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Towards a responsible policy on VDU health issues
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Towards a responsible policy on VDU h e a l t h i s s u e s TOM STEWART
The health problems associated with use of visual display units are reviewed from the practical perspective of those concerned with manufacturing, inst~niug and using VDUs. The factors that should be considered, in formulating a responsible corporate policy on VDUs, are outlined.
Keywords: visual display units, health issues
THE P R O B L E M There is widespread concern about the possible impact of prolonged VDU use on health. However, as more information becomes available, far from becoming clearer, the situation appears to be even more confused and confusing. It is increasingly difficult for reasonable people, whether users, trade unionists, health and safety specialists or management to interpret the evidence and formulate a responsible and realistic policy towards VDU use. Two extreme views are well publicized. One of these extremes holds that there really is no problem but that scaremongering and sensationalism have grossly exaggerated speculations based on unfortunate coincidence. The opposed view is that there is evidence, albeit seldom in the scientific literature, that users have been crippled, suffered miscarriages and had their health ruined by VDUs. Supporters of both viewpoints agree that discomfort is a common problem, and can be largely avoided by proper attention to ergonomics in the equipment and workplace and the design of the jobs themselves. But
System Concepts Ltd, Museum House, Museum Street, London WC1A 1JT This paper was first presented at "Visual display units --facing up to the health issues' London, UK, 5 March 1986 DISPLAYS, APRIL 1986
most attention gets focused on the controversial and disputed major health effects on the wrists and arms (repetitive strain injury, RSI) and on the impact on pregnancy outcome. Even though the evidence of these major effects is disputed, there is no denying that concern about these issues is growing among VDU users. This places responsible people in a difficult position. Even with further research, absolute certainty can never be achieved in medical science. A compromise must be reached between taking sensible precautions, which runs the risk of raising alarm, and doing nothing while awaiting scientific proof, which may be regarded as complacency and may lead to industrial relations problems. In this paper, a number of themes from all sides of the VDU argument are drawn together, and the key points which the author believes should be addressed in a corporate policy on VDU health issues are presented.
It is in the very nature of research that new findings disturb the status quo and reveal shortcomings in our previous understanding of a problem area. VDUs are no exception in this respect, so it is not only inevitable but highly desirable that researchers should continually question our assumptions and seek out relationships
0 ! 41--9382/86/020081 --04 $03.00 © Butterworth & Co (Publishers) Ltd
81
I:ornrn ent which we had not previously appreciated. This has two major consequences for user organizations. First, it is essential to monitor this research and to be willing to admit that our understanding and assumptions may indeed be invalid. We must avoid the kind of complacency that has given the medical establishment a tarnished reputation in the past. At present, for example, the evidence on radiation suggests that VDUs do not pose a hazard to health, but we must never use this as an excuse for ignoring legitimate concerns or new research findings. Keeping up with research knowledge is therefore an essential part of a VDU health policy. Second, the recognition that we cannot be absolutely certain about anything should not be interepreted as meaning that we must wait and see. It is not that we should ignore any risk associated with VDUs, but until we know exactly what the risk is then any remedial action we take may actually increase the danger rather than reduce it. For example, removing an electric light from a stairway may reduce the risk of electrocution but increase the risk of injury from falling down stairs. As far as VDU use is concerned, it seems sensible to accept some uncertainty but to minimize the known risks as far as is practicable.
EYESIGHT One of the first V D U health issues that surfaced concerned the long-term impact on eyesight. Certainly there has been considerable evidence that prolonged VDU use can be a source of visual discomfort, but there has been no evidence of damage to eyesight 1. However, working with a VDU can be much more demanding visually than the equivalent work with paper, and many people have found that they need correction for VDU work. In the UK, eyetests and basic visual correction are available on the National Health Service. For most people, this is sufficient and the corporate policy need do little more than note such provisions. In some organizations, visual screening before VDU use can be worthwhile, but this is seldom essential. Frequent screening is not appropriate, although everyone, VDU users or not, should be encouraged to have his or her vision checked every few years. Where the nature of the VDU itself, or the workplace, is such that the optician recommends special glasses, for example with tinted lenses or corrected for a nonstandard viewing distance, then it does not seem unreasonable for the employer to pay the cost.
SYMPTOMS OF DISCOMFORT Most of the research to date has found little evidence of health damage from VDU use, but has raised considerable evidence of discomfort from inadequate atten82
tion to ergonomics considerations in the VDU, its workplace or the environment. Even the most caring and well organized employer will find some staff experiencing such problems from time to time. There may well be a case for palliatives which treat such symptoms even if the root cause is more difficult to deal with. There is a flourishing market in all manner of palliatives, from document holders and adjustable desks to VDU glasses and screen filters. These may be a valuable short-term solution to a problem and may provide the individual users with some much-needed control over their own environment. However, they can become expensive, tend to be subject to the whims of fashion and may result in the 'real' problem being overlooked. Nonetheless, they have their place in the VDU user's working environment. A useful adjunct to the policy is a document providing some guidance on the various palliatives which the organization has found useful and is willing to supply to users if required.
PREGNANCY One of the most emotive VDU health issues in recent years has been the suggestion that prolonged VDU use may have an adverse impact on pregnancy. The main impetus for this suggestion was the reporting of clusters of adverse outcomes. However, statistical chance is quite sufficient to explain the reported clusters t'2. Reassuring though such explanations are to those of us who are not pregnant, there is no guarantee that chance is the correct explanation. Nonetheless, the evidence from the epidemiological and other studies recently reviewed by a World Health Organization working group reinforces the view that there is nothing about VDUs that should prevent a pregnant woman from using them safely. Some pregnant women may still be concerned, and though they are able to accept the risks of crossing the road, driving a car or even smoking, they may be unwilling to accept the risks of VDU work. The right of transfer to non-VDU work is not only unrealistic in many organizations (especially with VDUs becoming widely used as a general office tool) but may actually be counterproductive. Given our present state of knowledge, there is no guarantee that any other work to which the pregnant woman might transfer would pose any less risk to her baby. Lifting heavy weights, prolonged standing and even unemployment may be just as risky. Many women find it difficult to carry out their normal duties during pregnancy, and a good employer should be prepared to be helpful, sympathetic and flexible whether the work involves VDUs or not. In some situations, transfer may be the right solution, but the problem is one of coping with the demands of pregnancy, not VDU work p e r se. DISPLAYS, APRIL 1986
Eornment ORGANIZATION One reason why VDU health issues become significant is that there is often no one in the organization who is responsible for the various aspects of VDU work. The departments that buy the computer equipment are seldom the same as those responsible for the furniture, the environment, the way the work is organized, the health of the staff or the industrial relations. Trades unions have proved rather more effective at organizing themselves to deal with the introduction of VDUs than the suppliers of the equipment or the management of the user organizations. The VDU health policy should identify clearly what part of the organization is responsible for ensuring that VDU equipment is properly specified, installed, used and maintained.
NEWS/MEDIA It is an unfortunate truism that 'good news is no news'. Time and again the trade and lay press report VDU health stories with eye-catching dramatic headlines. The latest scare or 'expert opinion' is eagerly reported, often as a very brief news item which may convey little of the complexity of the original report. Inevitably, many VDU users receive their main information about VDU health issues from such sources. Often the text of the story is less dramatic than the headline or the full report less controversial than the news item. Such publicity is likely to continue as long as VDU stories promise dramatic headlines. This makes it all the more important to keep up to date with the latest information and to be prepared to answer the kinds of worries and concerns which are fuelled by such media attention. Attempts to play down the issues in the hope that they will go away are short-sighted and doomed to failure.
STANDARDS Many of the problems, health and otherwise, which VDU users experience could be avoided by ensuring that the VDU equipment, the associated workplace and the working environment meet good ergonomics standards. At present, there are no British Standards or International Standards which deal with VDU ergonomics, although both organizations are actively involved in producing such standards, and drafts may be available for discussion later this year. However, internal VDU ergonomics standards are an important part of the corporate VDU health policy. Many bodies, including the Health and Safety Executive, trades unions (FIET and more recently the TUC), trade associations (ECMA and BETA), and individual suppliers, such as IBM and DISPLAYS,APRIL1986
Ericssons, have produced checklists and guidelines which can form the basis of such internal standards. Although there is much advice available, care should be taken to avoid the 'feature counting' to which some have succumbed. The key is to specify only those ergonomics requirements that match the needs of the users, their tasks and the likely environment. The main requirements include clear stable displays, thin detachable keyboards, adequate worksurface and legroom, controlled illumination and adjustable, properly shaped seating. However, it is not just the individual items of equipment that matter but also how these interact in the working environment.
INTERACTIONS What makes VDU workplaces difficult to arrange is that the various components may interact in unforeseen or surprising ways. For example, the lighting in the room may interact with the display screen and cause irritating and distracting reflections. Both the lighting in the room and the characteristics of the display may be quite reasonable in isolation, but together they result in an unacceptable visual task for the user. Many aspects of the environment may interact with the VDU design, so it is important to ensure not only that the equipment itself is suitable but also that the workplace as a whole meets sound ergonomics standards. The way the work itself is organized is significant here. Ideally, the provision of work breaks and the control of worktime should be down to the individual, but this may be inappropriate in some organizations. Nonetheless, the aim of the policy statement should be to avoid rigid prescriptions and formulas wherever possible and to encourage flexibility and common sense.
BENEFITS The introduction of VDUs is seldom an isolated event. It is usually part of a process of change and has an impact on the way work is organized and even on the numbers of people employed. We frequently hear of the problems of overcoming resistance to change in such situations. More often, however, the resistance is to being changed rather than to the change itself. Indeed, such resistance may be entirely rational if there is little actual benefit for the individual in cooperating with the proposed change. Given that the introduction of VDU working is intended to provide benefits for the organization as a whole, it makes sense to state as a policy that the employees themselves should also receive some share of the benefits. This need not be directly financial, but may include better working environment, improved staff facilities etc. 83
Eomrnenl" The sharing of benefits should be an explicit part of the policy.
LIAISON WITH TRADES UNIONS VDU health issues can be used as a weapon in an industrial relations dispute between employer and staff representatives. Both sides have been guilty of using the VDU debate in this way, but there really should be no clash or conflict over VDU health issues. Everyone has a responsibility under the Health and Safety at Work Act to ensure that VDU work is safe. There may be disagreement over issues which may not be considered as 'safety' or as 'health' by everyone. However, what is quite clear is that poor VDU working conditions are uncomfortable, unproductive and unnecessary. Full liaison with trades unions and staff representatives helps to ensure that 'political' problems are minimized and real problems tackled in a constructive and commonsense way, to the benefit of all concerned.
press could have been avoided completely had someone realized early enough that something was wrong, taken it seriously and acted accordingly. The various booklets from the Health and Safety Executive3 provide a useful basis for the first line of user and supervisor education. Unfortunately, the VDU debate has become so highly charged that it is difficult for reasonable people, whether users, trade unionists, health and safety specialists or management to interpret the evidence and formulate a responsible and realistic policy towards VDU use. Not every organization believes in committing its policies to paper, and the author is always reluctant to suggest an extension to bureaucracy, Nonetheless, a clear policy statement should be made covering the above points and communicated effectively to all concerned. This is not only the responsible approach, but faces up to the health issues and will go far towards putting them into their proper perspective.
REFERENCES EDUCATION The final ingredient in the VDU health policy should be education. This needs to be aimed at everyone involved in VDU systems, including those responsible for authorizing and paying for them, those who select and design or install them, those who manage or supervise them and those who actually use them.
1 Mackay, C 'The health issues in perspective' in Proc. Visual Display Units - - Facing up to the Health Issues
London, UK, 5 March 1986 2 Mackay, C 'The alleged reproductive hazard' in Proc. Visual Display Units - - Facing up to the Health Issues
London, UK, 5 March 1986 3 Working with VDUs Health and Safety Executive
Many of the problems responsible for the VDU's bad
84
(1986)
DISPLAYS, APRIL 1986
Towards a responsible policy on VDU h e a l t h i s s u e s TOM STEWART
The health problems associated with use of visual display units are reviewed from the practical perspective of those concerned with manufacturing, inst~niug and using VDUs. The factors that should be considered, in formulating a responsible corporate policy on VDUs, are outlined.
Keywords: visual display units, health issues
THE P R O B L E M There is widespread concern about the possible impact of prolonged VDU use on health. However, as more information becomes available, far from becoming clearer, the situation appears to be even more confused and confusing. It is increasingly difficult for reasonable people, whether users, trade unionists, health and safety specialists or management to interpret the evidence and formulate a responsible and realistic policy towards VDU use. Two extreme views are well publicized. One of these extremes holds that there really is no problem but that scaremongering and sensationalism have grossly exaggerated speculations based on unfortunate coincidence. The opposed view is that there is evidence, albeit seldom in the scientific literature, that users have been crippled, suffered miscarriages and had their health ruined by VDUs. Supporters of both viewpoints agree that discomfort is a common problem, and can be largely avoided by proper attention to ergonomics in the equipment and workplace and the design of the jobs themselves. But
System Concepts Ltd, Museum House, Museum Street, London WC1A 1JT This paper was first presented at "Visual display units --facing up to the health issues' London, UK, 5 March 1986 DISPLAYS, APRIL 1986
most attention gets focused on the controversial and disputed major health effects on the wrists and arms (repetitive strain injury, RSI) and on the impact on pregnancy outcome. Even though the evidence of these major effects is disputed, there is no denying that concern about these issues is growing among VDU users. This places responsible people in a difficult position. Even with further research, absolute certainty can never be achieved in medical science. A compromise must be reached between taking sensible precautions, which runs the risk of raising alarm, and doing nothing while awaiting scientific proof, which may be regarded as complacency and may lead to industrial relations problems. In this paper, a number of themes from all sides of the VDU argument are drawn together, and the key points which the author believes should be addressed in a corporate policy on VDU health issues are presented.
It is in the very nature of research that new findings disturb the status quo and reveal shortcomings in our previous understanding of a problem area. VDUs are no exception in this respect, so it is not only inevitable but highly desirable that researchers should continually question our assumptions and seek out relationships
0 ! 41--9382/86/020081 --04 $03.00 © Butterworth & Co (Publishers) Ltd
81
I:ornrn ent which we had not previously appreciated. This has two major consequences for user organizations. First, it is essential to monitor this research and to be willing to admit that our understanding and assumptions may indeed be invalid. We must avoid the kind of complacency that has given the medical establishment a tarnished reputation in the past. At present, for example, the evidence on radiation suggests that VDUs do not pose a hazard to health, but we must never use this as an excuse for ignoring legitimate concerns or new research findings. Keeping up with research knowledge is therefore an essential part of a VDU health policy. Second, the recognition that we cannot be absolutely certain about anything should not be interepreted as meaning that we must wait and see. It is not that we should ignore any risk associated with VDUs, but until we know exactly what the risk is then any remedial action we take may actually increase the danger rather than reduce it. For example, removing an electric light from a stairway may reduce the risk of electrocution but increase the risk of injury from falling down stairs. As far as VDU use is concerned, it seems sensible to accept some uncertainty but to minimize the known risks as far as is practicable.
EYESIGHT One of the first V D U health issues that surfaced concerned the long-term impact on eyesight. Certainly there has been considerable evidence that prolonged VDU use can be a source of visual discomfort, but there has been no evidence of damage to eyesight 1. However, working with a VDU can be much more demanding visually than the equivalent work with paper, and many people have found that they need correction for VDU work. In the UK, eyetests and basic visual correction are available on the National Health Service. For most people, this is sufficient and the corporate policy need do little more than note such provisions. In some organizations, visual screening before VDU use can be worthwhile, but this is seldom essential. Frequent screening is not appropriate, although everyone, VDU users or not, should be encouraged to have his or her vision checked every few years. Where the nature of the VDU itself, or the workplace, is such that the optician recommends special glasses, for example with tinted lenses or corrected for a nonstandard viewing distance, then it does not seem unreasonable for the employer to pay the cost.
SYMPTOMS OF DISCOMFORT Most of the research to date has found little evidence of health damage from VDU use, but has raised considerable evidence of discomfort from inadequate atten82
tion to ergonomics considerations in the VDU, its workplace or the environment. Even the most caring and well organized employer will find some staff experiencing such problems from time to time. There may well be a case for palliatives which treat such symptoms even if the root cause is more difficult to deal with. There is a flourishing market in all manner of palliatives, from document holders and adjustable desks to VDU glasses and screen filters. These may be a valuable short-term solution to a problem and may provide the individual users with some much-needed control over their own environment. However, they can become expensive, tend to be subject to the whims of fashion and may result in the 'real' problem being overlooked. Nonetheless, they have their place in the VDU user's working environment. A useful adjunct to the policy is a document providing some guidance on the various palliatives which the organization has found useful and is willing to supply to users if required.
PREGNANCY One of the most emotive VDU health issues in recent years has been the suggestion that prolonged VDU use may have an adverse impact on pregnancy. The main impetus for this suggestion was the reporting of clusters of adverse outcomes. However, statistical chance is quite sufficient to explain the reported clusters t'2. Reassuring though such explanations are to those of us who are not pregnant, there is no guarantee that chance is the correct explanation. Nonetheless, the evidence from the epidemiological and other studies recently reviewed by a World Health Organization working group reinforces the view that there is nothing about VDUs that should prevent a pregnant woman from using them safely. Some pregnant women may still be concerned, and though they are able to accept the risks of crossing the road, driving a car or even smoking, they may be unwilling to accept the risks of VDU work. The right of transfer to non-VDU work is not only unrealistic in many organizations (especially with VDUs becoming widely used as a general office tool) but may actually be counterproductive. Given our present state of knowledge, there is no guarantee that any other work to which the pregnant woman might transfer would pose any less risk to her baby. Lifting heavy weights, prolonged standing and even unemployment may be just as risky. Many women find it difficult to carry out their normal duties during pregnancy, and a good employer should be prepared to be helpful, sympathetic and flexible whether the work involves VDUs or not. In some situations, transfer may be the right solution, but the problem is one of coping with the demands of pregnancy, not VDU work p e r se. DISPLAYS, APRIL 1986
Eornment ORGANIZATION One reason why VDU health issues become significant is that there is often no one in the organization who is responsible for the various aspects of VDU work. The departments that buy the computer equipment are seldom the same as those responsible for the furniture, the environment, the way the work is organized, the health of the staff or the industrial relations. Trades unions have proved rather more effective at organizing themselves to deal with the introduction of VDUs than the suppliers of the equipment or the management of the user organizations. The VDU health policy should identify clearly what part of the organization is responsible for ensuring that VDU equipment is properly specified, installed, used and maintained.
NEWS/MEDIA It is an unfortunate truism that 'good news is no news'. Time and again the trade and lay press report VDU health stories with eye-catching dramatic headlines. The latest scare or 'expert opinion' is eagerly reported, often as a very brief news item which may convey little of the complexity of the original report. Inevitably, many VDU users receive their main information about VDU health issues from such sources. Often the text of the story is less dramatic than the headline or the full report less controversial than the news item. Such publicity is likely to continue as long as VDU stories promise dramatic headlines. This makes it all the more important to keep up to date with the latest information and to be prepared to answer the kinds of worries and concerns which are fuelled by such media attention. Attempts to play down the issues in the hope that they will go away are short-sighted and doomed to failure.
STANDARDS Many of the problems, health and otherwise, which VDU users experience could be avoided by ensuring that the VDU equipment, the associated workplace and the working environment meet good ergonomics standards. At present, there are no British Standards or International Standards which deal with VDU ergonomics, although both organizations are actively involved in producing such standards, and drafts may be available for discussion later this year. However, internal VDU ergonomics standards are an important part of the corporate VDU health policy. Many bodies, including the Health and Safety Executive, trades unions (FIET and more recently the TUC), trade associations (ECMA and BETA), and individual suppliers, such as IBM and DISPLAYS,APRIL1986
Ericssons, have produced checklists and guidelines which can form the basis of such internal standards. Although there is much advice available, care should be taken to avoid the 'feature counting' to which some have succumbed. The key is to specify only those ergonomics requirements that match the needs of the users, their tasks and the likely environment. The main requirements include clear stable displays, thin detachable keyboards, adequate worksurface and legroom, controlled illumination and adjustable, properly shaped seating. However, it is not just the individual items of equipment that matter but also how these interact in the working environment.
INTERACTIONS What makes VDU workplaces difficult to arrange is that the various components may interact in unforeseen or surprising ways. For example, the lighting in the room may interact with the display screen and cause irritating and distracting reflections. Both the lighting in the room and the characteristics of the display may be quite reasonable in isolation, but together they result in an unacceptable visual task for the user. Many aspects of the environment may interact with the VDU design, so it is important to ensure not only that the equipment itself is suitable but also that the workplace as a whole meets sound ergonomics standards. The way the work itself is organized is significant here. Ideally, the provision of work breaks and the control of worktime should be down to the individual, but this may be inappropriate in some organizations. Nonetheless, the aim of the policy statement should be to avoid rigid prescriptions and formulas wherever possible and to encourage flexibility and common sense.
BENEFITS The introduction of VDUs is seldom an isolated event. It is usually part of a process of change and has an impact on the way work is organized and even on the numbers of people employed. We frequently hear of the problems of overcoming resistance to change in such situations. More often, however, the resistance is to being changed rather than to the change itself. Indeed, such resistance may be entirely rational if there is little actual benefit for the individual in cooperating with the proposed change. Given that the introduction of VDU working is intended to provide benefits for the organization as a whole, it makes sense to state as a policy that the employees themselves should also receive some share of the benefits. This need not be directly financial, but may include better working environment, improved staff facilities etc. 83
Eomrnenl" The sharing of benefits should be an explicit part of the policy.
LIAISON WITH TRADES UNIONS VDU health issues can be used as a weapon in an industrial relations dispute between employer and staff representatives. Both sides have been guilty of using the VDU debate in this way, but there really should be no clash or conflict over VDU health issues. Everyone has a responsibility under the Health and Safety at Work Act to ensure that VDU work is safe. There may be disagreement over issues which may not be considered as 'safety' or as 'health' by everyone. However, what is quite clear is that poor VDU working conditions are uncomfortable, unproductive and unnecessary. Full liaison with trades unions and staff representatives helps to ensure that 'political' problems are minimized and real problems tackled in a constructive and commonsense way, to the benefit of all concerned.
press could have been avoided completely had someone realized early enough that something was wrong, taken it seriously and acted accordingly. The various booklets from the Health and Safety Executive3 provide a useful basis for the first line of user and supervisor education. Unfortunately, the VDU debate has become so highly charged that it is difficult for reasonable people, whether users, trade unionists, health and safety specialists or management to interpret the evidence and formulate a responsible and realistic policy towards VDU use. Not every organization believes in committing its policies to paper, and the author is always reluctant to suggest an extension to bureaucracy, Nonetheless, a clear policy statement should be made covering the above points and communicated effectively to all concerned. This is not only the responsible approach, but faces up to the health issues and will go far towards putting them into their proper perspective.
REFERENCES EDUCATION The final ingredient in the VDU health policy should be education. This needs to be aimed at everyone involved in VDU systems, including those responsible for authorizing and paying for them, those who select and design or install them, those who manage or supervise them and those who actually use them.
1 Mackay, C 'The health issues in perspective' in Proc. Visual Display Units - - Facing up to the Health Issues
London, UK, 5 March 1986 2 Mackay, C 'The alleged reproductive hazard' in Proc. Visual Display Units - - Facing up to the Health Issues
London, UK, 5 March 1986 3 Working with VDUs Health and Safety Executive
Many of the problems responsible for the VDU's bad
84
(1986)
DISPLAYS, APRIL 1986