In July, the Health and Safety Executive (HSE) released two sets of data relating to deaths in the workplace. Provisional fatal injury statistics showed that a total of 147 people died as a result of work-related injuries (bit.ly/1jMmGvo) in 2018/19. That same month it was revealed that 2,523 people died as a result of mesothelioma (a cancer caused by asbestos exposure) in 2017 (bit.ly/1F3QbTC).
There is a huge disparity between these ï¬gures, yet it is often noted that industry has historically given far more attention to safety than health. There have been numerous efforts to redress this imbalance, such as IOSH's No Time to Lose campaign, which aims to raise awareness of, and find solutions to, work-related cancers (bit.ly/2GHmc09). This bias may partly be due to the unconscious, mental shortcuts (or heuristics) that we use to make sense of the world.
There are two schools of thought about heuristics. For the psychologists Daniel Kahneman and Amos Tversky, they are a source of error, leading people to arrive at decisions that defy the laws of statistics -- Kahneman was later awarded the Nobel prize for this work (bit.ly/2XcTbNo). Gerd Gigerenzer, a psychologist and a director emeritus in the Max Planck Institute, instead proposes that heuristics are a range of fast, decision-making strategies that help us to survive and thrive when we have limited or uncertain knowledge -- hence Gigerenzer uses the term 'fast and frugal' heuristics (bit.ly/2Hvm2at).
For example, if we are in a social situation and don't know what is expected of us, we could unconsciously select the 'social proof heuristic', which means adopting the same behaviour as others. Hotels have used this approach to encourage guests to reuse towels (bit.ly/32bmpiv).
Imagine that you wanted more information about a health issue. An internet search brings up reports from the HSE, the UK's National Health Service, a commercial organisation and an academic institution -- but you only have time to read one. Which would you pick? You could use the 'take-the-best' heuristic, in which one unconsciously uses one's own personal experience to create criteria to distinguish between different options. For example, you might ï¬rst consider which organisations are likely to have the most reliable information (perhaps enabling you to reject one or two), then you might consider which you personally know the best. The process goes on until you are left with one. Although this ï¬ltering happens unconsciously, you may be aware that you dithered briefly before making a ï¬nal decision.
If you walked into a situation where someone was overreaching on a step ladder and someone else was working with noisy equipment without hearing protection, you would need to decide which person to talk to ï¬rst. In this scenario, you would most likely adopt the 'take-the-ï¬rst' heuristic and act on your ï¬rst impulse. The question, however, is how you'd arrive at that judgement. To help us, we are likely to riï¬ e through a mental 'Filofax', and identify whichever hazard most easily conjures up examples of serious harm -- this is the 'recognition heuristic' at work (bit.ly/2LcCOfG).
Lack of mental images
When these heuristics are applied to health, many people will lack memories or mental images of people who have sustained health damage, and therefore instinctively consider them to be less relevant, compared with the vivid aftermath of an accident.
This can happen for many reasons. Work-related health conditions may become apparent only once someone has left the workplace, or the person may ï¬nd ways of adapting to their deteriorating health, making it less obvious to others. Seeing someone with an arm in plaster represents a dramatic change which is more easily noticed and sticks in our memory more than gradually declining health (neuroscience calls this 'salience'). Once a salient event is lodged in our memory, we will see a further occurrence as signiï¬cant, and our hippocampus will ï¬ le it in our long-term memory. This can become a self-reinforcing cycle, leading us to overestimate safety risks and under-estimate health risks.
The case studies in IOSH's No Time to Lose campaign illustrate how personal stories can be used to create powerful, meaningful memories, rather than reams of statistics, that we can unconsciously draw on to inform our judgements. Incidentally, we are also more likely to remember and be inï¬uenced by the most recent events -- the 'recency eï¬ect' (bit.ly/2Zpol56). Consequently, there may be value in rearranging the sequence of communications, so that they end with a key, impactful message about health.
An easier choice
Richard Thaler, an economist who went on to win a Nobel prize, and Cass Sunstein, a legal scholar, drew on these ideas when developing and justifying Nudge Theory, set out in the book Nudge. This attempts to side-step a lot of these challenges by simply making the healthiest choice the easiest one to adopt. The classic examples are putting healthier snacks near checkouts, or increasing organ donations by requiring people to opt out rather than opt in.
Our heuristics support us in making immediate judgements about a situation. Our strategies for ï¬nding and processing information will prioritise anything that immediately threatens or supports our goals in that situation. 'Melioration bias' describes the resultant cognitive bias where we attach more importance to immediate and certain outcomes rather than distant and uncertain consequences. The long latency period between exposure to health hazards and their discernible eï¬ ects, and our uncertainty that exposure will deï¬nitely lead to ill health, means that naturally we will be inclined to consider them less relevant than safety hazards and their instant and obvious consequences.
Public health campaigns sometimes try to tackle these biases by employing graphic images of the unseen damage of cigarettes, for example. This enables us to readily visualise the immediate harm being done to our bodies. However, this has to be done sensitively. Paul Slovic, the guru of risk perception, points out that we can develop a sense of dread about some risks (bit.ly/2mmheMX) that could be counter-productive if we stop engaging with the training material.
Seeing someone with an arm in plaster represents a dramatic change which is more easily noticed and sticks in our memory more
It is possible to double-check whether unconscious biases are apparent in, or could be supported by, the messages we give out. A recent example was the decision by the Safety Institute of Australia to rebrand itself as the Australian Institute of Health and Safety. At a much simpler level, we could review templates for workplace inspections or past safety bulletins, and see whether health has an equivalent place to safety.
All of this can help to 'normalise' health-related discussions, which will generate even more material for our brains to process. In recent years, there have been high-proï¬le eï¬orts to achieve this through discussions about employee mental health.
If we want health messages to become salient, and lodged in the memory so they can sway future judgements, it is worth considering whether health information could be more impactful coming from an occupational health professional. Alternatively, a health and safety professional could establish themselves as a credible source of information -- for example, by being seen to work closely with the occupational health provider, and drip-feeding short, accurate and relevant health facts and case studies through meetings and/or social media channels.
Although unconscious biases may result in people instinctively prioritising safety over health, it is possible to account for this, and to ensure health messages are absorbed and inï¬uence judgements and decisions.
