TY - JOUR
AU - Chind, Arun, Peter
AB - His suspense was understandable—his next job depended on it. Eagerly, my rope access technician glanced once more at the digital blood pressure (BP) device. For decade after decade, he had swung from one job to the next, travelling the world, negotiating customs and passport control and dodging ill-health while puffing away at a pack a day. Intermittent chest tightness from asthma hadn’t fazed him—the inhalers did their job while he continued his. ‘My BP was OK two years ago’, he contributed, in mitigation. As recently as a week ago, he had passed an exercise fitness test elsewhere. The BP was noted to be high, so he had been advised to pack it in. I didn’t need to ask if anything had changed—the smell of smoke announced the current state of affairs. Centuries after James I, King of England, published A Counterblaste to Tobacco, denouncing the ‘ ... custome … harmefull to the braine, daungerous to the Lungs ... ’, the fell fumes were delaying my clinic. When the whirring of the machine stopped, the writing was on the wall, or rather, the reading was on the screen. Emerging from the haze, the spectre of ill-health had now revealed itself: the pressures were too high for a 2-year certificate of fitness. Seeing the government health warnings had had no success, I added my specific verbal message and plea to him. As per offshore industry occupational health practice, I put my signature to a 3-week certificate and advised him to consult his general practitioner with my letter. ‘You’ve opened my eyes’, he said gratefully, ‘... I am giving up now.’ A week later, he emailed to say it was still holding. Over the years, my worker had kept a slim figure and consumed alcohol in moderation, but went astray in the area of smoking. Reflecting on this case, I am pleased that the game of delayed-action Russian roulette had a (relatively) happy ending. In the game of cat and mouse with risky health behaviours, we realize that while the mouse has only one life, the cat can claim many. I’d like to think that my efforts will help my hardy rope access technician avert an untimely health catastrophe. In the now iconic move, when John Snow arranged for the removal of the pump handle at Broad Street in Victorian London, the flow of contaminated water stopped, and the tide of cholera was stemmed. It would appear that the forces that govern human behaviour—including health behaviours—are also subject to the laws of motion. For our purposes, the law of inertia is of relevance—human behaviour will continue its trajectory unless compelled to change by another force. It is probably uncontroversial to state that the compulsion of policy is less disruptive than the impulsion of a stroke (or attack) of ill-health. In occupational health, as indeed in other areas of public health practice, time and time again, policy has been borne out to be better by far, than precept. © The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Policy is better by far, than precept
JF - Occupational Medicine
DO - 10.1093/occmed/kqy128
DA - 2019-02-07
UR - https://www.deepdyve.com/lp/oxford-university-press/policy-is-better-by-far-than-precept-irQBc2ZKOL
SP - 4
VL - 69
IS - 1
DP - DeepDyve
ER -