A key objective of social security is to safeguard the safety, health and well-being of every person. Work-related and non-work related risks must be prevented and addressed. Therefore, prevention does not only include the prevention of occupational accidents and diseases, but also the promotion of health and the prevention of work exclusion through early intervention and rehabilitation. This three-pronged approach is reflected in the three sets of prevention guidelines of the International Social Security Association (ISSA), which address occupational risks, workplace health promotion and return to work.

Well-functioning occupational safety and health (OSH) systems bring positive outcomes to employers, employees, and to society as a whole. In the Americas, efforts have been underway to establish a prevention culture that supports companies and workers in their efforts to reduce the exposure to occupational risks and promote prevention through awareness raising campaigns and various target actions.

Based on the ISSA Database of Good Practices, this article analyses prevention initiatives in Argentina, Brazil, Chile, Costa Rica, Mexico and Peru revolving around occupational risk prevention, workplace health promotion and return to work measures.

Prevention of occupational risks

Many ISSA members recognize that the benefits of prevention significantly outweigh the investment costs. The ISSA study Calculating the international return on prevention for companies (2013) found that it pays off to invest in occupational safety and health measures, and that each US dollar (USD) invested in prevention yields a potential return of USD 2.2. ISSA members that insure and compensate occupational accidents and diseases therefore have a strong interest in providing excellent prevention services. Many of them support workers and employers and run national awareness raising campaigns in an effort to reduce the exposure to occupational risks. To support these efforts, the ISSA, together with its Special Commission on Prevention, has developed the ISSA Guidelines on Prevention of Occupational Risks as well as the Vision Zero strategy, which is based on the belief that every accident, illness and harm at work can be prevented. Vision Zero is open to all actors in safety and health; from policy makers to employers, from workers to safety and health trainers and experts, and it has close to 15,000 supporters worldwide. The Vision Zero website provides a wealth of information, guides and campaign materials.

Chile

The Chilean Mutual for Safety (Mutual de Seguridad – CChC) has taken on board the ISSA’s Vision Zero philosophy and has developed a systematic approach to occupational risks, applicable to approximately 80,000 small and medium sized enterprises (SMEs) in order to gradually reduce, ultimately to zero, the number of injuries at the workplaces. This systemic approach is connected to a database that can be accessed by the SMEs via different electronic devices (tablets and mobile phones) and provides advice on occupational risk management, assessment and training.

The systematic approach was mainly inspired by the ISSA’s prevention guidelines, in particular guideline 41 on “Addressing small and medium-sized enterprises”. It helped reduce the rate of fatal occupational accidents from 13.1 to 5.0 per 100,000 workers between 2014 and 2019, and the rate of serious occupational accidents from 2.35 to 0.54 per 1,000 workers between 2011 and 2019. The overall rate of registered occupational accidents in SMEs was also significantly reduced by almost 50 per cent, from 6.55 per 1,000 workers in 2011 to 3.56 in 2019, thus preventing more than 23,000 accidents during this period.

Furthermore, shortly after the COVID-19 outbreak, the CChC acted swiftly to address the pandemic. It launched a risk-awareness campaign to assist businesses with the implementation of correct occupational safety and health measures. A COVID-19 prevention tool was created for companies in just 15 days. It addressed pressing COVID-19 questions from employers, including how to reduce the risk of infection whilst ensuring operational continuity. The tool also provided information about COVID-19, its forms of transmission and a set of general preventive measures to be applied and to be evaluated at the workplace. It also provided access to the national COVID-19 regulations and offered suggestions for preventive equipment and services.

From April to June 2020 the tool was distributed and implemented in more than 8,000 businesses, reaching about 37,000 workers. One month prior to the distribution of the COVID-19 prevention tool, CChC provided advice to 3.18 per cent of its businesses. The rate rose to 53.83 per cent after the distribution of the tool. In addition to the information campaign, the CChC faced another challenge. Every year the CChC conducts 800,000 trainings on occupational safety and health. However, due to national COVID-restrictions, all training had to be moved online. For example, for the period March – June 2020, over 257,600 training activities were planned of which 167,206 were originally proposed as face-to-face meetings. The CChC managed to continue the prevention training for companies and experts by conducting a total of 222,597 online learning activities during this time frame. The CChC thus managed to deliver continuous training in occupational safety and health during the pandemic.

Mexico

In an effort to significantly improve response times after registering an occupational accident or disease, the State Employees' Social Security and Social Services Institute (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado – ISSSTE) of Mexico reviewed the administrative procedures related to occupational risks and disability. The review revealed that there was a need for all prevention actors to recognise that occupational safety and health is a basic human right and that this should be the driver for reforms of the Mexican prevention system.

A new organisational structure for the Committee of Occupational Medicine (Comité de Medicina del Trabajo) and its regional subcommittees was set up, which allowed the recognition process of an occupational disease to be shortened from 20 days to only five days. The reform also introduced the faster processing of other general procedures related to occupational safety and health, such as new response strategies of less than seven days for cases of terminal illness or where workers’ lives are at risk. Moreover, new procedural guidelines for occupational physicians were developed and approved. The intention of the above measures was to address the human, medical and legal dimensions of each occupational case more efficiently and effectively. This also included the compensation procedures.

The new framework received solid support from beneficiaries, trade union groups and the different authorities. It allowed the ISSSTE to significantly reduce the response time for each case. For instance, the processes to reach decisions on occupational risks and cases of disability were shortened by 50 per cent from 60 to 30 days, and the response time to reach decisions on terminal illnesses was reduced to seven days from the previous four to six months.  Furthermore, a proper monitoring system is now in place with monthly performance reports submitted by the regions to the central office.

Argentina

In an effort to provide a more rapid response to user requests and to reduce the strain on its customer-service phone lines, Argentina’s Superintendency of Occupational Risks (Superintendencia de Riesgos del Trabajo – SRT), launched a chatbot that is accessible and operational 24 hours a day, 365 days a year. The chatbot provides answers to the most common questions related to the Argentinian occupational risk system. It also offers information on how to sign up with an occupational risk insurance company and is capable of providing information on personal data. The programmers connected the SRT’s IT database with the bot so that it could access all relevant information for each user and thereby provide a personalized experience.

When the chatbot was launched, it only had 100 pre-programmed responses that were linked to around 3,000 formulated questions. As the chatbot learned from user-feedback, it soon doubled the number of responses to 200 and generated 8,500 different questions. In the course of this process, the margin of error was reduced from 30 per cent to just 7 per cent. When the chatbot became fully operational in 2019, the SRT registered close to 200,000 exchanges with over 85,000 users, averaging over 500 enquiries a day. This allowed SRT’s customer service to focus their efforts on dealing with more complex enquiries and handle them faster.

After the successful completion of this first phase, SRT is now considering to set up a smart phone messenger service to forge even closer links with the general public. The digitization of the organization’s systems is a crucial factor in developing a more personalized service capable of providing tailored responses to each user in the area of occupational safety and health.

Workplace health promotion

Employment injury insurances promote a culture of health at the workplace in the broadest sense because the workplace is a setting for disseminating information and raising awareness on communicable illnesses and health conditions such as AIDS or COVID-19. Social security institutions therefore use tools for workplace health promotion that value the strengths and capabilities of the entire workforce and address the major risk factors for preventable and non-communicable illness, too. In the medium to long term, reducing the risk of illness would improve the population’s health and reduce the need to avail of social security benefits. The ISSA Guidelines on Workplace Health Promotion provide guidance to ISSA member institutions on strategic and practical approaches in this area.

Costa Rica

In 2020, the Social Insurance Fund of Costa Rica (Caja Costarricense de Seguro Social – CCSS) launched a health and well-being programme entitled “Active Breaks” in the San Juan de Dios Hospital, in the capital San José. During the previous three years, an internal evaluation of the organizational climate in the hospital stagnated at a very low 55 per cent. The aim of the programme was to generate a new team spirit and to make each individual feel a real sense of achievement at work. The programme addressed the well-being of the staff by looking at the physical and emotional health as well as social factors at work.

Three months after the implementation, the programme yielded the following results:  

• 90 per cent of staff praised their managers for demonstrating the ability to perform and meet the needs of their teams.
• 90 per cent of staff considered the implemented changes as beneficial to their Unit.
• 100 per cent of staff considered that the manager responded very well when they consulted on a specific topic.
• Over 70 positive comments on motivation, leadership, compensation, participation and equity were received.

Return to work and rehabilitation

One of the main challenges for employment injury institutions is to provide vocational and functional rehabilitation services for workers suffering from an occupational illness or accident and to facilitate their return to the labour market. The idea of a return to work programme is that the concerned individuals will eventually support themselves again without relying on the support of the social security system. The return-to-work processes take into account individual needs, the work environment as well as the company’s needs and legal responsibilities. It constitutes a coordinated effort that is focused on maintaining employment as a first step to prevent people with reduced work capacities from retiring prematurely. The ISSA Guidelines on Return to Work and Reintegration provide further guidance on how to set up a functioning return to work system.

Brazil

As an example of a successful return to work reintegration measure, the National Social Security Institute (Instituto Nacional do Seguro Social –  INSS) of Brazil applied the aforementioned return to work principles to a quadriplegic worker whose marked physical limitations would otherwise not have allowed him to return to work. However, the worker received the full support of the INSS, based on an assessment that looked at the worker’s physical, cognitive and emotional states as well as at his personal motivation to be able to work again. Furthermore it assessed the possibility for the worker to comply with the job requirements or if any physical limitations would stand in the way to carry out the job.

After the initial assessment, the worker was given assistive technologies that helped him perform basic motoric skills. This enabled him to work from home. At the same time, the rehabilitation team offered support – especially emotional support – for this initiative. Furthermore, the employer was also supportive of the reintegration initiative, by allowing the worker to work from home. He was assigned work tasks he already knew, which greatly helped his reintegration.

The INSS acted as a facilitator in the process and ensured that the reintegration would take place according to medical and therapeutic advice. It also checked that the demands of work would not aggravate the physical and mental health of the worker. Three years after returning to work, the health condition of the worker did not worsen. He reported feeling more productive and better adjusted to the constraints imposed by his physical condition and illness.

This success story shows that the reintegration of people with marked reductions in their capacity to work requires the integrated action of all actors involved. It should be noted that the worker’s motivation to return to work is a key factor for success and it cannot be achieved without additional encouragement and support from family members and from the multidisciplinary team responsible for the rehabilitation process.

Peru

In Peru, 10.4 per cent of the population has a disability, but only 33 per cent of persons with disabilities of working age actually participate in the labour market. Therefore, the Social Health Insurance Institute of Peru (Seguro Social de Salud – EsSalud) has been strongly promoting the social and labour market inclusion of persons living with disabilities.

EsSalud established several vocational rehabilitation centres. These centres provide vocational education, skills development and rehabilitation services to improve the health, worklife participation and the quality of life of the patients. This service is provided not only to the insured persons living with disabilities, but also to their family members, including children to support their school attendance.

In April 2020, during the pandemic, a new “Rehabilitation Online” strategy was launched. It was the first nationwide effort to leverage information technologies to provide rehabilitation and ensure the labour and educational inclusion of persons with disabilities.

Over the last three years, the number of persons living with disabilities who returned to work increased by 20 per cent. Some 5,675 families were trained and empowered and 2,278 children with disabilities attended school, changing the lives of 6,258 persons on average annually during the period under review.

Conclusion

The good practices of ISSA member institutions in the Americas clearly show the positive outcomes and the wide-ranging benefits of prevention and rehabilitation measures. Member institutions in the region are innovating as part of their prevention strategies and programmes to address occupational risks and to improve information and customer services.

These innovations are aligned with the ISSA Guidelines on Prevention of Occupational Risks, including the revision of procedures, exploring digital channels, deploying awareness campaigns and training activities, and actively involving workers and employers. To promote health at the workplace, preventive and safety measures address various communicable and non-communicable diseases. Importantly, effective reintegration measures based on enhanced multidisciplinary rehabilitation processes as well as medical and vocational training in rehabilitation centres are also being developed.

The COVID-19 crises saw social security institutions in the Americas quickly adapt their prevention and OSH-related programmes through an intensive use of digital channels and other specific measures. In anticipation of the protracted duration of the pandemic and the multiple challenges ahead, they continue to build and promote a prevention culture that maximizes the benefits of the region’s recent innovations. The ISSA supports the efforts of member institutions through guidelines, good practices, webinars, communities of practices, special events and the Vision Zero strategy.