September 21, 2020
Wilmark N. Gular, M.D.
Healthy workers contribute to a healthy workforce. Similarly, workers benefit from a workplace that promotes and preserves health. The World Health Organization states that the workplace influences the physical, mental, economic and social well-being of workers as well as their families, and the community that they live in.1
The workplace should therefore be a platform to promote health. One method to promote health is by assessment of the health status of the workers and their risks for developing a particular disease. This can be done through validated and widely accepted screening and risk assessment tools.
The construction industry is a prime example of a workplace experiencing specific health issues. Data from the 2007-2008 National Health Survey from Australia show the following health problems encountered in the construction workforce in order of decreasing frequency: a. highest level of smoking b. highest level of alcoholic beverage consumption c. second highest level of obesity compared to other industries.2 These problems increase the risks of cardiovascular and pulmonary diseases.
In a 2015 study by Tin S. et. al., conducted in Hong Kong, cardiopulmonary risks were identified in the construction workforce. This was done as a health promotion activity for their Worker Health and Wellbeing Month (WHM).3 This article provides an overview of the said study.
Risk assessment and profiling are integral parts of health promotion and prevention. These strategies are being used to develop health programs for general and specific populations.
Cardiovascular and pulmonary function status were measured in this study with the overall goal of health promotion and prevention through risk assessment and profiling. The results help identify high risk individuals prompting them to seek professional consult and treatment. It also compared risk profiles of different workers in the construction industry.
Participants in this study were mostly construction workers but tradesmen, office clerks, and professionals (engineers, architects, safety officers) working at the construction site which is a railway infrastructure were also involved. This is a cross-sectional study which identified participants by the availability of their work schedule, thereby employing convenience sampling.
71 one-hour health screening and promotion sessions were conducted. Each session had 30 individuals rotating at different health assessment stations. One station required participants to answer a standardized health assessment questionnaire that specifically asked about lifestyle, physical activity, and dietary habits. Other stations measured blood pressure, blood glucose, total cholesterol and HDL, anthropometric data (body mass index, waist to hip ratio), and pulmonary function status (measurement of peak expiratory flow and exhaled carbon monoxide level).
After finishing all stations, participants were directed to see a health educator that gave them a personalized feedback regarding their result. Those who were classified to have a high cardiopulmonary risk were advised to seek consult with their respective worksite nurses for confirmation of the risks and possible referral to specialized healthcare professionals.
1,765 individuals participated in the study. Majority were construction workers (81%) and the rest were clerks/professionals. Construction workers have moderate, high, or very high levels of work-related physical activity (92.2% vs. 49.0%) than office clerks or professionals. Moreover, construction workers were twice likely to smoke than their office counterparts (48.7% vs. 29.2%). There was no significant difference between the two groups in terms of alcohol consumption. Most respondents had insufficient fruit and vegetable intake while a third consumed more red meat than the usual dietary recommendations. This increases their CVD risk. The study suggests the provision of canteens which serve nutritional food in the worksite.
Hypertension was more prevalent among construction workers (22.6% vs. 15.4%) compared to clerks or professionals. However, there could be an overestimation of this finding since enough rest may not have been adequately provided before readings took place.
Construction workers were also found to be more at risk of dyslipidemia, having lower levels of HDL cholesterol (41.6% vs. 35.8%) and to have diabetic levels of non-fasting blood glucose (4.3% vs. 1.6%) compared to office clerks and professionals.
Majority (71.7%) of construction workers were found to be overweight or obese with 53.1% having centrally obesity. About 56% of office clerks and professionals were overweight or obese with 35% having central obesity. But there could be overestimation since body mass index does not differentiate between fat and muscle mass. Waist to hip ratio, as a measure of central obesity, better reflects the risk of having metabolic syndrome.
Construction workers had poorer lung function as indicated by below average PEF levels (28% vs. 22.5%) compared to their counterparts working at the offices. This problem is more prevalent among older workers and those more frequently assigned in underground work, reflecting some degree of occupational exposure. Furthermore, the have a higher level of exhaled CO (58.8% vs. 51.3%). These findings also reflect the higher level of smoking among construction workers.
The presence of metabolic syndrome was pursued in this study. One limitation though is that only 4 out of the 5 risk factors were measured. But adjustment for age and gender differences were made and it was found that 9.7% office workers and 12.6% construction workers had at least 3 risk factors for metabolic syndrome.
Cardiovascular and pulmonary risk assessments in the workplace can be used to screen and identify high risk individuals who can benefit from early referral to healthcare professional and prompt treatment. The findings of the study reveal higher risks for cardiovascular and pulmonary disease among construction workers compared with office clerks and professionals. The findings also serve as basis to develop appropriate health promotion and prevention interventions among subgroups working in the construction industry.