazards
•Establish baseline health status & measurements, past exposures,
pre-existing conditions, work/non-work
•Establish that the person is safely physical and health capabilities
to perform the job tasks

21. OCCUPATIONAL HEALTH PROFILE

22. Occupational Hazard Assessment

23. The OCC HEALTH MATRIX
Health
Assessment /
Monitoring
Mechanis
m
Freezer hand
Operator /
Packer / Stores
Mix Dept
Operator
Driver Forklift
Driver Tip Top
Vehicle
Technical (Lab)
Sales /
Merchandiser
Engineer
Electrician
Admin /
computer user
Pre-employ
questionnaire
All tests
Sent with
contract
X X
X
X X X X X X X
Pre-employ
drug screen
All staff
Preferred
OHN
provider
X X
X X X X X X X X
physical
assessment
Preferred
OHN
provider
X X
X X X X X
Annual Preferred
OHN
provider
Occupational
Questionnaire
Preferred
OHN
provider
X X
X X X X X X X
audiometry
Preferred
OHN
provider
X X
X X X X X
Lung
function test
&
questionnaire
Preferred
OHN
provider
?
X X X
X
X X X
MSK
assessment
Preferred
OHN
provider
X X
X
X ? X X
X
X X
Visual
accuracy
Preferred
OHN
provider
X X X X X X X
X
X X
BP & P
Preferred
OHN
provider
X
Chemical
Questionnaire
And or urine
/blood tests
Preferred
OHN
provider
X X X

25. Benchmarks & Measurement of Outcomes
Critical factors in analysis:
Number with an occupational illness/disease/injury
Determining critical level at which abnormal results show non
compliance to Health & Safety and Health & Safety control
failure to prevent problems
Percentage of the workforce with an illness/disease/injury
Expected levels of injury/illness/disease
Mean levels of injury/illness/disease acceptable
ACC costs for injury/illness/disease
Incident levels that could lead to injury/illness/disease
Distribution of injury/illness/disease: common trends and causes
Trends over time

26. References:
Salazar, Mary K (1997) AAOHN Core Curriculum for
Occupational Health Nursing
American Association of Occupational Health Nurses, Inc.
Rodahl, K (1989) The Physiology of Work. London Taylor &
Francis
Waldron, H A, Edling, C (1997) Occupational Health
Practice 4th edition
McConney, Robert (2003) Practical Approach to
Occupational & Environmental Medicine 3rd edition
Leijten, Fenna R M, MSc; van den Heuvel, Swenne G, PhD;
Ybema, Jan Fekke, PhD; Robroek, Suzan J W, PhD;Burdorf,
Alex, PhD. Do work factors modify the association between
chronic health problems and sickness absence among older
employees? Scandinavian Journal of Work, Environment &
Health.39.5 (2013): 477-85.
Saskia F.A. Duijtsa, , , Ijmert Kanta, Gerard M.H. Swaenb,
Piet A. van den Brandta, Maurice P.A. Zeegers. A meta-analysis
of observational studies identifies predictors of
sickness absence