The level to which an organisation should be involved in the private lives of its employees remains a highly emotive subject. Nowhere is this better illustrated than in an employer’s attitude to the health and fitness of its workforce. There are a number of drivers behind these varying attitudes that have complex interplay behind public perception.
Responsibility
First, some employers were originally motivated by altruism and were guided by principles of social responsibility. This resulted in the development of good-quality housing and improved public health of the workforce.
John Cadbury was guided by his Quaker faith to found Bournville Village. Such ideals were not the sole franchise of the Quakers, and Lord Leverhulme was equally guided by his Methodist beliefs to build Port Sunlight to house the employees who worked for his soap manufacturing company. That was not to say that religious principles could not sit comfortably with practical business considerations – Cadbury believed that cocoa drinks and chocolate were an alternative to alcohol.
Government interest
The second driver is the level of central government’s interest in both the role of the workplace in maintaining health and the potential adverse effects of work upon health. It would be fair to say that this interest has been inconsistent over the years.
The seminal Health of Munition Workers report published in 1918 demonstrated that a 12-hour working day was less productive than a 10-hour one. This report was driven by the practical consideration of maximising ammunition production in the First World War.
More recent initiatives have met with limited success – very little has ever been heard of the metrics supposed to underpin ‘Securing Health Together’ – the 10-year strategy for occupational health launched in July 2000. However, the government’s response to Dame Carol Black’s report clearly articulates the role of the workplace in improving the overall health of individuals. What is less clear, is the extent to which employers should be encouraged to pursue this aim.
Company values
The third driver is to articulate the values or proposition that is being delivered by the organisation. The Boorman report on the health of NHS staff clearly demonstrates that there is some way to go before the NHS can consistently embody healthy lifestyles and it will be interesting to see how widely and consistently the report’s recommendations are adopted. There are other aspects where an employer’s actions may be open to darker interpretation, and the recent law suit against Abercrombie & Fitch by an employee with a prosthetic limb is an example of this.
Cutting costs
The fourth consideration is that upfront investment in improving health will reduce longer-term treatment costs. Clearly, the financial arguments for this become progressively more compelling where an employer funds a far greater proportion of these costs, especially when this arrangement extends into retirement. This has underpinned the incentives to participate in health risk assessment (HRA) programmes in the US. However, there are other considerations that may also appeal in the UK. Studies have consistently shown a direct correlation between the number of risk factors in an individual’s HRA and their absence rates. This relationship also extends to their productivity at work. Therefore, investment in such programmes may be informed by a desire to increase commercial competitiveness as much as to reduce bottom-line healthcare expenditure.
Occupational requirements
The fifth factor is where there is a requirement for a demonstrable level of health and fitness to allow an individual to safely undertake their job without risk to their own health or that of colleagues or members of the public. There is, however, a significant difference in achieving a certain level of health (eg, a group 2 LGV licence holder) and maintaining a specified level of fitness (eg, members of the Armed Forces, firefighters). The second group assumes a proactive achievement of fitness whereas the first group would focus more on modifiable health risk factors. Certainly, some issues would have commonality – for example, smoking or weight reduction. There is also the issue of health impacting on the design parameters of equipment. A recent example of this was the Stagecoach transport company suspending bus drivers who weighed more than 20 stone from driving duties, as they would break the new seats.
Conclusion
This brief summary shows there are a number of reasons that underpin an organisation’s interest in their workforce’s health. This interest is also a reflection of the state of the relationship between employer and employee. In a poor atmosphere, any new initiative will be treated with distrust, whereas in other organisations, it will be seen as a reinforcement of caring values in other organisations. Thus, careful investment in employee health and wellness programmes can be a powerful means of articulating cultural change.
Dr Mark Simpson, medical dircetor, AXA Icas OH services
