UL 904Z BULLETIN

Abstract

In recent decades, U.S. employers have made significant progress in addressing issues of health and safety in the workplace. Since 1970, workplace fatalities have been reduced by more than 65 percent and injury and illness rates have declined by 67 percent, according to the Occupational Safety and Health Administration (OSHA).(1) Worker deaths have been reduced from approximately 38 per day in 1970 to 12 per day in 2012. <br>Major safety improvements have been made through the use of risk assessment, medical surveillance examinations, safety training, improved protective equipment, better mechanical safety engineering and other physical changes in the workplace, and a host of other factors. These include efforts by labor and management to address safety issues more comprehensively, the rise of new governmental agencies focused on safety, and an increase in research and education devoted to safety. The establishment of OSHA and the National Institute for Occupational Safety and Health (NIOSH) in 1970 was also an important factor. Over time, employers adopted safety as a company value and built what came to be known as a &#8220;culture of safety&#8221; among their employees. <br>Coinciding with advances in safety was the rise of a workplace wellness movement in the United States, driven in part by rising health care costs in the 1970s and 1980s. As costs increased, employers began to introduce &#8220;worksite health promotion&#8221; programs on a large scale in an effort to keep their employees healthier and thus reduce health-care cost impacts on their employee health plans. <br>Early employer-based programs consisted of health screenings, smoking cessation, weight-loss education, and on-site exercise offerings, including corporate fitness centers. Over time, these programs evolved into much more sophisticated efforts, which today include the use of health risk appraisals (HRAs) and biometric screening; programs for the management of chronic health conditions, such as diabetes; behavior modification; and large-scale population health strategies based on clinical data. Many large employers have even established medical clinics and pharmacies onsite. Increasingly, employers use these programs and other strategies to integrate health broadly into corporate practices in an effort to establish what is often referred to as a &#8220;culture of health&#8221; alongside a culture of safety. <br>Over the course of many decades, these two workplace activities &#8211; safety and wellness &#8211; have evolved in tandem, but they have operated mostly independently, with separate work teams and organizational reporting structures. (3) Today, they are broadly known as &#8220;health protection&#8221; (safety) and &#8220;health promotion&#8221; (wellness). <br>Health protection usually encompasses the activities that protect workers from occupational injury and illness &#8211; ranging from basic safety training and the use of protective gear to equipment safety-enhancements and improvements to the environment. Health promotion encompasses workplace policies, programs and practices that maintain or improve the personal health and well-being of a workforce &#8211; ranging from the provision of appropriate wages and benefits and the use of health risk assessments to immunizations to chronic-disease and catastrophic-illness management. The professionals who work within these activity centers include everything from safety engineers and industrial hygienists to occupational health nurses and physicians trained in occupational and environmental medicine (OEM), and they may be housed in a variety of operational centers, from occupational health to human resources or benefits administration. <br>In recent years, employers and others in the occupational health community have begun to view the traditionally separated &#8220;silos&#8221; of health promotion and health protection &#8211; or, more simply, health and safety -- in a new light, recognizing that their positive impact in the workplace could be magnified by more effectively aligning their strategies to be mutually beneficial. <br>A growing number of initiatives and studies, in fact, are embracing the idea that establishing a true culture of health in the workplace is dependent on the integration of health protection and health promotion efforts. Leading experts in both the health and safety professional communities are building programs around the concept that health activities impact safety and safety activities impact health. <br>In a 2011 paper titled Workplace Health Protection and Promotion: A New Pathway for a Healthier &#8211; and Safer &#8211; Workforce, Hymel et al described the integration of health protection and health promotion as a continuum, in which &#8220;health promotion interventions contribute dynamically to improved personal safety in addition to enhancing personal health, while occupational safety interventions contribute dynamically to improved personal health in addition to enhancing personal safety. The two factors, personal health and personal safety &#8211; each essential to a productive worker and to a productive workplace &#8211; are effectively combined in a symbiotic way that increases their impact on overall health and productivity. The whole becomes greater than the sum of its parts.&#8221; <br>Supporters of the health and safety continuum concept are increasing, and various integration projects, initiatives or studies are either under way or in development at organizations such as the American College of Occupational and Environmental Medicine (ACOEM), Underwriters Laboratories (UL), the American Society of Safety Engineers (ASSE), the American Industrial Hygiene Association (AIHA) and the National Institute for Occupational Safety and Health (NIOSH), as well as at leading employers, such as The Dow Chemical Company, American Express and Navistar, and at academic centers, such as Dartmouth-Hitchcock and UCLA. Diverse professional voices within these communities &#8211; ranging from industrial hygienists and safety engineers to occupational health nurses and practitioners of OEM &#8211; are seeking new ways to work together and leverage their various best-practices and long-established health and safety guidelines. <br>In the years since the publication of Workplace Health Protection and Promotion: A New Pathway for a Healthier &#8211; and Safer &#8211; Workforce, the chorus of voices advancing health and safety integration has certainly grown, but the number of employers actively exploring this concept remains small. Though employers have made great strides in creating separate cultures of health and safety in the United States, and many theorize that they could be more powerful if integrated, the two have yet to meet and merge into a truly sustainable and integrated culture. <br>Cross-discipline and cross-sector initiatives &#8211; including the integration of health interventions across the community (public health), the home (primary care) and the workplace (occupational health and safety), hold the most promise for success in addressing our growing global health issues <br>More recently, studies have begun linking worker health with the market performance of the companies that employ them. In 2013, for example, a study published in the Journal of Occupational and Environmental Medicine (JOEM) tracked the stock market performance of publicly traded companies with strong health, safety and environmental programs. Using simulation and past market performance, a theoretical initial $10,000 investment in these publicly traded companies over a 13-to-15-year span was shown by Fabius et al to outperform the S&P 500. Though correlation is not the same as causation, the results of the S&P 500 study consistently suggest that companies focusing on the health and safety of their workforce can yield greater value for their investors &#8211; including competitive advantage in the market <br>The widespread adoption of an Integrated Health and Safety standard in the workplace would ensure that this vital sector &#8211; impacting the health of more than 130 million Americans &#8211; is well-aligned and prepared as the transition to cross-sector health intervention strategies begins to take hold in the United States and globally. <br>UL XXXX seeks to create a more favorable environment for advancing the principles of health and safety integration in the United States