Table of Contents …………………………………………………………………………………………. / Page
i
List of Tables and Figures ………………………………………………….…………………………….. / iii
Acknowledgements ……………………………………………………………………………………….. / v
Executive Summary ..……………………………………………………………………………………… / 1
Chapter 1: Why Develop a Healthy Workplace Framework? …………..……………………………..
A. It is The Right Thing To Do: Business Ethics ………….………..……………..……..
B. It is The Smart Thing To Do: The Business Case ……..…………………………….
C. It is the Legal Thing to Do: The Law……………………………………………………
D. Why a Global Framework?……………………………….…………………………….. / 5
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Chapter 2: History of Global Efforts To Improve Worker Health ……………………………….…..... / 11
Chapter 3: What Is a Healthy Workplace? ………………………………….……………………….….
A. General Definitions ………………………………………….……………………..…...
B. The WHO Definition of a Healthy Workplace…………………………………………
C. Regional Approaches To Healthy Workplaces ……………………………………...
1. Regional Office For Africa (AFRO) …………………..………………….…...
2. Regional Office For the Americas (AMRO) …………...…………………….
3. Regional Office For the Eastern Mediterranean (EMRO)………………….
4. Regional Office For Europe (EURO) ………………………….……………..
5. Regional Office For South-East Asia (SEARO)……………….…………….
6. Regional Office For the Western Pacific (WPRO).…………….…………... / 15
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Chapter 4: Interrelationships of Work, Health and Community………………………………………..
A. How Work Affects the Health of Workers ……………………………..………..……
1. Work Influences Physical Safety and Health..…………………..……….…
2. Work Affects Mental Health and Well-Being……………………..…………
3. Interrelationships……………………………………………………………....
4. The Positive Impact of Work on Health …………………………………….
B. How Worker Health Affects the Enterprise………………..……………………….....
1. Accidents and Acute Injuries Affect the Enterprise ……………………......
2. The Physical Health of Workers Affects the Enterprise …….………......
3. The Mental Health of Workers Affects the Enterprise……......
C. How Worker Health and the Community Are Interrelated …………………………. / 25
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Chapter 5: Evaluating Interventions …………………………………..…………………………………
A. The Cochrane Collaboration …………………………………………………………..
B. General Evaluation Criteria …………………………………………………………….
C. Grey Literature …………………………………………………………………………..
D. The Precautionary Principle …………………………………………………………...
E. Interrelatedness of Worker Participation and Evaluation Evidence ……………….
F. Evaluating the Cost-Effectiveness of Interventions ………………………………… / 41
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Chapter 6: Evidence For Interventions That Make Workplaces Healthier ….………………………..
A. Evidence For Effectiveness of Occupational Health & Safety Interventions ..…….
B. Evidence For Effectiveness of Psychosocial/Organizational Culture Interventions
C. Evidence For Effectiveness of Personal Health Resources in the Workplace ……
D. Evidence For Effectiveness of Enterprise Involvement in the Community ......
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Chapter 7: The Process: How To Create a Healthy Workplace …………………………………......
A. Continual Improvement Process Models ………………………………………….….
B. Are Continual Improvement/OSH Management Systems Effective? ………….…..
C. Key Features of the Continual Improvement Process in Health & Safety…………
1. Leadership Engagement based on Core Values ………………………………..
2. Involve Workers and their Representatives………………………………………
3. Gap Analysis………………………………………………………………….……..
4. Learn from Others…………………………………………………………………..
5. Sustainability………………………………………………………………….……..
D. The Importance of Integration ………………………………………………………… / 59
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Chapter 8: Global Legal and Policy Context of Workplace Health……………………………………
A. Standards-setting Bodies……………………………………………………………..
B. Global Status of Occupational Health & Safety………………………………………
C. Workers’ Compensation ………………………………………………………………..
D. Trade Union Legislation …………………………………………………………..……
E. Employment Standards……………….…………….……………………………….…
F. Psychosocial Hazards …………………………………………...…………………….
G. Personal Health Resources in the Workplace ………………...……….…………..
H. Enterprise Involvement in the Community …………………………………………..
I. The Informal Economic Sector ………………………………………………………. / 69
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Chapter 9: The WHO Framework and Model..…………………………...…………………………….
A. Avenues of Influence for a Healthy Workplace ……………………………………..
1. The Physical Work Environment ………………………………………………......
2. The Psychosocial Work Environment ……………………………………………..
3. Personal Health Resources in the Workplace …………………………………..
4. Enterprise Community Involvement………………………………………………..
B. Process For Implementing a Healthy Workplace Programme ……………………..
1. Mobilize………………………………………………………………………………
2. Assemble…………………………………….………………………………………
3. Assess…………………………………………………………..……………………
4. Prioritize………………………………………………………………………………
5. Plan……………………………………………………………………………………
6. Do……………………………………………………………………………………..
7. Evaluate………………………………………………………………………………
8. Improve………………………………………………………………………………
C. Graphical Depiction …………………………………………………………………......
D. Basic Occupational Health Services – the Link ………………………………………
E. The Broader Context …………………………………………………………………....
F. Conclusion ………………………………………………………………………………. / 82
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Annex 1: Acronyms Used in this Document …………………………………………………..………… / 99
Annex 2: Glossary of Terms and Phrases .………………………………………………………..…….. / 101
Endnotes ……………………………………………………………………………………………………. / 108
List of Figures / Page
Figure ES1 WHO Healthy Workplace Model: Avenues of Influence, Process and Core Principles ……………. / 3
Figure 1.1 The Business Case in a Nutshell ………………………………………………………………………….. / 6
Figure 2.1 Timeline of Global Workplace Health Evolution …………………………………………………………. / 14
Figure 4.1 American Institute of Stress Traumatic Accident Model ……………………………...... / 26
Figure 4.2 Relationship Between Health and Wealth …………………………………………………..…………… / 40
Figure 9.1 WHO Four Avenues of Influence ………………………………………………………………………….. / 83
Figure 9.2 WHO Model of Healthy Workplace Continual Improvement Process ……………...... / 89
Figure 9.3 Maslow’s Hierarchy of Needs ……………………………………………………………………………… / 93
Figure 9.4 WHO Healthy Workplace Model: Avenues of Influence, Process and Core Principles……………… / 97
List of Tables and Boxes
Table 4.1 Work-Related Symptoms of Common Mental Disorders ………………………………...... / 37
Table 4.2 Work-Family Conflict Effects On Worker Health, the Enterprise and Society ……………….………... / 39
Table 6.1 Evidence for Effectiveness of Occupational Health & Safety Interventions …………………………… / 48
Table 6.2 Evidence for Effectiveness of Psychosocial Interventions …………………………………….………… / 50
Table 6.3 Evidence for Effectiveness of Personal Health Resource Interventions in the Workplace …………... / 52
Table 6.4 Examples of Enterprise Involvement in the Community….…………………………………..…………... / 57
Table 7.1 Comparison of Continual Improvement/OSH Management Systems ……………………………..…… / 60
Box 7.1 Learn from Others: WISE, WIND and WISH …………………………………………………….…………. / 65
Table 8.1 Countries Classified By National Economic Level And Labour Market Policies …………………….… / 70
Table 8.2 Percent of Countries in WHO Regions That Have Ratified Selected ILO Conventions …………….… / 71
Table 8.3 ILO Workers’ Compensation Conventions and Ratifications ……………………………………...…….. / 74
Table 8.4 Comparison of Selected Workers’ Compensation Features in USA, Canada, Australia ……...... / 75
Table 8.5 Work and the Protection of Workers’ Health in Wealthy and Poor Countries, 1880-2007. …...... / 77
Table 9.1 Application of WHO Continual Improvement Process in Large and Small Enterprises ….…………… / 95
Acknowledgements
This document was written by Joan Burton, , BSc, RN, MEd. Joan Burton is a Strategy Advisor for the Industrial Accident Prevention Association, Canada.
The following individuals who made up the Project Working Group worked closely with Joan Burton on the development of this document:
Evelyn Kortum, Global Project Coordinator, WHO, Occupational Health, Switzerland
PK Abeytunga, Canadian Centre for Occupational Health Safety, Canada
Fernando Coelho, Serviço Social da Indústria, Brazil
Aditya Jain, Institute of Work, Health and Organisations, United Kingdom
Marie Claude Lavoie, World Health Organization, AMRO, USA
Stavroula Leka, Institute of Work, Health and Organisations, United Kingdom
Manisha Pahwa, World Health Organization, AMRO, USA
Thanks are also due to the diligent and thoughtful comments provided by the Peer Reviewers:
Said Arnaout, World Health Organization, EMRO, Egypt
Janet Asherson, International Employers Organization, Switzerland
Linn I. V. Bergh, Industrial Occupational Hygiene Association, and Statoil, Norway
Joanne Crawford, Institute of Occupational Medicine, UK
Reuben Escorpizo, Swiss Paraplegic Research (SPF), Switzerland
Marilyn Fingerhut, National Institute for Occupational Safety & Health, USA
Fintan Hurley, Institute of Occupational Medicine, UK
Alice Grainger Gasser, World Heart Federation, Switzerland
Nedra Joseph, National Institute for Occupational Safety & Health, USA
Wolf Kirsten, International Health Consulting, Germany
Rob Gründemann, TNO, The Netherlands
Kazutaka Kogi, International Commission on Occupational Health
Ludmilla Kožená, National Institute of Public Health, Czech Republic
Wendy Macdonald, Centre for Ergonomics & Human Factors, Faculty of Health Sciences, La Trobe University, Australia
Kiwekete Hope Mugagga, Transnet Freight Rail, South Africa
Buhara Önal, Ministry of Labour and Social Security, Occupational Health and SafetyInstitute,Turkey
Teri Palmero, National Institute for Occupational Safety & Health, USA
Zinta Podneice, European Agency for Safety and Health at Work, Spain
Stephanie Pratt, National Institute for Occupational Safety and Health, USA
Stephanie Premji, CINBIOSE, Université du Québec à Montréal, Canada
David Rees, National Institute of Occupational Health, South Africa
Paul Schulte, National Institute of Occupational Safety & Health, USA
Tom Shakespeare, World Health Organization, Headquarters, Disability Task Force, Switzerland
Cathy Walker, Canadian Auto Workers (retired),Canada
Matti Ylikoski, Finnish Institute of Occupational Health, Finland
WHO Healthy Workplace Framework:
Background and Supporting Literature and Practices
“The wealth of business is best founded on the health of its workers."
Dr Maria Neira, Director, Department of Public Health and Environment
Executive Summary
Currently, an estimated two million men and women die each die each year as a result of occupational accidents and work-related illnesses or injuries[1]. There also are some 268 million non fatal workplace accidents resulting in an average of three lost workdays per casualty, as well as 160 million new cases of work-related illness[2]. Additionally, 8% of the global burden of disease from depression is currently attributed to occupational risks.[3] This data, collected by the International Labour Organization and the World Health Organization, only reflect the injuries and illnesses that occur in formal, registered workplaces. In many countries, a majority of workers are employed informally in factories and Businesses, where there is no record of their work-related injuries or illnesses, let alone any programmes in place to prevent injuries or illnesses. Addressing this huge burden of disease, economic cost, and long-term loss of human resources from unhealthy workplaces is thus a formidable challenge for countries, economic sectors, and health policymakers and practitioners.
In 2007 the World Health Assembly of the World Health Organization endorsed the Global Plan of Action on Workers Health (GPA), 2008-2017, with the aim to provide new impetus for action by Member States. This is based upon the 1996 World Health Assembly Global Strategy on Occupational Health for All. The Stresa Declaration on Workers’ Health (2006), the ILO Promotional Framework for Occupational Health and Safety Convention (ILO Convention 187) (2006), and the Bangkok Charter for Health Promotion in a Globalized World (2005) also provide important points of orientation. The Global Plan of Action sets out five objectives:
1: To devise and implement policy instruments on workers’ health
2: To protect and promote health at the workplace
3: To promote the performance of and access to occupational health services
4: To provide and communicate evidence for action and practice
5: To incorporate workers’ health into other policies.
In this context, this WHO model provides a flexible framework adaptable to diverse countries, workplaces and cultures. WHO will develop practical guidance specific to sectors, enterprises, countries and cultures, together with WHO collaborators, experts and stakeholders.
The principles outlined here are based on a systematic review of definitions of healthy workplaces in the global literature as well as policies and practices for improving workplace health. The documentation was reviewed at a global workshop in WHO in Geneva from 22nd to 23rd October 2009 involving 56 experts from 22 countries, WHO regional offices, related WHO programme representatives, an ILO representative, 2 international NGO representatives, as well as worker and employer representatives.
This complete review of evidence, together with references, is set forth in a background document, WHO healthy workplace, framework and model, background and supporting literature and practices, (WHO, 2010). It is available online at: http://www.who.int/occupational_health/healthy_workplaces/en/index.html.
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WHO Healthy Workplace Framework and Model: Background Document and Supporting Literature and Practices
This background document is written primarily for occupational health and/or safety professionals, scientists, and medical practitioners, to provide the scientific basis for a healthy workplace framework. It is intended to examine the literature related to healthy workplaces in some depth, and in the end, to suggest flexible, evidence-based working models for healthy workplaces that can be applied by employers and workers in collaboration, regardless of the sector or size of the enterprise, the degree of development of the country, or the regulatory or cultural background in the country. The phrase healthy workplace “model” is used to mean the abstract representation of the structure, content, processes and system of the healthy workplace concept. The models include both the content of the issues that should be addressed in a healthy workplace, grouped into four large “avenues of influence”, and also the process – one of continual improvement – that will ensure success and sustainability of healthy workplace initiatives. While the models can be demonstrated graphically, as is done on page 3, the review includes descriptions and explanations of what the models represent and how they work.
WHO intends that this document will be followed by practical Guidance documents tailored to specific sectors and cultures, which will summarize the review and provide practical assistance to employers and workers and their representatives for implementing healthy workplace policies in an enterprise.
The background document is organized into nine chapters, as follows:
Chapter 1 examines the question, “Why develop a framework for healthy workplaces? Indeed, why be concerned about healthy workplaces at all?” Some answers are provided from ethical, business, and legal standpoints. A very brief outline of recent WHO global directives is provided.
Chapter 2 expands on the global picture and describes key declarations and documents agreed to by the world community through the WHO and ILO over the past 60 years, looking at both occupational health and safety, and health promotion efforts and initiatives.
Chapter 3 looks at the question, “What is a healthy workplace?” Some general definitions are provided from the literature, as well as the WHO definition developed for this document. Then perspectives and the work being done in this area in each of the six WHO Regions are summarized.
The WHO definition of a healthy workplace is as follows:
A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of workers and the sustainability of the workplace by considering the following, based on identified needs: