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Healthy workplaces english

  1. 1. Healthy workplaces:a model for actionFor employers, workers, policy-makersand practitioners
  2. 2. WHO Library Cataloguing-in-Publication Data endorsed or recommended by the World Health Or- ganization in preference to others of a similar nature Healthy workplaces: a model for action: for employ- that are not mentioned. Errors and omissions ex-i | Healthy workplaces: a model for action ers, workers, policymakers and practitioners. cepted, the names of proprietary products are distin- guished by initial capital letters. 1.Occupational health. 2.Health promotion. 3.Workplace - standards. 4.Occupational diseases - All reasonable precautions have been taken by the prevention and control. I.World Health Organization. World Health Organization to verify the information contained in this publication. However, the published ISBN 978 92 4 159931 3 (NLM classification: material is being distributed without warranty of any WA 440) kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with © World Health Organization 2010 the reader. In no event shall the World Health Or- All rights reserved. Publications of the World Health ganization be liable for damages arising from its use. Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Printed in Switzerland Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: Re- quests for permission to reproduce or translate WHO publications – whether for sale or for noncom- mercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e- mail: The designations employed and the presentation of the material in this publication do not imply the ex- pression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its fron- tiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain DESIGN & LAYOUT manufacturers’ products does not imply that they are Philippos Yiannikouris
  3. 3. ii | Healthy workplaces: a model for action“The wealth of business depends on the health of workers.” Dr Maria Neira, Director, Department of Public Health and Environment, World Health Organization COVER Vertical Job. Photographer: Francisco Monterro, USA. Safe equipment and safe behaviours are both essential to pre- venting occupational risks associated with hazardous tasks (2nd prize in the WHO/Pan American Health Organization (PAHO) photo contest 2010, My work, my health) OVERLEAF Mens job, womens job. Young workers in a pottery workshop in Amman, Jordan, 1993 © ILO
  4. 4. iii | Healthy workplaces: a model for action
  5. 5. ContentsContents ....................................................................................... iv iv | Healthy workplaces: a model for actionIntroduction ..................................................................................... 01I. Why develop a healthy workplace ..................................................................................... 04initiative?II. Definition of a healthy workplace ..................................................................................... 06III: Healthy workplace processes and ..................................................................................... 07avenues of influenceIV. The content: avenues of influence for a ..................................................................................... 09healthy workplaceV. The process: initiating and sustaining a ..................................................................................... 15programmeVI. Underlying principles: keys to success ..................................................................................... 21VII. Adapting to local contexts and needs ..................................................................................... 24References ..................................................................................... 25Acknowledgements ..................................................................................... 26
  6. 6. Introduction: a model for action Workers’ health, safety and well-being are vital nomic sectors, and health policy-makers and concerns to hundreds of millions of working practitioners. people worldwide. But the issue extends even01 | Healthy workplaces: a model for action further beyond individuals and their families. It is In 2007 the World Health Assembly of the of paramount importance to the productivity, World Health Organization endorsed the Work- competitiveness and sustainability of enterprises, ers’ health: global plan of action (GPA) to provide communities, and to national and regional econo- new impetus for action by Member States. This is mies. based upon the 1996 World Health Assembly Global strategy for occupational health for all. The Currently, an estimated two million people die 2006 Stresa Declaration on Workers’ Health, the each year as a result of occupational accidents 2006 Promotional framework for occupational health and work-related illnesses or injuries (1). An- and safety convention (ILO Convention 187) and the other 268 million non-fatal workplace accidents 2005 Bangkok charter for health promotion in a result in an average of three lost workdays per globalized world also provide important points of casualty, as well as 160 million new cases of orientation. work-related illness each year (2). Additionally, 8% of the global burden of disease from depres- The Global Plan of Action sets out five objec- sion is currently attributed to occupational risks tives: (3). 1) To devise and implement policy instruments on workers’ health; These data, collected by the International Labour 2) To protect and promote health at the work- Organization and the World Health Organiza- place; tion, only reflect the injuries and illnesses that 3) To promote the performance of, and access occur in formally registered workplaces. In many to, occupational health services; countries, most workers are employed infor- 4) To provide and communicate evidence for mally in factories and businesses where there are action and practice; no records of work-related injuries or illnesses, 5) To incorporate workers’ health into other let alone any programmes to prevent injuries or policies. illnesses. Addressing this huge burden of disease, economic costs and long-term loss of human In line with the Global Plan of Action, this bro- resources from unhealthy workplaces is a formi- chure provides a framework for the develop- dable challenge for national governments, eco- ment of healthy workplace initiatives adaptable to diverse countries, workplaces and cultures.
  7. 7. 02 | Healthy workplaces: a model for action
  8. 8. OVERLEAF The strength of teamwork . Photographer: Andrés Bernardo López Carrasco, Mexico. Workers in a warehouse lift a heavy metal structure in unison to prevent injury (1st prize in the WHO/Pan American Health Organization (PAHO) photo contest 2010, My work, my health) BELOW Humanizing work. Photographer: Marcelo Henrique Silveira, Brazil. A nurse in a Brazilian hospital takes time to read to a patient, offering a moment of mutual enjoyment (3rd prize in the WHO/Pan American Health Organization (PAHO) photo contest 2010, My work, my health)03 | Healthy workplaces: a model for action Subsequently, practical guidance specific to sec- The review of this evidence is available in a 2010 tors, enterprises, countries and cultures will be background document, Healthy workplaces: a developed by WHO, in collaboration with coun- global framework and model: review of literature and tries, experts and stakeholders. practices. It is available online at: The principles outlined here are based on a sys- tematic review of healthy workplace pro- healthy_workplaces/en/index.html grammes in the global literature, including defini- tions, policies and practices for improving work- place health. The documentation was reviewed at a 22-23 October 2009 Geneva workshop in- volving 56 experts from 22 countries, WHO re- gional offices, related WHO programme repre- sentatives, an ILO representative, two interna- tional NGO representatives, and worker and employer representatives (see acknowledge- ments).
  9. 9. I. Why develop a healthy workplace initiative?It is the right thing to do: business ethics workers health are among the most successful and competitive, and also enjoy better rates of employee retention. Some factors employers 04 | Healthy workplaces: a model for actionPersonal and social codes of behaviour and ethicsare the foundation of every major religious and need to consider are:moral philosophy. One of the most basic of uni-versally accepted ethical principles is to “do no a) the costs of prevention versus the costs re-harm” to others. In the workplace, this means sulting from accidents;ensuring employees health and safety. b) financial consequences of legal violations of health, safety and occupational rules and laws;Long before national labour and health regula- c) workers health as an important business as-tions came into being, business entrepreneurs set for the company.learned that it was important to adhere to cer-tain social and ethical codes related to workers, Adherence to such principles avoids undue sickas part of their role in the broader community leave and disability, minimizes medical costs asand to insure the success of their endeavours. well as costs associated with high turnover such as training, and increases long-term productivityIn the modern era, both global declarations and and quality of products and services.voluntary organizations have emphasized the im-portance of ethical business practices involving Increasingly, consumer power also is being lever-workers. The 2008 Seoul declaration on safety and aged to promote healthy workplace at work (4) asserts that a safe and healthy For instance, a number of global movements ofwork environment is a fundamental human right. ethics-minded entrepreneurs and consumersThe United Nations Global Compact is a voluntary have introduced commercial "fair trade" labelsinternational leadership platform for employers. appealing to developed-country consumers.It recognizes the existence of universal principles These labels aim to ensure the health and socialrelated to human rights, corruption, labour stan- well-being of producers as well as environmentaldards and the environment. safeguards in product processing.It is the smart thing to do: the business case It is the legal thing to do: the legal caseA wealth of data demonstrates that in the long Most countries have enacted national and eventerm, companies that promote and protect local legislation requiring at least minimal em-
  10. 10. BELOW Paraplegic teacher in training centre, Harare, Zimbabwe, 1992 © ILO05 | Healthy workplaces: a model for action ployer protection of workers from workplace guilty of violations. Multinational companies that hazards that could cause injury or illness. As try to cut worker health and safety costs by trade mechanisms and awareness have devel- moving their most dangerous industrial proc- oped, and major industrial accidents in develop- esses to countries where health, safety and la- ing countries have received increased worldwide bour legislation or enforcement are perceived as media attention, many developing countries have weaker may discover that their firms and prod- increased their enforcement of occupational ucts become the focus of intense international health codes and laws. and media scrutiny, undermining their markets and profitability. Businesses that fail to provide healthy work envi- ronments do not only leave employees, their families and the public exposed to undue risks and human suffering. In addition, their enter- prises and leadership may become involved in costly litigation under national or international labour laws. This can result in fines or even im- prisonment of managers and directors found
  11. 11. II. Definition of a healthy workplaceWHO’s definition of health is: “A state of com-plete physical, mental and social well-being, andnot merely the absence of disease.” In line with 06 | Healthy workplaces: a model for actionthis, the definition of a healthy workplace thatwas developed in the consultations that tookplace around this document, is as follows:A healthy workplace is one in which workers and manag-ers collaborate to use a continual improvement process toprotect and promote the health, safety and well-being of “A healthy workplace isall workers and the sustainability of the workplace by con-sidering the following, based on identified needs: one in which workers and health and safety concerns in the physical work envi- managers collaborate to ronment; health, safety and well-being concerns in the psychoso- use a continual cial work environment, including organization of work and workplace culture; improvement process to personal health resources in the workplace; and ways of participating in the community to improve the protect and promote the health of workers, their families and other members of health, safety and well- the community.This definition reflects how understanding of oc- being of all workers andcupational health has evolved from an almost the sustainability of theexclusive focus on the physical work environ-ment to inclusion of psychosocial and personal workplace...”health practice factors. The workplace is increas-ingly being used as a setting for health promotionand preventive health activities – not only to pre-vent occupational injury, but to assess and im-prove peoples overall health. Another increasingemphasis is on workplaces that are supportiveand accommodating of older workers and thosewith chronic diseases or disabilities.
  12. 12. III. Healthy workplace processes and avenues of influence To create a healthy workplace, an enterprise Critical process aspects of the model include an needs to consider the avenues or arenas of influ- emphasis on a step-by-step continual processes ence where actions can best take place and the of mobilization and worker involvement around07 | Healthy workplaces: a model for action most effective processes by which employers and a shared set of ethics and values, as shown in workers can take action. According to the model Figure 1. The model’s key content and process described here, developed through systematic components are discussed in sections IV and V. literature and expert review, four key areas can be mobilized or influenced in healthy workplace initiatives:  the physical work environment;  the psychosocial work environment;  personal health resources;  enterprise involvement in the community. “To create a healthy workplace, an enterprise needs to consider the avenues or arenas of influence where actions can best take place and the most effective processes by which employers and workers can take action.”
  13. 13. FIGURE 1WHO healthy workplace model: avenues of influence,process, and core principles 08 | Healthy workplaces: a model for action Physical work environment Mobilize Improve Assemble Leadership engagement Psychosocial Personal work Evaluate ETHICS & VALUES Assess health environment resources Worker involvement Do Prioritize Plan Enterprise community involvement
  14. 14. IV. The content: avenues of influence for a healthy workplace Figure 2 depicts the four arenas in which actions physical safety and health as well as mental health towards a healthy workplace can best be taken. and well-being. In cases where workers perform These are briefly described below and selected tasks in a vehicle or outdoors, those vehicles or09 | Healthy workplaces: a model for action examples of typical actions also are provided. outdoors locations are also part of the physical These avenues of influence often overlap with work environment. one another, as the figure’s four overlapping cir- cles reflect. Hazards in the physical environment typically have the greatest potential to disable or kill workers, 1. The physical work environment so the earliest occupational health and safety laws and codes focused on these factors. Even The physical work environment refers to the so, these types of hazards still threaten workers’ structure, air, machinery, furniture, products, lives on a daily basis in developed as well as de- chemicals, materials and production processes in veloping countries. the workplace. These factors can affect workers’ Physical work Environment Psychosocial work Personal health environment resources Enterprise community involvement FIGURE 2 Avenues of influence for a healthy workplace
  15. 15. Problems typically include: exhaust ventilation to remove toxic gases, chemical hazards (solvents, pesticides, asbes- installing noise buffers and providing safe nee- tos, silica, tobacco smoke); dle systems and patient lifting devices in hos- 10 | Healthy workplaces: a model for action physical hazards (noise, radiation, vibration, pitals. excessive heat, nanoparticles);  Administrative controls: employers can ensure biological hazards (e.g. hepatitis B, malaria, good housekeeping, train workers on safe HIV, tuberculosis, mould, lack of clean water, operating procedures, perform preventive toilets and hygiene facilities); maintenance on machines and equipment and ergonomic hazards (e.g. processes requiring enforce smoke-free policies. excessive force, awkward posture, repetition,  Personal protective equipment can include respi- heavy lifting); rators for employees working in dusty condi- mechanical hazards (e.g. machine hazards re- tions; masks, gloves and respirators for health lated to nip points, cranes, forklifts); care workers; and hard hats and safety boots energy hazards (e.g. electrical hazards, falls for construction workers. from heights); mobile hazards (e.g. driving on ice or in rain- 2. The psychosocial work environment storms or in unfamiliar or poorly maintained vehicles). The psychosocial work environment includes organizational culture as well as attitudes, values,Examples of ways to influence the physical work envi- beliefs and daily practices in the enterprise thatronment: Typically, hazards must be identified, affect the mental and physical well-being of em-assessed and controlled through a hierarchy of ployees. Factors that might cause emotional orcontrol processes. Key steps typically include the mental stress are often called workplacefollowing: stressors. Elimination or substitution: e.g. a factory may opt to replace benzene, a powerful carcino- Examples of psychosocial hazards include but are gen, with toluene or another less-toxic not limited to: chemical. An office might eliminate driving in  poor work organization (problems with work dangerous conditions by holding teleconfer- demands, time pressure, decision latitude, ence meetings. reward and recognition, support from super- Engineering controls include installing machine visors, job clarity, job design, poor communi- guards on stamping machines, setting up local cation);
  16. 16. OPPOSITE Tokyo, 8 am on the way to the office, 1990 © ILO  organizational culture (lack of policies and  Protect workers by raising awareness and pro- practice related to dignity or respect for all viding training to workers, for example re- workers, harassment and bullying, gender dis- garding conflict prevention or harassment11 | Healthy workplaces: a model for action crimination, stigmatization due to HIV status, situations. intolerance for ethnic or religious diversity, lack of support for healthy lifestyles); 3. Personal health resources in the work-  command and control management style (lack place of consultation, negotiation, two-way commu- nication, constructive feedback, respectful Personal health resources are the health ser- performance management); vices, information, resources, opportunities,  lack of support for work-life balance; flexibility and otherwise supportive environment  fear of job loss related to mergers, acquisi- an enterprise provides to workers to support or tions, reorganizations or the labour market/ motivate their efforts to improve or maintain economy. healthy personal lifestyles, as well as to monitor and support their physical and mental health. Ways to influence the psychosocial work environ- ment: Psychosocial hazards typically are identified Examples of personal health resource issues in the and assessed using surveys or interviews, as workplace: Employment conditions or lack of compared to inspections for physical work haz- knowledge may make it difficult for workers to ards. A hierarchy of controls would then be ap- adopt healthy lifestyles or remain healthy. For plied to address hazards identified, including: example:  Eliminate or modify at the source: Reallocate work to reduce workload, remove supervi-  Physical inactivity may result from long work sors or retrain them in communication and hours, cost of fitness facilities or equipment, leadership skills, enforce zero tolerance for and lack of flexibility in when and how long workplace harassment and discrimination. breaks can be taken.  Lessen impact on workers: allow flexibility to  Poor diet may result from lack of access to deal with work-life conflict situations, provide healthy snacks or meals at work, lack of time supervisory and co-worker support to take breaks for meals, lack of refrigeration (resources and emotional support), allow to store healthy foods or lack of knowledge. flexibility in the location and timing of work,  Smoking may be allowed or enabled by work- and provide timely, open and honest commu- place environments. nication.
  17. 17. 12 | Healthy workplaces: a model for action “Hazards in the physical environment typically have thegreatest potential to disable or kill workers, so the earliest occupational health and safety laws and codes focused on these factors.”
  18. 18.  Illnesses may remain undiagnosed and/or un- status testing) and medical treatment if it is treated due to lack of accessible, affordable not accessible in the community (e.g. antiret- primary health care. roviral treatment for HIV).13 | Healthy workplaces: a model for action  Lack of knowledge or resources for preven-  Initiate health education and support activities tion of HIV/AIDS may result in high levels of upon employees’ return to work from a work HIV infection. -related illness or disability to prevent relapse or repeat of injury. Examples of ways to enhance workplace personal health resources: These may include medical ser- 4. Enterprise community involvement vices, information, training, financial support, fa- cilities, policy support, flexibility and promotional Enterprises impact on the communities in which programmes to enable and encourage workers they operate and are impacted by their commu- to develop healthy lifestyle practices. Some ex- nities. Workers health, for instance, is pro- amples are: foundly affected by the physical and social envi-  Provide fitness facilities for workers or a fi- ronment of the broader community. Enterprise nancial subsidy for fitness classes or equip- community involvement refers to the activities in ment. which an enterprise might engage, or expertise  Encourage walking and cycling in the course and resources it might provide, to support the of work functions by adapting workload and social and physical wellbeing of a community in processes. which it operates. This particularly includes fac-  Provide and subsidize healthy food choices in tors affecting the physical and mental health, cafeterias and vending machines. safety and well-being of workers and their fami-  Allow flexibility in timing and length of work lies. breaks to allow for exercise.  Put no-smoking policies in place and enforce Examples of ways enterprises may become involved them. in the community: The enterprise may choose to  Provide smoking cessation programmes for provide support and resources such as: employees.  Initiating activities to control pollution emis-  Provide confidential medical services such as sions and clean up production operations, or health assessments, medical examinations, to address polluted air or water sources in medical surveillance (e.g. measuring hearing the community more generally. loss, blood lead levels, HIV and tuberculosis  Supporting community screening and treat-
  19. 19. ment for HIV infection, tuberculosis, hepatitis make a profound difference for more vulner- or other prevalent diseases. able sectors of the enterprises workforce or Extending free or subsidized primary health communitys residents. In a setting where af- 14 | Healthy workplaces: a model for action care to workers and their families or support- fordable health care is absent or labour and ing the establishment of primary health care environmental legislation weak or missing, the facilities in the community. These can serve enterprise’s community involvement may groups that do not otherwise have access, e.g. make a world of difference to the community’s employees of small and medium-size enter- environmental health as well as to employees’ prises and informal workers. and their families’ quality of life. Instituting gender equality policies within the workplace to protect and support women or protective policies for other vulnerable groups, even when these are not legally re- quired. Providing free or affordable supplemental lit- eracy education to workers and their families. Providing leadership and expertise related to workplace health and safety to small and me- dium-size enterprises (SMEs). Going beyond legislated standards for mini- mizing the enterprise’s carbon footprint. “Enterprise community Extending access to antiretroviral medications to workers’ family members. involvement may make a Working with community planners to build bike paths, sidewalks, etc. world of difference Subsidizing public transportation and bicycles to the communitys for employees to ride to work. environmental health...”In a country, city or region with universal healthcare and strong, well-enforced legislation relatedto health, safety, pollution emissions and humanrights, enterprise initiatives in a community may
  20. 20. V. The process: initiating and sustaining a programme The process of developing a healthy workplace is format as represented in Figure 3. Steps in the in many ways as critical to its success as its con- process are described below and Section VI dis- tent. The WHO model is anchored in a well- cusses its underlying principles.15 | Healthy workplaces: a model for action recognized organizational process of "continual improvement" which ensures that a health, safety 1. Mobilize and well-being programme meets the needs of all concerned and is sustainable over time. The To mobilize workers and employers to invest in concept (5) recognizes that any new endeavour change, it is often necessary to first collect infor- is unlikely to be perfect from the start. A model mation about peoples needs, values and priority of "continual improvement" for workplace health issues. People hold different values and operate and safety was developed in 1998 by the WHO in differing ethical frameworks. They are moti- Regional Office for the Western Pacific. The vated to action by different things – by data, sci- model has been gradually modified by experts ence, logic, human stories, conscience or reli- and agencies such as the ILO into the present gious beliefs. Knowing who the key opinion Mobilize Improve Assemble Leadership engagement Evaluate ETHICS & VALUES Assess Worker involvement Do Prioritize FIGURE 3 WHO model of healthy workplace continual Plan improvement process
  21. 21. leaders and influencers are in an enterprise and community occupational health clinic or repre-what issues are likely to mobilize them will be sentatives from a local industry-specific networkcritical to building commitment around an action or a health and safety agency may be invaluable. 16 | Healthy workplaces: a model for actionor initiative. 3. Assess2. Assemble Assessment is typically the first task the healthyOnce key stakeholders have been mobilized, workplace team addresses, using diverse toolsthey will be able to demonstrate their commit- and measures such as:ment by assembling a "healthy workplace team"and resources to work on implementing a par- Baseline data on workplace inspections, priorticular change in the workplace. If there is an hazard identification and risk assessment proc-existing health and safety committee, that pre- esses, health and safety committee minutes, em-existing group may be able to take on this addi- ployee demographics, turnover and productivitytional role. statistics, union grievances (if applicable). All these should be documented if available. If aIn a large enterprise, the health and safety com- comprehensive hazard identification and risk as-mittee should include representatives from vari- sessment has not been done, it should be doneous levels and sectors of the business. These may at this time. Current policies or practices relat-include health and safety professionals, human ing to the four avenues of influence should beresource personnel, engineers and any medical reviewed and tabulated.personnel who provide services. The ILO rec-ommends that in joint health and safety commit- Workers’ health is another critical factor to assesstees workers have at least equal representation in terms of occupational health data, such aswith employers representatives. It is also critical rates of sick leave and workplace-related injuriesto have equitable gender representation on such and illnesses, including short- and long-term dis-teams (6). abilities. The other essential aspect is the per- sonal health status of employees. This informa-In a small enterprise, the involvement of experts tion may be obtained via a confidential survey, oror support personnel from outside the organiza- in smaller business settings, a walk-through withtion may be helpful. For example, medical per- a checklist and/or dialogue between the manager,sonnel from a neighbouring large enterprise or workers and ideally a health professional.
  22. 22. OPPOSITE Building construction in Chicago, USA, 1987 © ILO The desired future for the enterprise and workers  Ease of implementing solutions, such as “quick must also be assessed. For a large corporation, wins” that may motivate and encourage con- this may involve some benchmarking exercises to tinued progress;17 | Healthy workplaces: a model for action determine how similar companies are doing with  Risk to workers (severity of exposure to a respect to the data just described. It may be im- hazard and probability that exposure will oc- portant to do a literature review to read recom- cur); mendations or case studies of good practice. For  Possibility of making a difference, e.g. exis- individual workers, it is necessary to ask their tence of effective solutions, employer readi- ideas about how they would seek to improve ness to change, likelihood of success and their working environment and health, and what other issues related to workplace policies or they think the employer could do to assist them. politics;  The likely costs of ignoring or neglecting the For a small enterprise, determining local good problem; practice is important. Talking to local experts or  The subjective opinions and preferences of visiting local enterprises that have addressed the workplace parties, including managers, similar situations is a good way to find out what workers and their representatives. can be done and get ideas on how to do it. 5. Plan Whatever methods are used to collect this infor- mation, it is important to make sure that women The next step is to develop a health plan. The have as much opportunity for input as men, and plan developed by a small or medium-size enter- that their issues can be disaggregated. prise, at least initially, might be quite simple, de- pending on the enterprise’s size and complexity. 4. Prioritize It may focus on a few of the priorities identified as most critical to health, as well as goals most Priority-setting criteria should take diverse fac- readily attainable, with an indication of time tors into consideration while recognizing that frames. some priorities are more directly essential to health, such as limiting exposure to occupational In a large enterprise, a plan could take a much hazards. Other criteria that may be considered more complex, “big picture” approach to the are: next 3-5 years. This kind of plan would set out general activities to address priority problems
  23. 23. 18 | Healthy workplaces: a model for action“For a small enterprise, determining local good practice is important.Talking to local experts or visiting enterprises that have addressed similar situations is a good way tofind out what can be done and get ideas on how to do it.”
  24. 24. BELOW Lady with sewing machine, Republic of Korea, 2008. Photog- rapher: Suvi Lehtinen, Finland. Developing healthy work- places in the informal economic sector is a global challenge that needs to be faced.19 | Healthy workplaces: a model for action with broad time frames. The overall plan should After obtaining any required approvals for the have some long-term goals and objectives set in plan, it is time to develop specific action plans order to measure success. After developing the that spell out goals, expected outcomes, time long-term plan, annual plans would be developed lines and responsibilities. For health education to address issues in order of priority. programmes, it is important to go beyond raising When considering solutions, it is important to awareness to include skill development and be- remember the “learn from others” principle and haviour change. The required budgets, facilities to research ways of solving problems. It also is and resources should be included, as well as important at this point to remember the four planning for launching, marketing and promoting avenues of influence when developing solutions. the programme or policy, training for any new For example, a common mistake is to think that policy, maintenance and evaluation plan. Ensuring solutions for problems in the physical work envi- that each point in a plan or an initiative has ronment must always be physical solutions, clearly stated, measurable goals and objectives when, for instance, training or behaviour change will make evaluation easier. might also address the issue.
  25. 25. 6. Do add on the next components. On the other hand, some notable successes may have beenThis is the “just do it” stage. Responsibilities for achieved. It is important to recognize successes, 20 | Healthy workplaces: a model for actioneach planned action should be assigned to vari- to appreciate the people who participated inous actors within the implementation team and achieving the successful outcome and to makefollow-up should be ensured. sure that all stakeholders are aware of the achievement.7. EvaluateEvaluation is essential to see what is working andwhat is not, and to determine why or why not.Both the implementation process and outcomesshould be evaluated in the short and long terms.In addition to evaluating each initiative, it is im-portant to evaluate the healthy workplace pro-gramme’s overall success after 3-5 years, or aftera significant change such as new management.Sometimes repeating a survey or reviewing the Leadership engagementkinds of data collected as a baseline can providethis overall assessment. While it is unlikely thatthe changes to worker health will be able to be ETHICS & VALUEScausally linked to changes in enterprise produc-tivity or profitability, it is important to trackthese numbers and compare them to bench- Worker involvementmarks.8. ImproveThis last step is also the first in the next cycle ofactions. This involves making changes based on FIGURE 4evaluation results. These changes can improve Underlying principles - keys to successthe programmes that have been implemented, or
  26. 26. VI. Underlying principles: keys to success While all enterprises have different needs and Workers and their representatives must not sim- situations, there are some key underlying princi- ply be “consulted” or “informed” about what is ples of a healthy workplace initiative that will happening but must be actively involved, with21 | Healthy workplaces: a model for action raise its likelihood of success. Figure 4 refers. their opinions and ideas sought out, listened to and implemented. 1. Leadership engagement based on core values Due to the inherent dynamics of relations be- tween labour and management, it is critical that This hinges on three factors. The first is mobiliz- workers have some collective means of expres- ing and gaining commitment from major stake- sion, stronger than that of individual workers. holders, because a healthy workplace pro- Participation in trade unions or representation gramme must be integrated into the enterprise’s by regional worker representatives can help pro- business goals and values. Another must is get- vide this voice. ting necessary permissions, resources and sup- port from owners, senior managers, union lead- 3. Gap analysis ers or informal leaders. It is critical to get that commitment and buy-in before trying to pro- This involves assessment of "what is the situation ceed. The third factor is providing key evidence now?" as compared with what ideal conditions of this commitment by developing and adopting a would be, and then dealing with gaps between comprehensive policy that is signed by the enter- the two. prise’s highest authority and communicated to all workers. This clearly indicates that healthy work- 4. Learn from others place initiatives are part of the organization’s business strategy. It is important to acknowledge that not every- one, including workplace health and safety offi- 2. Involve workers and their representa- cials, has the knowledge and tools to address tives certain priority issues. In such cases, it is impor- tant to call upon other experts, e.g. researchers One of the most consistent findings of effective- from a local university or experts in a local safety ness research is that in successful programmes agency. Union representatives who have received the workers affected must be involved in every special occupational safety and health training step of the process from planning to evaluation. and occupational health and safety experts in
  27. 27. BELOW Office of home appliance company, Hangzhou, China © ILO 22 | Healthy workplaces: a model for actionlarger enterprises in the community may also be 6. The Importance of integrationrecruited. These experts can mentor and assistsmaller enterprises. Visiting other enterprises to In larger organizations, work is increasingly spe-observe local good practice is another excellent cialized. Similarly, in many large organizations,way to learn from others. Additionally, the vir- health and safety personnel work in one depart-tual world contains a wealth of resources and ment, wellness professionals in another and hu-information, including the websites of ILO, man resource professionals in yet other depart-WHO and its Collaborating Centres for Occupa- ments. The latter group deals with many issuestional Health and Safety. related to leadership, staff development and the psychosocial work environment. All of these de-5. Sustainability partments are separate from the enterprise’s management team, which is focused on increasedEvaluation and continuous improvement are key, output quality and quantity. Often these activitiesas is ensuring that healthy workplace initiatives will work at cross purposes or in direct opposi-are integrated into the enterprise’s overall stra- tion to worker health, even though the healthytegic business plan rather than existing in a sepa- workers are as critical as other aspects of pro-rate isolated work group. duction and quality.
  28. 28. How can integration be assured? Here are a few An integrated approach would examine all examples: aspects of the problem and thus identify a  Strategic planning must incorporate the hu- wider range of effective solutions.23 | Healthy workplaces: a model for action man side of the equation. Kaplan and Norton  Behaviour that is rewarded is reinforced. A in 1992 developed a “balanced scorecard” performance management system that re- approach to management and integrated man- wards high output, regardless of how the re- agement systems (7). It points out the desir- sults are achieved, will encourage people to ability of measuring not only financial per- take shortcuts or to use less-than-healthy formance but also customer knowledge, in- interpersonal skills to get work done. On the ternal business processes and employees’ other hand, a performance management sys- learning and growth to develop long-term tem that sets behavioural standards as well as business success. output targets can reinforce the desired be-  Develop and gain senior management accep- haviours and recognize people who demon- tance and use of a health, safety and well- strate behaviours and attitudes that lead to a being “filter” for all decisions. healthy workplace culture.  Keep the various components of a healthy  Use of cross-functional teams or matrices can workplace in mind whenever a problem is help reduce isolation of work groups. If an being addressed. For example, if muscu- organization has a health and safety commit- loskeletal disorders were occurring among tee and a workplace wellness committee, they people who work all day at sewing machines, could avoid working in isolation by having a common (and appropriate) approach would cross-membership, so that each is aware of be to examine the ergonomics of the opera- and able to participate in the other’s activities. tors in their work stations, and to fix any haz- ardous physical conditions. However, addi- tional contributors to the problem might be psychosocial issues such as workload and time pressure. And there may be personal health issues related to physical fitness and obesity that are contributing to the problem. Or a lack of primary health care resources in the community may mean workers cannot be as- sessed and treated in the early stages of pain.
  29. 29. VII. Adapting to local contexts and needsThe healthy workplace model set forth here implementation of the WHO Global Plan of Actionrepresents a synthesis of best available knowl- advances, the WHO and its Member States, col-edge and experiences worldwide, as collected laborating centres and other experts will provide 24 | Healthy workplaces: a model for actionand analyzed by occupational health experts in more targeted and practical guidance. This willdiverse countries. guide enterprises, employers and workers, in applying principles of this framework to differentIt provides guidance for action at the workplace cultures, sectors, and workplaces, in adherencelevel, particularly when the employer, workers with the principles of continuing improvement ofand their representatives work together in a col- interventions.laborative manner. However, workplaces exist ina much larger context. Governments, nationaland regional laws and standards, civil society,market conditions and primary health care sys-tems all have a tremendous impact on work-places, for better or for worse, and on what canbe achieved by workplace parties.These interrelationships are extremely complex,and are expanded upon in the Healthy workplacesbackground document cited in page 3. Guidanceand procedures are also needed to engage di-verse actors directly in healthy workplaces initia- “...developing andtives. In terms of advancing workplace health, developed countries havedeveloping and developed countries have verydifferent needs and challenges, as do smaller and very different needs andlarger enterprises. The Background document alsoincludes examples of how this model might be challenges, as do smallerimplemented in large and small enterprises, andcase studies of what works and what doesn’t and larger enterprises. ”work in diverse situations. Links and resourcesprovided there can help employers, workers,policy-makers and practitioners adapt these prin-ciples to their specific situations. Additionally, as
  30. 30. References (1) ILO, Facts on safety at work. April 2005. Useful links: (2) ILO/WHO joint press release. Number of WHO Occupational Health home-25 | Healthy workplaces: a model for action work-related accidents and illnesses continues to page: increase: ILO and WHO join in call for preven- tion strategies. 28 April 2005. WHO Healthy Workplaces homepage: http:// (3) Prüss-Ustün A, Corvalan C. Preventing dis- healthy_workplaces/en/index.html ease through health environments: towards an estimate of the environmental burden of disease. WHO Collaborating Centres: http:// Geneva: WHO, 2006. (4) ILO website: download/43103/824949/ file/2Seoul_Declaration.pdf WHO healthy workplaces background docu- ment: (5) The concept of continual improvement was first popularized in the 1950s by social scientists healthy_workplaces/en/index.html. such as Edward Deming, who developed the Plan, Do, Check, Act (PCDA) model. This, in turn, was inspired by the scientific method of “hypothesize, experiment, evaluate.” (6) Recommendation 164 to Convention 155 on Occupational Safety and Health, 1981Review 82 (2): 52-63. (7) Kaplan RS, Norton DP. "The balanced score- card: measures that drive performance." Harvard Business Review 82(2): 52-63.
  31. 31. AcknowledgementsLead author: Marilyn Fingerhut, National Institute for OccupationalJoan Burton, BSc, RN, MEd, strategy advisor for the Safety & Health, USAIndustrial Accident Prevention Association, Canada. Fintan Hurley, Institute of Occupational Medicine, UK 26 | Healthy workplaces: a model for action Alice Grainger Gasser, World Heart Federation, Swit-The photos on the cover page, and on pages 2 and 3, zerlandwere winning entries in a first-ever photographic Nedra Joseph, National Institute for Occupationalcompetition on the theme, Healthy workplaces, my Safety & Health, USAwork, my health, sponsored by the WHO Regional Wolf Kirsten, International Health Consulting, Ger- manyOffice for the Americas/Pan American Health Organi- Rob Gründemann, TNO, The Netherlandszation (PAHO) in 2010. Kazutaka Kogi, International Commission on Occupa- tional HealthProject working group: Ludmilla Kožená, National Institute of Public Health,Evelyn Kortum, Global project coordinator, Depart- Czech Republicment of Public Health and Environment, World Wendy Macdonald, Centre for Ergonomics & HumanHealth Organization, Geneva, Switzerland Factors, Faculty of Health Sciences, La Trobe Univer-PK Abeytunga, Canadian Centre for Occupational sity, AustraliaHealth & Safety, Canada Kiwekete Hope Mugagga, Transnet Freight Rail, SouthFernando Coelho, Serviço Social da Indústria, Brazil AfricaAditya Jain, Institute of Work, Health and Organisa- Buhara Önal, Ministry of Labour and Social Security,tions, United Kingdom Occupational Health and Safety Institute,TurkeyMarie Claude Lavoie, World Health Organization, Teri Palmero, National Institute for OccupationalAMRO, USA Safety & Health, USAStavroula Leka, Institute of Work, Health and Organi- Zinta Podniece, European Agency for Safety andsations, United Kingdom Health at Work, SpainManisha Pahwa, World Health Organization, AMRO, Stephanie Pratt, National Institute for OccupationalUSA Safety and Health, USA Stephanie Premji, CINBIOSE, Université du Québec àPeer reviewers: Montréal, CanadaSaid Arnaout, WHO Regional Office for the Eastern David Rees, National Institute of Occupational Health,Mediterranean Region (EMRO), Cairo, Egypt South AfricaJanet Asherson, International Employers Organization, Paul Schulte, National Institute of Occupational SafetySwitzerland & Health, USALinn I. V. Bergh, Industrial Occupational Hygiene As- Tom Shakespeare, Disability Task Force, Worldsociation, and Statoil, Norway Health Organization, Geneva, SwitzerlandJoanne Crawford, Institute of Occupational Medicine, Cathy Walker, Canadian Auto WorkersUK (retired),CanadaReuben Escorpizo, Swiss Paraplegic Research (SPF), Matti Ylikoski, Finnish Institute of OccupationalSwitzerland Health, Finland
  32. 32. Healthy Workplaces: a model for action For employers, workers, policy-makers and practitionersWorkers’ health, safety and well-being are vital Dr Maria Neiraconcerns to hundreds of millions of working Directorpeople worldwide. However, the issue extends Department of Public Health and Environmenteven beyond individuals and their families. It is of World Health Organizationparamount importance to the productivity, com-petitiveness and sustainability of enterprises,, and to national and regional econo-mies. World Health Organization 20, Avenue AppiaCurrently, an estimated two million people die CH‐1211 Geneva 27each year as a result of occupational accidentsand work-related illnesses or injuries. Another T: +41 22 791 2111268 million non-fatal workplace accidents, as well F: +41 22 791 3111as 160 million new cases of work-related illness,occur each year. Additionally, 8% of the global www.who.intburden of disease from depression is currentlyattributed to occupational risks.This document proposes a global framework forplanning, delivery, and evaluation of essential in-terventions for workplace health protection andpromotion.