Sharing a vision of a sustainable prevention culture
Today's working population is faced with "traditional" occupational risks, as well as a multitude of emerging work- and non-work related health challenges. New technologies, ergonomic risks, demographic changes, stress and other psychosocial factors affect the lives and health of workers. Increasingly, both occupational and non-occupational factors determine health and well-being at work. At the same time the health of workers has become a crucial factor for the sustainability of social security schemes.
The focus in prevention at the workplace is therefore widening, from a classical, more technical risk-management approach, to the promotion of a prevention culture, where safety, health and well-being are interrelated. This integrated prevention approach requires the involvement of diverse societal actors, and a unified approach to prevention, which takes into account both work and non-work related risk factors.
The positive socio-economic return on prevention
According to International Social Security Association (ISSA) research, prevention not only benefits the health and well-being of the workforce, but also boosts the productivity and competitiveness of the economy as the average cost/benefit ratio for enterprises that invest in prevention activities is a significant 1:2.2. Such significant return rates demonstrate a strong business case for investments in prevention, both for business, but also for society at large. The return on prevention achieved at the societal level is expected to be even more positive, with improved health and well-being leading to higher levels of employability and reduced social and health expenditure.
Prevention and Occupational Safety and Health (OSH): The challenges to be addressed
- Globalization is accompanied by a growth in informal employment, increased migration flows and profound social shifts, thus posing new challenges to safety and health at work, especially in countries with less developed prevention cultures. Workers in the informal sector and migrant workers are often employed in more vulnerable jobs with higher risks and less protection.
- The uncertain global economic climate adds to the overall challenges, putting pressure on workers and undermining established prevention systems and practices. This affects workers' safety and health, including psychosocial strain due to job insecurity and due to reduced funding for protective equipment and OSH-training.
- New technologies, including nanotechnology, ergonomic risks, as well as stress and other psychosocial factors, further increase the complexity of prevention.
- While the prevention of safety risks has resulted in positive outcomes, including reduced accident levels, occupational health risks remain a key challenge. According to the International Labour Organization (ILO), each year 160 million new cases of occupational illnesses are reported. Psychosocial issues are of special concern. European Union figures state that mental ill-health accounts for almost 20 per cent of illnesses in Europe and affects one in four people at some point in their life. This has a wider impact when mental ill-health leads to work absenteeism and eventually exclusion from the labour market.
- The financial burden of compensation, health care, rehabilitation and incapacity to work is huge: equivalent to 4 per cent of world GDP annually for work injuries alone; in some developing countries, the cost can be as high as 10 per cent of GDP.
Challenges in occupational health
The ILO estimates that 2.3 million people die annually as a result of occupational accidents and work-related diseases, and the incidence of non-fatal workplace accidents is rising. While the global mortality rate of workers arising from work-related accidents has fallen, fatality rates due to occupational diseases are stagnating and represent 85 per cent of all work-related fatalities according to ILO estimates.
Reflecting the changing nature of occupational health hazards, there is a trend towards more severe medical conditions, for example due to exposure to carcinogens, asbestos and silica. In many countries, mental health issues, or psychosocial risks, in the workplace are on the increase due to a changing world of work. Stress-related health problems and absenteeism levels are on the rise, due to factors such as increased work intensity, higher demands, job insecurity and even harassment and violence.
As a consequence of these trends, OSH policy is shifting from an injury and accident centred approach to one that increasingly is occupational health focused. Social security organizations responsible for insuring and compensating occupational accidents and work-related diseases are adopting a more holistic approach to the health and employability of workers and increase their efforts to prevent non-communicable diseases through health surveillance and early intervention at the workplace. In order to improve the prevention of work-related diseases, national lists of occupational diseases have to be revised, compensation practices reviewed and monitoring, data collection and record keeping have to improve.
However, in countries where social security coverage levels are low and where the reach of OSH inspectors is limited, the true extent of workplace accidents and exposure to hazards will be unascertainable and knowledge about the incidence of occupational diseases will remain incomplete.
Diversity in the world of work
The traditional approach to OSH focuses on the individual worker, in a formal work place that is assumed to be separate from the place of residence. This model has limited relevance for the majority of the world's contemporary workforce. Many work in public places such as on streets or in informal roadside market places. Many work in their own homes. Others, such as domestic workers and paid carers, may work in someone else's private home. The informality of these workplaces often leaves the workers without any adequate social protection coverage. These workplaces often don't comply with national safety and hygiene regulations and the possibility of a work-related accident or illness is a constant threat to the health of the workers.
Workforce vulnerability is not limited to the informal sector, as the formal sector also has groups of workers with special needs.
An ageing workforce
The average population age worldwide is increasing as a result of rising life expectancy and falling birth rates. Naturally these changes also affect the age structure of the working population. Globally, the number of older persons will increase by a factor of 2.4 (from 841 million in 2013 to more than 2 billion in 2050).(1) With advancing age, the need for medical care and health expenditure increases. In industrialized countries this figure is four times higher for those older than age 65 than for the rest of the population.
One of the central challenges, however, is the recognition that advancing age brings with it increased risks at work. In 15 European countries, studies found that there was a clear relationship between employee age and the occurrence of occupational accidents. The studies showed that while older employees had fewer occupational accidents that required reporting to the authorities, when such accidents did occur they were more serious and led to longer periods of incapacity for work. Fatal accidents occur most often to employees between the ages of 55 and 64.(2)
However, there are programmes that take into account the vulnerability of elder workers and allow them to work according to their rhythm and needs in order to avoid the risk of an accident or of falling sick. Often these measures can also provide an added value to the companies that run these programmes:
- A Japanese car manufacturer increased its productivity by 10 per cent by allowing its production lines to run at different operating speeds for different age groups.
- A multinational electricity company in Latin America has introduced a Work-Life Balance policy ensuring diversity, retention as well as health and well-being of all employees of any age and condition in order to maintain competitiveness and its innovation capacity.
- Other measures include flexible retirement schemes where elder workers are allowed to reduce their working time gradually.
Working conditions of migrant workers also cause major concerns for labour protection. For instance, casual seasonal workers recruited for short periods are often unfamiliar with the work processes, products or people, the language and the national safety regulations. Hence, they are exposed to high work-related risks. When accidents occur, they are often not reported.
Employment of people with disabilities
It is estimated that 15 per cent of the world's population live with a disability. Individuals with an assessed disability are more likely to be unemployed than the general population and are at greater risk of living in poverty. And those who live in poverty have a far greater likelihood of being disabled.
One strategy that is suggested in the ISSA Guidelines on Return to Work is the principle of early intervention. Studies have shown that the likelihood of a person returning to work after a work-related injury decreases with every month that the person is out of job. Therefore return-to-work programmes, such as that of Malaysia's Social Security Organisation (SOCSO), support both, medical rehabilitation as well as job-reintegration services where case managers help the individual to find a new job or convert the old job into a disability-friendly work environment. The main objective is to bring the individual back to work, as part-time or full-time employment may not only support the healing process, but may also have a positive effect on the individual and society.
The ISSA: A leader in prevention
In the field of social policy there is growing understanding of the necessity of integrated and coherent policy responses to life cycle and labour market risks wherein sustainable prevention activities are embedded as a central pillar alongside those offering compensation and rehabilitation. The work of the International Social Security Association (ISSA), in developing guidelines for social security administration in the three interconnected domains of the prevention of occupational risks, on workplace health promotion and on return to work and rehabilitation, is exemplary in this regard.
Each of these three dimensions of prevention contributes to the overall objective of a safer and healthier workplace and society. The risk management dimension limits the incidence of accidents and occupational diseases; the health promotion dimension aims to reduce the risks related to non-communicable disease through health surveillance, early diagnosis and intervention. But prevention does not stop there. The return-to work dimension aims to prevent exclusion through early intervention and rehabilitation.
Together, these three dimensions illustrate that the health of the individual remains at the centre of prevention, and that at each level, a proactive effort is required in order to protect, maintain or restore the health of the worker. The workplace plays a crucial role in all three-dimensional prevention activities, as it is the ideal environment to reach the workforce, promote a culture of prevention, and organize training measures and organizational prevention efforts.
For the ISSA, the message is clear: prevention measures are indispensable to ensure financially sustainable social security schemes, especially as they strengthen the capacities of individuals to remain healthy and active in the labour market. Underpinned by its three-dimensional strategy, the ISSA calls for a global paradigm shift in the prevention of occupational safety and health risks based on a more holistic view of the health and the employability of the workforce.
The 2014 World Congress on Safety and Health at Work, organized by the ISSA in partnership with the International Labour Organization (ILO) and the German Social Accident Insurance (DGUV), addressed three key topics, each of which has a prevention "dimension": Prevention culture – Prevention strategies – "Vision Zero"; Challenges in occupational health; Diversity in the world of work.
In social policy, prevention includes every measure aimed at preventing undesirable events that might be harmful to the physical or mental health and well-being of the individual. It is equally a matter of ethical, organizational and economic concern: successful prevention reinforces the social, political and financial sustainability of social security schemes and is beneficial for workers, enterprises and society as a whole.
For the ISSA, the preservation of the health and well-being of every human being – of workers and non-workers alike – is a key objective of social security systems. Social security systems, however, have an important historic responsibility towards people that are exposed to safety and health risks at work. It is in pursuit of this objective, to ensure a world of work that is safe and healthy, one that is without severe or fatal occupational accidents, that "Vision Zero" has become a guiding global leitmotif.
Towards a sustainable prevention culture
The ISSA fully supports that safety, health and well-being at work must be placed high on national and international agendas and lead to the development of a genuine prevention culture at the workplace and beyond. A well-functioning occupational safety and health system, supported by a range of societal actors, brings positive effects not only to employers and employees, but, ultimately, also to society as a whole. By shifting their role from "payer" to "player", social security administrations can make a significant contribution to building a sustainable prevention culture.
(1) United Nations, World Population Prospects: The 2012 Revision (medium scenario), 2014.
(2) Eurostat. 2005. Database. Standardised incidence rate of accidents at work