El enfoque de capacidades según Martha Nussbaum

Voice problems in teachers, if acquired at, or exacerbated by, work may be an issue of health and safety in the workplace.

For member states of the EU, such as the UK, the main organisation governing health and safety in the workplace is the European Agency for Health and Safety at Work (EU- OSHA) [110]. The remit of EU-OSHA includes making EU workplaces safer and healthier for employees by promoting risk prevention measures to improve working conditions. The primary EU framework in terms of legislation on health and safety at work is Directive 89/391/EEC [111].

5.1.1 Directive 89/391/EEC

Directive 89/391/EEC details minimum health and safety standards to be applied by member states.

The Directive requires employers to adopt a pre-emptive approach to health and safety management by undertaking risk assessments and adopting preventative measures. It also requires that health and safety management forms an intrinsic part of general management procedures to ensure an integrated approach.

EU member states are obliged to implement the directive through national legislation. In the UK this is done via the Health and Safety at Work etc. Act.

5.1.2 Health and Safety at Work etc. Act

The Health and Safety at Work etc. Act 1974 [112] implements the requirements of Directive 89/391/EE. The act ensures the health, safety and welfare of persons at work and places duties on both employees and employers. Employers must, as far as practicable, maintain the workplace in a safe condition without risks to health.

The act places a requirement on employers to ensure the health of employees by arranging medical examinations, health surveys, together with the monitoring of conditions in the working environment. There is a requirement for the provision of protective clothing or equipment which could potentially include voice amplification systems for voice support in classrooms. For employees there is a responsibility to take reasonable care for their own health and safety: ‘reasonable care’ is not defined.

The act also sets out principles for health and safety management in the workplace. These include the Management of Health and Safety at Work Regulations 1999 [113] which are discussed in the next section.

5.1.3 The Management of Health and Safety at Work Regulations 1999

These regulations reflect the general principles of prevention in Directive 89/391/EEC. The regulations require employers to undertake assessments of the risks to the health and safety of employees which they are exposed to whilst at work. The risks to health and safety identified in the assessment are to be notified to employees, along with details of the preventative and protective measures taken as a result. There is, in addition, a requirement for health surveillance to be provided by the employer where the risk assessment identifies a need for this.

The need for employers to show compliance with Directive 89/391 EEC has led to the development of management guidance documents which will be discussed in the next section.

5.1.4 BSI and HSE guidance

British Standard OHSAS 18001:2007 Occupational Health and Safety Management Systems - Requirements [114] details a suitable management system which uses the model known as Plan Do Check Act (PDCA). The standard further details the need for organisations to have, and implement, a procedure for dealing with actual and potential non-compliance. An example of non-compliance could be where the voice ergonomics of a teacher had not been considered and voice problems had arisen as a result.

The UK’s Health and Safety Executive gives the following definitions for hazards and risks [115]:

‘A hazard is something (e.g. an object, a property of a substance, a phenomenon or an activity) that can cause adverse effects’.

‘A risk is the likelihood that a hazard will actually cause its adverse effects, together with a measure of the effect’.

In terms of the voice health of teachers it may be appropriate to consider that some voice problems (the effect) may result from occupational voice use (the hazard) and that the risk of this may be more significant for teachers than for the general population (the likelihood).

If there is a risk and a hazard present then it would be appropriate to undertake a risk assessment to determine if the hazard can be reduced or eliminated. Although the voice is used in almost all work roles, in the case of professions which place a particularly high workload on the voice, there may be a need for specific consideration.

There appears to be limited attention paid to the risks of occupational voice problems for teachers in school workplace assessments. The HSE has produced a health and safety checklist for classrooms [116]. This primarily focuses on classroom safety for pupils and does not refer to voice health for teachers. The checklist is shown in Appendix A.

A risk assessment form [117] specific to voice care for teachers has been developed by Voice: The union for educational professionals and is included in Appendix A.

Although well intentioned, these template workplace risk assessments do not appear to consider the myriad of factors covered by ‘acoustics’, nor individual susceptibility factors such as gender or voice problems.

The management of noise at work perhaps gives a guide to how the risks of occupational voice problems could be considered. The Control of Noise at Work Regulations 2005 [118] specify a framework for determining noise exposure at work, provide action and limiting levels and guidance on hearing surveillance and hearing protection. Although not directly comparable there are many potential parallels to the use of the voice in the workplace; however there is currently no specific legislation relating to occupational voice health in the UK.

5.1.5 Summary

In health and safety terms teachers with voice problems are typically treated on a case by case basis by their employers (that is the school body). This means that voice problems are considered as individual cases of illness or voice misuse, rather than as a potentially broader issue of occupationally acquired or work-exacerbated conditions. Therefore the working environment, working practices and other factors are not assessed on a wider basis.

As a result the hazards associated with voice problems may escape the attention and consideration of an occupational health and safety management system and the potential for there to be a causal relationship between teachers’ voice issues and the tasks at work, or the working environment, are not investigated. This means that potential risks applicable to the wider profession are not identified or addressed.

A comprehensive voice screening and monitoring procedure designed for teachers might, for instance, include an ENT examination, voice health questionnaires and voice performance tests. This would help to identify those individuals who may have greater susceptibility to voice problems and thus inform an individual program of care and monitoring. This type of approach is currently used for workplace hearing surveillance programs.