key: cord-0838977-v2sfbqps
authors: nan
title: Department of Error
date: 2004-07-16
journal: The Lancet
DOI: 10.1016/s0140-6736(04)16624-5
sha: a13b65a8225642e50d3f40cdd83407885ab46067
doc_id: 838977
cord_uid: v2sfbqps

nan

few definitive data on the costeffectiveness of a proactive occupational health service, but solely in the field of sickness absence, the direct cost to UK employers is estimated to be £500 (US$900) per employee per year. Assuming a workforce of 30 million, this figure represents a direct cost to British industry of £15 billion ($27 billion) each year.

Many of the UK's European partners have realised the value of quality occupational health. As stated by Greenberg, Finland leads the field, but it is a legislative requirement in many countries that all businesses employing more than a relatively small number of workers must provide access to occupational health services. Such services can only be led by legislation from an enlightened government that clearly understands the benefits of occupational health and its value to the economy and the health of the nation. 

I found Morris Greenberg's Commentary (Feb 28, p 273) 1 to be both accurate and extremely depressing. He is right in stating that the UK was a world-class player in academic occupational health in the 1970s, but that the situation today is very different. I believe that the reason for this decline is the failure of successive governments to promote the benefits of good occupational health services to all employers. In the past, such benefits were recognised by most larger employers, who provided comprehensive in-house occupational health services. However, over recent years many of these services have been downgraded or outsourced to external providers. By contrast, the discipline of occupational medicine itself has gained credibility through establishment of the Faculty of Occupational Medicine and a clear postgraduate training and examination structure.

There has been a major increase in legislation referring to occupational health, most of it emanating from the European Parliament. However, there is much ignorance (or apathy) over its implementation, and not only within small businesses. This situation has not been helped by the continuing emasculation of the country's Health and Safety Executive.

With difficult economic conditions, most companies erroneously believe that health and safety issues are merely a drain on precious resources. There are to finish the pack, or eat everything on their plate, irrespective of the quantity provided.

One contribution to solving this problem could be to regulate the price in relation to the portion size of certain high-calorie foods such as hamburgers, fried chips, and sugar-containing drinks. A standard size of portion could be defined by governments, and the cost of larger ones be made the same multiple of the weight. So, for example, a hamburger weighing 170 g would cost twice as much as a standard 85 g hamburger. This would tend to focus competition on reducing price and increasing quality, rather than to provide larger portions for the same or similar price. The effect on consumer choice could be tested in pilot trials. 

The epidemic of obesity poses a publichealth challenge. In the UK and USA, about two in three adults are overweight (body-mass index у25 kg/m 2 ) and about one in three are clinically obese (body-mass index у30 kg/m 2 ). The morbidity associated with obesity is well recognised. Although, ultimately, individuals choose what and how much they eat, there is a need for effective societal action to stem and reverse the epidemic.

An important contributory cause of the epidemic has been the increase in the size of food portions over time, fuelled by commercial competition to supply more food for the same price. Consumers are understandably attracted by the better value and tend

Deforestation, hunting and the ecology of microbial emergence

Exposure to nonhuman primates in Cameroon

No evidence of antibody to human foamy virus in widespread human populations

Frequent simian foamy virus infection in persons occupationally exposed to nonhuman primates