With work increasingly recognised as a valuable health outcome in its own right, an effective occupational health service can add value to an organisation and contribute to employers’ strategies to provide and promote ‘good’ work, writes Professor Anne Harriss.
Occupational health (OH) delivery is multi-faceted, frequently involving a multi-professional team that may include physicians, ergonomists, occupational hygienists, physical therapists and psychologists.
Within many organisations, occupational health nurses (OHNs) are the linchpin of this provision, ensuring that the health of employees is not adversely affected by their work, nor their work tasks adversely affected by their health status.
OH interventions commence at recruitment, continuing throughout the person’s employment until the time they leave the organisation. To be effective, those delivering OH services must have a broad understanding of the factors impacting on the health and wellbeing of the workforces with whom they work.
This article aims to give an overview of the interplay of some of the factors impacting on the physical and mental health of workers and how OH strategies can contribute to work being what Taylor (2017) considers to be “good work”.
Taylor’s concept of good work is referred to later. The World Health Organization (2012) recognises that exposure to workplace health hazards is a major influence on the social determinants of health across the WHO European region and accounts for more than 300,000 worker fatalities annually.
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It would be a utopian assumption that all employees have 100% health and fitness for 100% of the duration of their employment.
A proportion of employees across the UK will have differing abilities; some of these may be hidden such as those that are neurodiverse.
The difficulties experienced by a wheelchair user, say, or a person who is visually impaired and has a guide dog will be more obvious. Many living with significant physical or mental health challenges are still able to stay in work as a result of the expertise and advice of OHNs.
Work as a health outcome
As Waddell and Burton (2006) highlight, and the Trade Union Congress (2015) later confirmed, work is good for health.
To be effective, those delivering OH services must have a broad understanding of the factors impacting on the health and wellbeing of the workforces with whom they work.”
Work should be viewed as a health outcome by all healthcare professionals, whether those practitioners work in primary or secondary care settings.
Unfortunately, many health professionals may find this a steep learning curve, as the effects of work on health and health on work are not yet a required component within their pre-registration preparation.
As a consequence of this gap in their pre-registration education, a large proportion of healthcare practitioners seem to have a poor understanding of the principles of OH. They are unaware of the benefits of collaborative working with OH services to support an effective, graduated and early return to work.
Work, health, wellbeing and occupational health practice
OH practice has long been underpinned by the principle that work should be good for health. Worker health has far-reaching effects impacting on the well-being of themselves, their families and the communities in which they live.
Black (2008) emphasises the importance of supporting those with significant health deficits to gain employment. She refers to the importance of developing strategies to integrate those who have been absent from work because of illness or injury back into the work environment.
This is important for the worker and their family. Families lacking a member who is in work are more likely to live in poverty and face the challenges of inequalities of health. There is a correlation between lower parental income and the poor health of their children.
Improved health of the working-age population has implications for society as it supports the economy and has the potential to increase social equality, so reducing inequalities in health. OH strategies to enable people to stay in work is therefore an important public health initiative
Black and Frost (2011) were commissioned by the Department for Work and Pensions (DWP) to report on sickness absence management systems. They were tasked with identifying any flaws in these systems and to make recommendations for improvement to facilitate people staying in work.
Of particular interest to the DWP was the opportunity for reduced government spending on sick pay and associated benefits. Unfortunately, this report was not followed by a statutory requirement for all employees to have access to appropriate OH advice.
Improved health of the working-age population has implications for society as it supports the economy and has the potential to increase social equality, so reducing inequalities in health. OH strategies to enable people to stay in work is therefore an important public health initiative.”
Young and Bhaumik (2011) highlight that only 38% of workers in the UK have access to an occupational health service, contrasting starkly to the situation in Finland, where more than 90% of employees have such provision (World Health Organization, 2012).
Employers providing OH services can demonstrate social responsibility and concern for their staff, thereby enhancing their image with stakeholders including employees, regulators, shareholders and investors.
Business case for intervention
Such provision is not just an altruistic organisational intervention, there are benefits for all parties. Highly effective companies commit to a culture of health as they recognise the inter-relationships between good workplaces, wellbeing, employee engagement, and productivity (Nicholson 2017).
Employee health and wellbeing interventions contribute to effective employee engagement and reduced costs associated with sickness absence and lost productivity. These impact on successful business performance. Occupational health provision, therefore, adds definite organisational value and should be viewed by them as an investment, not a cost.
It has been confirmed that work, provided it is ‘good’ work, is good for employee health and wellbeing (Black 2008; Waddell and Burton, 2006).
It provides an income stream, enabling workers to provide for themselves and their families. Financial buoyancy facilitates a more comfortable lifestyle, funding past-times and activities from which they gain enjoyment.
For some, provided they receive what they consider to be fair remuneration, job satisfaction, opportunities for career progression and job tasks that are interesting and fulfilling are of equal importance to financial reward.
Opportunities for positive social interaction at work are important for promoting mental health and wellbeing. For many, the work they undertake is a significant facet of their identity, particularly when they find their work meaningful and it is valued and respected.
Job satisfaction versus increased absence
Meaningful work is inextricably linked with job satisfaction and less meaningful work is associated with increased sickness absence.
Those workers engaged in what they consider to be meaningful work are less likely to miss work than those who report merely being satisfied with their jobs. Interestingly, there is also an association between meaningful work, lower levels of depression and better satisfaction with life in general (Steger et al 2012, Steger 2017).
Some work processes, such as those in the construction sector, have inherent dangers but effective management controls and OH interventions can considerably reduce those risks.
For example, OHNs assess and confirm fitness to work for both safety-critical and non-safety-critical roles. Statutory health surveillance is required for employees using vibrating tools, work in noisy environments or with hazardous chemicals.
The aim of this surveillance is the early identification of work-related health changes. OHNs are also well placed to ascertain aspects of work that might have adverse effects on worker health as a result of their knowledge of workplace hazards and elements of the working environment, work equipment and work processes design.
Health and wellbeing within construction
Construction work is undoubtedly hazardous. There were 40 fatalities in construction during 2019 and an average of 37 fatalities pa the years between 2015-16 and 2019-2020 reveal an average of 37 fatalities to workers year, of these construction deaths 47% over the same five year period resulted from falls from height (Health and Safety Executive, 2020).
Despite these alarming statistics, many of those employed in the sector consider it to be ‘good’ work for them.
They value the high demand for skilled and non-skilled workers and companies are willing to pay competitive salaries to attract the talented workers they need.
They appreciate that employers invest in their workforce, on-the-job training is an industry-standard and paid apprenticeships are available for a wide variety of tradespersons from plumbers and electricians to steel erectors, and contractors involved in tunnelling.
Some roles have a very high degree of reliance on each other for safety – particularly jobs involving work carried out in confined spaces or those above ground such as scaffolding, roofing and steel erection.
Despite the sub-contracting nature of the sector, the teamwork required to complete projects can result in strong networks developing.
Knowing their contribution has been valued and integral to the completion of a project can be satisfying. The larger construction companies support the health of their employees through the delivery of corporate wellness initiatives.
An effective OH service adds value to the organisation when delivering proactive approaches to wellness. It supports return-to-work recovery strategies resulting from injury or significant illness, whether that be physical or mental ill health.”
Although many construction workers consider their work to be ‘good’, a significant number of them have issues with their mental health. Randstad, for example, highlights that 34% of construction workers had suffered from sub-optimal mental health in the preceding 12 months.
The mental health charity Mates in Mind has made a commitment to focusing on the mental health of construction workers to address this. OH professionals are well placed to be involved in promoting mental health in this sector.
Black (2008) refers to evidence that good work directly benefits employees, their families and the population as a whole. The review of modern working practices by Taylor (2017) was established to consider what constitutes good work, the implications of the rise of the ‘gig economy’ and modern working practices.
Its primary focus was not on workplace health but elements of the Taylor report have a strong message for workplace health and human resource professionals.
Good job and work design
This includes the premise that work should be fair, decent and provide realistic scope for both development and fulfilment. Good design of workplaces, work processes and work equipment get the best out of people and good work sustains and promotes mental health and wellbeing. Integral to this review was the idea that well-run companies recognise the importance of the people who work for them and treat their workforce with respect.
Taylor stresses the strategic importance and benefits of healthy workplaces and appropriate work-life balance, noting that good-quality work is strongly associated with better health outcomes. Reference is made to the ‘QuInnE’ model, which proposes six indicators of job quality, namely:
- wages
- employment quality
- education and training
- consultative collective representation
- working conditions, and
- work-life balance.
Unfortunately, a safe working environment is not made explicit within working conditions. HR and management functions influence the first four of the indicators that contribute to job quality, but OH advice can influence working conditions and work-life balance.
It can play an important part in the development of the organisation’s health and health and safety policies. In May 2021 the HR body the Chartered Institute of Personnel and Development (CIPD) published its ‘Mental Health at Work Commitment’.
This CIPD initiative is supported by a range of public and private sector organisations, including the Cabinet Office, higher education, financial services, construction and manufacturing. Examples of such organisations are included in the section on the CIPD’s website featuring this initiative.
The CIPD commitment is designed to aid organisations to promote employee mental health and wellbeing, to support staff with sub-optimal mental health, and to demonstrate that mental health is an organisational priority. It provides a framework of actions underpinned by six standards:
- prioritising workplace mental health
- promoting an open culture around mental health
- increase organisational confidence and capability
- provision of mental health tools and support
- increasing transparency and accountability through internal and external reporting, and
- being proactive in ensuring work design and organisational culture drive mental health outcomes.
The standards also incorporate proactive approaches to ensure work design and organisational culture do not adversely affect employee mental health. Organisational policies are central to this and should include those that address excessive work demands, diversity, inclusion and dignity at work.
The content of, and policy compliance reflects the organisation’s values and influences its culture and management strategies.
They are also congruent with the core standards of the Stevenson/Farmer (2017) review of mental health and employers. These, to recap, included:
- producing, implementing then communicating a mental health-at-work plan
- fostering mental health awareness amongst the workforce
- encouraging open conversations about mental health highlighting available support should employees be struggling to cope
- providing employees with good working conditions, opportunities for development and ensuring they have a healthy work-life balance
- promoting effective people management by line managers and supervisors, and
- routinely monitoring employee health and wellbeing.
Conclusions
‘Good’ work, therefore, not only enables people to support themselves and their families financially but, with the right kind of support from employers and others, work can have a positive impact on health and wellbeing.
Just as it has become conventional for both parents of small children to work, in an ageing society we must get better at supporting those with caring responsibilities and health conditions to remain active contributors over longer working lives.
There is a definite overlap between OH and management interventions to ensure that work does not harm health or wellbeing, indeed the premise is that work should enhance health and wellbeing.
In conclusion, an effective OH service adds value to the organisation when delivering proactive approaches to wellness. It supports return-to-work recovery strategies resulting from injury or significant illness, whether that be physical or mental ill health.
Ultimately, the input of occupational health contributes to employers’ strategies to provide ‘good’ work.
References
Black, C ( 2008). ‘Working for a Healthier Tomorrow’. London: Department for Work and Pensions. Available from: https://www.gov.uk/government/publications/working-for-a-healthier-tomorrow-work-and-health-in-britain
Black C and Frost D (2011). ‘Health at Work – an independent review of sickness absence’. London: Department for Work and Pensions. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/181060/health-at-work.pdf
CIPD (2021). ‘The Mental Health at Work Commitment’. Available from: https://www.mentalhealthatwork.org.uk/commitment/
Health and Safety Executive (2020). ‘Construction Statistics in Great Britain’. Bootle: HSE. Available from: https://www.hse.gov.uk/statistics/industry/construction.pdf
Nicholson P (2017). ‘Occupational Health the Value Proposition’. London: Society of Occupational Medicine. Available from: https://www.som.org.uk/sites/som.org.uk/files/Occupational_health_the_value_proposition.pdf
Steger M F (2017). ‘Creating Meaning and Purpose at Work’. In The Wiley Blackwell Handbook of The Psychology of Positivity and Strengths Based Approaches at Work’, first edition, edited by Oades L G et al. Chichester: Wiley Blackwell. Available from https://onlinelibrary.wiley.com/doi/10.1002/9781118977620.ch5
Randstad, ‘Taking down the walls around mental health in construction’ London.
Available from: https://www.randstad.co.uk/s3fs-media/uk/public/2019-11/r-006-randstad-white-paper-digital-version_0.pdf
Steger M F, Dik B J and Duffy R. D (2012). ‘Measuring Meaningful Work: The Work and Meaning Inventory (WAMI)’. Journal of Career Assessment, 20, 322-337. Available from: https://journals.sagepub.com/doi/10.1177/1069072711436160
Stevenson D and Farmer P (2017). ‘Thriving at work: a review of mental health and Employers’. London: Department for Work and Pensions. Available from: https://www.gov.uk/government/publications/thriving-at-work-a-review-of-mental-health-and-employers
Trade Union Congress (2015). ‘Work and Wellbeing – a Trade Union Resource’. Second edition. London: TUC. Available from: https://www.tuc.org.uk/resource/work-and-wellbeing
Taylor M (2017). ‘Good work: the Taylor review of modern working practices’. London: Department for Business, Energy and Industrial Strategy. Available from: https://www.gov.uk/government/publications/good-work-the-taylor-review-of-modern-working-practices
Waddell G and Burton K (2006). ‘Is work good for your health and wellbeing?’, London: Department for Work and Pensions. Available from: https://www.gov.uk/government/publications/is-work-good-for-your-health-and-well-being
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World Health Organization (2012). ‘National Profile of Occupational Health System in Finland’. Geneva: WHO Regional Office for Europe: Copenhagen. Available from: https://www.euro.who.int/__data/assets/pdf_file/0016/160522/e96482.pdf
Young V, Bhaumik C (2011). ‘Research Report No 751. Health and well-being at work: a survey of employees’. Department for Work and Pensions. London. 2011. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/214526/rrep751.pdf
