H is for health

For anyone concerned with safe and healthy working environments, the initials speak for themselves. But how have definitions of the ‘health’ part of OSH changed, and what does this mean for workplaces and OSH professionals?

For millennia, occupational safety and health has been shaped by the forces that shape work itself. The ancient Greek physician Hippocrates told his followers that to understand their patients’ illnesses, they should look to their environment. And in the 16th century, German humanist scholar and metallurgist Georgius Agricola observed that ore miners suffered shortness of breath and died prematurely.

H is for history

The H in OSH has a long and venerable history, says Dr Karen Michell, IOSH’s research programme lead on occupational health (OH). 
‘If you go back to the 1700s, you’ll find writings 
by Bernardino Ramazzini – who is considered 
the father of OH – describing conditions that 
we’re still seeing today.’

But while concern for OH is nothing new, it has long been the poor cousin of safety, according to Dr Mike Esbester of the University of Portsmouth, a historian of safety and accident prevention in transport and leisure settings as well as in homes and workplaces, and co-author of the IOSH report The changing legitimacy of health and safety at work, 1960-2015 (Almond and Esbester, 2016).

‘There are all sorts of reasons why health has been problematic to approach and address,’ says Mike. ‘In most cases, you can tell very straightforwardly when someone’s had an 
accident: there’s a physical injury, or worse 
a fatality. But health is obviously much more 
long-term; it’s much more difficult to detect. 
There may be multiple employers involved, and 
you may not know where the exposure happened.’

Karen has seen this personally and professionally. ‘When I started out in OH in the 1990s, there was a heavy focus on injury prevention. In the entire time I worked in industry, I don’t think I ever saw an incident investigation for an occupational disease. They were all accident-related,’ she explains. ‘Compared with physical injuries, occupational ill health is far more insidious. I saw it in my own father, who went from being an active soccer player to struggling to walk from his car to his workplace. He thought he was becoming unfit. Only after he left employment was he diagnosed with asbestosis.’

The same is true between occupational health and occupational hygiene professionals, says Kevin Bampton, chief executive of the British Occupational Hygiene Society (BOHS) – most of whose members work as occupational hygiene scientists in the GB Health and Safety Executive (HSE), safety-critical industries and private-sector consulting. In the 1950s and 1960s, functions were separated into occupational hygiene (preventing exposures that lead to work-related ill health), OH (monitoring and supporting people who suffered ill health in the workplace) and occupational safety (protection from injury in the workplace), before becoming telescoped into ‘health and safety’. 

‘The safety focus has been great in saving lives and preventing injury, but it has not had the impact on health,’ says Kevin. ‘For every 100 people who die because of workplace health and safety failures, 99 die from health exposures and only one from accidents. You see a person falling off a ladder, but don’t see them dying from cancer in a hospital.’

H includes mental health

The past 25 years have seen mental as well as physical health being seen as a workplace issue. Many factors are responsible, including greater understanding of the prevalence and cost to business of mental ill health. There are 1.5 million people in the UK with a diagnosed long-term mental health condition in work, and some 300,000 people lose their jobs each year due to mental ill health, costing employers £33bn to £42bn a year in sick pay and lost productivity (Stevenson and Farmer, 2017).

Although much has been done to destigmatise mental health in the workplace, the pace of change remains sluggish (see Managing mental health, above). ‘As the nature of work has changed, we’ve realised that work has more and more impact on people’s mental health,’ says Karen. ‘We’re moving away from physical labour, especially in high-income countries, and towards jobs that require cognitive skills. That’s bringing many of these mental health issues to the fore.’

‘Twenty years ago, employers said mental health is an individual issue’

Organisations and initiatives – from Business in the Community’s (BITC’s) mental health for employers toolkit and Mind’s dedicated mental health at work website to Mates in Mind, which is altering attitudes to mental health in the construction industry – are all helping create cultures that champion good mental health and support workers who need it. 

Last year saw publication of the world’s first international standard on mental health at work: ISO 45003, Occupational health and safety management – psychological health and safety at work. 

W is for wellbeing

‘Twenty years ago, an employer would say that mental health in the workplace is an individual issue and not their concern,’ says Aditya Jain of Nottingham University Business School, a member of the International Organization for Standardization (ISO) committee on OSH. ‘Times have changed since then, but that doesn’t mean the solutions are simple and the problem has gone away. With a change in mindset and much-awaited tangible tools such as ISO 45003, there is a lot of hope that real change is on the horizon.’

Change is already under way at Bath and North East Somerset Council, says Tracy Curtis CMIOSH, its health, safety and wellbeing manager. The council recognised the issues of wellbeing early, rolling out a programme of mental health first aiders and health champions. She’s also impressed by what the construction industry has achieved. ‘They’ve been incredible with initiatives like Mates in Mind. I keep a close eye on that because I’m the proud owner of a son who works in construction.’

Having started out in HR at the council in the 1990s before moving into health and safety, Tracy’s role was redefined four years ago to include wellbeing. ‘I had a new director who restructured health and safety. I often tell her that she must have had a crystal ball, because focusing on wellbeing was absolutely the right thing to do. I’m still a member of the CIPD [Chartered Institute of Personnel and Development] as well as IOSH and both professions are now talking about wellbeing.’ The rise of wellbeing up the OSH agenda is something IOSH welcomes. Its guidance states that the issue is particularly important in an ageing workforce because good work is good for workers’ health and wellbeing and because employers must work harder to attract, retrain and retain staff (IOSH, 2018b).

Health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, the World Health Organization Constitution states (2020). Building on this definition, the guidance encourages OSH practitioners to be more effective and proactive in preventing work-related ill health as well as promoting health and good rehabilitation practices. ‘OSH practitioners should already be implementing strategies to address work-related health and safety risks. Wellbeing offers an opportunity for a different approach to getting health and safety on 
the business agenda,’ the guidance says.

C is for COVID

Since 2020, all these changes have been dwarfed by the effects of COVID-19, which upended notions of work and workplaces and challenged everyone to think and do things differently. Throughout the pandemic, the OSH community has been on the frontline, learning how best to respond to an existential threat, supporting businesses as well as an increasingly remote workforce.

Infectious diseases have risen up the OSH agenda. In December 2021, the HSE said that during 2020-21, 93,000 people reported they believed they may have caught COVID from exposure to the virus at work (HSE, 2021). The HSE introduced two new measures to understand the pandemic’s contribution to work-related ill health to estimate COVID-19 infections from exposure to the virus at work as reported by workers and other work-related illness caused or made worse by the pandemic.

The pandemic showed that British employers could implement dramatic and effective control of even the trickiest of diseases, says Kevin. ‘January 2021 – when all social opportunities for transmitting the disease had been curtailed – was a unique experiment in what businesses and employers could do to prevent disease. If employers were not effective in controlling COVID-19, cases would continue to spiral. Instead, they plummeted.’

And OSH professionals are providing vital support and advice on long COVID. The CIPD’s latest survey on health, wellbeing and absence in UK workplaces found that long COVID is now a major cause of long-term absence and 46% of organisations have employees who have 
– or have had – long COVID (CIPD, 2022).

The OSH professionals we spoke to all have COVID stories – of fear and burnout, but also of cooperation and leadership. All agree that COVID was – and remains – a massive challenge, but also a rare opportunity. The virus has significantly affected people’s mental health. OSH professionals have been stretched and stressed, but they will be central to the recovery of workers and businesses.

‘There will be a tsunami of mental health issues that derive from the pandemic,’ says Kevin. ‘Mass, extreme loss, without the scope for grieving; disruptions in the labour market; children’s mental health anguish – all these things amount to a crisis that we will either manage together or it will overwhelm us. Mental illness is the second pandemic. I hope companies, as they pick themselves up, look to ISO 45003 to address what will be the major HR issue of the next few years.’

But the pandemic has brought benefits that the OSH profession needs to reflect on and learn from. Michael Byrne is regional manager for the Building Safety Group (BSG), a major UK construction safety group for health, safety and environmental advice. A BSG member company provided safety advice to construction firms building the Nightingale hospitals, causing a sea-change in the way leaders, boardrooms and workers respond to OSH.

'If OSH professionals don’t collaborate, we are not going to get the holistic health management we need'

‘The pandemic changed working life, family life, social life – perhaps forever,’ he says. ‘People became aware of their own mortality. Suddenly it wasn’t just their own health and safety at stake – they could spread a virus that could also kill family and colleagues. People really started to listen.’

As boardrooms sought their advice, OSH professionals gained a seat at the top table, says Tracy. ‘Bizarrely, COVID has done us a huge favour; it’s absolutely raised the profile of health, safety and wellbeing. It feels different now. When we’re invited to meetings, it’s because [senior leaders know that] our opinion matters.’

The pandemic has also broken down barriers between OSH, HR, line managers and other professionals says Nick Pahl, chief executive of the Society of Occupational Medicine. ‘We are working well with CIPD, IOSH, ACAS, BITC and Mind, and with occupational therapists, psychologists and OH technicians.’ 

Interprofessional and multiprofessional working is key to solving problems. Kevin hopes another positive impact of the pandemic is that business becomes more broad-minded and outward-looking in its problem-solving. ‘Often we want to go to one place as an employer to get all the expertise that we need,’ he says. ‘We need to work closely as expert groups, both in the evolution of practice and ultimately in the delivery of solutions in the marketplace.’

The pandemic has taught us to expect the unexpected and that revolutionary change is not a thing of the past. What’s next for the H in OSH will be more of the same, as well as the increasing importance of data, technology and artificial intelligence, Nick believes: ‘From AI to hybrid working, the workplace is changing, and that’s a challenge.’

Access to OH services remains a key issue, says Karen. ‘Eighty per cent of the population don’t have access to OH services, so we’re going to have to find creative ways of delivering them.’ 

And health economics will rise up the agenda, Kevin says. ‘Healthy workplaces are the cornerstone of our national health. I hope the economics of health protection – incentives to prevent, rather than taxes to treat illnesses – will come to the fore. It is the only sustainable way to keep our country healthy.’ 

OSH will increasingly embrace sustainable development – in the shape of human capital as well as the Sustainable Development Goals (SDGs) adopted by the UN in 2015 as a call to end poverty, protect the planet, and ensure that by 2030 all people enjoy peace and prosperity.

According to Dr Peter Bonfield, vice-chancellor of the University of Westminster and chair of the IOSH Board of Trustees, OSH will be key to achieving this. ‘Sustainable development has started to come through. The SDGs embrace a host of issues to do with social justice, from equality and inclusion to poverty and education. Around one-third of the UN targets, from safety at work and good working practices to health and wellbeing, relate to OSH.’

P is for pride

If it all seems a little overwhelming, there are three key messages to take heart from. First, 
keep collaborating. ‘People have 
often been protective of their domains 
and expertise. But if OSH professionals don’t collaborate, we are not going to get the holistic health management we need,’ 
says Karen. Second, maintain – and build on – the current interest in, visibility of and reliance on OSH, says Nick. ‘OSH professionals helped us through the pandemic. They’ve helped provide organisations with answers about how 
to manage new risks. They still need to 
be that relevant voice for leadership 
– and potentially be leaders themselves.’

Third – and maybe most importantly – take time to reflect on all OSH has achieved, says Kevin. ‘Be proud of your profession, but learn about and value other professional expertise that can make it more impactful. Read, learn and inwardly digest ISO 45003. Reward yourself for the amazing contribution you make to giving others quality of life – and when they are giving you a hard time, 
just remember that you are giving them 
a future, even if they can’t see it.’  

Aditya Jain

Image credit | iStock