Professor Damien McElvenny is a biostatistician and epidemiologist at the Institute of Occupational Medicine. He has Bachelors and Masters Degrees in Statistics and a PhD in Epidemiology.
He is a Chartered Statistician and an Honorary Fellow of the Faculty of Occupational Medicine. He is an honorary member of the Society of Occupational Medicine and an Honorary Senior Research Fellow at the University of Manchester. He is an Assistant Editor for Occupational Medicine, an independent scientific member of the Industrial Injuries Advisory Council, and Founder and Secretary of the UK/Ireland Occupational and Environmental Epidemiology Society.
Damien has worked in the nuclear industry, and the NHS, been a member of the Government Statistics Service, has been an academic Chair in Epidemiology, worked as an independent consultant, and is currently Principal Epidemiologist at the Institute of Occupational Medicine in Edinburgh.
The Interview
How would you define occupational epidemiology?
At its simplest, it’s the study of the pattern and causes of occupational diseases in workers.
How did you get into Occupational Epidemiology?
After obtaining my Masters in Statistics from the University of Sheffield, I joined the British Nuclear Fuels Limited’s in-house medical statistics unit. This was because I was mainly interested in the utilisation of statistics to answer health problems. I was initially involved in studying the health of a nuclear industry workforce before later becoming involved in environmental matters, specifically those relating to childhood leukaemia clusters around nuclear installations.
What are your research interests?
I’m interested in the effects of work on all aspects of human health, in cancer, neurological diseases, ageing workers, and mental health. Although I still have soft spot for ionising radiation-related diseases as they are what got me into my line of work in the first place.
What are you currently working on?
As ever, I am working on a number of projects relating to work and health. In collaboration with Neil Pearce and Valentina Gallo, I am examining the effect on cognition (as an early marker of dementia) of concussions in former elite rugby players and concussions and headers in former professional footballers. I am also working on an European exposure project (measure of all the exposures of an individual in a lifetime and how those exposures relate to health) focussing on cancer, neurological diseases, and work participation. In addition, I am doing some work to support the Industrial Injuries Advisory Council to enable them to make updated recommendations about prescribed diseases for respiratory cancers and chronic obstructive lung diseases. Recently, I’ve also been involved in projects working with Martie van Tongeren at the University of Manchester on a review of man-made mineral fibres and respiratory diseases, a review of respiratory health surveillance, establishing the feasibility of an occupational exposure control intelligence system to provide intelligence on leading indicators for work-related respiratory diseases and some COVID-19-related projects examining the role of occupation in the risk of COVID-19.
How has legislation shaped Occupational Epidemiology research?
I would probably ask this question the other way around! How has occupational epidemiology informed health and safety legislation? This has traditionally been in the form of establishing exposure-response relationships, principally for carcinogens. However, fewer and fewer occupational cancer epidemiology studies are being funded these days, especially in Great Britain.
How has epidemiology in OH changed over time?
I think it’s fair to say that because much of the traditional manufacturing industry has declined in Great Britain, with much of the production happening overseas, there is a perception that we don’t need to worry as much about protecting worker health as we used to. The consequence of this is that research funders have felt less of a need to put out calls for occupational epidemiology research on British working populations. The academic research base for traditional occupational epidemiology has all but disappeared, with only one or two academic departments still active in this area. This is exemplified by the lack of academic chairs in occupational medicine, the profession that often provided the focus for much of this work. The focus of work and health research has shifted over the past decade or two to concentrating more on mental health and musculoskeletal disorders.
As we are all working longer, do you feel there is enough research on aging and health at work?
There is a widely-held view in government that working is good for your health. Whilst, in general, this is probably true, it’s also because those not well enough to work are not working! As the workforce is growing older, primarily because of the financial need to cover retirement, the number of people with health conditions is increasing. It’s vitally important that we do further research to understand what adjustments need to be made to allow people to extend their working lives.
What are the key challenges in OE research?
One of the key challenges these days is the rules surrounding research governance. In order to carry out studies where we wish to understand the mortality and/or cancer burden in a workforce, researchers need to obtain clearances from an NHS Ethics Committee, the Health Research Authority’s Confidentiality Advisory Group (CAG) and NHS Digital’s Independent Group Advising on the Release of Data. There is pressure brought on by Data Protection legislation that encourages researchers to delete data as soon as an analysis has been completed. This creates a challenging situation because it is harder to establish historic cohort studies (the traditional backbone of occupational epidemiology research) as national resources.
How has OE research impacted the everyday person?
A key feature of occupational epidemiology research is that it often allows the establishment of exposure-response relationships. This means that as well as determining acceptable levels of exposure to hazardous substances in workplaces, it also helps allow safe levels in the environment and consumer products to be established.
Funding in OE research is often seen as inadequate, compared to other medical disciplines, do you agree?
We spend a large proportion of our lives working and many workers are exposed to hazardous agents. There needs to be a balance in apportioning funding between research that finds better cures for patients and that which understands what is making people ill in the first place.
What are the upcoming challenges for society in both the UK and globally from an OE perspective?
There are many areas of occupational epidemiology that have been relatively under-researched. For example, more research is required to better understand the causes of neurological diseases and cardiovascular diseases and the role of workplace exposures in these. We also need to better understand to what extent the exporting of manufacturing involving hazardous substances outside North America and Western Europe has moved the associated ill-health to other countries. We can have the best practices in the west but if all we have done is shift the problem elsewhere then the problem hasn’t really been solved.
What do you feel is needed to drive the future research agenda?
We need a balanced research agenda in which public, occupational and environmental health, and epidemiology research is balanced against research into finding better treatments. It would also be helpful if occupational and environmental issues were more to the forefront when a clinician is treating a patient so that they are alert for new or repetitive causes of disease in a way that they once were.
Why is investing in OE research more important than ever?
Hazardous substances may be less prevalent in North American and Western European workplaces than they once were, but manufacturing still occurs all over the globe. We need to learn to take a more global perspective on reducing the burden of occupational ill-health from a global perspective.
What opportunities do you see for OE to improve global health?
There needs to be more work to understand the global burden of work-related diseases and for this to be backed up with internationally-agreed policies to provide working conditions that have an acceptable level of risk.
How do you see the future of research in OE?
In Great Britain, OE research has to compete with environmental and public health epidemiology research which unfortunately seem to be more favourable. To address that we can use examples from COVID-19 to remind research funders of the importance of OE research in modern society. Accessing more funding will allow us to better understand what occupational exposures cause those under-researched diseases such as neurological and cardiovascular diseases being tackled.
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