ELSEVIER Safety Science 20 (1995) 323-328

Occupational health and safety promotion: Problems and solutions

David Koh Division of Occupational Medicine, Department of Community, Occupational and Family Medicine,

National University of Singapore, Lower Kent Ridge Road, Singapore 051 I, Singapore

Abstract

Most occupational safety and health (OSH) professionals would agree that having a good OSH promotion programme is a challenge, and problems can be encountered at almost every stage in the planning and delivery of the programme.

The first obstacle which may be encountered is programme justification. How does one convince employers and employees of the need for OSH promotion, and does competition from “Wellness Programmes” reduce available resources? Programme planning, deciding what constitutes a pro- gramme, and what to include in the OSH promotion programme, may be a dilemma. The programme implementation, deciding who implements the activities and how a programme is sustained, may be other difficult issues. Finally, programme evaluation can be problematic: How is it done properly? and Who should evaluate the programme?

Possible solutions to these problems may include the costing of work accidents and occupational ill health to justify the need and benefits of an OSH programme, and riding on the bandwagon of “wellness promotion” instead of competition for limited resources. In programme planning, knowing what is wanted and employing a professional to plan the programme is essential. The programme coverage should encompass health and safety issues, and preventive strategies should be directed towards both environment and lifestyle factors. There should be a prioritization of topics according to the needs of workers. The choice of OSH professionals versus “wellness promoters” or human resource officers as programme co-ordinators may affect the programme outcome. Training supervi- sors and line workers to be trainers would involve those directly in contact with work hazards in the programme. Programme evaluation is crucial. There should be provision for both process and outcome evaluations, and pains should be taken to ensure independence and objectivity of evaluations. The idea of linking programme results to the OSH personnel assessments is worth considering.

The delivery of OSH promotion programmes in a relevant and effective manner poses a real challenge. While some obstacles and problems appear to be insurmountable, these challenges have to be faced and overcome in order to achieve the goals of protecting and promoting the health of the worker.

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324 D. Koh /Safety Science 20 (1995) 323-328

1. Introduction

Professionals in occupational safety and health (OSH) are generally convinced of the importance of OSH promotion in the workplace. Yet most would also agree that having a good programme is a challenge, and problems can be encountered at almost every stage in the planning and delivery of the programme. Some of the common problems and possible solutions will be discussed, with appropriate examples and case studies used to illustrate

the points raised.

2. Common problems and possible solutions

Common problems may be encountered at all stages in the programme. There are no easy answers to these problems, and sometimes unique solutions have to be considered for unique situations. A variety of approaches have been successfully applied to overcome common obstacles, and could perhaps be applicable to your situation.

3. Getting started

The first step of initiating an OSH programme is often to justify the need for such a programme. Persuading employers and employees on the need for OSH promotion can be a real challenge. Moral and ethical reasons can be offered on the need to protect the health

of the worker, but in the business world, such arguments may sometimes have little persua- sive impact. In many instances, legislative requirements and/or economic analysis provide much greater influence for justifying the need for OSH programmes.

3.1. Programme justljkation

Costing of work accidents and occupational ill health to justify the need and benefits of an OSH programme is an activity which the OSH professional is often uncomfortable with. This may be because economic analysis is often not adequately taught in many professional OSH training programmes. Yet the cost of accidents, which includes medical costs, lost time, equipment damage and materials and output loss, disruption of work processes, and loss of trained manpower, can approximately be estimated. A similar costing can be per- formed for occupational ill health. These can be compared against the cost of an OSH programme, and a compelling argument made for the introduction of the programme.

3.2. The advent of wellness programmes

Another development in recent years is the introduction of programmes to promote general health or well being, sometimes termed ‘ ‘Wellness Programmes” in the workplace. In such situations, there may often be a competition for resources between such programmes and OSH programmes.

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‘ ‘Wellness Programmes” are often viewed with some reservation by OSH professionals. Conrad states that “One virtually never hears wellness people discussing occupational disease or hazardous working conditions. Whether they view it as someone else’s domain or as simply too downbeat for upbeat wellness programmes is difficult to know. This may in part explain why worksite health promotion has been greeted with scepticism by occu- pational health veterans” (Conrad, 1987).

“Wellness programmes” should not be viewed negatively or as a competitor. Instead, OSH professionals could ride on the bandwagon of “Wellness promotion”, and take advantage of corporate interest in this field. A comprehensive wellness programme should have OSH activities integrated within its framework, and could be a vehicle by which OSH activities is disseminated to the workers.

4. Programme planning

Assuming that the programme justification phase has been successfully overcome, the next important problem may be to decide what constitutes a programme, and what should be included in the OSH promotion programme. There are no easy answers to this problem, but nevertheless, this has to be well addressed if the programme is to be a success. Many OSH promotion programmes fail because of inadequate or poor planning.

In planning a programme, it is important to understand what constitutes a programme. An operational definition (Golaszewski, 1992) of a programme (as opposed to an activity), is that a programme: (a) has written goals or objectives, (b) has person(s) accountable for the achievement of objectives, (c) has a budget, and (d) occurs more than once. The programme coverage should include health and safety issues. Preventive strategies should be directed towards environmental control as well as the enhancement of lifestyle behav- iours.

The selection of topics should be according to the needs of the workers. For example, a “health promotion” programme for a taxi drivers co-operative was initially developed by a health education unit with little knowledge of occupational health (Koh and Phoon, 1989). The programme consisted of advice on personal hygiene (do not spit, wash your hands after visiting the toilet), exhortations to stop smoking, exercise more and eating less fat. There was little enthusiasm for this programme, as it was perceived to be irrelevant for taxi drivers and too childish.

A revised programme, which had the input of an occupational physician, discussed issues such as the job demands of taxi driving, common work related ill health, safety at work, and general preventive health advice (which was discussed in relation to fitness to drive). This was much better received by the drivers, who could identify the programme contents with their specific needs.

The enlargement of the programme scope to encompass work-related illness and general illness is useful, as the promotion of positive health has long been considered as one of the aims of an occupational health programme (Australian College of Occupational Medicine, 1983). The linking of general illnesses with fitness to work, and the focus on common causes of morbidity such as smoking, were also appropriate. This is because in many work

326 D. Koh /Safety Science 20 (1995) 323-328

situations, the impact of morbidity due to general illnesses and unhealthy lifestyles may outweigh the morbidity due to occupational ill health.

Another lesson learnt in this example is that it is important to employ an OSH professional in the development of such programmes. To plan such programmes well requires more than just a general orientation or competence in health education or health promotion. When

programmes are developed for specific workplaces and workers, OSH expertise is essential.

5. Programme implementation

After planning, the programme has to be implemented. Who should be responsible for the actual implementation of the programme, and how can a programme be sustained? Both

management as well as employee support are crucial, and efforts have to be sustained to be successful.

Management support is crucial to ensure the success of OSH promotion programmes. In the comparison of plants with high and low injury rates (Feldman, 1985), it was noted that the most important workforce factor which accounted for the difference in safety perform-

ance was greater management commitment and involvement in the total safety programme. This was reflected in the rank and stature of the company safety officer, regular inclusion of safety issues in plant meeting agenda and personal inspection of the workplace by senior management. Top management in plants with the best health and safety records often state that they place the same emphasis on health and safety as on production and sales.

The choice of OSH professionals or “wellness promoters” or human resource officers

as programme co-ordinators in the implementation of the programme is often not given much thought. Sometimes, the “most convenient” person is chosen. This may be someone who does not complain too much about the added responsibilities or someone too junior to protest. Such a situation is certainly not desirable.

Occasionally, a wellness promoter might be hired for the job. Again, this might not be

the best person to be responsible for an integrated programme which includes OSH. Unfor- tunately, “wellness promoters” very often have little or non-existent OSH training. As a result, they may tend to focus more on lifestyle factors, and often neglect to consider environmental control in the prevention of work-related ill-health. This problem may be overcome if the wellness promoter seeks the input from his or her OSH colleagues, but this does not always happen.

As an example, in an electronics company programme which is co-ordinated by a “well- ness promoter”, emphasis is totally on lifestyle changes, with no attention paid to the work environment (Koh, 1994). This was because the wellness promoter had extremely limited knowledge of OSH issues, and there was no attempt at all to work with the company safety committee and Safety, Health and Environment (SHE) co-ordinators for any of the pro- gramme activities. In this situation, both the wellness promoter as well as the OSH profes- sionals missed the excellent opportunity to work together.

Training the line workers to be trainers is important for a huge workforce. Active and motivated employees who have the respect of their peers are often the best persons to recruit as OSH promoters. Worker involvement in OSH programs ensures that those closest to potential problems (and in many cases, those most familiar with the problems) are utilized

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in the recognition, evaluation and control of workplace hazards (Feldman, 1985). Ulti-

mately, the first line of responsibility for OSH is at the line management.

6. Programme evaluation

The success of the programme has to be measured to allow for feedback, and possibly,

modification of the programme. Yet this evaluation process may be difficult. Two questions which are very often raised are “How does one evaluate a programme?” and “Who should

be responsible for doing the evaluation?“. A major achievement in many programmes

would simply be to include some sort of programme evaluation. Unfortunately this is often

neglected, and it reflects poorly on the programme. Evaluations should be made for both the process and outcome of the programme (Alsa-

go& 1993). These evaluations consist of evaluating a change in the defined variable and assessing if this change can be attributed to the intervention. Some techniques which could be used in evaluation could be expert panel reviews, internal audits of resource allocations, utilization and record reviews, participant surveys, observations of programs or sessions, component pretesting; and measurement of the health or safety outcome in an appropriate, validated and reproducible manner. The outcomes should be compared against the written objectives of the programme.

Evaluations should be independent and objective. As such, the best person to evaluate the programme could be someone other than the programme promoter. If this is unavoidable,

objective evaluation criteria should be prepared at the start of the programme. Another interesting suggestion is to link the results of the programme evaluation to the personnel assessments of the OSH professional (Golaszewski, 1992).

7. Conclusion

In industry today, health and safety promotion is often looked upon favourably by management. This is because such programmes have a role in containing or reducing rising health care costs, and increasing productivity at work. The OSH professional has much to offer in providing an effective OSH promotion programme.

Many problems may be encountered in the delivery of OSH programmes. These problems have to be overcome, and not all solutions are easy. The OSH professional must rise to the challenge to provide practical solutions to problems in programme justification, planning,

implementation and evaluation. It would be, at best, a pity to waste the opportunity to promote OSH, and at worst, unethical, if we allow less qualified and less capable persons to exploit the current interest in health and safety promotion.

References

Alsagoff, F. 1993. Evaluation of health promotion programs in the workplace. J. Oct. Med. Singapore, 5: to4- 10.

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Australian College of Occupational Medicine, 1983. Report: Health promotion in industry.

Conrad, P., 1987. Wellness in the workplace: Potentials and pitfalls of worksite health promotion. Milbank

Quarterly, 65: 255-75.

Feldman, R.H.L. 1985. Promoting occupational safety and health. In: R.H.L. Feldman and G.S. Everly (Eds.),

Occupational Health Promotion: Health Promotion at the Workplace. Wiley, NY, pp. 188-207.

Golaszewski, T., 1992. What is a program: Thoughts on definitions in work-site health promotion. J. Oct. Med.,

34: 162-3.

Koh, D, Phoon, W.O., 1989. Occupational health education of taxi drivers in Singapore. Proc. 1st Conf. on

Education and Training in Occupational Health. McMaster University, pp. 169-75.

Koh, P., 1994. Jnvesting in wellness programmes. Singapore Sot. Oct. Health Nurses Newsletter, 9: 16-8.