Question

the name of the course is workplace health promotion

1. What type of health data does health assessments evaluate both the individual and organizational levels?
2. Discuss how some groups are more vulnerable to discrimination, harassment, and stigmatization which lead to stress at the workplace?
3. Discuss the prevalence of cigarette smoking as a public health threat in Saudi Arabia, and the economic and the societal harms it causes. Support your answer with recent statistics of smoking in Saudi Arabia.

Answer 1

*Healthcare interventions are often implemented at the level of the organization or geographical area rather than at the level of the individual patient or healthy subject. For example, screening programmes are delivered to residents of a particular area; health promotion interventions might be delivered to towns or schools; general practitioners deliver services to general practice populations; hospital specialists deliver health care to clinic populations. Interventions at the area or organization level are delivered to clusters of individuals.

As companies increasingly face rising health costs and competition, comprehensive workplace health programs are becoming more widely used as a strategy for impacting employee health and productivity and, in turn, corporate bottom lines.

Comprehensive workplace health programs aim to reach employees through a variety of ways, including workplace policies, benefits, environmental changes, and programs and services available for employees, spouses, and dependents.

However, each company and its employees is unique and the strategies used to address employee health will vary from company to company based on the resources available, needs and interests of management and employees, and health issues that are priorities.

• A  workplace health assessment is a process of gathering information about the factors that support and/or hinder the health of employees at a particular workplace and identifying potential opportunities to improve or address them
• A workplace health assessment helps to identify the current picture of health at a company as well as ways to improve it that can potentially increase productivity, decrease absenteeism, and control health care costs for both employees and the organization as a whole
• It is a necessary first step before goals are developed, resources allocated, strategies adopted and interventions implemented, employees participate, and outcomes are measured

Many factors influence health in the workplace and can be impacted by supportive changes within the following levels of influence:

• Individual – elements of an employee’s health, such as their health behaviors, health risk factors such as high blood pressure, and current health status
• Interpersonal – elements of an employee’s social network including relationships with managers, coworkers, and family that provide support; mentoring or role models
• Organizational – elements of the workplace structure, culture, practices, and policies such as benefits, health promotion programs, work organization, and leadership and management support for workplace health and safety initiatives
• Environmental – elements of the physical workplace such as facilities and settings where employees work as well as access and opportunities for health promotion provided by the surrounding community where employees live

The types of data sources used to gather information in a workplace health assessment may include:

• Site visits
  Site visits are in-person observations of the workplace setting and include interviews with managers and employees to discuss health attitudes and beliefs, and review health promotion programs and policies, and evaluate the worksite environment for health risks
• Employee surveys
  Examples of employee surveys include Health Risk Appraisals; employee satisfaction and interest surveys; safety surveys and routine inspections
• Health benefits
  The type of coverage and covered services employee receive under the health plan; vacation and sick time; access to health promotion programs
• Health care and pharmaceutical claims
  A source for identifying the common health conditions and procedures for which employees are seeking health care and their costs
• Other data sources
  Examples include time and attendance; injury; and participation in, satisfaction with, or outcomes from other employee health programs

Other data sources may also provide information that will be useful for designing and evaluating a workplace health program. Such data sources include data on injury prevalence, causes, and workers compensation; absenteeism; use of existing health programs such as EAP or fitness facilities.

* Work-related stress is a growing problem around the world that affects not only the health and well-being of employees but also the productivity of organizations. Work-related stress arises where work demands of various types and combinations exceed the person’s capacity and capability to cope.

Work-related stress can be caused by various events. For example, a person might feel under pressure if the demands of their job (such as hours or responsibilities) are greater than they can comfortably manage. Other sources of work-related stress include conflict with co-workers or bosses, constant change, and threats to job security, such as potential redundancy.

Injustices at the interpersonal and institutional level lead to the differential risk of vulnerable workers to adverse occupational health outcomes. Members of demographic minority groups are more likely to be victims of workplace injustice and suffer more adverse outcomes when exposed to workplace injustice compared to demographic majority groups. A growing body of research links workplace injustice to poor psychological and physical health, and a smaller body of evidence links workplace injustice to unhealthy behaviors. Although not as well studied, studies also show that workplace injustice can influence workers’ health through effects on workers’ family life and job-related outcomes.

Workplace discrimination refers to actions of institutions and/or individuals within them, setting unfair terms and conditions that systematically impair the ability of members of a group to work [Rospenda, et al. 2009]. Often, it is motivated by beliefs of the inferiority of a disadvantaged outgroup compared to a dominant group [Roberts, et al. 2004]. Racism, or discrimination based on race, justifies the mistreatment and dominance of members of a particular racial or ethnic group due to beliefs of their genetic and/or cultural inferiority; it also carries a history of societal power relationships between races [Williams 1997]. Discrimination can also occur between disadvantaged groups themselves. For example, de Castro et al. (2006) found that some ethnic groups were favored over others among immigrant worker groups. This favoritism was initiated and perpetuated by both coworkers and employers/supervisors alike [de Castro, et al. 2006]. Latino indigenous-speaking farm workers in Oregon reported differentially distributed hazardous work conditions, including lack of educational materials in languages they understood, between themselves and Spanish-speaking workers; they also reported that these conditions were often perpetrated by Spanish-speaking Latino former farmworkers who had risen through the ranks to become supervisors [Farquhar, et al. 2008]. Similarly, in a study of 356 African-American workers, 43% of the 219 workers who reported workplace discrimination reported that the perpetrators included fellow African-Americans [Din-Dzietham, et al. 2004].

Discrimination against workers with disabilities, younger and older workers, and gender persists, as well. Studies have shown that discrimination against workers with disabilities has both societal and historical influences and persists despite being prohibited by the Americans with Disabilities Act [Scheid 2005, Stuart 2006, Snyder, et al. 2010, Moore, et al. 2011]. Ageism, discrimination based on age, has been shown to have a curvilinear life course trajectory whereby it disproportionately impacts younger workers in their 20s and older workers above 50 [Gee, et al. 2007].

Workplace harassment differs from discrimination because it involves negative actions toward a worker due to attributes, such as race/ethnicity, gender etc., that lead to a hostile workplace whereas discrimination involves unequal treatment or limiting of opportunities due to these attributes [Rospenda et al, 2009]. Harassment must target workers’ protected EEOC status in order to meet the US legal definition [Ehrenreich 1999, Carbo 2008]. Sexual harassment is a type of workplace harassment that is typically characterized along gender/sex lines [Pina et al, 2009]. Fitzgerald and colleagues (1999) delineated four types of sexual harassment—sexist behavior, sexual hostility, unwanted sexual attention, and sexual coercion. Sexist behaviors describe actions in which one's gender or sex is the primary target of discrimination [Fitzgerald, et al. 1999]. This overlap in definition can make distinguishing between gender discrimination versus harassment difficult. The other three describe experiences that are more physical and sexual in nature.

Workplace bullying or abuse involves actions that offend or socially exclude a worker or group of workers or actions that have a negative effect on the person or group's work tasks [Grubb, et al. 2004]. These actions are often status-blind and occur repeatedly and regularly over a period of time [Grubb, et al. 2004]. The actions were taken and workers’ sensitivity to them can vary according to culture [Cassitto, et al. 2003].

*Tobacco consumption is alarming in Saudi Arabia as it is ranked fourth worldwide in terms of tobacco sale, and a high proportion of males students (32.7%) smoke in the country. A large body of epidemiological evidence reveals that smoking is related to oral conditions which include periodontal disease, gingival recession, tooth loss, dental caries, staining of teeth, halitosis, benign mucosal conditions, and precancerous and malignant oral lesions. Smokers live approximately 10 years lesser than never smokers, and smoking cessation efforts can reduce 97% risk of death associated with continuing smoking before the age of 30 years. This underscores the importance of increasing the awareness about the negative consequences of smoking among adolescents so that morbidities, mortalities, and oral and systematic health inequalities resulting from smoking can be prevented at an earlier age.

Adolescents are vulnerable to starting smoking and becoming addicted to nicotine because they go through rapid hormonal and cognitive changes during their adolescence and they are influenced by cultural, social, familial, and behavioral factors.

Adolescent smokers are likely to become addicted to nicotine, and about 90% of adult smokers used to smoke regularly during their adolescence.

The factors that lead adolescents to start smoking include advertising of cigarettes, stress, low self-esteem, poor academic performance, and occurrence of smoking among parents and other family members, friends, and staff at school. Moreover, research indicates that initiation of smoking is associated with the perception of risks and benefits of smoking. It was found that adolescents with low perception about the long term risks related to smoking were 3.64 times more likely to smoke compared with those who had a high perception of smoking-related risks.

Saudi Arabia has a national tobacco control program that aims at evaluating the prevalence of smoking and its adverse health effects including economic impact and preventing the epidemic of smoking complications. In addition, there are policies about controlling smoking in educational institutions, health-care facilities, public transportation, and banning tobacco commercial advertisements.

It is suggested that antismoking policies aimed at enforcing the control of tobacco use and improving oral and systemic health should consider the support of family members particularly parents. The supportive environment for developing healthy lifestyles among children should be created utilizing possibilities of interaction among teachers, parents, and health-care providers in schools. Educating students about the complications of smoking on oral health should be part of smoking cessation programs and policies.