Managing health in the workplace
Health has traditionally played a poor second to safety. Nick Bell, Colin Powell and Peter Sykes offer their top ten tips on how to better manage health in the workplace.
Health hazards, and their consequences, can sometimes be harder to visualise than safety issues. In fact, that’s one of the precise problems that allow us to downplay the significance of health issues. [1,2] Therefore, it may be helpful to tackle the subject with a scenario.
Let’s imagine that we employ someone to count traffic. In a typical week she’ll be covering the morning and evening rush hours, and several hours in between, at busy junctions in a city. It’s fairly easy to imagine what hazardous events could injure her (and what the results would be). These could include being struck by vehicles, tripping on uneven surfaces or someone being physically violent. We would never ask her to work in a position where she would be in the path of a passing vehicle or wing mirror.
No matter where she stands, she will be exposed to a host of hazards that could harm her health: Soot from exhaust emissions, the noise of rush hour traffic (or nearby streetworks), high or low temperatures (and whatever the weather or sun wants to throw at us), the ergonomic issues of being on her feet for hours and the psychological effects if she is abused or threatened.
We can quickly get our hands on some facts and figures regarding these health hazards. For example, people regularly exposed to diesel engine exhaust fumes are up to 40 per cent more likely to develop lung cancer and more than 650 people a year die of lung or bladder cancer caused by diesel fumes at work.  The challenge is trying to work out whether our traffic counter is having a potentially harmful level of exposure to health hazards and what we can do to manage the risks.
Health issues are usually more complex matters to assess and manage than safety issues.  It can be difficult to see, hear, taste or feel the hazards that can harm our health so we may not know that we might be or have been exposed. Even when we are aware of the hazards, we need appropriate skills and equipment and careful planning to accurately assess our exposure. Randomly measuring noise at a road junction will not provide any meaningful insight into this individual worker’s noise exposure.
In some instances, we might not know what represents a ‘safe’ threshold. For example, how much sun exposure could give our worker skin cancer and how could we realistically and accurately measure her ultraviolet light exposure? We simply have to take reasonable precautions, and HSE guidance to workers hasn’t changed since 1998.  More detailed advice for employers appeared in these pages earlier this year. [6,7]
Cancers are just one of a plethora of chronic health effects that can take many years to develop or through random quirks of luck and genetics may not appear at all. This is another factor which makes it easy for us to downplay the significance of health issues: We pay closer attention to outcomes which are immediate and certain, rather than distant and uncertain. 
A logical approach
It is not all doom and gloom. Health issues can be managed effectively by broadly using the same systematic approach that we apply to safety: The HSE’s Plan-Do-Check-Act model.  For the reasons outlined above, some extra thought and care is needed. Here are our top ten tips to make the model work in practice.
1. A holistic audit: An audit is a really good place to start. This needs to go beyond looking at how health hazards are identified and controlled and should cover procedures around managing employee health such as pre-start checks, health surveillance etc. As many as 40 per cent of companies have no arrangements at all for managing sickness absence.  Returning to our scenario, it might also be informative to compare the sickness (or turnover) rates of our traffic counters to other teams.
2. Back to basics: Health hazards come in all shapes and forms. These can be physical, chemical, biological, ergonomic and psychosocial. Using this simple framework might help to plan and structure audits. An audit of biological issues, for example, could cover the management of legionella and sharps. When used as part of a risk assessment methodology, e.g. for the traffic counting job, this framework can be a surprisingly useful way of winkling out health issues.
3. What’s in a word? Watch out for terminology or procedures that exclude health such as safety inspections or behavioural safety. Is this just a matter of semantics or are we genuinely missing health issues? For example, some companies have lists of ten or 12 life-saving or golden rules. These are usually (and probably unhelpfully) biased towards safety e.g. wearing seat belts, holding onto handrails or use of lockout tag-out procedures.
4. Benchmark: When we bring on new workers, and they are likely to be exposed to health hazards, we need to think carefully about whether a pre-start questionnaire is enough or whether we need to do more to establish if that individual has pre-existing conditions that we need to take into account. Such evidence can also be essential if responding to any subsequent civil action.
5. Escape the silos: It is critical that human resources, health and safety, unions, management and third party providers all work together on health issues.  Collectively, we have the data and skills to identify and investigate trends, patterns etc. Specialist working parties, sub-committees and so on may then need to be formed to tackle specific health issues.
6. Help workers visualise health risks: Our traffic counter might return home and find that the TV seems quieter than normal or discovers that the ‘arisings’ when she sneezes are black and sooty. Obviously, training must help workers to recognise and act on health-related signs and symptoms. However, it could also try to tackle our innate tendency to ignore things that we cannot visualise or which have distant and uncertain consequences. Recent government smoking cessation adverts show what cigarette smoke might look like if it was visible to the naked eye, and the physical harm it causes to our bodies. Our own health-related training can take the same approach and might show the emotional fall out, too.
7. Domestic exposure: Staff may be trained to protect their hearing at work but, depending on her hobbies, our traffic counter could significantly add to her personal noise exposure outside work. Training sessions might help her to reflect on the precautions she could take in her own time. This can bring howls of protest about the ‘nanny state’ but it is in the workers’ and employers’ best interests to help staff to keep themselves healthy wherever they are.  On that basis, some companies offer smoking cessation support, general health MOTs, healthy eating campaigns etc.
8. Coaching: We have previously discussed the benefits of coaching to improve health and safety outcomes.  This is probably even more important for health issues than safety. Most managers will appreciate the safety issues faced by our traffic counter. With some open questions, we could get insights into how her health is being affected and potential solutions. We might also sense whether our employee is dismissing health risks, which could be a beneficial area to explore together.
9. Lines in the sand: The ‘managers manage, advisors advise’ mantra may not work particularly well with some health issues. It may be necessary to accept that some issues are so complex that they need to be referred to the health and safety team. It would probably be unrealistic to expect a line manager to assess and act on the traffic counter’s exposure to exhaust fumes.
10. Resource appropriately: Measuring, monitoring and managing health hazards can take specialist (i.e. not particularly cheap) skills and equipment  as well as time and effort across an organisation. This inevitably means we need to get senior management buy-in.  Many of the previous steps will equip us with the facts and figures we need to make a business case. Directors might also be persuaded by Dame Carol Black’s argument and supporting evidence : Good health is good business.
By recognising what makes health hazards more complex issues to tackle than safety, we can begin finding solutions. Once health issues are being managed effectively, employers might start examining the wellbeing agenda (which goes beyond safeguarding and promoting health).
- Pachur, T., Hertwig, R., Steinmann, F., 2012. How Do People Judge Risks: Availability Heuristic, Affect Heuristic, or Both? Journal of Experimental Psychology: Applied, 18(3), 314-330.
- Sharman, A., 2015. Unconscious thinking. Safety and Health Practitioner, May 2015.
- IOSH, 2014. Diesel Engine Exhaust Fumes: The Facts. Available online at: http://www.iosh.co.uk/~/media/NTTL%20files/POL2531%20-%20Diesel%20Fact%20Sheet%20WEB.ashx
- Fishwick, D., 2015. Moving Health from the Margins. Safety and Health Practitioner, May 2015.
- HSE, 1998. Keep your top on: Health risks from working in the sun. INDG147 (rev1). Available online at: hse.gov.uk/pubns/indg147.pdf
- Madgwick, P., 2015. Sun exposure and skin cancer health advice for outdoor workers. Safety and Health Practitioner, April 2015.
- Patel, C., 2015. A burning issue. Safety and Health Practitioner, May 2015.
- Zohar, D., Erev, I., 2007. On the difficulty of promoting workers’ safety behaviour: overcoming the underweighting of routine risks. International Journal of Risk Assessment and Management, 7(2), 122 – 136.
- HSE, 2013. Managing for Health and Safety. Available online at: http://www.hse.gov.uk/pubns/books/hsg65.htm
- Dame Carol Black, 2008. Working for a healthier tomorrow. London: TSO. Available online at: https://www.gov.uk/government/publications/working-for-a-healthier-tomorrow-work-and-health-in-britain
- Bell, N., Powell, C., Sykes, P., 2015. Transformational Leadership. Safety and Health Practitioner, April 2015.
Nick Bell, CFIOSH, runs his own risk consultancy, Dr Colin Powell is a member of the academic team and Dr Peter Sykes is a principal lecturer at Cardiff School of Health Sciences, Cardiff Metropolitan University
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