Friday, September 26, 2014

The Workplace & Diabetes

A couple of recent studies tying type 2 diabetes to the work place seem to me to add fuel to the universal medical provision argument.

A German study of more than 5,300 working adults found that high levels of workplace stress can lead directly to an occurrence of type 2 diabetes.

The study comes from the Institute of Epidemiology in Munich. It followed workers ages 29 to 66, measuring their levels of stress and correlating it to their health.

The conclusion was that those under high work place stress are 45 percent more likely to develop type 2 diabetes regardless of whether one is overweight or not.

Related disorders include stroke, heart disease and blindness.

The Institute reportedly followed the subjects for 13 years. During that time, almost 300 of those in the study developed type 2 diabetes despite the fact that they all been healthy at the start of the study.

The increase in risk in work-related stress was identified independently of classic risk factors such as obesity, age or gender.

Researcher Professor Karl-Heinz Ladwig told the British publication Daily Mail: “According to our data, roughly one in five people in employment is affected by high levels of stress at work. We don't mean normal job stress but rather the situation in which the individuals concerned rate the demands made upon them as very high and at the same time have little scope for maneuver or decision-making.”

The findings were published by the journal Psychosomatic Medicine.

Yesterday the LA Times published a story about another study that found a link between long work hours, low pay and diabetes, but there is inadequate explanation for why.

The study was made available online Thursday by the journal Lancet Diabetes and Endocrinology.

The team of researchers scoured the medical literature and found reliable data on 222,120 adults from the United States, Europe, Australia and Japan, where up to 68% of them worked “long hours” (generally defined as more than 55 hours per week).

A total of 4,963 of these men and women were diagnosed with Type 2 diabetes during the time they were tracked. There was a small link to "long hours" - about 7 percent.

More interesting was the link to socio-economic status: of those with low incomes, working long hours was associated with a 26% increased risk of developing diabetes after adjusting for other demographic factors.

In a commentary that accompanies the study, a pair of Harvard researchers wrote that it’s too early to rule out the idea that “working long hours per se is toxic.”
Bowzer stress and diabetes?!!

According to the American Diabetes Association's website, 23.6 million Americans have diabetes, constituting 7.8% of the population. Of that 23.6 million, 5.7 million have not been diagnosed yet. 

That's a big potential work comp claims population...

Workers' compensation for the most part covers industrially related (not necessarily caused) disease - if there is some work place exposure to elements that may cause or contribute to disease then there generally is workers' compensation liability.

This is a paradox that is as old as workers' compensation - the causation question.

For instance, many states have either limitations or complete dissociation of mental disease from work comp coverage - presumably because outside influences are too difficult to control and business doesn't believe it should be responsible for someone's mental health.

On the other side are exposures that generally are highly correlated to industrial settings - mesothelioma as a consequence of asbestos is an example (and was the subject of independent compensation systems).

In the middle, and it's a big middle, are these fuzzy exposures like diabetes and work place stress.

One man's stress is another man's stimulation. The degree to which a person can tolerate stress, or long work hours, is highly subjective and dependent upon a person's "pain tolerance."

Which is why workers' compensation laws are to be liberally construed in favor of the injured worker.

The purpose of that rule of construction is because this big fuzzy middle area can't be well defined and in order to make good on the promise of expeditiousness workers' compensation is supposed to do away with as much controversy and dispute as possible.

Over 100 years of workers' compensation legal interpretation by the courts should have taught us that, for the most part, disputes on causation when there is a scintilla of evidence of industrial exposure are going to be resolved in favor of the worker.

Will work comp systems see an increase in diabetes related claims as a consequence of these recent studies? I don't know - maybe.

I did a search on WorkCompCentral for "stress diabetes" and the results demonstrate the contentiousness of such claims.

I think the bigger lesson is that workers' compensation systems seem archaically anachronistic - for the most part workers' compensation has not evolved, and the issue of causation, essentially a dispute regarding liability, is a precursor to the provision of medical treatment.

This gets in the way of one of the primary missions of workers' compensation - to expeditiously provide medical treatment.

As long as there is a legal requirement on causation (AOE/COE) there will be disputes, which delays treatment, increases costs (exponentially by the way - just look at attorneys fees inflation) and destroys lives.

And really the only way out of this conundrum is to simply get rid of the causation requirement, which is basically to envelope employer paid medical treatment into a universal program regardless of causation, leaving the indemnity part of the equation for argument.

I know that prospect doesn't sit well with many, particularly more conservative thinkers. I get that. But at some point someone pays, directly or indirectly, for the health of the population.

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