The second annual Health and Safety Executive lecture took place in April. This year’s speaker was Dr Richard Heron, chief medical officer at BP and former president of the Society and Faculty of Occupational Medicine on “safe, healthy and productive work in the fourth industrial revolution”. This is an abridged version of what he had to say.
It’s an absolute pleasure and a privilege to be invited to do this lecture tonight. As we approach 2020, the national discourse again struggles to balance the need for economic growth with human progress and a growing sense of unease about inequality, social cohesion, insecurity and exclusion.
Safe, healthy and productive work for all? Is it an aspiration or is it a pot of gold at the end of a rainbow that we can never reach? Or in fact are we standing at a point of inflexion where thriving in decent work for all, rather than surviving in any occupation, is a realistic goal for our working-age population? And the fourth industrial revolution, what do we mean by this?
Broadly speaking, the first industrial revolution in the eighteenth and nineteenth centuries was steam power-driven, starting in textiles and moving more widely with the railways to touch almost every aspect of industrial life. The second industrial revolution around the turn of the century was brought with electricity, the internal combustion engine and, with Henry Ford, assembly line production, which ushered in mass production.
About the author
Dr Richard Heron is vice president health and chief medical officer at BP and a former president of both the Society and Faculty of Occupational Medicine. He is a fellow of the Royal College of Physicians, Faculty of Occupational Medicine and the American College of Occupational and Environmental Medicine. He also holds honorary appointments as professor of international business and health at the Institute of Work, Health and Organisations, Nottingham University, and is an honorary teacher at the University of Manchester
The third industrial revolution in the 1980s saw personal computers and the digitalisation of services and also manufacturing. And now, according to Klaus Schwab, the founder and executive chairman of the World Economic Forum, we are in the midst of a fourth industrial revolution. What is it about? Well, it’s about emerging technologies on many fronts. Robotics, artificial intelligence, blockchain, nanotechnology, the internet of things, 3D printing, quantum computing and biotechnology, to name but several.
The question on my mind as we go through each of these revolutions is, who stands to gain? Whose standards of living rise during such a revolution, and at what cost? Globally, the International Labor Organization estimates that, today, 2.3 million men and women around the world will succumb to a work-related disease or accident every year. This is 6,000 deaths every single day. And that’s today.
Managing a multi-generational workforce
We’re also now an ageing working population. The eldest and the youngest are over-represented in this number. The challenges of managing health and safety in a multi-generational workforce will be imperative. Even these global figures are likely to be under-estimates, with gross under-reporting of occupational diseases and accidents, including fatal accidents, giving us a false picture of the true scope and scale in the world today.
But what about closer to home? There were 1.3 million work-related illnesses reported in the country in 2017, and work-related stress and musculo-skeletal cases dominate, with half a million each. Yet, when we refer to cases, this data, while helpful, hides the fact that every one is a brother, a sister, a father or a mother. Each one is a case that affects the health and life of an individual. And quite often, potentially, the health and wellbeing of a family, and perhaps generations after them. So, every one is a cost to each of us, to society, whether they result from the direct effects of a worker who is unable to be as productive as an organisation may wish, or whether indirectly as they move from contributors to economic growth to the necessary recipients of welfare when unfit to be at work.
We can see the costs not only arising out of work-related ill-health but, at the same time we see 131 million working days lost every year from ill-health in general, much of it from absence from work but also much from presenteeism – being at work whilst still ill. And, of course, the same underlying causes, mental health and musculoskeletal, predominate.
With extremely low rates of unemployment and continual need for productive work, we have to find ways to enhance the health and productivity of this working-age population. It is a population where one in four has a physical condition, one in three a long-term condition, and one in eight a mental health condition.
Enabling healthier choices and behaviours
As the workforce ages, these statistics will get larger. The majority waking hours spent by these people are in our workplaces. We have the best opportunity, then, not only to prevent further harm, but to enhance health. Enabling healthier choices about what we eat and how active we are is becoming much more of the norm in many workplaces, not purely for the benefit of the worker, but for the employer, too.
Now we’re talking mostly at this stage about people who are in work. About three-quarters of the working-age population are in work, an extremely high level at the moment. And yet only half, only 50%, of those who are disabled are at work. Increasing the number of people with a disability who are in our workplace is not just for their own wellbeing, but actually brings with it our ability to access capabilities that we will need to build and maintain the healthy, safe and productive workforce – and economy – that we all seek.
We need more people to see coming back to work, and getting into work – and I mean “good” work rather than any work – as a stepping stone back to health. Rather than seeing work as a barrier to resuming normal health and functional capability
Reducing those barriers will enable employers to access those diverse talents and capabilities with a much greater potential for productivity. The Improving Lives: the future of health, work and disability green paper from the Government was a superb piece of consultation, with massive feedback, which is now being worked on to address some of those questions. But being able to access advice about fitness for work does remain a problem, particularly for small and micro employers, who find access to advice at any level, and certainly specialist advice, is pretty well non-existent. It is a problem, also, for all of us in large organisations, particularly when we have complex cases. In the next decade, these case will get more complex. We will have more people with multiple conditions who need to be at work, and we will need to access the capabilities that they bring.
The good news is that GPs who have had some basic training and have taken a diploma in occupational medicine are really well-distributed around the country. They are particularly concentrated in areas where workplace and industrial activity takes place. I’m not suggesting everybody needs to see their GP, but if we can increase the knowledge and awareness of health and safety practitioners across the country to be able to handle queries about fitness to work, and to take them into consideration, we’ll make significant strides forward. This does need us to change the mindsets of health and care professionals. It’s a challenge the green paper seeks to address.
Importance of “good” work
We need more people to see coming back to work, and getting into work – and I mean “good” work rather than any work – as a stepping stone back to health. Rather than seeing work as a barrier to resuming normal health and functional capability.
When we look at the period 1850-1900 one measure of “who benefits” is to look at wages. Real wages increased significantly in the period, so one could be forgiven for thinking everybody gained. But if we think about the physical, chemical, ergonomic, biological and psychosocial risks and threats that also occurred during that period – exposure to dust, noise, chemicals and many other harms – many people saw their lives significantly worse during that period.
Another interesting measure of looking at whether people benefit from improved social status is height. What you see between 1830 and 1850 is the average height of the English soldier came down. It was a period where there was fantastic economic growth. Yet many people also moved into cities, there was over-crowding, there were issues of sanitation, and a whole series of employment-related issues, including malnutrition and reduced ability to access good food from an agrarian economy to an industrial economy. So it is clear that being able to to measure the benefits, or the harms, of the next industrial revolution, in terms of health, wellbeing and productivity, is not straightforward.
Again, however, one piece of good news is that there are increasingly sound links between measures of happiness, wellbeing, engagement and productivity and, one need look no further than the work of the What Works Centre for Wellbeing. This is where a body of evidence is both growing and being publicised about how we can measure wellbeing and how we can link it to productivity. Not only that, how we can compare our own progress with others. But I do think we probably need to close in on the measures we all want to use.
So how do we measure health and productivity and, crucially, how will we know we are making a difference? The bottom line, as we enter and progress through this fourth industrial revolution, is that, if we are to maximise productivity and improve the health and wellbeing of the current and the future generations, we have to manage legacies of the past as well as the risks of the future.
In the future we’ve talked about nanotechnology and biotechnology, ergonomic conditions, and other as yet unknown hazards. But we’re still seeing the legacy of the exposures of the past. We’re still seeing significant issues with lung disease, and the “Breathe Freely” campaign continues to address some of the current risks from lung disease. We’re still seeing the legacy of exposure to asbestos, and asbestos is still around in many countries in the world.
The economist Keynes who was often quoted, particularly in the 1980s, in 1930 wrote about the “legacy of leisure” that his grandchildren would be likely to inherit. We are his grandchildren, and we are therefore in this world of leisure that he spoke of. Feels good, doesn’t it?! He said that the world he was describing was coming out of a bad attack of economic pessimism. I think that sounds familiar? And beginning to suffer affliction of a new disease, this disease where technological unemployment is outrunning the pace to find new uses for labour. Again, I think that’s very relevant today. How do we ensure that the capabilities of today’s workforce keep up with the demands that arise from the labour market? We’re behind, and we need to make that happen.
We need to think about the soldiers whose health and height are going down, the forgotten workforce who may not be the ones who immediately benefit from what sounds like a technological nirvana being described.
So how do these lofty aspirations play out in the matter of safe, healthy and productive work in the UK? I hope most of you have seen and read the Taylor review of “good” work last year and the subsequent response through the Department for Business, Energy and Industrial Strategy. That was really important. We often look at these things through an HSE perspective, from a Department of Health, health or public health perspective. But we’re now also looking at it from the impact on business, and this is incredibly important.
What underpinned the Taylor review was that high-quality jobs increased participation rates and increased productivity and economic performance. Low-quality work pushes people out of the labour market or into work which does not fully utilise their skills or experience, reduces their wellbeing and productivity. We could see the impact of that.
Changing nature of work and employment
The review called for a national strategy to provide good work for all; fair and decent work with a realistic scope for development and fulfilment and one for which the Government should be held ultimately accountable. And it called for a range of areas to be clarified. Not least, how can we be really clear about what a “worker” is? We talk about new platforms such as Uber and Deliveroo, but what are the obligations and accountabilities in that situation, between the platform and those who might move services between clients?
The report talks about a number of steps towards “decent” work. The clearer definition of what a “worker” is, and some basic levels of protection applying. Clarity in the law about the rights of such workers, but also the right to earn above the minimum wage where you do not have guaranteed hours. Increased protections – and we’re talking about a new definition of worker, the “dependent contractor”, and how we describe them and how businesses pledge to employ and support them. Increasing requests for governance on working practices. Realistic ways of achieving promotion and development. And a more proactive approach to workplace health and promoting health and wellbeing in workplaces; health gets a mention within that report.
The What Works Centre for Wellbeing that I mentioned has assimilated many of these conclusions, not only the Taylor review but also some of those touched on in Paul Farmer’s recent review of mental health at work. And it begins to address an important further question: what do workers want in order to thrive at work?
We looked at these in the HSE’s stress management standards some years ago. But we’re talking about control over work, autonomy (which requires trust between an employer and those who work for that employer), clarify of what’s expected. Clear accountabilities. Variety in what we do. Positive relationships with my manager. We know from multiple studies that the most likely reason for leaving an employer is a failed relationship between their employer and their manager. A safe and pleasant working environment. Belief in fair pay. Supportive supervision. A sense of purpose. Good work-life balance.
But this in turn begs the question “can we align the goals of employers and workers?”. I believe we can do this. There are points of alignment where we can meet the need for increased commitment from workers – reliability, activity, quality and ultimately profitability – but also safer, more interesting, more purposeful, more flexible work; more fulfilment and, ultimately, more money.
These are the six questions I share with my own teams in BP: show me the data, what is it telling you, why should what worries you worry me, what should we do about it, where should we start, how will we know we are getting there?
So it is not just about simply explaining what the data, the “evidence”, is telling me. It is about I need to be able to explain why what’s worrying me should worry you too, my boss. If it’s keeping me awake that’s one thing, but I need to convince my boss it should also be keeping him or her up at night. And, from there, what should we do about? Where should we start, where’s the first step? And then, finally, how will we know when we’re getting there?
When we look at the issues of the past, wouldn’t it have been nice if we controlled exposure to those hazards that we talked about right at the beginning? No exposure, no effect, no illness, no adverse outcome, not extra work for the lawyers.
How to establish management controls
In reality, what we’re doing now, particularly with some of those long-latency diseases, is really just measuring lagging indicators of cases and seeing how those drop down. It’s not that we shouldn’t do that. But we know when there’s 20-40 years’ worth of latency, that’s a long time to wait for a lot of people. So where exposures are taking place now it is how do we establish the management controls of the ones we’re talking about now, but also those ones we’ll be talking about in the future?
What are the leading indicators we need to be looking at? Are we able to define those toxic exposures today, what they will be, what will constitute a toxic exposure in our fourth industrial revolution? Are we able to think about the exposure limits, what’s acceptable or not acceptable in terms of daily exposure? How can we get early indications, perhaps direct reading, perhaps technology, to help us with establishing that early exposure is taking place?
And coming back to those six questions I share with my team – how do we change the behaviours, with perhaps a sceptical and focused leader who is focused on delivery of a successful enterprise? And if that wasn’t complicated enough, the changing nature of how people are being employed means an increasing number of people moving into self-employment or working for small or medium-sized employers or micro employers means that those things that we felt were the places, the vehicles by which we articulated good health and “good” work may be very, very different. It won’t be through the large employer.
To conclude, what it will take us to aim to answer as we aim for that aspiration to become a reality of safe, healthy, productive work for all, and turning what is a dream into a reality? It is going to mean, at the very least, asking but also, hopefully, addressing a number of important questions.
How can we reduce the likelihood of a worker failing to go home healthier? How do we increase the likelihood of people of working age coming into work getting into a healthier and more productive state? How do you measure this, and what measures do we agree on to improve health and productivity?
How can we ensure that the capabilities of today’s workforce really keep up with the demands that the labour market is putting on us? What is a “worker” and what are the accountabilities that arise from being a worker, and the relationship with an employer, a client, a platform or independent contractor or whatever it is?
And, yes, how can we identify those risks associated with the working practices of the next industrial revolution early enough to prevent those harmful outcomes that we’ve seen in the last? Finally, having done that, and having won the intellectual argument, how do we align those actions and behaviours within workplaces to bring about safe and health and productive working environments for everybody?