🇮🇹 Lessons from Italy: Insights into the Occupational Health Landscape
Learn about Italy’s occupational health strategies, offering insights to improve employee health globally
Dr Kabir Varghese is a GP and Occupational Medicine trainee based in London. He connected with an Italian colleague, Dr Lorenzo Anselmi who was undertaking an overseas fellowship in London while completing his final year of speciality training in occupational medicine in Italy. Kabir interviewed Lorenzo on how the occupational health landscape differs in Italy compared to our infrastructure in the UK. Here are the highlights from their chat:
KV: What is the legislative framework around OH provision in Italy?
LA: In Italy, employers with more than 15 employees are mandated to provide access to occupational health care. Exactly what they are obliged to provide for their workers depends on the risk profile of the work and workforce. For example, a desk- based administrator under the age of 50 would be entitled to a minimum of one OH review every five years. For employees over 50 years old, this increases to a minimum of one OH review every two years. For higher risk roles, there is a higher mandatory baseline engagement with OH. For example, employees working with chemical hazards require annual input. OH reviews focus mainly on health surveillance and containing occupational risks. The employer funds the occupational health provision.
With time, the work and health legislation in Italy becoming more comprehensive. Recently, the threshold for OH input has been lowered and health surveillance is now required wherever a health risk is identified in the workplace. Again, frequency and depth of OH input depends on the risk level, but this legislative change makes OH input a more ubiquitous feature of the economic landscape in Italy.
KV: That sounds better than what we have here in the UK regarding a minimum level of provision and some guidance around mapping risk to provision. Equally, we know that work- related ill health can crop up in any setting, even low risk settings.
LA: Yes, the general perspective on the role of OH in Italy can be quite archaic in that it has a heavy industrial focus. There is a lot of space for the speciality to evolve into, in particular around work and health prevention. It is difficult to predict whether this will be happen in practice in the absence of legal enforcement which is much more geared at treatment and surveillance. The current legal framework resulted from high levels of work-related mortality and morbidity around 20 years ago, amounting to press coverage and pressure on the government to enforce better standards around health and safety at work. Who knows what the catalyst to change might be in future.
KV: Yes, we have similar challenges here in the UK with pivoting stakeholders towards prevention. And with a less directive legal framework many employers pitch their offering at the minimum, which may involve no occupational health expertise at all. Here in the UK work- related mental illness accounts for the majority of cases we see. What’s the landscape like when it comes to work-related mental illness?
LA: In Italy, psychological occupational hazards are still fairly off the radar. There is a lot of work to be done across stakeholder groups in recognising and addressing work-related contributors to mental illness. The biggest focus of OH input in office based settings is display screen equipment, again, reflecting what is emphasised in law.
KV: What about the return to work infrastructure in Italy? Since OH input is more pervasive across workplaces do they take the lead on supporting workers to navigate sickness absence and return to work?
LA: In general primary care physicians are the main medical support available for people taking sickness absence. Occupational health input comes in prior to return to work only for those who have been off for more than two months. Communication between occupational health teams and treating clinicians is often poor which also impedes effective support.
KV: Many of those challenges are familiar to us here in the UK. The two month threshold does seem late for occupational health intervention, and also being directed only at those returning to work would miss the opportunity to offer specialist support to others whose sickness absence is ongoing. This said, in the UK all of this is left up to employers - while some proactive employers leverage OH expertise many people will never see an occupational health physician at any point during sickness absence. So maybe things are overall better in Italy, even though the infrastructure isn’t optimised at least the foundations are there.
LA: In Italy there’s a lot of data collected by OH in their mandatory contact with employees across different kinds of organisations that is anonymised and sent to the government. This data could be extremely useful in understanding more about the health of the working age population, but to my knowledge it is not leveraged at all.
KV: Another example of infrastructure in place that isn’t used to its potential! Here in the UK we don’t have a central data bank of the occupational health of people working across settings. Much of the data is held by private providers and the quality and uniformity of data is likely to be quite variable. This is the sort of data that would be most important powerful for occupational health research but providers may not have the expertise or incentive to lead on using it.
Lara’s take:
Italy is an example where there is a greater degree of infrastructure and regulation around ensuring people in employment have access to occupational health expertise. While this does not reach the entire working age population, it’s definitely a better baseline than what we have in the UK. The gap in the occupational healthcare landscape in Italy is not as extensive as what we have here. This said, there is also lots to learn from Italy regarding how infrastructure must be scrutinised to meet current needs. It’s is difficult for legislation to evolve in sync with needs in the context of the way we work changing at pace. Where legislation is the framework stakeholders work towards, it can be difficult for them to be targeted in their approach beyond a check box exercise. This demonstrates a layer on top of the provision gap: the gap in understanding from all stakeholders on the value of targeted OH input, that supports workforce health to deliver return on investment.
During Dr Lorenzo Anselmi’s overseas fellowship he worked to produce a paper on ROI- compiling both the latest evidence and the challenges in producing high quality evidence. Read the full journal article here.
