There’s a new school of thought emerging that will advance the principles of health and safety integration. Report by Robert Dill.

At a time when many employers are questioning their results and struggling to justify their wellness programme costs, there is a growing body of evidence that supports the concept of integrating worker safety and worker health for better outcomes and lower costs.

The research is coming from reputable sources like Harvard, National Institute for Occupational Safety and Health (NIOSH) and The Commission on Health and Safety and Workers’ Comp, but also within Europe there is a growing recognition that employee wellbeing particularly when it relates to psychosocial risks and stress is a growing concern with studies showing that one-quarter of workers in Europe feeling stressed at work all or most of the time, and a similar proportion say that work affects their health negatively. Psychosocial risks — for example, monotonous tasks, high work intensity, tight deadlines, work-life unbalance, violence and harassment from the public or from colleagues — contribute to work-related stress.

Psychosocial Risks in Europe: Prevalence and strategies for prevention was published jointly by the European Agency for Safety and Health at Work (EU-OSHA) and the European Foundation for the Improvement of Working and Living Conditions (Eurofound) in 2014. The report acknowledges the complexity of the relationship between health and work and recognises that practical support is needed to bring about change Director of EU-OSHA, Dr Christa Sedlatschek, described the report as an excellent example of interagency collaboration. ‘One of the key messages of our 2014–15 Healthy Workplaces Campaign is that psychosocial risks, although more sensitive, can be tackled in the same systematic way as “traditional” workplace risks.

There is a nomenclature developing along with the research. We now have terms like total worker health, health promotion, health protection, integrated health and safety (IHS) and population health management (PHM) just to mention a few. Add to this the disruption of the Affordable Care Act for employers and providers, the varying political winds and there is no wonder that the level of uncertainty has become palpable.

As a result, a small number of employers are responding with a different approach in managing human capital health risk within their organisations. They have begun building bridges to the traditional silos of workers’ comp and safety and medical and wellness benefits.

The movement has advanced enough for the Harvard School of Public Health to hold a conference in Boston earlier this year and in the summer of 2014 a conference, sponsored by health and safety provider UL and architecture and construction giant AECOM, brought together experts from government, corporate and not-for-profit, higher education and research organisations. The results of the summit brought forth key factors, which if addressed, would help create a more favourable environment for advancing the principles of health and safety integration.

The efforts of this summit resulted in a May 2015 article in the Journal of Occupational and Environmental Medicine titled ‘Integrating Health and Safety in the Workplace’. In this article the authors identify key factors for:

  • Determining why health and safety integration is important and how it should be defined.
  • Formulating what should be measured to evaluate the impact of IHS programmes.
  • Describing how employers can systematically develop and implement IHS programmes.

The article said there is not only a need for a better definition of the components that comprise an integrated health and safety programme but that a clearer demonstration of the value proposition for IHS is required.

Additionally, a key set of metrics is also needed in order to effectively measure the results of these strategies and determine their value for employers, investors, and policymakers.

According to the Journal of Occupational and Environmental Medicine article, a set of practical, scalable, comprehensive guidelines is needed for employers and specifically for their health and safety teams that would give guidance on how to integrate strategic health and safety programmes across operational silos.

Historical silos

For several decades employers have made significant progress in improving worksite safety with falling accident rates whilst health issues although also being addressed to a certain extent have largely been given less priority. According to the HSE in the UK between 1974 and 2014 fatal injuries to employees have fallen by 87% and reported non-fatal injuries by 77% to 2012.


Rates of stress and related conditions have doubled. Recent statistics on ill health issued by the HSE show:

  • An estimated 1.2 million people who worked in 2013/14 were suffering from an illness they believed was caused or made worse by work. 535 000 of these were new cases which started in the year.
  • Around 80% of the new work-related conditions in 2013/14 were musculoskeletal disorders or stress, depression or anxiety.
  • An estimated 2604 new cases of work-related ill health seen in general practice clinics were reported by 157 GPs in 2013. The majority of the cases were work-related musculoskeletal disorders (48%) and mental ill health (38%) (THOR-GP).
  • Rates of total cases and new cases of self-reported work-related illness, and specifically MSDs, have generally fallen since 2001/02, although rates in the latest year are higher than those in 2011/12.

For the most part this has been accomplished through a host of factors including coordination of effort between employers, governmental agencies, employees and trade unions. As the science of safety has broadened, incident rates have diminished and for the most part industry has been able to successfully create an improved culture of safety, we now need to do more to improve the culture of health.

In the US we have seen the development of workplace wellness programmes as one of the responses to the increasing cost of providing medical benefits to employees, in the UK there is also a growing body of evidence that highlights the costs of absenteeism and presenteeism due to worker ill health and the importance of wellbeing programmes. Early on, these programmes were, for the most part, participation based with mixed results in cost containment and measurable metrics regarding absenteeism, presenteeism and overall return on investment.

Safety culture firmly rooted the foundation of a significant wellness culture has remained elusive.

For several decades we have seen the advancement of safety and workplace wellness develop in separate silos and even though they have evolved in tandem in most organisations, they operate separate from one another with different metrics, data sources and organisational reporting structures.

The conferences mentioned above were organised in part to recognize and develop an emerging new school of thought, as employers and others in the occupational health community have begun to observe health and safety in a new light. The conference supporters believe their impact in the workplace can be enhanced measurably by more judicious alignment of respective health and safety strategies as opposed to continuing in existing silos. Early evidence of the effectiveness of these emerging programmes is promising.

One of the things to come out of the UL/AECOM conference was the recognition and definition of five elements of IHS. Those essential elements are:

Planning: develop a rationale for why strategic integration is important and needed.

Assessment: evaluate the current health and safety status of the organisation.

Implementation: develop and implement a new, integrated strategy and vision.

Monitoring: create a system for collecting data and for monitoring and evaluating programmes during implementation.

Review: gauge progress periodically and take corrective action as needed.

When one looks at the above essential elements it becomes clear that achieving meaningful integration of safety and health with the many moving parts and traditional silos is no easy task.

One of the most powerful tools is technology and when combined with the emerging management philosophy a lot can be achieved.

The development of risk management technology like Sotarea and products from Cardinus, together with a strong commitment from executive management and other stakeholders, means it will be possible to accomplish what needs to be achieved.

Robert Dill is an employee benefit consultant and CEO of Sotarea, Inc. Robert’s career has been dedicated to helping companies, associations and union groups develop health trend management strategies and programmes to provide cost effective plans for employees and members. Sotarea, Inc. is an integrated health and safety (IHS) platform that brings disparate health and safety data sources together to provide management measurable and actionable data for the effective integration of health and safety programs.

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