Abstract

Objective: One of many lessons for occupational epidemiologists from the COVID-19 pandemic was the importance of taking a precautionary approach to using science for policy recommendations. To prepare for future health emergencies, this presentation describes opportunities for integrating the Precautionary Principle (PP) into methods for synthesizing evidence and formulating occupational/environmental health guidance. Material, Methods and Results: Authoritative reviews of global response to the emergence of the SARS-CoV-2 virus faulted public health agencies for being too slow to warn of a possible epidemic because they waited for “sufficient” evidence of human-to-human transmission, rather than taking a precautionary approach and assuming airborne human transmission. A widely adopted definition of the Precautionary Principle (PP) states: “When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically”. Historical development of the PP is reviewed, and four key components are presented: taking preventive action in the face of uncertainty; explicitly considering the weight of evidence or ‘burden of proof’ needed to recommend one action over another; exploring a wide range of alternatives to possibly harmful actions; and increasing public participation in decision-making. Drawing lessons from past applications and missed opportunities, we propose that a precautionary framework should be a key component of a pragmatic approach to using science for evaluating occupational health risks and interventions. Criticisms of the PP are discussed, including: not providing guidance on when precaution should be invoked; not specifying how much precaution should be taken; and simply being unscientific. These criticisms are addressed, and we conclude that effectively acting with foresight requires a complex, multifactorial assessment that is best conducted within a precautionary framework. Conclusion: The PP should be integral to a pragmatic scientific approach to evaluating occupational health risks.

Merel Schuring, Raun van Ooijen, Sandra Brouwer

Abstract

Objective: Long-term sickness absence (LTSA) can negatively affect the employee’s income, leading to more health problems due to financial stress. This affects people in adverse situations more. Therefore, LTSA impacts individuals and society, creating a public health problem. More knowledge is needed about which group(s) of employees are the most vulnerable to financial consequences after a disability claim decision. Therefore, we investigated monthly income trajectories of long-term sick-listed employees in the Netherlands, before and after a disability claim decision. Material and Methods: Pseudonymized data on a disability claim decision from the Dutch Employee Insurance Agency were used from 32,647 long-term sick-listed employees with a claim decision in 2017. These data were linked to income records from Statistics Netherlands two years before and after the decision. Group-based trajectory modelling was applied to identify income trajectories over time. Sex, age, disability claim decision, and type of disease are used as explanatory variables of trajectory membership. Results: Preliminary results identified three similar income trajectories starting at € 1,360, € 2,680 and € 4430. Income stays stable in the first six months of sick leave, then slightly declines with a little peak around the disability claim decision after two years. A decline before recovery close to the starting income follows. Males, middle- and older-aged people, those partially disabled with a good chance of recovery and with a physical disability tend to fall in the middle- and high income groups. Conclusion: Similar income trajectories were observed across groups with recovery near baseline income, reflecting income security within the Dutch system. Persistently low income were found among females, younger individuals, those without a disability benefit or with full disability and those with psychological disorders identifying them as vulnerable groups. This highlights the need for greater equity not only during sickness but in society as a whole. This work, conducted within a project to improve reintegration of long-term sick-listed employees, was supported by funding of ZonMW.