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October 26, 2010

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Construction – Structural deficit

The construction industry is notorious for paying inadequate attention to workers’ health, says Michelle Aldous, who proposes a new framework to help businesses address the shortfall in the sector’s occupational-health delivery.

Even with the huge decline in economic activity experienced by some parts of the construction sector during the recession, the industry, as a whole, remains a powerhouse of the economy and a significant employer.

Given the size and importance of the sector, its record on occupational health clearly deserves considerable attention. Work-related illness in the UK costs society an estimated £10 billion each year, with the musculoskeletal conditions common to workers in construction accounting for £5.5 billion of this total,1 and thought to be responsible for a quarter of working days lost through absence.2

Thousands of workers die every year of occupational health-related conditions, yet fewer than a hundred – albeit, still far too many – are killed at work as a result of failures in safety.3 It is equally sobering to know that 20 skilled workers (such as electricians, plumbers, etc.) die every week from asbestos-related disease, and 12 more construction workers die every week from silica-related lung cancer.4

Further data from the HSE confirm the magnitude of the occupational-health issues facing construction – 88,000 people currently working, or recently employed in the sector are suffering from an illness caused, or made worse, by their job.57National importance has been placed on the creation and maintenance of a health and well-being management strategy, particularly following the publication of Dame Carol Black’s review of the health of the UK’s working population, and supporting data. As such a prominent employer, construction must step up to this challenge and make the necessary changes.6

But why does construction have such a poor record when it comes to occupational-health management? One factor is the latent nature of many construction-related occupational-health issues. Conditions that may take decades to develop cannot be effectively monitored by employers. Construction workers frequently move employer and spend periods as self-employed, so it becomes very difficult, if not impossible, to monitor workers’ health over the long term.

But the sheer size and nature of the sector also goes some way to explaining why occupational-health management is such a challenging task, a challenge that grows exponentially when you consider the complexity of the construction supply chain.

Primary contractors on a given site have clear roles and responsibilities, plus, being generally larger and longer-lived businesses, they also tend to have a more stable workforce. As the supply chain shakes out, sub-contractors and sub-sub-contractors tend to be small to medium-sized enterprises (SMEs), or self-employed workers, many of whom have neither the infrastructure nor any incentive to factor occupational-health monitoring and management into their operations.

What is encouraging, however, is the acceptance that a ‘bottom-up’ safety culture is not likely to succeed,7 so the responsibility for driving change in the sector lies with larger players, such as primary contractors. These organisations should be able to see the business benefits of encouraging occupational health in their workforce, both from a financial point of view and a corporate social responsibility perspective. Those imperatives should persuade primary contractors to insist that their supply chains follow suit – right down to giving support and guidance to self-employed workers.

There is a clear process for firms to follow – understanding occupational health as clearly distinct from safety, and then creating a workable and economically justifiable occupational-health management programme. The challenge then is to engage with the long ‘tail’ of the supply chain and insist that a condition of sub-contractors winning contracts is that they adopt their own fit-for-purpose occupational-health processes.
What are the health risks in construction?

Most work-related health disorders suffered by UK construction workers fall into one of the following six groups:

  • MSDs – the most common occupational illness in the UK, affecting muscles, tendons, ligaments, nerves, and other soft tissues and joints;
  • Hand-Arm Vibration Syndrome (HAVS) – typically, this develops from the use of hand-held power tools; carpal tunnel syndrome (CTS) and vibration white finger are other conditions that can develop;
  • noise-induced hearing loss – continual, or sudden exposure to noise can lead to irreversible hearing loss;
  • skin disorders – mostly work-related irritant dermatitis, or eczema, caused by cement, sand and other substances, and which can develop into an allergy;
  • respiratory disease – includes asthma and chronic obstructive pulmonary disease (COPD), plus asbestosis; and
  •  work-related stress – the HSE defines stress as “the adverse reaction people have to excessive pressure, or other types of demand placed on them”.8

Despite the fact that construction workers,  as an occupational group, have one of the highest rates of occupational ill health, awareness of the topics outlined above is mainly restricted to the larger contractors.9 This lack of knowledge is compounded by the fact that employers in the construction industry are not sure where to go for expert help.

The business case for health in construction

Few organisations have the luxury of being able to adopt strategies that do not, in some way, contribute to financial well-being. Construction firms operate in a sector where margins can be slim and where, in a tough economic climate, breaking even can be viewed as an admirable achievement. At the top end of the supply chain, contractors are mostly publicly-owned and must maintain healthy profits to appease investors, whereas, on site, many sub-contractors live hand-to-mouth, with all cash invested in maintaining operations.

Neither of these scenarios would suit a corporate social responsibility attitude that did not pay for itself, and is, perhaps, why long-term worker-health management strategies are seen by many as a non-starter. However, the evidence suggests that investing in worker health and well-being does produce a return on investment.

Dame Carol Black’s report clearly identifies non-financial reasons for investing in health and well-being initiatives:10

‘pure’ corporate social responsibility to improve the quality of life of the workers and their families;

  • differentiation of conditions of employment to attract and retain the best staff in a competitive labour market; and
  • halting the rising cost of sickness in the workforce, which could threaten the very survival of individual businesses.

Clearly, the second and third reasons will also, ultimately, impact positively on the financial performance of a business.

A greater incentive for the larger contractors to invest in occupational-health management programmes can be found in research by PricewaterhouseCoopers (PwC), as reported in the Black report.11 PwC conducted a literature review and compiled more than 50 UK case studies that showed a positive impact as a result of introducing health and well-being programmes.

Benefits included: reduced absence due to sickness; lower turnover of personnel; higher levels of employee satisfaction; lower levels of accidents and injuries; higher productivity; and improved company profile.

Each of these, by themselves, could be an attractive argument to introduce a new initiative. But, considered together, they make a highly compelling case for occupational-health monitoring as being, at the least, cash-neutral and, at best, having a positive impact on the bottom line.

Creating an OH strategic framework

A potential occupational-health framework could address the issue at two levels:

  • having a manageable scheme for employers, which enables them to quickly assess new workers while minimising their record-keeping and administrative burdens; and
  • having a tailored and personalised record for each worker, which assesses the risks specific to the worker and informs the resulting occupational-health strategy.

This two-pronged solution would enable a site manager to instantly assess a worker’s fitness for a given task. It would also satisfy the audit requirements for sub-contractors providing workers, in addition to the main contractor’s personnel.

Constructing Better Health has introduced a card scheme, which can be linked to the CSCS and other industry-related card schemes, to satisfy the occupational-health management programme requirements of employers and individual workers.

Training and education, which target both workers and employers, are a key component of the scheme. Rapid and widespread take-up will only happen if workers are satisfied that their occupational-health records are working in their favour and not preventing them from working.

Employers will also need to become educated clients of occupational-health service providers, who can provide the expertise currently lacking at management level. In the results of a pilot, it was highlighted that employers’ managers lacked not only occupational-health expertise but also the knowledge about where to find help and how best to apply the expertise available.12

Figure 1 overleaf provides a simple representation of how the process could work. It starts with the contractor completing an occupational-health risk analysis.

On completion of the risk analysis, a contractor would have an individual action plan produced that reflects the actual occupational-health risks faced by workers as a result of the contractor’s specific activities on site. The action plan will clearly highlight guidance on preventative measures that should be taken. It will also indicate the health-surveillance programme required as a result of the occupational-health risks identified.

The next stage for the contractor would be to contact an occupational-health provider accredited with Constructing Better Health, in order that a workforce health-surveillance programme can be finalised and delivered.

On completion of the health assessments of individual workers, the outcomes would be returned to the contractor and, assuming the worker provides consent, the data uploaded on the system’s database. An education campaign is particularly important to ensure that workers understand what data will be supplied to the database and how the results will impact on the improvement of future work-related health issues for the construction industry workforce.

Individual workers will each receive a card that provides the route for site management to confirm their health and fitness to perform particular roles on site. This ensures that the main contractor running the site knows that all sub-contractors and self-employed workers have undergone occupational-health assessments, and prevents workers engaging in tasks that they should not perform.

In parallel, the contractor can maintain records on each individual worker. The audit trail will allow sub-contractors to demonstrate to primary contractors that they have implemented an occupational-health management strategy. In addition, the audit trail can be kept on record, in the event of any future civil claim by the worker.


The last decade has seen an intense policy focus on health and well-being in the workplace. Traditional models of fitness for work have been challenged and the positive power of employment has been trumpeted as a pathway to returning to work.

As the UK economy cycles through another recession, with the inevitable reduction of the construction workforce, desperately-needed construction skills are leaving the sector. Entry-level recruitment is not enough to fill the gap, and the spectre of ill health promises to heap more woes on a troubled industry.

While the safety element of health and safety in the sector has received much merited attention in the past decade, health has been the poor relation. Pilot occupational-health monitoring schemes have identified clear gaps in the management skills of construction’s current and future leaders. This needs to be tackled immediately for the following reasons:
 We need to keep key skills in the construction sector;

  • Healthy companies perform much better;
  • We need to reduce the cost of health liabilities and the risk of future litigation; and 
  • It is the right thing to do as part of a corporate social responsibility agenda.

1  HSE (2000): Securing Health Together: A long-term occupational-health strategy for England, Scotland and Wales, p3
2  Black, C (2008): Working for a healthier tomorrow, p41, The Stationery Office
3  Donaghy, R (2009): One death is too many: Inquiry into the underlying causes of construction fatal accidents, p10 and p45
4  Ibid. p13
6  Health, Work and Wellbeing Steering Board (2008): Improving health and work: changing lives (the Government’s response to Dame Carol Black’s review of the health of Britain’s working-age population)
7  Donaghy, R: p11
8  Constructing Better Health (2008): Occupational-health standards for the UK construction industry, Part one: Fitness for Work Standards, Constructing Better Health, Croydon
9  Constructing Better Health (2008): Occupational-health standards for the UK construction industry, Part two: Standards for occupational-health service providers working within the construction industry. Constructing Better Health, Croydon
10  Black, C: pp53-4
11  Ibid.
12  Tyers, C, Sinclair, A, Rick, J, Lucy, D, Cowling, M and Gordon-Dseagu, V (2007): Constructing Better Health: Final Evaluation Report, HSE Books 

Michelle Aldous is chief executive at Constructing Better Health.

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