Pre-employment health screening
The document outlines the objectives and practices of pre-employment health screening (PEHS) to ensure prospective employees are medically fit for specific job roles without posing risks to themselves or others. It discusses the legislative framework in New Zealand and the significance of thorough assessments, including questionnaires and medical examinations for certain high-risk jobs. Recent findings highlight that while PEHS is common, evidence on its effectiveness in preventing future health-related issues is limited, advocating for better practices and tailored assessments based on job-specific requirements.
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Pre-employment health screening
- 1. Dr C.T.C. Kenny,FAFOEM Specialist Occupational Physician Waitemata District Health Board September 2014
- 2. • Introduction •Definitions • Goals of PEHS • Medical examinations • Legislation • Origins • Recent practice • Evidence Base
- 3. • The Pre-employmentHealth Screening (PEHS) assessment has traditionally been performed to ensure that a prospective employee can perform his/her job(s) safely without placing him/herself or co-workers at risk
- 4. • Ensuring thatemployee is medically suitable for the proposed employment role, without risk to him/herself or to others • Ensuring a good match physically, psychologically and cognitively between the candidate and the proposed role • Identifying any workplace modifications which may be required to ensure the employee is able to perform the role • Ensuring that the employee can undertake the role regularly, reliably and safely
- 5. • Necessary forthe person/agency assessing the candidate’s medical fitness for the proposed employment to have a detailed understanding of both …. • the work (tasks and responsibilities) and • the relevant health conditions • The majority of such assessments can be performed through an appropriate and well-constructed questionnaire
- 6. • Medical examinationsonly justified when … • questionnaire has identified potentially significant health condition(s) and further clarification may be required • the proposed work involves hazardous tasks or a hazardous environment • the proposed work requires a very high level of physical fitness or endurance • the safety and well-being of other employees and/or the general public is of concern • required by statutory licensing requirements or other law
- 7. • Legislation inNew Zealand relevant to PEHS includes … • The Human Rights Act 1993 • The Privacy Act 1993 (and Health Information Privacy Code) • The Health and Safety in Employment Act 1992 and amendments Similar laws in Australia and in UK
- 8. • Recruitment tomilitary and to large industrial organisations typically involved PEHS questionnaires, clinical examinations (including visual acuity and colour vision testing) and various medical investigations (spirometry, audiometry and urinalysis) • Various forms of physical and anthropometric assessment have been required for military forces since early last century • Medical officers within the military and in large organisations (particular in mining, oil/gas exploration and merchant marine sectors) performed a combined role; - occupational health/occupational medicine - primary care
- 9. • Initial medicalassessments were performed not only to determine medical fitness for work, but also as part of providing a baseline health record for subsequent health care • Many of the military bases and industrial sites were geographically remote, and the base medical officer or company doctor fulfilled the function of the general practitioner as well as the occupational health doctor
- 10. • In themilitary, the recruit examination or pre-deployment examination was to identify and exclude those candidates who were considered medically unsuitable for active military service, often for reasons which may no longer be valid or legally acceptable • Consequently, pre-employment or recruit medical examinations typically involved an extensive health questionnaire followed by a full general medical examination and ancillary tests, most of which had no direct relevance to the prospective employment role
- 11. • Development ofthe goals for PEHS, including .. • - To assess ‘fitness for the job’, by reducing morbidity and mortality in a specific occupation by excluding unsuitable candidates • - To assess fitness (eligibility) to participate in sick pay and superannuation schemes • - To act as a baseline record to help repudiate subsequent compensation claims by employees • - To comply with statutory requirements (Houghton et al; 1989)
- 12. • Guide onPEHS published by the National Health Service (NHS), advising that such health checks were undertaken … • To ensure that prospective staff are physically and psychologically capable of doing the work proposed, taking into account any current or previous illness • To identify anyone likely to be at excess risk of developing work-related diseases from hazardous agents in the workplace • To ensure, as far as possible, that the prospective employee does not represent a risk to patients • To ensure that they will be doing work that is suitable and safe for them (Madan et al; 2010)
- 13. • Occupations withheavy and/or repetitive lifting associated with higher frequency of back pain (and possibly back injury) (CJM Poole; 1999) • Strength and aerobic fitness training in Firefighters and mitigation against back injuries (Cady et al; 1979) • PEHS protocol as substitute for maximum age for hiring, in Police and Fire Services (Mostardi et al; 1990)
- 14. • International Commissionon Occupational Health (ICOH) • ‘The determination of fitness for a given job should be based on the assessment of the health of the worker and on a good knowledge of the job demands and of the work site’ • ‘The occupational health practitioner has to explain necessity of public health policy, ergonomic arrangement, training for the job requirement and medical supervision, in order to attenuate, as much as possible, discriminations based on age, gender, illness or handicap, and (to) try to maintain equal opportunity for all’
- 15. Shepherd; 1992 •‘Scant evidence on the effectiveness of pre-employment examinations to prevent future health-related occupational risks’
- 16. • World HealthOrganisation (WHO) – (Pachman; 2008) Review of the evidence base for PEHS • PEHS ‘strives to place and maintain employees in an occupational environment adapted to their physiological and psychological capacities’ • ‘The goal of the pre-employment examination is to determine whether an individual is fit to perform his or her job without risk to himself/herself or others’
- 17. • Advised that‘the assessment of fitness for work was considered a better predictor of future health outcomes and costs than medical diagnosis alone’ • ‘Despite being common practice in occupational medicine, the validity and effectiveness of judgements on unfitness for work are not based on evidence and are likely “doubtful”’ (Pachman; 2008)
- 18. • Concluded that‘any health assessment should be appropriate to the requirement. Medical examinations are only justified when the job involves working in hazardous environments, requires high standards of fitness, is required by law, or when the safety of other workers or of the public is required’ • • ‘Generally, a health assessment by questionnaire should suffice and physicians should advise against the application of physical or mental standards that are not relevant to fulfilment of the essential job functions’ (Pachman; 2008)
- 19. • Pachman made3 recommendations regarding PEHS; • To eliminate the pre-employment physical examination (the requirement for an applicant to complete a medical history form was reasonable, which could then be review by a medical examiner; a job-demands analysis should be available to the physician) • To eliminate pre-employment drug testing (insufficient evidence that this is cost-effective), and • To develop some consensus around best practice and conduct clinical trials regarding assumptions
- 20. • A furthersystematic review of the literature looked at whether health questions asked prior to employment are effective in predicting health and employment outcomes • Concluded that no evidence that PEHS can consistently and reliably identify workers whose health prevents them from carrying out their job as safely as other workers • Recommended that all jobs should be risk assessed, and specific workplace exposures be identified before applicants are appointed to the roles • Where PEHS does take place, it must be based on clear health standards with explicit criteria for rejection (Madan and Williams; 2012)
- 21. • Considered whetherpre-employment examinations could prevent occupational injury and disease • The authors concluded that ‘there is very low-quality evidence that pre-employment examinations that are specific to certain jobs or health problems could reduce occupational disease, injury or sickness absence’ • ‘This supports the current policy to restrict pre-employment examinations to job-specific examinations. More studies are needed that take into account the harms of rejecting job applicants’ (Mahmud et al; 2011)
- 22. • Moshe etal (Occup Med; 2007) compared three different methods of pre-employment screening in the workplace • They noted that pre-employment examinations of white-collar employees evaluated in several previous research studies, had demonstrated that the cost of the examinations was higher than the excess costs of the high-risk employees • The study supported the findings of earlier studies that the use of a self-administered questionnaire evaluated by an occupational physician was found to be more cost effective and yielded similar fitness for work outcomes (similar restriction rates) than either an occupational physician medical examination or a GP medical examination alone
- 23. • International Committeeon Occupational Health (ICOH; 2012) • ‘The potentially positive and negative consequences of participation in screening and health surveillance programmes should be discussed as part of the consent process’ • ‘The health surveillance must be performed by an occupational health professional approved by the competent authority’ • ‘Biological tests and other investigations must be chosen for their validity and relevance for protection of the health of the worker concerned, with due regard to their sensitivity, their specificity and their predictive value’
- 24. • The fulltext of this presentation, and a complete list of references, will be made available to OHSIG to put on the website or to be otherwise available to delegates • Copies of specific journal articles noted in the Reference list can be requested from Dr Kenny by e-mail, at the following address; [email protected]