Occupational Health and Sustainability
Occupational health is an area of applied scientific inquiry that is multidisciplinary in scope, drawing on the environmental, medical, public health, industrial and technological sciences, as well as epidemiological methods, to understand the etiologies of work-related diseases and injuries (Levy et al. 2011; Alli 2008). The goal of practitioners is to prevent, correctly diagnose, and treat occupational health conditions and maintain the fitness of the workforce, as well as enhance individual worker wellbeing. The field’s grounding paradigms are drawn from a diverse body of knowledge that changes as the nature of work changes. Understandings of and solutions for work-related health concerns are best approached through a systems analysis lens, the same approach that environmental sustainability issues are best understood through (Meadows 2008). Consequently, occupational health concerns and sustainability challenges share many intersectional ties (Boileau 2016; Hartwell 2012).
Early humans succeeded because they were astute observers of their environment. Whether stone age hunters (Magura Cave, Bulgaria, 8,000–10,000 BP), observing the relationships between environment, herd and hunt, or the ancient Greek philosophers (Hippocrates 430 BCE), discoursing on the health and wellbeing of the population and the air quality in various localities, the environment and human health connection has always been keenly monitored (Friss 2015). This was formally extended to the work environment in 1700 with the Italian Physician, Bernardino Ramazzini’s publication of “On the Diseases of Workers (trnsl.).” It is sobering to read the words of Ramazzini today, as he describes the carpel tunnel problems that plagued, “clerks” who spent hours daily laboring over the ledgers of their employers, and to contemplate how work has and has not changed since that time.
Environmental sustainability as described by the Brundtland Commission Report (Barnaby 1987) discusses the need to steward natural resources and systems to protect them for use by future generations. Sustainability science’s goal is to understand and respect the abilities and limitations of those environmental systems to provide future generations flexibility of choice within the system. In similar fashion, the work, health, and built-work environment are examined as a system. Optimizing that system is understood by practitioners of occupational health to involve protecting the wellbeing of the worker, assuring that the worker’s future will continue to be one of flexibility of choice and good health. Both approaches seek not to just understand the elements in each system but the exchanges between elements, and to understand what stabilizes or creates change in the system overall (Cunningham et al. 2010; Meadows 2008). Occupational health and environmental sustainability problems are systems problems and they are best understood and ameliorated as such (Docherty et al. 2009). Further, by addressing both of the critical sustainability issues of environmental and social justice that employees face at work, they are often also improved in the larger society (Hightower 2006; Hartman et al. 2003).
Health and Safety Risks and Outcomes
Occupational health and safety (OHS) professionals are trained to assess worker health and safety risks, understand and meet regulatory standards that help control those risks, and to understand and recommend both technological/behavioral measures (i.e., hearing protection programs and earplugs) to protect workers as well as administrative/production (i.e., manufacturing methods or throughput) oriented changes to address health and safety issues (Bailey et al. 2016). OHS professionals are often also involved with health promotion professionals who work with corporate wellness programs designed to address overall worker health and wellbeing (Lincoln and Owen 2015).
Exposures at work are often more intense and chronologically discontinuous than the exposures in the home and general community with a repetitive cycle that can span multiple decades. Over 80,000 chemicals are in use in industry, and thousands of new chemicals are introduced each year (Heckel and Branche 2013; Levy et al. 2011). Potential exposures include direct, often intense episodes of both safety (physical injury, physical extremes, radio frequency, and ionizing radiation exposures) and health hazards (infectious, chemical, immunological, bioengineered, nanotechnology, and psychosocial) (Houdmont and Leka 2010; Hofmann and Tetrick 2003). This creates the potential for safety-associated risks such as freezing/burning injuries, crushing injuries, and amputations. And, both acute and chronic health reactions to metals, multiple organic chemicals such as plasticizers, petrochemicals/solvents of all variety, radionuclides, biological agents, and nanoparticle materials that can range from skin conditions to chronic lung disease and cancer (Friss 2015). Further, the conditions of the workplace can travel home on the clothes, hair, skin, and shoes of a worker or become exposures for the community, if abandoned manufacturing facilities are transformed into sites for community spaces or home development (Alli 2008).
The risks posed by these workplace exposures are real and vary in nature and degree by both type of employment and by other demographics such as gender, race/ethnicity, and age cohort. The International Labor Organization (ILO) estimates that approximately 374 million injuries and 2.78 million deaths occur each year due to work-related conditions and accidents (ILO 2017). These deaths and injuries, in addition to the human suffering and grief they cause, involve many billions of dollars of losses due to productivity declines, medical treatment costs, legal costs, and reputational damage (Stringer 2016). And although these numbers are staggering, occupational health practitioners note that they are likely far higher as many conditions go unrecognized as work-related or unreported, due to fear of job loss (Levy et al. 2011).
Considering workplace fatality rates provides a descriptive example of the way diverse demographics both within and between countries impact the risks workers face and the outcomes they experience. Consider the issue of child labor in poorer countries; 250 million children globally are involved in dangerous child labor, mainly in agriculture (WHO 2017). Often their work life begins as early as 4 years old. The exposures of children of this age will be of a different range and magnitude than that of an older worker. The child’s breathing zone for example is very different than the adult’s simply due to stature. The ability of a child to recognize and respond well to a dangerous situation or exploitive conditions is also quite different than an adult. Consider also the differences in workplace risks for death based on gender. Depending on the year, homicide is the first or second leading cause of death for women at work in the United States. Most of these workplace homicides are the result of domestic abuse issues with most killers being male partners or ex-partners (55%). Further, race, ethnicity, and immigration status can play an important role in workplace fatality rates, for example, in the USA, undocumented immigrants have an occupational fatality rate that is 33% higher than US citizens (Levy et al. 2011).
Intersectionality of Occupational Health and Sustainability Solutions
OHS concerns and environmental sustainability challenges, as previously noted, share the same origins in multifaceted human interactions with complex environments whether natural or work/built environments. They are best characterized as systems and if interventions are needed to correct problems in these human/environment systems, they often must be made on multiple levels. As such, it is not surprising that as occupational health specialists have endeavored to ameliorate or prevent workplace exposures, both workplaces and natural environments have become more sustainable (Schulte et al. 2016). These approaches gave rise to the need to both characterize and understand system complexity in worksite health and wellbeing and the need to standardize approaches to OHS globally.
In addition to OHS programs that met the requirements of environmental and occupational health regulations, employee wellbeing, fitness, and workplace wellness programs began to be developed in earnest in the 1950s, 1960s, and were clearly established by the 1970s (Lincoln and Owen 2015). These programs go beyond the meeting of OHS regulations and embrace the 10 dimensions of wellbeing, offering employees’ opportunities to cope with addiction and mental health issues, control weight, get blood pressure checks, learn about nutritional programs, or stay current with their flu immunization (Stringer 2016). Examples of leaders in this area of OHS and corporate wellness programming would include such companies as Johnson & Johnson which established the, “Fit for Life” employee wellness program in 1979. Most large to medium size businesses now offer employee wellness programs. And it is estimated that savings from such programs can be significant, for example, a 2014 study found that when programs are targeted to workers struggling with chronic disease such as diabetes and hypertension, $136 USD per month could be saved in health care costs with most of that being accomplished through a 29% reduction in the use of hospital care services (Stan 2018; Caloyeras et al. 2014.
The 1980s saw the development of standardized approaches to forecasting and describing the impact on human health of policy proposals, policy choices, project proposals, and new technologies. This approach has become known as the Health Impact/Risk Assessment process, HIA. This can be applied at any scale of complexity and can be used to predict the impacts of changes in the workplace on employee health and safety. During the 1980s, the World Health Organization developed some of the first procedural guidelines for doing HIAs and has produced consensus papers on methodologies and applications such as the WHO Gothenburg Consensus paper (Morgan 2003). In the USA, these approaches have of been incorporated into larger environmental impact statements, but in Europe, the HIA has been refined and extensively used with over a dozen models for doing HIAs with the Nordic countries having very advanced applications of HIA for the workplace and larger community projects (Hubel and Hedin 2003).
In the 1990s, efforts to reduce workplace exposures and to limit environmental pollution in both the USA and Europe began to be developed as waste reduction or industrial ecology efforts, which as the decade advanced became known as pollution prevention/source reduction or now, cleaner production. A body of knowledge has developed for the major industrial and service sectors that includes best practices in reducing worker exposures to raw materials, wastes, safety hazards, and psychosocial stressors. This includes the development of techniques in raw materials substitution and reduction, closed-loop recycling, modification of processes or equipment to use less raw material, produce less waste, and enhance safety, reformulation or products to use less toxic materials, changes in cleaning and inventorying processes to reduce waste and worker exposure, and efforts to design the work environment to reduce safety risks and repetitive motion injury as well as promote psychosocial wellbeing (Schulte et al. 2016; Hendrick and Kleiner 2002). The improved environment for the worker means less emissions and waste to the air, water, and land also.
Today green or triple bottom line (TBL) business practices are gaining favor with industry and communities alike as they promote economic growth, responsible stances toward community and employees, and protection of the natural environment (Schulte et al. 2016). The International Organization for Standardization (ISO) headquartered in Geneva, Switzerland, was founded in 1947 to provide standardization for commercial and proprietary activities (ISO 2019) They have developed global industry benchmarking standards such as ISO 14,000 for environmentally sound business management practices and in March of 2018, ISO 45001 the first international management system for the development, implementation, and performance evaluation of occupational health and safety programs. Prior to this time, the most commonly used standard was OHSAS 18001. This standard will be retired in March of 2021, when the ISO 45001 will become the only international standard.
ISO 45001 is a management system or a framework which takes the user through the steps necessary to design a quality OHS program. ISO 45001 provides guidance for leadership of OHS programs, worker participation guidelines, guidance for the planning of programs, and structures for how such programs should be supported (ISO 2019). The ISO 45001 system is based on the “Hierarchy of Control” familiar to all OHS directors seeking first to identify and eliminate risks, substitute dangerous processes and chemistries, make engineering and administrative changes to enhance worker health and safety when possible, and finally use personal protective gear for employees when and if necessary. It is structured through ten classes of definitions and actions: Introduction and Scope, Normative References, Terms and Definitions, Context (of organization), Leadership (management and worker), Planning, Support, Operation, Performance Evaluation, and Continual Improvement.
It differs from the earlier OSHAS 18001 standard in that it is truly international and able to integrate with other ISO standards. It is scalable to any size business. It is innovations focused, encouraging compliance with the legal requirements of OHS through new technologies. Further this standard requires the collaborative efforts of employees and management as well as integrating the context of the operation. Thus, it integrates the leadership function with the employee and community stakeholder concerns, a central tenant of TBL practices.
These ISO standards although newly developed speak to the global importance of implementing sound OHS programs in the workplace. ISO 45001 is also fully integrated with other ISO programs. For organizations wishing to achieve a truly, internationally harmonized TBL business practice ISO 1400, ISO 9001 and ISO 45001 can be implemented together creating a comprehensive sustainability approach to planet, profit, and people reflecting the spirit of the current United Nations Sustainable Development Goals and TBL practices. This is an ever more important marketing tool to attract top talent and customers.
Many businesses and organizations are migrating their OHSAS 18001 programs into the ISO 45001 standard which will become the predominant OHS management approach. The ISO website provides data on certification trends. Across the nine standards that ISO offers, the two most popular are ISO 9001 and ISO 14001 with approximately 94% of the certificates being issued to Europe, East Asia, and the Pacific and the remaining roughly 6% being certified to American companies and organizations (ISO 2019). The costs to certify include a fee for a Registrar and depend on the size of the organization and the degree to which the current OSH management system is developed. Further, if the company can use documentation templates and a training program, they will save dollars others may have to spend on seasoned consultants. Therefore, cost estimates range from several hundred to tens of thousands of dollars depending on these factors. Many Universities are ISO 9001 certified and may also hold ISO 14001 certification. Many of these are also supporters of sustainability and TBL approaches making the addition of the ISO 45001 certification an attractive way to illustrate their harmonization with the best TBL practices.
A variety of international consultancies such as Corporate Social Responsibility, CSR Europe have been developed to assist in this OHS effort (Houdmont and Leka 2010). And while the approach of voluntary compliance with industry standards has been favored in the West, which has embraced ISO 14,000 and now also ISO 45001 outside of the typical command and control worker health and safety regulations, other regions such as the European Union have begun to encourage sustainable business practices through their environmental risk management regulations process (i.e., extended producer responsibility for recycling and reuse) (Vogel 2012).
Whether achieved through voluntary programs or regulatory requirements, these TBL approaches when they lead to new technologies to reduce pollution ensure worker safety, or create more sustainable and safe built environments also lead to distinct forms of economic development which protects natural environments and workers while advancing the economy (Phillips et al. 2013; Goklany 2007). Technology innovation and development has historically followed a trajectory of increasing efficiency in materials use and reduction in manufacturing waste. Thus, TBL solutions have the added benefit of driving innovation and resilient economic development. Consider the development of ergonomic solutions in the work place that lead to innovations in the layout of the office to prevent injury while enhancing productivity, or the implementation of lighting solutions that reduce psychosocial stress and energy consumption through the artful incorporation of both natural light and energy saving illustrate this synergistic principle (Boileau 2016; Hendrick and Kleiner 2002).
Occupational health problems and solutions that require understandings of race/ethnicity, gender, or age cohort work to break-down one of the most problematic contributors to social strife and poor economic growth-horizontal inequalities. Horizontal inequalities are the inequalities between groups rather than vertical inequalities which are the inequalities between any random groups of individuals. Meta-analyses have associated horizontal inequalities strongly with income inequality, poorly performing economies and violence (Mahler et al. 2015; Constantin 2014; Ostby 2013; Dell 2004). Assuring a safe and healthy work environment for all reduces inequality, especially horizontal inequality (Hartman et al. 2003). And in as much as these efforts produce a healthier better-performing workforce, return on investment in employee health and wellbeing is realized as poor employee health incurs costs for businesses at multiple levels from direct healthcare cost, increasingly sophisticated litigation backed by more nuanced research, and serious loss of reputation (Phillips et al. 2013).
Finally, the common interests and natural synergies of occupational health efforts and sustainability have built bridges. Many “blue and green” coalitions between various worker associations, unions, and professional groups have developed around the world (Cunningham et al. 2010). Some have included partnerships with major corporations that are aiding in further driving these TBL approaches such as Harvard University’s Health and Human Performance Index, HHPI. The HHPI was developed with Johnson and Johnson Company to identify and encourage the use of TBL performance metrics. Undoubtedly, the continuing development of these synergies will make the practice of occupational health an important and interesting contributor to the advancement of a just and environmentally respectful and resilient human civilization.
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