Obesity as a Covered Disability Under Employment Discrimination Law: An Analysis of Canadian Approaches

Depuis l'adoption des premières lois anti-discrimination en Amérique du Nord, le nombre de groupes ou de classes protégées a crû lentement. Les personnes handicapées sont un de ces nombreux groupes couverts par de telles lois. Durant la dernière décennie, quelques états américains ont ajouté l'obésité à la liste des handicaps couverts par leurs lois.Aucune loi canadienne anti-discrimination n'inclut les personnes obèses ou de poids excessif dans un groupe désigné distinct. Seule la Colombie-Britannique considère que l'obésité peut en soi être une invalidité couverte. Toutes les autres juridictions canadiennes ayant touché ce sujet exige que le réclamant prouve que son obésité est de cause médicale involontaire.À partir d'échantillons recueillis aux États-Unis, au Canada et au Royaume-Uni, les chercheurs accumulent lentement des données systématiques suggérant que la discrimination résulte en une perte de chances d'emploi et de gains substantiellement plus bas pour ces individus obèses ou « non attrayants » aussi qualifiés que les autres.Mais, malgré les efforts des défenseurs organisés des obèses, il semble y avoir peu de momentum politique pour les ajouter comme groupe séparé, protégé en vertu des lois anti-discrimination. L'histoire juridique récente suggère que les tribunaux qui appliquent les dispositions anti-discrimination aux obèses le font en recourant aux catégories de handicaps déjà protégés. Les codes canadiens de droits de la personne suivent en gros deux modèles pour inclure les invalides. Toutes les lois canadiennes en la matière incluent des variantes de « handicap », d'« invalidité », d'« invalidité physique » ou d'« invalidité mentale » dans leurs classes de protection. La Charte canadienne des droits de la personne et la Charte des droits de la personne de la Colombie-Britannique prohibent la discrimination en emploi sur la base de l'« invalidité » ou de l'« invalidité physique ou mentale », sans pour autant en fournir la définition. Vu cette discrétion, les tribunaux des droits de la personne dans ces juridictions ont étendu l'application de ces lois aux obèses ou ont interprété de façon plus libérale le mot « invalidité ». La Charte québécoise des droits et libertés de la personne prohibe la discrimination sur la base d'un « handicap ou l'utilisation de tout moyen pour pallier un handicap ». Cependant, ce ne sera que récemment que le Québec a joint ces deux motifs offrant ainsi une plus grande protection aux obèses contre la discrimination.Le second groupe de lois ici visées utilise une terminologie qui soulève plusieurs questions quant à l'inclusion de l'obésité. Ces lois incluent des définitions détaillées des mots « invalidité » ou « handicap ». Le Code ontarien caractérise ce groupe de telle sorte que sa terminologie est excédée, opaque et redondante. Les tribunaux prudents de l'Ontario et de la Saskatchewan ont interprété des dispositions identiques de telle manière qu'ils contredisent les grands objectifs d'une loi sur les droits de la personne et qu'ils évitent d'inclure les obèses.Les tribunaux de l'Ontario et de la Saskatchewan ont élaboré deux méthodes possibles par lesquelles les individus obèses peuvent réclamer leur inclusion à la loi. Ils doivent établir l'une de deux choses : que l'obésité en général est un handicap ou que leur propre obésité satisfait à la définition légale de handicap. Il y a amplement de raison d'inclure l'obésité dans la définition de handicap dans les codes de type ontarien. Cela devrait suffire aux futurs réclamants de poursuivre leur cause s'ils prouvent discrimination sur cette base. Cela n'est pas encore arrivé. La seconde avenue possible qui exige une preuve individuelle est imparfaite à plusieurs égards.En bref, cette avenue se concentre sur les caractéristiques du réclamant et non sur l'acte discriminatoire. De plus, cette avenue peut facilement mener à un traitement inégal des réclamants obèses selon leur habileté à présenter une preuve scientifique de leur condition. Cela exigerait également des tribunaux des évaluations scientifiques répétées, ce qui ne leur convient guère. Deux récents guides administratifs de la Commission ontarienne des droits de la personne (CODP) indiquent la préférence de la CODP pour cette dernière avenue. Notons ici un aspect très important : l'exigence de la preuve individuelle crée également le risque que les protections légales essentielles contre la discrimination sur la base de quelques invalidités perçues s'évaporeront. Finalement, cette insistance sur la preuve scientifique des causes de l'obésité de chaque réclamant peut être une bénédiction suspecte pour les employeurs vu les exigences d'information et l'incertitude imposée dans leur tentative d'éviter leur responsabilité. Un examen attentif du Code ontarien suggère que l'obésité satisfait à son test en deux parties pour être inclue à titre de handicap. En bref, la première partie de ce test exige qu'une condition soit une « invalidité physique, une infirmité, une malformation ou une défiguration ». L'obésité est-elle une invalidité physique ? L'obésité a des relations substantielles probables avec plusieurs conditions invalidantes. Elle en cause même un certain nombre. La preuve scientifique à cet égard est non seulement impressionnante, mais également croissante. Une proportion des personnes obèses possèdent quelque degré d'invalidité physique, d'infirmité ou/de défiguration comparée aux personnes avec des caractéristiques physiques moyennes.Cela devrait suffire pour satisfaire à la première exigence pour inclure l'obésité comme handicap couvert si la protection légale contre la discrimination sur la base d'une invalidité perçue veut dire quelque chose. La seconde partie du test ontarien, pour déterminer s'il y a handicap ou non, s'attarde à la causalité de la condition handicapante. Les tribunaux des droits de la personne ont interprété l'exigence de la loi qui stipule « causé par une blessure corporelle, un défaut de naissance ou une maladie » comme signifiant qu'une condition (physique) doit être involontaire et immuable pour être considérée comme un handicap couvert. Alors qu'il peut être moralement tentant de distinguer entre les conditions volontaires et muables d'une part et les invalidités involontaires et permanentes d'autre part, tel exercice appliqué à l'obésité devient rapidement un nid de crabe tant sur le plan scientifique que juridique.Exiger une preuve de cause médicale de l'obésité mène à des distinctions arbitraires quant au champ d'application de la loi. Il est peu probable que les employeurs vont connaître la cause de l'obésité d'un employé. Considérant l'état des connaissances scientifiques, est-il sage et de politique publique efficace que d'exiger des employeurs de déterminer les causes de l'obésité de leurs employés ? S'ils discriminent de facto, ce sera probablement sur la base d'apparences extérieures et de leurs conclusions quant aux limitations actuelles ou présumées imposées par telle condition physique.Le champ d'application de la loi connaîtra inévitablement des démarcations arbitraires si les tribunaux des droits de la personne consacrent la validité des règles d'emploi qui discriminent contre les obèses sur la base de la possibilité pour un réclamant particulier de fournir une preuve suffisante de la cause médicale de sa condition. Les réclamants sont forts distincts quant à leur degré de sophistication et quant à leurs moyens de soutenir leurs causes. On peut douter de la qualité de la formation des membres et du personnel des agences des droits de la personne pour être responsables de telles enquêtes. Ce serait plus simple, plus sensé et plus conforme avec l'esprit général des lois sur les droits de la personne, de se centrer sur la décision de l'employeur et sur sa justification d'affaires.Since the passage of the first anti-discrimination laws in North America, the number of groups or classes protected has slowly expanded. People with disabilities are one of the more recent groups to be covered by such laws. No Canadian human rights statute includes the obese or overweight as a separate designated group. British Columbia is the only jurisdiction in which obesity per se has been found to be a covered disability. All other Canadian jurisdictions that have explicitly addressed the issue require claimants to prove that their obesity is a disabling condition and has an underlying involuntary medical cause. This paper examines the treatment of the obese under the antidiscrimination laws of the Canadian federal and provincial jurisdictions, focusing primarily upon the laws of Ontario. Its central thesis is that despite the reticence of various human rights agencies, there is ample legal basis for including obesity as a covered disability under human rights law.Desde la aprobaciòn de las primeras leyes anti discriminatorias en la America del Norte, el numéro de grupos o clases protegidos por estas leyes esta en lenta expansion. Las gentes que sufren de una invalides son el mas recientemente grupo cubierto por estas leyes. Ninguna leye o ordenanza canadiense cubre la obesidad o el sobrepeso como grupo designado de invalides. La Colombia Britànica es la ûnica jurisdicciòn que encontrò que la obesidad estaba cubierta por las leyes anti discriminatorias como invalides. Todas las otras jurisdicciones que han tocado el tema requieren a la persona que pruebe que la obesidad que sufren es en realidad una invalides y que esta obesidad se debe a causas de tipo medico. Este documento examina el tratamiento que se le da a las personas obesas en las leyes anti discriminatorias fédérales canadienses y en las jurisdicciones provinciales con especial énfasis en las leyes de la provincia de Ontario. La tesis central es que a pesar de las dudas de ciertos grupos de protecciòn a los derechos humanos, existe un importante précédente légal para establecer la obesidad como invalides cubierta por las leyes anti discriminatorias

Use of Rollover Protective Structures -- Iowa, Kentucky, New York, and Ohio, 1992-1997

Agriculture has one of the highest occupational fatality rates of all industries in the United States (1). Tractors and other types of agricultural equipment account for a large proportion of these fatalities, and farm-tractor rollovers account for approximately 130 work-related deaths each year in the United States (2). Although rollover protective structures (ROPS) are effective in protecting tractor operators from fatal injuries during rollovers (3-5), most tractors in the United States are not equipped with ROPS (4-7). Beginning in 1985, tractor manufacturers in the United Sates agreed to sell only tractors with ROPS; however, many older tractors without ROPS remain in use. To determine the prevalence of the use of ROPS, beginning in 1992, the Farm Family Health and Hazard Surveillance (FFHHS) program * collected state-based data on tractor age and use of ROPS from selected states. As of August 1997, four states had completed collection and analysis of data on farm tractors. This report summarizes the results of that survey, which indicates that 80%-90% of tractors in use in the four states were manufactured before 1985 and that less than 40% are equipped with ROPS

Defining the research agenda to measure and reduce tuberculosis stigmas

This is an Open Access article, © 2017 International Union Against Tuberculosis and Lung Disease. Content in the UH Research Archive is made available for personal research, educational, and non-commercial purposes only. Unless otherwise stated, all content is protected by copyright, and in the absence of an open license, permissions for further re-use should be sought from the publisher, the author, or other copyright holder.Crucial to finding and treating the 4 million tuberculosis (TB) patients currently missed by National TB Programs, TB stigma is receiving well-deserved and long-delayed attention at the global level. However, the ability to measure and evaluate the success of TB stigma reduction efforts is limited by the need for additional tools. At a 2016 TB stigma measurement meeting held in The Hague, stigma experts discussed and proposed a research agenda around four themes: (1) Drivers: What are the main drivers and domains of TB stigma(s)?; (2) Consequences: How consequential are TB stigmas? How are negative impacts most felt?; (3) Burden: What is the global prevalence and distribution of TB stigma(s)? What explains any variation? (4): Intervention: What can be done to reduce the extent and impact of TB stigma(s)? Each theme was further subdivided into research topics to be addressed to move the agenda forward. These include more clarity on what causes TB stigmas to emerge and thrive, the difficulty of measuring the complexity of stigma, and the improbability of a universal stigma ‘cure’. Notwithstanding, these challenges should not hinder investments in TB stigma measurement and reduction. We believe it is time to focus on how and not whether the global community should measure and reduce TB stigma.Peer reviewedFinal Published versio

The effectiveness of interventions to change six health behaviours: a review of reviews

Background: Several World Health Organisation reports over recent years have highlighted the high incidence of chronic diseases such as diabetes, coronary heart disease and cancer. Contributory factors include unhealthy diets, alcohol and tobacco use and sedentary lifestyles. This paper reports the findings of a review of reviews of behavioural change interventions to reduce unhealthy behaviours or promote healthy behaviours. We included six different health-related behaviours in the review: healthy eating, physical exercise, smoking, alcohol misuse, sexual risk taking (in young people) and illicit drug use. We excluded reviews which focussed on pharmacological treatments or those which required intensive treatments (e. g. for drug or alcohol dependency). Methods: The Cochrane Library, Database of Abstracts of Reviews of Effectiveness (DARE) and several Ovid databases were searched for systematic reviews of interventions for the six behaviours (updated search 2008). Two reviewers applied the inclusion criteria, extracted data and assessed the quality of the reviews. The results were discussed in a narrative synthesis. Results: We included 103 reviews published between 1995 and 2008. The focus of interventions varied, but those targeting specific individuals were generally designed to change an existing behaviour (e. g. cigarette smoking, alcohol misuse), whilst those aimed at the general population or groups such as school children were designed to promote positive behaviours (e. g. healthy eating). Almost 50% (n = 48) of the reviews focussed on smoking (either prevention or cessation). Interventions that were most effective across a range of health behaviours included physician advice or individual counselling, and workplace- and school-based activities. Mass media campaigns and legislative interventions also showed small to moderate effects in changing health behaviours. Generally, the evidence related to short-term effects rather than sustained/longer-term impact and there was a relative lack of evidence on how best to address inequalities. Conclusions: Despite limitations of the review of reviews approach, it is encouraging that there are interventions that are effective in achieving behavioural change. Further emphasis in both primary studies and secondary analysis (e.g. systematic reviews) should be placed on assessing the differential effectiveness of interventions across different population subgroups to ensure that health inequalities are addressed.</p

Alcohol and Substance Misuse in the Construction Industry

The study investigates the factors contributing to the menace of Alcohol and Substance Misuse (ASM) in the construction industry, and its mitigation. Sequential exploratory mixed method design, involving interview and questionnaire were used for collecting data that were subsequently analysed using thematic analysis, factor analysis and Kruskal-Wallis test. Findings suggest that the problem of ASM is largely caused and exacerbated by mental strain, site working conditions, male dominance and ineffective HR management. Screening and educational approaches were confirmed as the carrot and stick methods for mitigating the menace in the construction industry. The finding implies that by making construction companies more accountable for the wellbeing of their workers, a change could be brought in the industry. These changes could be incentivised by initiatives like PREVENT to mitigate the crisis currently endemic in construction. The study suggests some practical measures for tackling the menace of ASM that is bedevilling the constructio

Rural High North: A High Rate of Fatal Injury and Prehospital Death

Finnmark County is the northernmost county in Norway. For several decades, the rate of mortality after injury in this sparsely inhabited region has remained above the national average. Following documentation of this discrepancy for the period 1991–1995, improvements to the trauma system were implemented. The present study aims to assess whether trauma-related mortality rates have subsequently improved. All injury-associated fatalities in Finnmark from 1995–2004 were identified retrospectively from the National Registry of Death and reviewed. Low-energy trauma in elderly individuals and poisonings were excluded. A total of 453 cases of trauma-related death occurred during the study period, and 327 of those met the inclusion criteria. Information was retrievable for 266 cases. The majority of deaths (86%) occurred in the prehospital phase. The main causes of death were suicide (33%) and road traffic accidents (21%). Drowning and snowmobile injuries accounted for an unexpectedly high proportion (12 and 8%, respectively). The time of death did not show trimodal distribution. Compared to the previous study period, there was a significant overall decline in injury-related mortality, yet there was no change in place of death, mechanism of injury, or time from injury until death. Changes in injury-related mortality cannot be linked to improvements in the trauma system. There was no change in the epidemiological patterns of injury. The high rate of on-scene mortality indicates that any major improvement in the number of injury-related deaths lies in targeted prevention

Within-Subject Variability of Interferon-g Assay Results for Tuberculosis and Boosting Effect of Tuberculin Skin Testing: A Systematic Review

Background: Variability in interferon-gamma release assays (IGRAs) results for tuberculosis has implications for interpretation of results close to the cut-point, and for defining thresholds for test conversion and reversion. However, little is known about the within-subject variability (reproducibility) of IGRAs. Several national guidelines recommend a twostep testing procedure (tuberculin skin test [TST] followed by IGRA) for the diagnosis of LTBI. However, the effect of a preceding TST on subsequent IGRA results has been reported in studies with apparently conflicting results. Methodology/Findings: We conducted a systematic review to synthesize evidence on within-subject variability of IGRA results and the potential boosting effect of TST. We searched several databases and reviewed citations of previous reviews on IGRAs. We included studies using commercial IGRAs, in addition to non-commercial versions of the ELISPOT assay. Four studies, fulfilling our predefined criteria, examined within-subject variability and 13 studies evaluated TST effects on subsequent IGRA responses. Meta-analysis was not considered appropriate because of heterogeneity in study methods, assays, and populations. Although based on limited data, within-subject variability was present in all studies but the magnitude varied (16-80%) across studies. A TST induced ‘‘boosting’ ’ of IGRA responses was demonstrated in several studies and although more pronounced in IGRA-positive (i.e. sensitized) individuals, also occurred in a smaller but not insignificant proportion of IGRA-negative subjects. The TST appeared to affect IGRA responses only after 3 days and may apparentl

Effects of Ambulant Myofeedback Training and Ergonomic Counselling in Female Computer Workers with Work-Related Neck-Shoulder Complaints: A Randomized Controlled Trial

Objective: To investigate the effects of ambulant myofeedback training including ergonomic counselling (Mfb) and ergonomic counselling alone (EC), on work-related neck-shoulder pain and disability. Methods: Seventy-nine female computer workers reporting neck-shoulder complaints were randomly assigned to Mfb or EC and received four weeks of intervention. Pain intensity in neck, shoulders, and upper back, and pain disability, were measured at baseline, immediately after intervention, and at three and six months follow-up. Results: Pain intensity and disability had significantly decreased immediately after four weeks Mfb or EC, and the effects remained at follow up. No differences were observed between the Mfb and EC group for outcome and subjects in both intervention groups showed comparable chances for improvement in pain intensity and disability. Conclusions: Pain intensity and disability significantly reduced after both interventions and this effect remained at follow-up. No differences were observed between the two intervention groups

Prospective Monitoring Reveals Dynamic Levels of T Cell Immunity to Mycobacterium Tuberculosis in HIV Infected Individuals

Monitoring of latent Mycobacterium tuberculosis infection may prevent disease. We tested an ESAT-6 and CFP-10-specific IFN-γ Elispot assay (RD1-Elispot) on 163 HIV-infected individuals living in a TB-endemic setting. An RD1-Elispot was performed every 3 months for a period of 3–21 months. 62% of RD1-Elispot negative individuals were positive by cultured Elispot. Fluctuations in T cell response were observed with rates of change ranging from −150 to +153 spot-forming cells (SFC)/200,000 PBMC in a 3-month period. To validate these responses we used an RD1-specific real time quantitative PCR assay for monokine-induced by IFN-γ (MIG) and IFN-γ inducible protein-10 (IP10) (MIG: r = 0.6527, p = 0.0114; IP-10: r = 0.6967, p = 0.0056; IP-10+MIG: r = 0.7055, p = 0.0048). During follow-up 30 individuals were placed on ARVs and 4 progressed to active TB. Fluctuations in SFC did not correlate with CD4 count, viral load, treatment initiation, or progression to active TB. The RD1-Elispot appears to have limited value in this setting