Is it time to marry safety and wellness?

On March 12, 2009, 17 people were killed after a helicopter crashed off the coast of Newfoundland. Commissioner Robert Wells was tasked with heading up the Offshore Helicopter Safety Inquiry to investigate the incident and make recommendations to prevent future similar occurrences. In his report, Wells said the lone survivor, Robert Decker, likely lived through the accident due to a number of factors, including his fitness level.

“(He) was a tall, lean fella and they think that because other passengers may have been heavier and less fit then him, during the descent the other passengers may have passed out or been unable to escape because of their weight,” says Mike Wahl, senior director of wellness strategy and solutions, Horizon Occupational Health Solutions and the Medisys Health Group. “The fitness of workers was one of the reasons they may not have been able to get out.”

Although occupational health and safety encompasses the word “health,” all too often the health promotion activities in an organization are categorized as “wellness” and operate separately from the OHS department. Research has emerged in recent years about the impact health has on safety and the organization as a whole, from reduced injuries to increased productivity and considerable financial savings. But in order to reap these rewards, experts say employers need to marry their OHS and wellness programming.

There are a variety of ways health impacts safety, including obesity. Wahl’s research has found that soft tissue injuries drop in concordance with a decrease in waist circumference for workers. Once they hit the average waist circumference or drop below that threshold, they essentially become protected against injury, experiencing even less injuries as a result, he says.

His research has also found that a man with a waist circumference of more than 42 inches and a woman with a waist circumference of more than 38 inches will cost six times as much over the course of their employment when it comes to disability and preventable health costs than someone who is below that threshold.

“So that doesn’t mean a person (needs to have) a tiny little waist and six-pack abs and a great Facebook picture. It just means that they’re not at risk for metabolic disease. They’re lean enough to be healthy so that that extra weight doesn’t lead to co-morbid conditions,” says Wahl, who is based in St. John’s. N.L.

Fitness levels and nutrition habits are related to the development of musculoskeletal disorders (MSDs), says Pam Dempster, founder and senior health/wellness specialist at Dempster Wellness in Halifax.

“When we have a high population of our employees that are struggling with weight, dealing with a chronic disease, maybe not making the healthiest lifestyle choices, that’s going to impact their risk factors for developing those types of injuries,” she says. “So, if their fitness levels and their nutrition levels go down, their risk of getting musculoskeletal disorders go up.”

Overexertion injuries account for about one-quarter of all reported occupational injuries in North America, says Wahl. Of that, two-thirds are involved in lifting loads and one-fifth involved in pushing or pulling. Workers need to be exercising and eating properly to strengthen their bodies and avoid MSDs, he says.

“When you’re doing the same lift over and over again, your body eventually either gets tired acutely or chronically, it starts to wear down. People will bend over to pick up a piece of paper and their back will go.”

In Nova Scotia, workers’ compensation claims for MSDs can run up to $14,000 in direct costs per injury. Indirect costs, such as training new employees, sick day coverage, replacement equipment et cetera, can bump this up to $30,000 per injury, Dempster says. The overall costs of MSDs in Nova Scotia is estimated between $100 million and $1 billion per year.

“The cost of these injuries is absolutely staggering. I bring these (statistics) to company heads when I’m called on site because it’s mind-blowing actually,” she says.

Wahl recalls one company that was seeing a lot of injuries to rotator cuffs, knees and backs. While the firm was focusing on the “safety” aspects of OHS, it was ignoring the health side, which was certainly impacting the injury statistics.

“You couldn’t catch your desk on fire. It’s intrinsically safe and eyeglasses and hard hats and all the stuff that’s inherent to safety. But there they were feeding them garbage food for 20 years. Non-stop French fries and they weren’t warming them up.”

Physical inactivity is strongly associated with the development of obesity and Type 2 diabetes. Uncontrolled diabetes can be problematic for worker safety. Wahl recalls a crane operator on a oil rig offshore whose vision was changing constantly but he didn’t know why.

“He was unloading massive containers onto a moving vessel from a moving vessel with all of his colleagues working down below him. His prescription was changing faster than they could send glasses out to the rig, so we tested his blood sugars and he was massively diabetic. He had little sugar particles stuck in his eyes,” Wahl says.

“Once he controlled his diabetes, he was able to see again but he was actually operating a heavy crane half blind and it would have been another two years before he had another medical that would have picked it up.”

Diabetes can have an impact on motor vehicle accidents because becoming hypoglycemic while driving is a “hazardous condition and may lead to a greater incidence of driving mishaps,” according to research by DJ Cox of the University of Virginia School of Medicine in Charlottesville, Va. If workers are diabetic, it’s important to educate them on blood sugar. In one study, Cox found diabetic drivers who were able to control their blood sugar had three times lower crash rates.

Sleep is another topic area that is highly personal but that affects workers’ ability to do their job safely. Over-tired employees face heightened safety risks. According to the Canadian Centre for Occupational Health and Safety, fatigue is a “recipe for shoddy, unsafe work” and affects judgment, concentration, hand-eye co-ordination, visual perception, communication skills, productivity, performance, decision-making and stress.

A 2013 study by K. Uehli and colleagues at the University of Basel in Switzerland found that workers with sleep problems had a 1.62 times higher risk of being injured. The study also stated that 13 per cent of work injuries could be attributed to sleep problems.

Fatigue costs employers big time. The National Safety Council in Itasca, Ill., reports fatigued workers cost about US$1,200 to $3,100 per employee in declining job performance each year.

Mental health (or psychological safety) should also be of high concern to safety professionals because individuals cannot operate at peak performance if they are struggling with their mental health. According to the Canadian Mental Health Association, one in five Canadians will experience a mental health issue in any given year.

SOLUTIONS

One potential solution is the Total Worker Health approach. Developed by the National Institute for Occupational Safety and Health (NIOSH) in Washington, D.C., Total Worker Health integrates workplace interventions that protect safety and health with activities that advance the overall well-being of workers.

“(Employers) that understand the value of this Total Worker Health approach, they send their workers home at the end of the day with more health than they arrived that morning. Of course, that’s good for the worker, it’s good for their families, it helps keep them on the job longer,” says Casey Chosewood, director of the office for Total Worker Health at NIOSH.

“That translates into better outcomes, better customer service, higher levels of engagement, less turnover, better retention… All in all, everybody wins.”

To achieve this highly sought-after state, safety and human resources must work more closely together.

“It’s not separate. There’s no wellness committee over here and no OHS committee over there. If you’re going to do it, you’re going to have one committee in your organization tackling both occupational health and safety and wellness at the same time,” Dempster says.

Traditionally, the HR and safety departments have operated separately. While safety covers things like personal protective equipment, fall protection systems and confined space, HR takes the lead on wellness programming, office ergonomics and mental health.

“There’s a gap and that gap is where the injuries are still occurring. We need to get these departments closer together and closer aligned,” says Dempster. “I think we’re all in agreement that both occupational health and safety and wellness departments in our companies have one common goal: We want to protect and improve our worker health. It’s a common goal, but we’re still working independent from one another.”

Many wellness programs today are seen as external and not core to the company, which contributes to their sometimes-lackluster success.

“That’s where the lack of support becomes apparent to the workers and they see it as an outsider,” says Wahl. “But when it’s seen as part of the safety management system, it’s part of the culture and people adopt it more readily.”

About a decade ago, General Mills in the U.S. merged its wellness and OHS programing under the vice-president of occupational health and safety. It now has one employee newsletter from the department that combines health, safety and wellness information. The company found certain injuries and illnesses were easily predictable and avoidable under the combined program.

“The health improvements of our employees simply will lead to safety improvements as well,” Dempster says. “And that’s by thinking about and maybe starting to open up discussion about OHS and wellness within organizations to start communicating together.”

Of course, bringing the HR and safety departments together can seem like a large endeavour for most organizations. The first step is forming a cross-functional team that would include safety and HR (including those responsible for disability management, return-to-work procedures, workers’ compensation and the employee assistance program), employee wellness champions and occupational health nurses. All these individuals would work together on integrated interventions that collectively address worker health, safety and well-being.

Ultimately, senior leaders need to drive this.

“Someone in control of both HR and safety, that senior level of leadership, says, ‘This is the new paradigm that we are going to approach this issue. We’re not just revamping the safety program to fit the Total Worker Health model, we’re revamping our organization as a whole to better embrace the safety, health and well-being of our workers,’” says Chosewood. “These efforts really, to be most successful, have to be led by someone who has the authority over all of these lines of business.”

The goal is to shift the corporate culture to integrate health into all day-to-day activities, says Wahl. In order to do this, it’s important that workers understand how their health relates to their job and why they need to take care of themselves.

“Because they’re crouching, because they’re standing, because they’re lifting, because they’re bending all day long,” he says. “All of a sudden people are engaged because they understand the fundamental need of why it’s relevant and that it’s not going to kill them if they try to be healthy.”

When considering workers’ overall well-being, it’s important to take into account a wide variety of job-related factors, including work hours, wages, workload, stress level, sick leave, benefits, quality supervision, technology, flexibility and autonomy.

“Giving people control over their start and stop time, how do they get from point A to point B? As long as they get to point B, give workers a say in how they do so and the path there really has tremendous opportunities to decrease stress, to build more engagement, to give them a stronger voice,” Chosewood says.

The safety department should re-examine how each job is designed, because that’s where the greatest ability to impact health and safety outcomes lies, he says.

“(Ask yourselves) ‘Have we designed this job with health outcomes in mind?’”

In order for Total Worker Health to be successful, workers need to be involved. Chosewood is strongly in favour of a participatory approach where the health, safety and well-being challenges are addressed by asking the workforce what they want.

“Let them tell you where they want the program to go, not the other way around. Let them identify what are their top priorities,” Chosewood says. “It isn’t so much ‘If we build it, they will come.’ It’s ‘If they build it, they will come.’”

Companies should be checking in with workers at least annually to this effect.

And employers need to ensure their environment supports workers’ health.

“A lot of the time you see things like lip service, giving us something like, ‘We want you to be healthy,’ but then the environment, the leadership, the supervisors, they don’t support that healthy behaviour in any way or give people the opportunity while on the job to engage in it,” Wahl says.

CHALLENGES

One of the challenges companies may face when putting more of an operational focus on worker health and wellness is privacy — a common concern heard from employees.

“It’s especially true if we’re saying, ‘Not only am I interested in your health and well-being at work — the focus of most traditional safety programs — but I’m also interested in your overall health: How do you sleep at night and your access to health care and how you and your family are getting along and your health habits,’” says Chosewood.

Discussing health is a personal matter and employees might not want co-workers knowing they are seeking help for a particular issue. Employees need access to various services away from work — such as nutrition and fitness coaching — so if they are concerned about privacy, they can still improve their health behind closed doors or in the comfort of their own home, says Wahl. 

He recommends making health part of the company’s occupational health and safety requirements. This can be accomplished through job demands analysis, personal injury prevention plans, bona fide testing and fitness for duty, warm-up programs and ergonomic programs. Employers should outline what they are able to do to help the workers, but also what the workers need to do to help themselves.

“You say, ‘As part of your job, here’s the things that you need to do in order to be healthy to operate in a safe and efficient manner,’” Wahl says. “All of a sudden that person who would never stretch on their own because they would feel stupid stretching is now like, ‘Well, everybody has to stretch.’… Or they get their blood tested or they meet with somebody about exercise and diet.”

The impact of removing the stigma, which allows workers to feel comfortable going into an environment they would have shied away from before, should not be underestimated, Wahl adds.

The newly integrated health, safety and wellness strategy must be audited. In order to do this properly, the safety manager needs to have a clear understanding of what she is trying to shift at the onset. For example, perhaps metabolic disease is a high-risk factor in an organization. The safety manager would measure how many workers are at risk before the program starts, put strategies in place and then take measurements again at the end of the program.

“If you move the needle, great. Continue to do that or refine it. If you didn’t move the needle, try something else,” says Wahl. “It’s a continuous improvement and the goal would be to reduce illness, injury and incidence frequency.”

Safety professionals need to think about reporting on health data as much as they report on safety data.

“They can report safety stats like crazy. I guarantee they can tell me dropped objects, recordables, incident rate, whatever it is, but when it comes to health, what do they report for health stats?” asks Wahl.

NIOSH is working on developing a tool to measure worker well-being, expected to be available later this year.

“If folks had as much attention to their bottom line, if they had as much of a focus on these greater health metrics as safety, then not only would worker health and safety be served but the organization would benefit as well,” says Chosewood. 

With the growth of the gig economy and individuals in non-standard jobs — part-time, contract, freelance — work arrangements are complex and require a more holistic approach to health and safety than what has been traditionally done.

“We would encourage safety managers to swim further upstream than they have found themselves before and that means using all of the components of the organization other than just the safety team to examine this issue more broadly,” Chosewood says. “You cannot overcome eight, 10, 12 hours a day of poor working conditions with a tai chi class at noon.”

SIDEBAR

Total worker health

There are many, many issues relevant to advancing worker well-being through NIOSH’s Total Worker Health approach. The following are just a sampling of some that you may want to consider if your organization is trying to look at worker health and well-being through a wider lens.

Control of hazards and exposures

• Chemicals

• Physical agents

• Biological agents

Operation of work

• Fatigue and stress prevention

• Overtime management

• Flexible work arrangements

Built environment supports

• Healthy air quality

• Access to healthy, affordable food options

• Safe access to the workplace

Leadership

• Shared commitment to safety, health and well-being

• Worker recognition and respect

• Responsible business decision-making

Compensation and benefits

• Adequate wages

• Equitable performance appraisals and promotion

• Paid time off (sick, vacation, caregiving)

• Retirement planning and benefits

• Chronic disease prevention and management

Community supports

• Safe, healthy and affordable housing options

• Safe and clean environment (air and water quality, noise levels, tobacco-free policies)

Changing workforce demographics

• Multigenerational and diverse workforce

• Workers with disabilities

Policy issues

• Health information privacy

• Equal employment opportunity

• Elimination of bullying, violence, harassment and discrimination

• Prevention of stressful job-monitoring practices

New employment patterns

• Contracting and subcontracting

• Multi-employer work sites

• Organizational restructuring, downsizing and mergers

• Financial and job security.

Source: Fundamentals of Total Worker Health Approach, National Institute for Occupational Safety and Health

This article originally appeared in the August/September 2018 issue of COS.