Productiviteit en gezondheid werknemer

Chapter for book 10th anniversary Prevent, Belgium, autumn 2007

Healthy and productive work

Frank Pot

Summary. Some companies and public organisations have extended their health protection policies to vitality of the workforce. I will go one step further and argue that many of the preventive measures also contribute to enhancing productivity if interventions for prevention on the one hand and redesign for better performance on the other hand are purposefully combined. This is even more important as productivity is back on the political agenda. To reduce ill health effects and costs and to enhance productivity at the same time all parts of the health system should contribute as well as employment and organisation policies.

Health protection
First of all health is a value in itself. That is why prevention of occupational diseases, accidents and work related complaints is important and why the linked costs are justifiable.
Furthermore, considering the global situation “the health of workers is an essential prerequisite for productivity and economic development.”(World Health Assembly 23 May 2007; see also the ILO policy on ‘decent work’)
A third reason for health protection is to reduce the costs on company level and society level that are caused by poor working conditions. A growing number of intervention studies and cost-benefit analyses show that investments in prevention and in back-to-work programmes pay off.
Some companies and public organisations have extended their policies to health promotion and vitality of the workforce as part of their corporate social responsibility. I will go one step further and argue that many of the preventive measures also contribute to enhancing productivity if interventions for prevention on the one hand and redesign for better performance on the other hand are purposefully combined.
This is even more important as productivity is back on the political agenda of the European countries.

Productivity and healthy workforce
Continuous innovation and growth of productivity cannot be achieved just by new technologies and by seeking competitive advantage by means of cutting costs. What is needed – in this time of ageing workforce and lower birth rates in the developed countries more than ever before – is the optimal utilisation of the potential workforce.
Productivity is in some countries no longer a taboo in collective bargaining; the debate is on finding a balance between ‘working harder’, ‘working more hours’ and ‘working smarter’.
The need to address the issue of productivity again has also been discussed over the last few years by bodies of the UN and the EU.
The WHO Collaborating Centres for Occupational Health observed “a growing recognition about the linkages between working conditions, health, and productivity.”(Declaration on Workers Health 2006)
The European Association of National Productivity Centres (EANPC) stresses the links with working conditions in its memorandum ‘Productivity, the high road to wealth’ (2005).
The EU draws attention to the need to foster high skills and ‘high quality jobs’ which are expected to contribute to the well-being of the employees, to high quality products and services and to enhanced productivity and innovation. Or – as it is called after the re-launch and refocus of the Lisbon strategy in 2005 – the two principle tasks of the EU are “delivering stronger, lasting growth and more and better jobs.” The ‘Community strategy 2007 – 2012 on health and safety at work’ was presented in February 2007 under the heading of ‘Improving quality and productivity at work’. In this document increased productivity is seen as an effect of reduced costs of absence and enhanced worker motivation.

Costs: loss of healthy life and productivity
The ILO has estimated that, globally, about 2.2 million people die every year from occupational accidents and diseases, while some 270 million suffer serious non-fatal injuries and a further 160 million women and men fall ill for shorter or longer periods from work-related causes (Decent work-Safe work 2005).
The WHO has calculated the global burden of disease in terms of Disability-Adjusted Life Years. DALY’s for a disease are the sum of years of potential life lost due to premature mortality in the population and the years of productive life lost due to disability for incident cases of the health condition. In a joint publication of the WHO (Eijkemans) and the ILO (Takala) in the American Journal of Industrial Medicine it is estimated that occupational risk factors are responsible for 8.1% of the DALY’s due to unintentional injuries worldwide. The WHO analysed the specific effects of 5 occupational risk factors of which data were available sufficiently: carcinogens, airborne particulates, hazards for injuries, ergonomic stressors for back pain and noise. These 5 factors account for 24 million years of healthy life lost each year (Fingerhut et al. SJWEH Suppl 2005).
In the EU about 1250 million working days are lost each year due to health problems in general. About 210 million days are lost due to accidents at work and 340 million due to work-related diseases (Eurostat).
Furthermore, the ILO has estimated that the total costs of such accidents and ill health amount to approximately 4% of the world’s GDP (ILO 2005). In EU-15 2.6% to 3.8% has been calculated. In the Netherlands this was 2.96% and meant 1768 euro per worker in the year 2000 (Koningsveld, TNO, Journal of Safety Research 2005, European Commission SEC(2007) 215/2 and website European Foundation Dublin).
The total labour costs attributable to accidents at work in EU-15 in the year 2000 were estimated by Eurostat at around 48 billion euros.
Apart from discomfort and tragedies for individuals and families these figures show a considerable loss of productivity for organisations and society.

Strategy: extension to non-health policies
To reduce ill health effects and costs and to promote health and enhance productivity at the same time all parts of the health system (not only the occupational part) should contribute as well as employment policies and organisation policies.

The health system
What is needed is consultation between occupational physicians and general practitioners and medical experts concerning the (potentially work-related) cause of ill health and absenteeism and concerning the (therapeutic) back-to-work strategy. In many countries this is a ‘blind spot’ in the health system.
Reduction of waiting times in health care clinics and hospitals is another important issue.
Improvement is also possible regarding the division of the attribution of health care costs of work-related problems to the individual, the employer, the insurance company or the state.
These measures will reduce absenteeism and increase the labour productivity per employee.

Employment policies
Special attention should be paid to the so-called vulnerable groups: immigrants, women, ‘older’ workers and people with disabilities or chronic diseases. They are vulnerable regarding working conditions as well as reorganisations. More and more public and private organisations are learning how to manage diversity in the workforce related to gender, age, ethnicity, health and individual needs.
An active labour market policy with back-to-work programmes and a social security system that attributes the right costs and incentives to the right parties are under construction in most European countries. This also includes policies on work-life balance and change of early retirement schemes. How can people be tempted to continue in paid jobs? And how can management be convinced that their prejudices towards ‘older’ or disabled workers are wrong?
Furthermore there is a need to develop and utilise the skills and competences of the potential workforce to increase the added value as part of a competitive and knowledge based economy.
These policies will affect national productivity positively, although there are many nuances for different groups (McGuckin and Van Ark. Productivity and participation: an international comparison. Ministry of Economic Affairs, the Hague 2005).

Organisation policy
A number of concepts have emerged that include healthy and productive work: healthy company, corporate social responsibility, working smarter and social innovation (meant as complementary to technological innovation).
Individual and group performance is not directly the result of employee satisfaction or motivation, but of involvement and commitment through workers’ representation and work organisation. Involvement and commitment can be brought about by an organisational design that provides job autonomy, control capacity, possibilities of consulting others, learning opportunities etc. These are exactly the same measures that are recommended to reduce psychological stress risks as a way of ‘prevention at the source’ (Pot et al. Assessment of stress risks and learning opportunities in the work organisation, European Work and Organisational Psychologist, 1994, 4). These preventive measures appear to be much more effective than courses in individual stress management, although there are circumstances in which such courses can help.
The same holds for ergonomic design of workplaces. This serves not only as the objective of health protection (better posture; less lifting) and health improvement (better movements) but also that of productivity (easier and faster handling and processing; better lay-out).
Psychological stress counts for 28.7% of absenteeism in the Netherlands, musculoskeletal disorders for 32.7%. Of the stress cases 40% and 45% of the MSD cases is estimated to be directly work-related (accidents were not included because there is no separate registration of work-related and other accidents).
If purposefully combined prevention and performance are in many cases two sides of the same coin. There is a growing number of case studies that support this conclusion (see figure; and Ramstad in Alasoini et al. The Finnish Workplace Development Programme, 2005).
Besides health benefits this approach increases the labour productivity per hour.

I expect progress by developing more comprehensive concepts of occupational safety and health, and productivity. What we need furthermore are programmes and experiments on sector and national level supported by social partners. Examples are TYKES in Finland, Innovative Arbeitsgestaltung in Germany and Social Innovation in the Netherlands. Of cause these should be accompanied by research to find out which interventions are effective.

Dr. F.D. Pot was until recently director research TNO Quality of Life and is member of the board of the Netherlands Centre for Social Innovation.