Wednesday, February 12, 2014

The Health Benefits of Work?


Open Letter to Royal Australasian College of Physicians




Dr John O'Donnell FRACP

New Zealand President

Royal Australasian College of Physicians

PO Box 10601

WELLINGTON



Dear Dr O’Donnell



On behalf of the members of my Union branch and all affected by the influence your prestigious college exerts, I write to you a matter of grave concern to us all. What concerns us is evidence that the advocacy of one of your constituent faculties, the Australasian Faculty of Occupational and Environmental Medicine (AFOEM), is having consequences it may not have foreseen and which in the current economic climate and under the current political regime could have adverse health effects which far outweigh any benefits it seeks to bring about. This being so, we think it incumbent on the RCAP to issue a public statement criticising the unbalanced position of the AFOEM and the opportunistic use the government has made of it, and bring this to the attention of the government, opposition MPs and the media.



The adverse consequences I have referred to follow from the use made by the present government of the AFOEM’s Position Statement (1) on the health benefits of work. The statement is quoted on Work and Income's application form for work assessment (2) in a blatant attempt to influence G.P s to disqualify applicants from the Supported Living payment. Moreover, one of our supporters (who, for understandable reasons wishes to remain anonymous) reports having obtained under the Official Information Act evidence that WINZ 'designated doctors' are being indoctrinated in the converse of the 'health benefits of work', viz. the allegedly adverse health consequences of living on a benefit. The idea is even being propagated that benefit dependency is an addiction! (2).



It is no secret that the government's benefit reforms are intended to reduce the number of beneficiaries by tens of thousands: 40,000 has been mentioned as a target.

If these reforms were genuinely promulgated as a public health measure, we would expect the government to say so publicly, and to back its words with deeds by ensuring there were jobs available for job-seekers to apply for. The fact that they have done neither surely indicates firstly that they know such a claim could not withstand the storm of criticism it would be bound to provoke, and secondly (when considered in conjunction with other employment-related legislation) that the real purpose is altogether different: A predictable consequence of throwing tens of thousands more onto the labour market at a time of global and local recession is intensified competition for scarce jobs, resulting in greater stresses on individuals - many of whom have mental and/or physical ailments- and downward pressure on wages. The latter effect will certainly be seen as desirable by employer friendly government keen to restore business profitability, and the measures taken to achieve it signify that it considers the inflicted stresses worthwhile. Any such government would naturally be delighted if its harsh measures could be represented as beneficial from the point of view of health, and would welcome such advocacy as the AOEFM's with open arms.

It would be truly shocking if the AFOEM foresaw and approved of this consequence of its advocacy, but not so surprising if any corporate interests it may serve (such as insurance companies) did so. This possibility is further discussed below.

Meanwhile New Zealand's appalling childhood poverty rates have finally been getting the media attention they deserve, as has the link between poverty and illness. We find it remarkable that despite what it says in your admirable Public Health and Policy Statement (3) about 'complex interactions between social and economic factors', nowhere on your website can be found any reference whatsoever to any link between poverty and illness, such as is ably described in the following article in NZ Herald of 23rd Oct 2013. (4) As a specialist faculty of RCAP, it is somewhat more understandable that the AFOEM should in its Position Paper omit discussion of poverty as a more direct causative factor in illness than unemployment.

We would, however, expect a scientific investigation to consider alternative hypotheses to the one advanced, and to acknowledge that statistical correlation is not evidence of direct causation. Even less is it ‘compelling’ evidence, especially when the evidence of an alternative explanation of the data is so strong.

What is ironical is the position paper’s acknowledgement, albeit without any discussion of its significance of two observations that conflict with its primary hypothesis. Firstly that for a certain stratum of society the possession of wealth is a sufficient prophylactic against the allegedly adverse health effects of idleness! Secondly, the inclusion of children in the statistics adduced in support of the 'health benefits of work' hypothesis is 'compelling evidence' (to use a phrase AFOEM has used and the government is fond of quoting) not of the health benefits of work (unless the AFOEM attributes childhood illness to idleness!), but of the adverse health effects of poverty. And let us not forget that increased poverty is the inevitable consequence of the benefit reforms. For the government to acknowledge the latter would be fatal to one of its main policy platforms. Hence it's state of denial.

The noted omissions would be explicable if the AFOEM's research was 'commissioned research and, as such, pre-disposed towards ideologically determined outcomes' (to quote Prof Alison Ravetz' appraisal of similar research done in the UK).

What is particularly disturbing is evidence of the influence on the AFOEM of Sir Mansel Aylward. (5) Aylward was formerly Chief Medical Adviser, Medical Director and Chief Scientist at the UK Department of Work and Pensions, and is now HOD in an academic chair sponsored by Unum, the world's largest disability insurer. (6) Not only has Unum been thoroughly discredited for the scale on which it has attempted to evade payouts (California Insurance Commissioner John Garamendi has state that is is 'an outlaw company...that for years has operated in an illegal fashion.' (7) A Yale University research paper commented that, with regards to Employee Retirement Income Security Act (ERISA) and other cases, Unum was, 'engaged in a program of deliberate bad faith denial of meritorious claims'; (8). Moreover Unum has according to one disability researcher from Leeds University 'demonstrated an interest in taking over the UK welfare system' (9).

It was Aylward who devised the Personal Capability assessment (PCA) to which British claimants are subjected, the administration of which is contacted out to a private sector firm ATOS. Amongst the charges levelled against the sponsors of Aylward's academic chair by the insurance commissioners of a number of U.S. states (7) is 'excessive reliance of in-house medical professionals.' If Aylward does not fit that description, he comes perilously close to it. The RACP should be seriously concerned for its reputation for scientific impartiality.

Aylward’s version of the bio-psycho-social-model of illness differs from that of the RACP’s public policy statement in its emaciated interpretation of the social dimension, which conveniently (for the purposes of such as WINZ and Unum) restricts it to the immediate circle of the client’s family, employer and caregivers, and excludes capital, income distribution and such redoubtable social institutions as, governments, universities, professional associations, trans-national insurance companies etc. Moreover it lends itself to interpretations that stigmatise the infirm and disabled, as has happened in the UK. (10)

The United Kingdom is further down the path of work-focused welfare reform than is New Zealand, and the results it has achieved- little published in New Zealand, are truly alarming, and include the ‘ruthless pressurising (of) the sick and disabled into work’ and thousands dying while on work-related activity placements. (11)

Insofar as the success claimed by the government in reducing expenditure on welfare is a consequence of AFOEM's advocacy, one consequence of that advocacy is increased financial stress on beneficiaries disqualified from receipt of the supported living payment without any guarantee of employment (12) It is precisely when the income loss affects ability to meet expenses for healthy food, accommodation, power and doctors bills that the 'complex interactions between social and economic factors' referred to in your Public Health and Policy Statement take effect.

In summary, it bears repeating that the government has reasons for reluctance to acknowledge the reality of a link between child poverty and illness, is totally reliant on unregulated and demonstrably unreliable market forces to eradicate poverty and is evidently therefore profoundly grateful for such advocacy as is offered by AFOEM which, supported by the continued silence of the RACP, diverts blame for a disgraceful state of affairs from the policies which perpetuate it onto the victims. There are grounds for suspecting that in issuing its Position Statement the AFOEM has been manipulated by corporate interests into lending its prestige as a professional body toward endorsing goals that have nothing to do with health and everything to do with profit-making.

The most shameful episodes in the history of the medical profession have been when in the name of science it has given ideological support to slave-owning oligarchs and fascists. Greater vigilance is evidently required to ensure nothing like that ever happens again.

Yours sincerely

D.K. Henderson

Honorary Secretary

Waitemata Branch of Unite Union



Footnotes: ___________________________________________________

(1) AFOEM Position Statement: http://www.racp.org.nz/i ndex.cfm?objectid=F07790EC-0F2D-D1EB-4298E5D44500162A

Consensus Statement: http://www.racp.org.nz/index.cfm?objectid=57063EA7-0A13-1AB6-E0CA75D0CB353BA8

The fact that WINZ erroneously attributes a quote from AFOEM's position statement to its consensus statement could signify that it has not even studied the evidence that it blithely quotes as being 'compelling.'

(2) http://www.nzherald.co.nz/simon-collins/news/article.cfm?a_id=135&objectid=10898616

(3) We wholeheartedly approve of RACP's excellent public health and social policy statement, which can be seen in full at:

http://www.racp.org.nz/page/policy-and-advocacy/public-health-and-social-policy

However it should not be taken to endorse Aylward's (and the AFOEM's and WINZ's retrograde version of bio-psycho-social medicine).

(4) Child Poverty http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11168848

http://www.scoop.co.nz/stories/PO1312/S00111/unicef-nz-statement-on-child-poverty-monitor.htm

http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11144397

(5) http://www.racp.org.nz/page/racp-faculties/australasian-faculty-of-occupational-and-environmental-medicine/realising-the-health-benefits-of-work/may-2010-video-presentation-professor-sir-mansel-aylward/

(6) http://www.corporatewatch.org.uk/?lid=2940

(7) http://www.austinmehr.com/about-us/articles/articles-austin-mehr/103-unum-life-insurance-fined

(8) A Yale University research paper commented that, with regards to Employee Retirement Income Security Act (ERISA) and other cases, Unum was, 'engaged in a program of deliberate bad faith denial of meritorious claims'

(9) http://disability-studies.leeds.ac.uk/files/library/FROM-BRITISH-WELFARE-STATE-TO-ANOTHER-AMERICAN-STATE-2013-3rd-edit-FINAL.pdf

(10) ) http://blacktrianglecampaign.org/

(11) http://www.newstatesman.com/politics/2008/05/work-benefit-claimants-reform;

http://www.dailymail.co.uk/news/article-2180899/Flawed-disability-tests-send-genuinely-s ick-unable-work.html

(12) Benefit Cuts http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11144397 http://www.scoop.co.nz/stories/PO1401/S00024/changes-to-invalids-benefit-sees-beneficiaries-income-drop.htm




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