Foreign postings
Europe
There are two main reasons why multinational companies generally find that sending workers abroad to European countries poses significantly fewer health and safety problems than sending them to other parts of the world. First, work in Europe involves little or no exposure to tropical or other diseases.
Also, and maybe more importantly, in contrast to other parts of the world, most European countries now maintain relatively highly-developed systems for legally enforcing health and safety in the workplace, together with comprehensive health protection schemes, be they private or state-run.
But despite this, preparations are still needed. Paul Mitchell, head of human resources at the British American Tobacco Company (BAT), outlines the arrangements the company makes for staff sent to or maintained in other countries. The company is one of the UK's largest multinationals with "tens of thousands" of workers, including 3,400 managers, in a dozen or so European manufacturing plants.
"When we're aware that someone's going to be posted overseas, the occupational health department is alerted, prompting them to conduct a full medical for the individual and his or her partner and children," says Mitchell. "This is very comprehensive, including blood tests, an ECG, tests for lungs and eyes and so on. There is also an annual medical which is either done in the UK or in the host country, through an international clinic or a local hospital," he says.
"We also provide staff with reports on the country they're going to, which considers risk levels for specific diseases. For Hungary, say, there will be a journey profile, which will list main diseases, such as tetanus, hepatitis, rabies, dysentery etc, and provide advice on the risk level and any precautions that might be necessary," says Mitchell. "Of course, Hungary, as a central European country, would be low risk, but something such as rabies is present, and people would need to be aware of that and given appropriate advice."
BAT also provides its workers with contact details of the British embassy in the host country and advises them to register as a family unit with the local international clinic.
BAT makes sure the company's plants and factories abroad all fully respect the local health and safety at work regulations. Mitchell adds that when the company acquires a new operation, "our medical advisers would normally look at the manufacturing facilities and make sure they were in line with our global standards so the plant would meet local employment health and safety (EHS) rules, as well as complying with BAT's global EHS standards".
There is also additional security for expatriate BAT employees in other European countries. Under a scheme run with the insurance company Allianz, employees are guaranteed provision of any medical cover that may be beyond the local clinic or hospital, including transportation to more advanced centres. "We've had three medical evacuations in Izbekistan, and Allianz has covered the costs, making sure that air ambulances got in as quickly as possible and taking people to where they could get Western-style medical attention," says Mitchell.
South-east Asia
According to the British Occupational Health Research Foundation, there is no single point of information that any company looking to set up in south-east Asia can turn to for OH advice. In Singapore, for instance, OH is run under the auspices of the Occupational Health Department of Industrial Health, which answers to the Ministry of Manpower. It has the remit to control health hazards at workplaces and reduce the incidence of occupational diseases through assessing and monitoring the work environment; conduct medical investigations and surveillance; organise promotional activities; and provide advisory services.
The result is an infrastructure as strict as anything in the UK. The Ministry of Manpower is currently widening the scope of the key legislation in this field - the Factories Act - which covers issues such as sanitation, ventilation and first aid, as well as the appointment of safety officers, to cover non-industrial workplaces. In the first phase, the healthcare sector, hotels, restaurants and catering establishments, and research and development laboratories will be included.
For white-collar workers, companies face similar responsibilities to those in the UK - for example, ensuring that the level of chemicals in the air do not exceed permissible exposure levels and lower environmental noise levels are kept low. However, the health risks are heightened for expats who work with machinery and outside the major cities in the region. In particular, while many companies have offices in Singapore, staff often go into the field in neighbouring countries, such as Cambodia, Indonesia and Vietnam, where health and safety rules are - if they exist at all - frequently ignored.
Most UK companies sending staff to the region offer free medical insurance and staff their OH departments with locals, or an occupational in-house doctor. They also implement local OH laws. Unilever, for example, delegates all OH responsibilities to the local factories and units in the country concerned. It also has a general policy for all overseas operations, though it says this is "not in the public domain".
One OH practitioner, who has recently returned from south-east Asia, said that in spite of Singapore's 'squeaky-clean' image, the region did present challenges. "Malaria is an issue in some areas, and the region has a denial culture where HIV/Aids is concerned," she said.
"Malaysia, for example, has a very good reputation on occupational health, but when you get outside Kuala Lumpur, there are issues for workers. Many local people will keep pigs, which attract mosquitoes that can transmit Japanese encephalitis. Often the best thing to do is to consult the Lonely Planet guide, as backpackers also go off the beaten track."
BT uses its in-house OH service in London to give advice on immunisation, medicines and places to avoid. The staff that do travel tend to be managers, and they are given free medical insurance and emergency repatriation if necessary. Aside from that, staff will liaise with local offices on the ground for OH support.
Like most other companies, BT does not have a list of local laws to be aware of, as staff are advised to gather this information from the regional OH in Singapore or Hong Kong. However, if a crisis develops, such as SARS, then headquarters in London takes over.
"During the SARS outbreak, we did stop people travelling to the region and we stopped our staff out there from travelling around," says BT spokesperson, Roger Westbury.
HSBC, however, took a different approach. "We didn't deviate from the advice given by the World Health Organisation," says Gail Scott, from HSBC's OH department. "We didn't embargo travel but we told people to be sensible. People were fine about it."
The United States
As befits a land that is - as George Bernard Shaw famously said - divided from Britain by a common language, the United States presents special challenges as well as a certain familiarity for the travelling employee.
Ursula Ferriday, senior medical adviser for Unilever, told Occupational Health that her company's employees are thoroughly briefed with regards to any health and safety precautions that should be taken while in the US. For instance, when sending its employees to the US, the Anglo-Dutch multinational provides them with a comprehensive portfolio on living alongside Americans, among which are the key OH problems that need to be considered. Some of this information is basic administration, such as acquiring social security numbers. However, guidelines on health and safety rules and regulations in the US are also included, as well as specific advice on driving safety, how to safeguard against violence, such as muggings, and basic health advice, such as preventing sun exposure.
Prior to leaving the UK, Unilever employees must undergo an overseas medical, which entails a blood test, blood grouping, eye test, a weigh-in and blood pressure checks, as well as an appointment with the in-house doctor for a physical examination.
Unilever staff in the US are insured with Bupa International policies, covering long-term chronic illness, and are also provided with cover from International SOS for urgent acute health treatment.
In-house company doctors are also made available to staff to advise them on any specialised medical assistance they may need, and can also help with smaller problems, including health and safety issues.
Ferriday says this triple coverage and assistance is essential for their employees: "I think it helps with consistency in approach, in that Unilever has a global network of doctors." She adds that these doctors were able to help the company's component parts implement 'global health standards' written by Unilever for all branches and subsidiaries, with the aim of providing a harmonised OH policy. These include a demand that there is a named company doctor and a named OH department available. This 'framework standard for occupational health' also insists that Unilever's businesses design OH policies based on 'local risk assessments', which in the US, for instance, includes the need to protect staff from violent crime.
Indeed, if problems of this type develop locally, security officials working within the company in the US are supposed to relay pertinent information to local OH departments, who can alert Unilever employees about any risks.
Ferriday adds that Unilever designated local representatives to advise staff on local safety issues generally, with transferred employees being given named Unilever contacts in their portfolios to deal with a range of personal issues.
With regards to specific medical issues and their relation to the company's occupational health policies, Ferriday says: "These doctors are all aware of the policies and can then initiate appropriate processes and systems to ensure that those standards are complied with."
Ferriday says that if an employee does become ill while in the US, its health services are generally of such a high standard that staff are usually treated locally, even for long-term illnesses. She could think of only one instance where Unilever repatriated an employee from the US to the UK, and that was for personal reasons.
Of course, with Unilever employing 21,000 employees in North America, the bulk of its staff in the US are actually American citizens. Ferriday says that the company also makes sure that these workers are supplied with adequate health insurance coverage, in a country where free-delivery public healthcare is not always available.
