Improving health in the workplace: ILO’s framework for action

If integrated into occupational safety and health (OSH) policies, the potential of workplace health promotion (HP) to improve working life increases as it complements occupational health. It benefits both workers and employers by improving the long-term well-being of workers and their families, increasing productivity and performance, and reducing pressure on health, welfare and social security systems. Integrating HP measures into workplace OSH management systems enhances occupational health practice and contributes in building a global preventive culture.

Occupational safety and health (OSH) is an integral part of the Decent Work Agenda of the ILO. Decent Work is defined as the right to productive work in conditions of freedom, equity, security and human dignity. Work can only be decent if it is safe and healthy.

The commitment for the protection of workers against sickness, disease and injury arising out of their employment is one of the ILO’s main objectives. In line with this mandate, the ILO develops international labour standards in the field of OSH to guide governments in setting national laws and regulations and enforcing their application at the workplace. Employers and workers and their organizations also have the framework to improve working conditions and OSH. There are 38 up-to-date ILO instruments directly relevant to OSH. Three main conventions are relevant in this context.

The ILO Convention on Occupational Safety and Health (No.155) and its Recommendation (No. 164) provide for the adoption, implementation and review of a coherent national policy on OSH, mechanisms for consultation and participation of employers and workers and their organizations and measures for its implementation at national and enterprise level.

The Occupational Health Services Convention (No. 161) and its Recommendation (No. 171) define the role of occupational health services as multidisciplinary services having essentially preventive and advisory functions and being responsible for assisting employers, workers and their representatives in establishing and maintaining a safe and healthy working environment, including the adaptation of work to the capabilities of workers to facilitate optimal physical and mental health at work.

The Promotional Framework for Occupational Safety and Health Convention (No. 187) and its Recommendation (No.197) adapt to the needs of today in this field. They incorporate the core principles from ILO Standards on OSH and provide guidelines for a coherent and effective national management system. Further guidance for implementing a workplace OSH management system is provided in the ILO Guidelines on occupational safety and health management systems (ILO-OSH, 2001).

All ILO standards on OSH and ILO’s Policy in this field reflect the following three core values:
  • Work should take place in an safe and healthy working environment;
  • Conditions of work should be consistent with worker’s well-being and human dignity;
  • Work should offer real possibilities for personal achievement, self-fulfilment and service for society.
The primary responsibility of the employer to provide safe and healthy working conditions and the participation of workers in the management of OSH are embodied in all ILO standards in this field. The knowledge and active participation of workers’ representatives and OSH committees in the establishment of preventive measures at the workplace have proven to be effective tools for action.

ILO action in this field is undertaken through the Labour Administration, Labour Inspection and Occupational Safety and Health Branch (LABADMIN/OSH). The Branch supports ILO constituents and other social partners in protecting workers’ health and promoting their well-being through the improvement of their working conditions and working environments and the prevention and control of occupational accidents and injuries and occupational and work-related diseases.

ILO’s contribution in the design of workplace policies and preventive programmes on OSH takes into account global knowledge gained through research and good practices. As part of this approach, the ILO/WHO Joint Committee on Occupational Heath adopted a comprehensive definition of the aim of occupational health:
“The promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations”.
To achieve this objective, a safe and healthy working environment and access to occupational health services should be ensured for all workers as provided for in ILO Convention (No. 155) and ILO Convention (No. 161) mentioned above. In this framework, OSH is defined as a multidisciplinary field devoted to the anticipation, recognition, evaluation and control of hazards arising in or from the workplace that could impair the health and well-being of workers, taking also into account the possible impact on the surrounding communities and the environment.

In addition, the scope of occupational health practice is expanding beyond the traditional scope of occupational health and safety to also incorporate psychological and social well-being and the ability to conduct a socially and economically productive life.

Health promotion

The close link between occupational health and health promotion (HP) has become more evident in recent years. Scientific evidence shows that in the long term, work-related stress can contribute to musculoskeletal disorders, hypertension and cardiovascular diseases. It may also alter immune functions which in turn can facilitate the development of cancer. More widely, it can lead indirectly to problems in and outside the workplace such as violence, the abuse of drugs and alcohol, strained family relationships, depression, physical and mental health disorders and even suicide. Similarly, many harmful effects of lifestyle behaviours, such as smoking, alcohol and drug abuse, nutritional deficiencies, and physical inactivity can also interact with workplace hazards. Taken together they can lead to accidents, injuries, illnesses, incapacity and death. However, the early detection and appropriate treatment of incipient occupational and non-communicable diseases will reduce mortality and lower the frequency and extent of residual disability from many of such diseases. For example, there is growing evidence that the elimination or limiting of such health risks can also prevent or delay the onset of life-threatening diseases such as strokes, coronary artery diseases and cancer.

In recent years, assisting workers in managing their chronic conditions and becoming proactive in their health care has turn into an accepted strategy for worksite HP programmes in many developed countries. These programmes are often designed to encourage and help build healthy behaviours, especially in relation to stress, alcohol and drug, tobacco, nutrition and physical activity. Such programs will continue to develop and expand as the workforce ages and chronic health problems place increased burdens on health systems and national economies. Although, HP initiatives are not always integrated into OSH programmes to complement the prevention of occupational accidents and diseases and the improvement of the working environment.

However, if integrated into OSH policies, the potential of workplace HP to improve working life increases as it complements occupational health. It benefits both workers and employers by improving the long-term well-being of workers and their families, increasing productivity and performance, and reducing pressure on health, welfare and social security systems. Integrating HP measures into workplace OSH management systems enhances occupational health practice and contributes in building a global preventive culture. For this reason, the ILO designed the SOLVE training package to complement other OSH tools and focus on the prevention of psychosocial risks and the promotion of health and well-being at work integrating workplace HP into OSH policies and action.

ILO experience shows that a successful enterprise is based on the people that work in it and on its organizational culture. Workers in a safe and supportive environment feel better and are healthier, which in turn leads to reduced absenteeism, enhanced motivation, improved productivity and a positive enterprise’s image. The prevention of occupational accidents and diseases, the promotion of a healthy working life and the building of a preventative culture is a shared responsibility of governments, employers and workers, health professionals and society as a whole.

Health promotion in the workplace contributes to:
  • The improvement of work organization and the working environment;
  • Social dialogue and the active participation of social partners in the improvement of working conditions at the workplace level;
  • The promotion of health among all workers, their families and their communities;
  • The encouragement of personal development and well-being by enabling workers to reach a higher level of self-determination concerning their health and its improvement.
Health promotion at work benefits not only workers but also the employer, since it is a vital component in:
  • Improving workplace productivity and performance;
  • The long-term well-being of workers and their families;
  • Reducing pressure on health, welfare and social security systems.
Health promotion at the workplace is effective when:
  • It complements occupational safety and health measures to prevent accidents and diseases and to protect workers’ health;
  • Action is taken based on an analysis of the health requirements and needs of an enterprise;
  • Employers, workers and their representatives are involved;
  • Activities in this area seek to improve the quality of working conditions and work organization focusing on healthy behaviours; 
This approach is very important and effective because:
  • Social dialogue brings together a wide range of partners to discuss unresolved issues for which the natural reaction is often to ignore the problem, pretend it does not affect the enterprise or profession concerned, or get rid of workers implicated in the problem. The workplace not only offers direct access to many of the workers most at risk, but is also an effective channel for reaching workers' families and, through its central position in the community, other areas of society, such as schools and social services.
  • Practices and attitudes relating to the abuse of tobacco, drugs and alcohol, violent behaviour can only be modified in the long term through changes in behaviour and social attitudes. Many employers insist that their workplace is not affected by the problem, or ignore it in the hope that it will resolve by itself. These responses merely serve to conceal problems which will continue to have an important detrimental effect on the safety, performance, health and well-being of workers and their communities.
  • A social dialogue approach helps to create networks in the workplace and beyond, involving families, schools, community groups and public authorities in dealing with issues requiring changes in behaviours and social attitudes in order to achieve lasting and effective progress. The social dialogue approach is a valuable means of developing close and mutually beneficial partnerships which can be useful in many other areas of working life. For example, companies which have implemented ILO programmes to combat drug and alcohol abuse have found them to be important instruments for developing social dialogue and partnerships. In certain cases, this has provided a good basis for reaching agreement on other issues, such as the training and restructuring required for the adoption of new technologies and work techniques, as well as for the development of broader-based health promotion programmes for workers and their families.
Time spent in developing partnerships to improve workplace health and well-being is an investment in the most important asset of any enterprise or organization, its workers. It is also an investment in the social context within which a company or organization operates, and therefore in its future and the future of the community and the country as a whole.
Los cinco estudios de caso -realizados en Camerún, Colombia, Indonesia, Filipinas y Túnez- describen la situación de la seguridad y la salud en el trabajo (SST) en las mipymes y las iniciativas adoptadas en este ámbito.

Los estudios de casos que se presentan en esta publicación se desarrollaron a lo largo del primer año del proyecto de la OIT Mantenimiento de mecanismos sostenibles para promover la seguridad y salud en el trabajo en las pequeñas y medianas empresas (Upholding sustainable delivery mechanisms to promote occupational safety and health in small and medium sized enterprises).

Los cinco estudios de caso tienen como objectivo:

• describir el contexto nacional en relación con las mipymes (por ejemplo, la definición nacional, su presencia y su papel en la economía nacional);
• proporcionar una visión general de las condiciones de SST en las mipymes del país;
• ilustrar el marco nacional relevante para la SST en las mipymes, incluyendo la identificación de los actores clave, las políticas y estrategias nacionales, etc.;
• analizar las iniciativas sobre SST desarrolladas a nivel nacional, sectorial y local dirigidas a las mipymes;
• identificar las enseñanzas extraídas y las oportunidades de mejora de la SST en las mipymes y ampliar las buenas prácticas.

Esta publicación complementa el informe "Improving Safety and Health in Micro-, Small and Medium-Sized Enterprises: An overview of initiatives and delivery mechanisms", en el que se analizan ejemplos de mecanismos de apoyo e iniciativas que los gobiernos y otros agentes utilizan para promover la seguridad y la salud en las mipymes.