850 Occupational health and the social determinants of health: identifying the ethical issues

Abstract

Introduction ‘Job security increases health, wellbeing and job satisfaction. Higher rates of unemployment cause more illness and premature death’. Encouraging individuals to be at work can be beneficial, but it also raises questions such as: Do the socially disadvantaged have access to opportunities to improve their health? Do they have fair access to health-enhancing ‘good’ work? OH professionals can have an important influence in matters of health and work, both at ‘front line’ and policy levels. This paper identifies the ethical issues that arise in the wider social determinants of health (SDOH) discourse, from an OH perspective. Methods An applied ethics analytical approach was used to examine the relationship between OH and SDOH, especially in terms of worklessness arising from ill-health. The capability approach as a theory of justice was used. Specifically, a concept of health justice when one is unable to work through ill-health or disability was explored. Results Areas of ethical concern: The medicalisation of the ill–health assessment process, whereas societal factors are ignored. The extension of ‘responsibilisation’, i.e. making individuals responsible for their ability to work as well as for their health. Ethical tensions for OH practitioners when their relationship with the worker may not be the traditional ‘doctor–patient’ one. Discussion Unemployment, job insecurity and sickness absence are serious problems, impacting on the health of individuals and society, and a financial burden to employers and the State. However, although it may be desirable for individuals to be in employment to improve their health, there is also a danger that those unable to work become stigmatised. So, ‘tackling’ these problems should be done in fair and ethical ways. A first step is identifying the ethical issues.