Ann. occup. Hyg., Vol. 46, No. 4, pp. 423-428, 2002
© 2002 British Occupational Hygiene Society
Published by Oxford University Press
Partnership for Sustainable Healthy Workplaces
Warner Lecture, British Occupational Hygiene Society, Sheffield 9 April 2002
Centre for Working Life Research, Kingston University, Kingston Hill, Kingston upon Thames KT2 7LB, UK
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ABSTRACT |
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The paper sets out a fresh approach to healthy workplaces, laying foundations to meet the demands of the new millennium. Professionals such as occupational hygienists deal with issues at the heart of the economy and society, which are beginning to attract the attention of politicians. Old disciplinary barriers must be crossed and communication improved so that healthy work is accepted as a mainstream concern, integral to sustainable development. This presents challenges both to professionals and to those with responsibilities for policy. As a first step, we need to develop an understanding of how conclusions from research can inform responsible decision making. We will not be able to design and build perfectly safe environments, but real progress can be made in the field of ‘workplace health defence’, using available human, technical and financial resources. A vital ingredient is partnership in the workplace, involving social partners and professionals working in collaboration.
Keywords: communication; indicators; knowledge; quality of work; networks; partnerships; work organization; workplace health
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INTRODUCTION |
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‘Healthy work’ and ‘healthy workplaces’, as a basis for ‘occupational health’ and ‘occupational hygiene’, with their medical associations, and ‘occupational safety’, with the implied emphasis on regulation, have become mainstream political and economic issues in both industrialized and developing countries. In the UK this involves numerous different government departments, uniting in support of a common strategy (Health and Safety Commission, 2000), while in Southern Africa health, including occupational health, is seen as central to sustainable development (SADC, 2002). Healthy work is integral to the Employment Strategy of the European Union and the provisions of European Framework Directive 89/391, which raises particular issues for small enterprises (Walters, 2001). There are emerging strategies at the global level in the private sector (Stokke, 2001) and through the International Labour Office (Larsson, 2001). There has been prominent media coverage of dramatic cases in the UK of accidents in both the public (such as the Hatfield Rail Disaster) and private sectors (BP refineries and construction companies).
Healthy work is now recognized as being central to successful employment policies, as governments and regional organizations seek to improve competitiveness and productivity and understand the economic and social cost of sickness absence and industrial injuries. There are numerous publications from the European Foundation for the Improvement of Living and Working Conditions and the European Agency for Safety and Health at Work, both working with networks across Europe. The Securing Health Together programme in the UK has recognized the new priority, by establishing a Continuous Improvement Programme Action Group, integrating workplace health with the quality improvement agenda (Health and Safety Commission, 2000). Issues such as demographic change and labour shortages in particular sectors are exacerbated by problems arising from avoidably unhealthy work, with implications for other policy areas such as immigration and labour mobility. Appropriate investments in workplace health should now be seen as part of the infrastructure cost of a modern economy.
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RESPONSIBILITIES |
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Workplace health and hygiene cannot merely be a matter of regulation, on the one hand, or of market forces, on the other. Enterprises cannot necessarily leave these matters to government and there are central legal responsibilities placed on employers to provide healthy workplaces, just as there are responsibilities placed on the employee to take appropriate precautions, in a context of participation and dialogue.
In a globalized economy, with increased transparency of information, it is not morally acceptable for employers to derive competitive advantage through economies in the areas of health, safety and well-being for employees. This was argued by the winner of the 2001 Nobel Prize for Economics, Joseph Stiglitz, in his lecture ‘Employment, social justice and societal well-being’ at the ILO Global Employment Forum (Stiglitz, 2001). Economies in labour costs tend to accompany outsourcing and agency arrangements, when responsibility for workplace health and hygiene can become ambiguous. The consequences of economies can be dramatic, as in the case of child labour, debated by the ILO (International Commission on Occupational Health, 2001a), and long-lasting, as in the case of asbestos, discussed at a recent international workshop in London (International Commission on Occupational Health, 2001b). We must deal with the consequences of decisions and exposures some decades in the past; even today, there is a continuing refusal to accept the scale of the problem. Employers need to be persuaded of the case for even modest investments in workplace improvements; we cannot rely on the British tradition of voluntarism alone if we are to comply with international standards. For governments to go further, with legislation and regulations backed by enforcement, there is a requirement for research, inspection and advice from experts.
How is this issue to be addressed? To what extent can we build on the expertise and research accumulated in the past? How can knowledge derived from research be applied in practice in the workplace? Does each country need to develop its own national research programmes or can knowledge be shared internationally? In the UK public funding for research in workplace health and hygiene has been limited by comparison with Northern European countries, in particular in Scandinavia. This poses new challenges to the research community, at the national and international levels.
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COLLABORATION |
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One potential mechanism is collaboration through the scientific committees and networks of the International Commission on Occupational Health (ICOH), whose members are leading international experts. For example, Westerholm and Marklund (2000) produced a report on international research strategies. The international occupational hygiene community works with IOHA and relations between ICOH and IOHA are long established. The forthcoming ICOH 2003 congress is on ‘The challenge of equity in occupational health and safety’, which will require international experts to engage with the political agenda.
A number of innovations have been seen in Sweden, with the Work Life 2000: Quality in Work project 1997–2001, linked to the Swedish Presidency of the European Union, involving 64 workshops, an international conference and a network of 1000 researchers (Ennals, 1999, 2000, 2001; Skiöld, 2001; Wennberg, 2001). Again in Sweden there has been the SALTSA programme of research and development in European working life, jointly sponsored by the National Institute for Working Life and the Swedish Trade Unions, with a major theme on ‘Work environment and health’. The Work Life and EU Enlargement programme, led from the Swedish National Labour Market Board 2001–2004, is taking the agenda to the 13 applicant countries to the EU.
At the global level the new Global Employment Agenda, launched by ILO, calls for new global alliances, involving NGOs concerned with healthy work. WHO is committed to work on healthy workplaces and UNESCO, in the UNISPAR programme, has pioneered approaches to networking which link universities with science and industry. The Agenda, converted into a Strategy at the ILO Congress in 2002, is due to be launched at the UN summit in Johannesburg in September 2002.
Closer to home, there is increasing activity at the European level, based on networking across regions and member states. The WHO Europe Healthy Workplaces programme, which works with a network of collaborating centres, is extending its activities to the applicant countries to the EU. The European Network for Workplace Health Promotion links partner agencies across the European Union, with a partner network for large enterprises. The Health Development Agency in the UK is working with the International Union for Health Promotion and Education on the conference ‘New dimensions in promoting health: linking health promoting programmes with public policies’. For each to succeed, they need to take advantage of the culture of networks and development coalitions (Ennals and Gustavsen, 1999), which has developed with support from the European Commission DG Employment and Social Affairs, for example through the European Work Organisation Network. In the UK all of these strands are brought together through the UK Work Organisation Network (Ennals, 2002), managed by the Work Research Foundation and involving trade unions, employers and a consortium of universities. The overall network of networks provides access to the necessary partners and should facilitate sustainable improvement.
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PAST AND PRESENT |
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The topic of ‘healthy work’ is not new. Together with the new hazards and challenges presented by the ‘new economy’, we find the continued presence of many of the problems of the past, such as physical and chemical exposures, as well as newer topics of concern, such as psychosocial factors, including cognitive exposures and electro-magnetic fields (Knave, 2000). There is a long history of scientific research and ongoing debate in the Occupational Hygiene Newsletter and the Annals of Occupational Hygiene.
This makes it all the more important that the scarce expertise of specialists in workplace health and hygiene from the different contributing professions is made available in an appropriate manner. It is not the case that business or political ‘commonsense’ is adequate, as this tends to lead to decisions that interventions must be limited to what is ‘reasonably practicable’, thus giving precedence to short-term economic considerations. It is time for ‘joined up thinking’ across disciplines and departments, involving the development of partnership relationships, including social partnerships. This is not an alternative to financial investment, but a means of transforming workplace relationships so that investments can be more effective. It means continuing conversations and increasing the responsibilities of the work of workplace health and hygiene professionals in a changing world.
People are the critical resource for economic and social activities in the next generation. This has serious implications, especially in cultures, such as Japan, where hard work has been seen as a good thing in itself and where family and social life have been regarded as relatively unimportant. The consequences are emerging in the form of psychosocial problems, which can be linked to increased workplace demands and reduced control, increased effort and inadequate rewards. Employers and governments have traditionally been reluctant to address such problems, but the evidence has grown that stress at work is causing a number of occupational diseases and leading to large-scale sickness absence. Karasek and Theorell (1990) set out the demand–control model for psychosocial facts at work. Cox et al. (2000), in a report for the European Agency for Safety and Health at Work, summarize research linking stress with other disorders. It is particularly pronounced among employees in hard-pressed public services, such as education and health. Epidemiological evidence links stress with musculoskeletal and coronary disorders, as was reported at the Work Life 2000: Quality in Work workshops (Ennals, 1999, 2000, 2001; Skiöld, 2001; Wennberg, 2001). We must build in healthy work as part of the design of the workplace: this represents an enormous challenge to occupational hygienists.
Just as we talk of ‘value chains’, we should be considering ‘health chains’, the health consequences of each work activity. Work that obliges the worker to lift heavy loads or to experience harmful exposures incurs a cost in terms of health impact, which tends not to appear on the accountant’s balance sheet. Global companies which outsource manufacturing to low cost sweatshops in developing countries (Klein, 2000), where the demanding standards of developed countries are not applied, are passing the costs to public authorities while maximizing private profits. Asbestos manufacturers continued operations in South Africa long after closing elsewhere. Conversely, we can identify examples of healthy modes of working, healthy workplaces and forms of work organization in which it is recognized that the health and learning of the workforce is a key element for sustainable enterprise and development.
We must recognize that inequities in health and safety at work do not arise by chance. They are an outcome, albeit often unintended, of decisions by employers, which may not have involved participation by the workforce. Principles of human rights, both individual and collective, are often at stake. Resolving such inequities requires activity in the business and political arenas, with a foundation of research evidence. Ignorance is no defence for strategic managers.
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A NEW BUSINESS MODEL |
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It is now more widely understood that accountants, who are trained to consider the details of costs and to demand clear evidence of proven benefits in support of any decision to invest, have been unable to grasp, within their ‘virtual reality’, key features of the modern economy. In the modern knowledge-based economy the learning and health of the worker are of vital importance, but accountants are not agreed on how to value either learning or health, so they focus their attention elsewhere. In many financial services and new technology companies a large part of the value resides in the workforce: if they leave, the company collapses. We are told to rely on ‘hard data’, but the figures are built on a foundation of sand. Work is done by people in the workplace, and their concerns cannot simply be dismissed as ‘soft’.
What is perhaps more serious is that accountants do not know how to evaluate the case for investments in workplace health and hygiene improvements or in education and training. Failure to prove the case for an investment makes refusal most likely, with potentially drastic implications for those denied resources. This is seen at a national level with developing countries seeking support from the IMF and World Bank, who are often pressed to cut public spending on health and welfare programmes, exacerbating poverty and division.
What should be measured in order to assess the results of interventions? The search has begun for reliable ‘indicators’ of quality in work, which can assist in making improvements to match good practice elsewhere. Using such indicators, profiles can be developed at company or country level, as has been pioneered in Finland (Rantanen et al., 2001), enabling benchmarking against comparable cases and implementation of programmes of continuous improvement. This enables workplace health and hygiene to join the mainstream of business benchmarking. This in turn is an entry point to the European Employment Strategy, which is based on a system of open coordination by the European Commission, using soft law and social benchmarking.
We need to evaluate existing efforts and to develop new business models which take account of learning and health. We need to learn from different examples of good practice. There is a role here for the different workplace health and hygiene professionals, with insights from both theory and practice. How can workplace health and hygiene expertise be most effectively made available and deployed for questions like these in working life?
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EMPLOYMENT STRATEGY |
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The approach of the European Employment Strategy (Larsson, 1999) and of the new ILO Global Employment Agenda and Strategy (Larsson, 2001) is to regard healthy work as an integral part of employment strategy. For the ILO employment policy is not simply a matter of commercial profit, but of social justice and societal well-being. This means adopting a positive model of health and not simply treating illness.
For this approach to healthy work to develop, there needs to be a dialogue which involves participants from a number of disciplines. This is essential, not just in order to improve communication, but to reach the overwhelming majority of workplaces, which are small, not well equipped with expertise or health and safety representatives and not well covered by national legislation, which tends to have been based on experience with large enterprises. In Europe the process of social dialogue between employers and trade unions has a central role in the Employment Strategy and is the means by which agreement is reached on improvements in working conditions.
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CHANGES |
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We must take into account that changes in the world of work, and the transforming impact of new technology, mean that work no longer takes place in the same locations and at the same times as in the past. The concept of ‘the workplace’ is no longer clear and this has radical implications for occupational hygiene. Instead of lifelong employment, we look for lifelong learning and employability. Instead of full-time permanent employment, we see a variety of forms of precarious employment, with adverse consequences for the health of the workers concerned (Quinlan and Mayhew, 2000). The dividing line between work and the rest of life is less clear: in Europe the social partners are considering the implications of teleworking and devising an appropriate regulatory framework. Having signed the Social Chapter in 1997, the UK is bound by the Directives that result from European Social Dialogue and are then transposed into UK legislation.
Workplace health and hygiene research and practice is changing in a number of ways, with the balance of the changes varying in different countries. There have been numerous case study examples through the Work Life 2000: Quality in Work programme in Europe, the Work Life and EU Enlargement programme with the applicant countries to the European Union and from work within the ICOH. We will not arrive at a single solution which fits all cases: our challenge in the UK is to address our local context, as part of the global economy.
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TRENDS |
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A number of overall trends can be identified. Whereas traditional policies and practices have derived from experience of large enterprises, increasing account is now being taken of the needs of small enterprises (Walters, 2001). This poses new challenges for the enforcement of standards and regulations, the delivery of expert support and the raising of levels of awareness and understanding. Research by the Health and Safety Executive suggests that the average reading age of owner-managers of small enterprises is 12 yr, yet much information sent to companies is complex and highly technical. New approaches based on social partnerships and the use of intermediaries are required, enabling knowledge transfer from the health and safety community to the workplace.
A new research focus is on the links between psychosocial factors and conventional occupational diseases and disorders. Changes in the world of work are leading to new exposures, which are as yet poorly understood. For example, long periods of computer use, seated in front of a screen, or frequent sudden bursts of intensive monitored activity in a call centre may have direct or cumulative consequences.
Research is dealing with new technical issues, such as electro-magnetic fields, where knowledge is limited (Knave, 2000) and modes of explanation are complex, controversial and require more than commonsense levels of understanding. Public concern is not necessarily well-informed and concepts such as the precautionary principle, which underpins European policies in the field, require careful exposition. There are similar problems in recycling waste materials: a recent European report has pointed to the health hazards associated with working and living near landfill sites.
Diversity is bringing new dimensions to workplace health and hygiene research and practice, as workforces are becoming more heterogeneous and workers may bring different assumptions. These may include attitudes to collaborative working, personal safety and levels of literacy in the dominant language of the workplace, in which instructions and warnings may be presented. It is recognized in the European Union that a gender perspective is essential in workplace health and hygiene research and practice and that the changing demographic profile of Europe has radical implications for work and health. EU member states have typically ratified the relevant ILO conventions.
Workplace health and hygiene is acquiring a political and economic dimension. For example, in the case of asbestos the view taken by ICOH is that asbestos manufacture and use should be banned world wide, in the light of the overwhelming medical evidence of the consequences of exposure to asbestos for the health of the workers (International Commission on Occupational Health, 2001b). However, implementing such a view may involve confronting the interests of major producers and manufacturers and jeopardizing continuity of employment for the workers concerned. Battles for compensation have become complex and global and it is apparent that the workers and their medical advisers need to be as adept at collaborating on the global scale as the major employers have been.
There is a related argument, for example concerning tobacco, which obliges us to consider the world beyond the workplace, in which workers are also engaged as citizens. When analysing the effects of occupational exposures it has been established that lifestyle factors can have a significant impact: these factors include consumption of tobacco and alcohol, both of which bring in valuable revenue to governments. Thus the work of workplace health and hygiene professionals falls within controversial areas of public health policy. The effects can be widespread, including concerns over the sources of funding for workplace health and hygiene research.
As an extension of this argument, workplace health and hygiene research and practice is also involved in debates on health promotion. The traditional approach has been to launch short-term initiatives intended to ameliorate adverse conditions. An alternative is to embed good practice in job and workplace design and procedures: thus good decent work is seen as promoting health. Occupational hygiene should be built in.
Education in workplace health and hygiene is needed, for in many cases research has run ahead of practice or, as in rural Southern Africa, occupational health and hygiene services have only recently become available (Goldstein et al., 2001). In order to meet pressing practical needs professionals such as occupational health nurses need to be equipped to play a leading role. In the context of the current HIV/AIDS pandemic fresh approaches in the context of the workplace are proving effective and less personally threatening to those concerned (Setwse, 2001). Based on initiatives by occupational hygienist Gopolang Sekobe of the South African Department of Health, ICOH is supporting a new diploma course for occupational health nurses and a new integrated programme in public health for health professionals (Knave and Ennals, 2001).
Emerging from this is an increased emphasis on communication, which is the focus of a further ICOH network, led by Max Lum of NIOSH. Workplace health and hygiene specialists need to find a common language with politicians, decision makers and practitioners. This is not easy, and it is not likely to be successful if it is based on one-way communication, issuing directives, guidance and instruction booklets. Workplace health and hygiene must enter the public arena and become part of the debate in civil society, in which work plays a vital part and healthy work is critical for sustainability. As work with small enterprises has demonstrated (Walters, 2001), there are complex issues of language to be resolved and managers need to be able to understand that workplace health and hygiene is an integral part of systematic and sustainable management.
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CONCLUSION |
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TOPABSTRACTINTRODUCTIONRESPONSIBILITIESCOLLABORATIONPAST AND PRESENTA NEW BUSINESS MODELEMPLOYMENT STRATEGYCHANGESTRENDSCONCLUSIONREFERENCES |
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Science is international, but business and economic relations are culturally situated, as has been argued by the philosopher Stephen Toulmin, in his Return to reason (Toulmin, 2001). Workplace health and hygiene research and practice has to be seen internationally and as more than simply a medical matter, while having an irreducible medical core. Where there have been research advances, they need to be complemented by appropriate dissemination strategies and mechanisms, which take account of the local cultural context and make use of a range of available intermediaries.
The future of workplace health and hygiene research and practice will build on the past, but will not be the same. This means that the training and preparation of new generations of professionals cannot just be a matter of cloning the current experts. We need to equip the next generation with the capacity to learn from differences and to make sense of what is going on in other countries, as part of the process of updating practice at home. If the situation is to be improved we need to bring to bear the combined expertise of workplace health and hygiene professionals.
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FOOTNOTES |
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* E-mail: ennals@kingston.ac.uk
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REFERENCES |
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TOPABSTRACTINTRODUCTIONRESPONSIBILITIESCOLLABORATIONPAST AND PRESENTA NEW BUSINESS MODELEMPLOYMENT STRATEGYCHANGESTRENDSCONCLUSIONREFERENCES |
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