How healthy is your workforce?

PROMOTING a healthy workforce can bring many benefits to employees and business, including better physical and mental health, increased productivity, retention and attraction advantages, and positive bottom line impacts. By Cindy Brown
How healthy is your workforce? How healthy is your workforce? How healthy is your workforce? How healthy is your workforce? How healthy is your workforce?

Published in the October 2011 PNG Report magazine

PNG faces massive health challenges - HIV and tuberculosis are endemic; many health centres do not have running water and proper sanitation facilities; one mother dies every 12 hours and one child dies every two hours from treatable or preventable causes.

The country is also experiencing an upward trend in lifestyle-related illnesses including cancer and heart disease.

University of Adelaide medical and psychological anthropologist Dr Susan Hemer has spent time researching and working in the PNG resources industry, and has published a paper on health care and illness in Lihir Island in the context of the development of the Lihir gold mine.

Dr Hemer says there are many health issues companies have to deal with in a developing country, particularly in tropical environments where people are dying from malaria and tuberculosis. Companies also have to contend with emerging chronic illnesses common in developed societies as locals gain access to alcohol, commercial cigarettes, store-bought food and food from the company mess.

"As local people become employed they can better afford to purchase alcohol and cigarettes, which they may never have been able to do before," she says. "Alcohol may contribute to a rise in violence, accidents and money spent on it rather than things like school fees or food. It also contributes to the development of diabetes."

Cultural consideration, education and negotiation are often required to help manage health issues effectively. For example, Dr Hemer says the PNG culture is known to include a strong ethic of generosity and exchange.

"It is not uncommon in PNG for local resources employees to consume large food servings in the company mess, which may contribute to a shift from under-nutrition to over-nutrition, leading to obesity and diabetes problems. Many PNG people would not be aware of this, and would feel stingy if they didn't serve a generous portion of food."

Communicable illnesses including sexually transmitted diseases and tuberculosis are also serious issues in PNG, which is particularly concerning for the fly-in, fly-out workforce.

"Large groups of workers travel to and from work sites from various locations, potentially carrying diseases with them. There are also workers who have to leave their families at home, which may change the sexual behavior of the worker or partner, and prostitution often develops in fly-in, fly-out areas. People flying into new areas may also not have the same level of immunity to certain illnesses such as malaria," Dr Hemer says.

So what approach should companies entering PNG take to develop a successful health strategy?

"It needs to be taken into account as part of a company's key occupational, health and safety measures. Particularly in the resources industry, there tends to be more of an emphasis on safety, such as reducing workplace injuries, where there needs to be an equal focus on employee health.

"As a minimum, an employer should conduct pre, post and annual medical checks, partly to identify if a person's work role has any impacts on their health. Health education at either the job induction, or on a regular basis, around the key health risks at that particular work site, plus medical treatment as issues arise should also be included. The type of health service offered also partially depends on the capacity of health services in the area.

"Additionally, I would always suggest the company aligns its health strategy to the government's national health plan, which is very well-structured, to ensure resources are going to the same areas of importance. If this doesn't happen expectations could be out of sync with the rest of the country's.

"Positively, I noticed the PNG people are willing to listen and learn. Unlike people living in developed countries, they don't have many information sources, so any knowledge is usually greatly appreciated."

Dr Hemer cites a program run by Misima Mines to eliminate lymphatic filariasis in the area. "The campaign was simple but highly effective. The population was asked to take tablets on a regular basis for a few years, which led to an eradication of the disease. There was an educational campaign, tablet distribution system, and monitoring of dosages.

"Another great example is a theatre group in Lihir called Kokonas Services. The group attends community events and uses the medium of entertaining theatre to deliver serious health messages."

To successfully penetrate a PNG audience, consideration of gender sensitivities and language diversity are often required.

"In many areas of PNG there is a cultural sensitivity around openly discussing sexuality, so it is often required to deliver messages related to sexuality to same-sex groups, and often groups of the same age," Dr Hemer says.

"Companies often walk a fine line in that it may seem easier to avoid communicating about certain issues, but it is essential, though it should be done in a sensitive way."

There over 850 often unrelated languages in PNG and not everyone can speak and understand Tok Pisin or English so messages may need to be delivered in a variety of mediums and languages. Using local champions and respected elders for translation is often a valuable communication tool.

Dr Hemer says a health strategy should incorporate coordination with local services.

"Services may already be provided by government and churches. Coordination avoids duplication and confusion as to what services people should be accessing. Companies can also contribute to building local capacity."

A social and often legal obligation for companies to provide health services to PNG communities surrounding a work site also exists, and challenges may be presented in managing service inundation and cost. Dr Hemer says providing the service can be beneficial for companies and there are management mechanisms which can be implemented.

"Companies may consider charging fees, as much or slightly more than the local aid post. A focus on preventative programs over reactive treatment would also reduce strain on services and increase long-term sustainability.

"The great benefit in providing community health care is it lowers transmission rates of disease in the area, including transmission amongst your workforce, so you are preventing a lot of illness in a sort of unplanned way. You also avoid community resentment."

Dr Hemer says measuring statistics around a healthy workforce strategy should be done carefully.

"Often when embarking on a health program the amount of related cases will increase in the first instance, as the illness has either not been reported well in that area, or certain areas may have better detection mechanisms than others."

She says companies operating in developing countries could make a huge positive impact on workforce and community health.

"Any benefits from treatment and information provided in the workplace will ideally flow on to communities and families. There has also been a direct link proven between education and lowered mortality rates: children of more educated women have more chance of staying alive - which is a really important and positive outcome companies can play a direct role in."

Regional and remote supplier of medical support Anodyne Services Australia has provided its services to resources companies worldwide, including operating in PNG for the past seven years.

Anodyne Services Australia commercial manager Todd McKenzie says health service provision in remote areas is critical.

"Your operation is further away from ‘normal' health support, so minor health issues could become major very quickly and the potential for ongoing issues is protracted. Additionally, in our experience healthy workforce programs result in much lower absenteeism."

McKenzie agrees with Dr Hemer's comments regarding the requirement for cultural sensitivity when developing a healthy workforce strategy in PNG.

"The PNG people have a similar cultural trait of hospitality and sharing we have seen in Afghanistan, Sudan and Mongolia," he says.

"This trait may inadvertently contribute to health issues like obesity through examples like large meals served at company messes. Companies can make big inroads to promote healthy eating through advice and guidance.

"We have found a big challenge to maintain a healthy remote workforce in the resources industry to be the high rotation of employees. Companies have to implement an effective system to monitor intake and capture new people."

McKenzie says any money a company spends on employee healthcare will not be wasted.

"It is very hard to put a figure on a standard cost of a healthy workforce strategy; you have to take into account things like a company's location, existing health facilities and logistics. It is worthwhile for a company to invest in a health consultancy with experience in developing countries to review the situation and provide recommendations."

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