¨ Establishing a Common language: Productivity and Workforce

¨ Karl Kuhn, Federal Institute for Occupational Health and Safety (FIOHS), Dortmund

¨ Evaluate the European perspective of work and productivity

¨ At the moment Europe is undergoing profound structural change which is reflected in the technological and economical developments in the labour market and in the entire social structure. New forms of work are on the increase, for example, outworking and contract work, tele-working, long-term low paid work and apparent self-employment as a new form of independence. This is visible in the new company structures, in the changes which have taken place in inner and inter-company work-organisation such as decentralisation of production and customer service, outsourcing of company operations, virtual enterprises, external workshops and in the establishing of small enterprises. The change is also to be seen in the new framework conditions for companies such as globalisation, single customers who have individual product, delivery and quality requirements, in the rapid developments in technology, the new organisational structures and finally, in the increased competition. Hierarchical structures are increasingly being replaced by a more flexible organisation; i.e. an organisation which is based on teamwork, projects and processes and orientated towards the market and customers. The aim is towards a learning organisational structure which can cope with the permanent pressure caused by the need for organisational flexibility.

¨ Organisations are nowadays not only valued on the basis of their products or machines but primarily on the knowledge creating capacity of the workforce, the people who work for them, how they work and what work means to them. Maintaining and effectively managing human resources in the long term i.e. employees’ health, will be a crucial economic factor for Europe. 29% of workers in Europe questioned, consider that their work affects their health. The work-related health problems mentioned most frequently are musculo-skeletal complaints (30% of workers claim to suffer backache and 17% muscular pains in their arms or legs) and stress (28% of employees).

¨ Europe’s future social and economic success increasingly depends on highly qualified, motivated and healthy employees: In this case policies and strategies in work and health opens up new answers to the changing circumstances in many organisations.

¨ Millions of people in Europe are out of work and need to be integrated or re-integrated into work, but many, - i.e. in Europe nearly 25% of the unemployed - have health complaints/ill-health which reduces their employability dramatically. Being unemployed also results in an increase in their mental and psychological problems. In order to increase their employability they need to be supported by adequate health promotion measures to make them fit for work, fit for the company, fit for coping with the situation, strengthening personal skills and abilities by life long learning and training and encouraging personal development.

¨ In Europe, Workplace Health Promotion (WHP) is a comparatively young field of action. Its development is characterized by different concepts of work and health as well as approaches used in practice to improve health and well-being of the workforce.

¨ The current state of WHP in the countries of the European Community widely differs due to different professional traditions, differences with regards to the organisation of public health as well as occupational health and safety including their legislative basis. Other aspects which contribute to the great variety of WHP approaches in Europe include:

¨ The state of the national economy

¨ Policy priorities of the relevant stakeholders on national level such as the social partner organisations, the respective governmental institutions in the labour and health policy arena

¨ Policies and strategies adopted by leading businesses

¨ Existence of economic incentives for action (such as the impact of high absenteeism costs on the employer, the health care system and the social security system)

¨ The role of initiatives concerning issues of work democracy and the quality of working life

¨ This context has led to the development of a number of definitions of workplace health promotion. They differ in scope and due to the underlying understanding of the relationship between workplace factors and health. They also make use of different health concepts ranging from a medical concept of individual health to psycho-social concepts of organizational health.

¨ The current stage of programme development sees the involvement of organisational change and approaches to integrate health aspects into management systems (eg. systems for quality, occupational health and safety, environmental protection, human resources management systems).

¨ In some countries public health based agencies and institutions have achieved considerable success addressing the workplace setting and implementing WHP programmes. In the UK, the Health Education Authority launched major WHP initiatives in the 1990‘s. Similar programmes have been initiated in Scotland and Wales by the responsible public health agencies.

¨ In Germany and Austria the statutory health insurance organisations have been the driving force behind the dissemination of WHP into the workplaces of the private and public sector. Based on legislative incentives these countries have established a kind of national standard for WHP mainly in medium-sized and larger enterprises.

¨ In the Netherlands WHP has also been successfully advocated and developed as a legitimate field for public health action.

¨ In southern Europe, Portugal has been a good example for a national public health-based approach to the dissemination of WHP.

¨ Today’s understanding of modern occupational health and safety includes WHP. The implementation of the Council Directive (89/391/EEC) into national health and safety law has significantly contributed towards a modernized approach to safety and health of workers at work in every country of the European Union. While occupational health and safety legislation has so far focused on single risk factors (such as noise, radiation, hazardous substances etc.) the new legislative basis requires the consideration of all potential health hazards including psycho-social factors.

¨ Whereas traditional occupational health and safety focused on occupational diseases and the prevention of occupational accidents the tasks now also include the prevention of workplace-related health hazards. Thus the range of approaches and measures has been broadened to also involve workplace health promotion as a strategy to reduce workplace-related health hazards.

¨ In practice, occupational health services in many companies as well as safety professionals have begun to include WHP activities into their daily practice and to start joint cooperations with WHP professionals. In Germany, a number of WHP initiatives are now managed by company doctors, safety professionals and other professional OSH practitioners. In Finland the maintenance of work ability approach is regarded as a WHP concept and widely used among occupational health professionals.

¨ WHP has also been explicitly identified as one element in a recently established framework for the assessment of individual occupational health and safety management systems. In a number of countries different concepts for occupational health and safety management systems have been developed and put into practice in various companies either parallel to other management systems (e.g. for quality and the environment) or in an integrated form. (In a position paper which was recently published by the German Federal Ministry of Labour and Social Affairs WHP has been included into a core element for occupational health and safety management concepts.) Furthermore, in many countries WHP has become a part of vocational training for occupational health and safety professionals.

¨ To reach agreement on a common definition of WHP, the European Network for Workplace Health Promotion (ENWHP) formulated two important documents. The documents were drawn up and adopted by all 18 members of the Network to serve as a basis for network activity.

¨ The first document, the Luxembourg Declaration was ratified in December 1997, defining for the first time, a Europe-wide, commonly agreed concept for WHP.

¨ In the Luxembourg Declaration, Workplace Health Promotion is defined as follows:

¨ Workplace Health Promotion (WHP) is the combined efforts of employers, employees and society to improve the health and well-being of people at work.

¨ This can be achieved through a combination of:

¨ improving the work organisation and the working environment

¨ promoting active participation

¨ encouraging personal development

¨ The second document, the Cardiff Memorandum was ratified in March 1998. This document focuses on WHP in small and medium sized enterprises.

¨ The main aim of the Network is to develop and formulate recommendations and strategies for the implementation of WHP in Europe and on the basis of a continual exchange of experience, to identify and disseminate models of good workplace health practice. The EU encourages the Members States to give priority to WHP and to take health at the workplace into consideration when making political decisions.

¨ Identify the health policy priority programs of the European Union

¨ The Treaty of Amsterdam enlarged the scope, purpose and legal possibilities for Public Health Policy at EU level, very much along the lines asked for by the European Parliament. The new Article (Article 152), stipulates explicitly that ”health protection requirements shall form a constituent part of the Communities' other policies”.

¨ The Commission recently submitted a proposal for a public health policy to the Council and European Parliament suggesting a strategy and package of measures aimed at injecting greater coherence into Community policy.

¨ The Commission has proposed three themes/policy strands:

¨ Improving information for the development of public health

¨ Reacting rapidly to threats to health

¨ Tackling health determinants through health promotion and disease prevention.

¨ Let have a closer look to the legal context of health objectives in the European Union.

¨ The basic health objective of the Community is set out in Article 3(p) of the EC Treaty. This states that ”the activities of the Community shall include … a contribution to the attainment of a high level of health protection.”

¨ This objective is pursued throughout the full range of Community policies. The provisions of the Treaty relate to health in three main ways.

¨ First, there is a direct reference to the protection of health as an objective of Community action in several Treaty Articles: Articles 137 and 140 (occupational health and safety), 152 (Public Health), 153 (Consumer Protection), and 174 (Environment).

¨ Second, the protection of health is one of the grounds on which Member States can justify restricting free circulation of goods and people in the Community (Articles 30 and 46).

¨ Third, there are a large number of actions taken under numerous Treaty Articles which relate to the protection of health.

¨ Article 152, which sets out the specific public health competence of the Community, has to be considered against this general policy background. Indeed it makes explicit reference to the wider context right at the outset by underlining that a high level of health protection shall be ensured in the definition and implementation of all Community policies. The Article goes on to spell out that public health actions should be directed towards improving public health, preventing human illness and diseases, and obviating sources of danger to human health. In addition, a major part of the Community’s legislation on animal and plant health has been brought within the scope of this Article. A number of specific new competences have been given to the Community in areas such as blood products, organs and substances of human origin.

¨ Finally, the Article specifically requires that Community action in the field of public health must fully respect the responsibilities of the Member States for the organisation and delivery of health services and medical care.

¨ Since the inauguration of the Health Promotion Programme in 1996 the EC has established partnerships in the form of European networks; one of this networks is the ENWHP.

¨ The European Network for Workplace Health Promotion is an information network in which the FIOHS provides assistance and acts as mediator between the Commission and the Member States. The ENWHP plays an advisory role in the implementation of WHP in Europe. In addition to the fifteen EU Member States, Norway, Liechtenstein, Iceland, Bulgaria, Hungary and the Czech Republic have now become members of the ENWHP. The Network meetings which take place every six months are attended by representatives from the European Commission, WHO, Europe and HQ, the European Agency for Safety and Health at Work and the European Foundation for the Improvement of Living and Working Conditions in Dublin.

¨ One of the main responsibilities of the European Liaison Office at the Federal Institute for Occupational Safety and Health in Dortmund, is to gather and disseminate all major European activities in the field of WHP and to ensure the transfer of information through the Internet, publications (e.g. WHP NET-NEWS published twice annually) and presentations at conferences, to encourage multilateral partnerships and publicise important results.

¨ The Liaison Office is involved in a number of other European projects (e.g., WHP in SMEs, Unemployment and Mental Health) and closely linked to other networks (e.g. the European Network of Health Promoting Agencies, the European Network on Smoking Prevention and the European Network on Mental Health Promotion).

¨ The National Contact Offices (NCO's) are responsible for the organisation and maintenance of a national net. This includes the collection and dissemination of important information in the field of national WHP as well as the participation in specific European projects carried out within the frame of the network. The national information is forwarded regularly by the NCO's to the Liaison Office which is responsible for further European wide dissemination.

¨ The existing network has provided an effective mechanism to ensure a professional input into the implementation of the current public health framework. Pursuant to its own mission it should in future primarily be used for developing policies and strategies. In this way the network will ensure that European initiatives will link intelligently with those of the Member States and does not cut across them.

¨ The actors/key players in workplace health promotion (WHP) will set up partnerships with all stakeholders and develop policies to deal with these issues. There is a need for intelligent policies.

¨ The ENWHP comprises of network members in the fifteen member states and the three EEA countries. All members and the different partners (WHO,ILO, European Foundation in Dublin, European Agency for Safety and Health at Work in Bilbao) meet twice per year to set up common strategies to improve health in the work environment and employability. In order to keep abreast with its mission: healthy people in healthy organisations. In developing policies and strategies, the national approaches are taken into account by a national network which is continuously monitored by the member of the network for his/her territory.

¨ During the last few years, the ENWHP has developed successful policies for a sustainable influence on improving work and health:

¨ the development of success factors for workplace health promotion

¨ quality assurance of good practice

¨ the Luxembourg Declaration which for the first time defines a European wide commonly agreed concept for workplace health promotion. As established in the Luxembourg Declaration WHP is based on:

¨ participation of all staff

¨ integration of health in all areas of organisations, including management

¨ implementation of comprehensive strategies (combining individual directed and environment directed measures)

¨ effective project management

¨ the Cardiff Memorandum for providing successful practice in SMEs in which the Network proposes the following initiatives to promote WHP in SMEs:

¨ To increase awareness of the current priorities, health concerns and health actions undertaken by SMEs.

¨ To identify and disseminate good practice in SMEs.

¨ To promote the benefits of WHP in SMEs to all stakeholders.

¨ To build alliances and partnerships with the small business sector and key representative organisations.

¨ To support the development of appropriate WHP models and methods for increasing health and well-being in SMEs.

¨ Future policy areas of the ENWHP:

¨ The following strategies will be developed by this network:

¨ WHP as behavioural prevention strategy in the work environment

¨ WHP as an essential component of an wide and modernised OHS

¨ WHP as a strategy to influence health determinants in the work environment

¨ WHP as a strategy to reduce absenteeism

¨ WHP as an organisational development strategy

¨ WHP as a human resource management strategy for increasing the employability

¨ The European Union established the the European Agency for the Safety and Health in Bilbao to meet the information needs of those active in the field of safety and health at work. It started work in September 1996 in Bilbao, Spain, becoming fully operational by 1999. During this time, the Agency established a network of Focal Points in each Member State and developed basic information activities within three key areas:

¨ Information network on Internet – building the links

¨ Information projects – collecting knowledge

¨ Information services – communicating knowledge

¨ Mission, vision and strategic goals for the Agency:

¨ The Agency is the European Union organisation responsible for the collection and dissemination of information that can serve the needs of people with an interest in safety and health at work.

¨ It is the vision of the Agency, through its information activities, to promote high levels of safety and health and to support the goal of making European workplaces safe, healthy and productive.

¨ The Agency shall create the principal source of safety and health information in Europe and the most comprehensive and user-friendly resource on the Internet.

¨ The Agency shall actively support the formulation and implementation of safety and health policies, and the organisations involved in this process.

¨ The Agency shall promote the identification and sharing of information on good practice solutions at the workplace level.

¨ The Agency shall promote Member State co-operation on information collection and research and thus make the best use of resources.

¨ Determine a common language for productivity and workforce

¨ Health promotion begins with the individuals and their environment. For the individual, it requires personality development training, professional health information and counselling; for his/her environment it requires encouraging mutual support and productive co-operation through more decision-making latitude, through transparency of company activity, appropriate structuring of working conditions and work processes, trough possibilities to participate and make use of employee’s knowledge and creative resources. A corporate culture of trust creates fertile soil for health promotion. On the other hand company health policies can be used as a means of facilitating the transition from a culture of distrust to a culture of trust, openness an co-operation. WHP can serve as an instrument of trust creation; it can transcend departmental frontiers and hierarchies and bring movement into deadlocked company dialogue. WHP is an important instrument in increasing individual companies’ productivity and in reducing costs at company level and for the national economy by:

¨ monitoring and reporting employees’ state of health

¨ identifying demotivating leadership and organisation structures,

¨ developing health resources of individual and organisations

¨ taking action to eliminate and reduce health risks,

¨ ensuring evaluation and continuous improvement of measures introduced.

¨ In many enterprises WHP still gives rise to scepticism or even resistance. Central weaknesses of WHP measures have emerged in the past:

¨ lack of/or inadequate diagnosis and monitoring procedures.

¨ Priorities and target group selection are not determined by real needs.

¨ Measures of behavioural prevention are deployed, the effectivity of which has not be sufficiently tested.

¨ WHP is regarded as a project of limited duration and therefore being of marginal value with low priority for the organisation.

¨ Lack of evaluation of the measures taken.

¨ WHP is a modern corporate strategy aimed to prevent illness at the workplace (including work related sickness, accidents at work, occupational diseases and stress), to increase health potential and to improve well-being at the workplace.

¨ WHP seeks to influence those factors which improve the health of employees.

¨ These include:

¨ Company policy and guidelines which regard employees as a success factor and not only a cost factor

¨ a company culture and a management philosophy which embodies staff participation and encourages employees to take responsibility

¨ a work organisation which provides the employees with the appropriate balance between job demand and control over their own work, level of skills and social support

¨ a personnel policy, which pursues active health promotion objectives

¨ an integrated safety and health policy

¨ This comprehensive strategy is depicted in the following illustration:

¨ The objective "healthy employees in healthy organisations" can be

¨ achieved with the help of the following guidelines:

¨ The entire staff need to be included (participation)

¨ WHP should be taken into consideration in all important decisions and in all areas of the company (integration)

¨ The activities and programmes should be carried out systematically: needs analyses, setting of priorities, planning and implementation, continual monitoring and evaluation of the results (project management).

¨ WHP comprises both behaviour and situation-related measures . It unites the approach oriented towards risk reduction with the development of preventive factors and health potential (holistic approach).

¨ On the basis of this concept, the next step of the ENWHP was to show that this concept could be successfully put into practice and that the strategy could provide an important contribution to company success. For this reason there was much discussion on how and in which way this concept could be integrated in company management systems, how to assure quality and how it could be implemented successfully in company practice.

¨ In a joint Network project which was co-ordinated by the German National Contact Office, sixty six "Models of Good Practice", gathered from every country in Europe, were identified and documented. To evaluate what makes good practice, a catalogue of criteria was drawn up, based on the model from the European Foundation for Quality Management (EFQM). The criteria were divided into six sectors which taken together produce a comprehensive picture of the quality of workplace health promotion activities:

¨ Workplace health promotion (WHP) and corporate policy

¨ Human resources and work organisation

¨ Planning of workplace health promotion

¨ Social responsibility

¨ Implementation of workplace health promotion

¨ Results of workplace health promotion

¨ For workplace health promotion activities to succeed however, they need to be integrated into the structures and routines of the company organisation. An important approach towards this linkage has been made in the discussions on management systems in occupational safety and health. Management systems form the bond between the strategic solutions generated by a company to meet the needs and their implementation in actual company practice. They translate company strategy into practical action and ensure their systematic implementation.