🇺🇸 Learning from the USA: Dr Shriti Pattani
How occupational health differs in the USA vs the UK
I caught up with Dr Shriti Pattani, President of the Society of Occupational Medicine, on her learning points from the 2023 American College of Occupational and Environmental Medicine Conference. Here’s a summary of what we discussed.
What’s the context?
The United States of America (US) is the largest economy in the world but offers a low level of employment protection compared to other OECD countries. Data on the proportion of the working age population economically inactive due to ill health in the US vs the UK are not directly comparable but suggest a similar level of around 6-7%.
The Occupational Safety and Health Act 1970 created the Occupational Safety and Health Administration (OSHA) to enforce evidence-based standards in occupational health. Alongside this, the National Institute for Occupational Safety and Health (NIOSH) was created to undertake the research necessary to provide this evidence base.
Similar to the UK legislative framework, the legal framework in the US involves a number of laws employers must follow, but does not prescribe OH services within this. Estimates suggest only around 35% of the US workforce have access to OH.
Occupational AND environmental medicine…
US occupational medicine as a specialty places greater salience on environmental health, which, in comparison we have neglected in the UK with the transition from a manufacturing to service led labour market and economy. In the US, occupational and environmental medicine is a specialty area within preventative medicine, and environmental health is included within different strands of the core competencies to specialise. The environmental health angle is becoming increasingly important to all health systems. This became evident during the covid-19 pandemic, particularly in the NHS where doing risks assessments for a new biological hazard was a challenge for many organisations. We should learn from our colleagues in the US to build more environmental health into training, CPD and practice.
Healthcare ecosystems
The context of the US healthcare system is as a mixed system, where publicly financed care co-exists with privately financed healthcare. The heterogeneity of the landscape means it is more challenging to take a top-down population-based approach to care, including when it comes to occupational health issues. An example is the lack of a national proactive health surveillance programme for silicosis.
On the other hand, there is a much closer relationship between work and health, given that 50% of citizens receive private health insurance from their employer. Arrangements between employer, insurer and employee differ but employers can be very invested in the health of their workforce, given the financial incentives align when it comes to healthcare and insurance, as well as productivity.
The limitations of publicly funded healthcare also leads to a greater role and emphasis on what occupational medicine doctors can provide to organisations. The value and remit of chief medical officers and occupational medicine teams are being realised by US companies, beyond the status quo in the UK.
Layers of regulation
While neither the US or the UK have achieved universal access to occupational health, the legal framework is slightly more consistent in the UK. In the US, occupational health regulations are primarily governed by federal agencies. However, since states have the authority to create and enforce their own occupational health regulations, there is some variation depending on where workers and employers are based. For example, the California Division of Occupational Safety and Health specifically addresses heat-related hazards. Some state plans have industry-focussed regulation, such as Wyoming that has a standard for the oil and gas industry. For businesses operating across the US, this might mean complying with a mix of federal and state regulations. For workers, this means a less level playing field.
Takeaway
The piecemeal makeup of the US health system and fragmented approach to regulation at state level creates more occupational health disparity. However, the very same context is driving innovation and uniting stakeholders on health and work.