The ISSA Vision: Promoting Safety, Health and Wellbeing in a Changing World of Work

For social security organizations prevention historically has played a key role. Besides compensation and rehabilitation, prevention was part of the provisions of the first social security scheme established in 1884 in Germany by Chancellor Otto von Bismarck and prevention efforts have increased dramatically with the industrialization of our societies. In the 20th century, the main focus in prevention was on work-related accidents and occupational diseases in specific industrial sectors. However, recent developments, including the impact of globalization, have transformed the world of work tremendously and have increased the complexity of prevention. This article is based on the author´s opening speech on the 1st Vision Zero Europe Conference on 7th September 2016 in Bochum/Germany.

There are a multitude of new challenges arising for occupational safety and health. The traditional occupational safety and health risks remain while the introduction of new technologies at the work place, such as nanotechnologies, ergonomic and psychosocial risks, are increasing the complexity of prevention. The digitalization of workplaces, machines, tools or even of cars add to these challenges. It also includes the use of robots powered by artificial intelligence, which could pose new threats to the health and safety of workers.

In addition, there are also increasingly flexible forms of work organization, such as flexible working hours, teleworking, changing working environments, informal working arrangements, free-lance work or sub-contracted work. The flexibility can sometimes drizzle into a grey zone of informality, where no social security contributions are being paid. All these trends contribute to the challenge to effectively address the risks at the workplace. These risks are not only of occupational nature. The workplace is a hub of many socio-economic aspects, such as labour market participation, health and wellbeing, or the need for professional and medical rehabilitation after an accident, an occupational disease or a psycho-social situation has manifested. This complexity is being discussed in various contexts:

1. The demographic context.
   Demographic developments strongly influence prevention. Globalization has led to increased informal employment and massive migration. This is often accompanied by an ageing society. Prevention needs to address the safety and health of all workers, including those who are the least protected, such as the informal sector and the migrant workers, who are often employed in jobs with high risk exposure but little protection. In addition the employability of an ageing workforce must be taken into account, too, as older workers more often are suffering from serious injuries. European and Asian countries are increasingly faced with young and inexperienced men and women, who are trying to enter the labour market, while the pension age is gradually being increased at the same time with the effect that older workers stay longer in employment. From a demographic perspective, there is also a need to address the lack of skilled workers in order to ensure productivity and employability.

2. Occupational safety and health is important for both demographic groups.
   Young workers need to be engaged in proper skills development, paired with the right safety and health training and awareness raising, while older workers are more experienced when dealing with risks. However, when an accident occurs, they experience it with a more severe impact on their health and require more recovery time. Good prevention systems, which are agreed upon and established by employers, workers and state enforcement agencies, e. g. labour inspectors, need to be established and maintained in order to accommodate for the young and for the older workers. The main focus should be put on how prevention can ensure the long-term employment and mitigate the workplace-related risks.

3. The health context.
   While the prevention of safety risks has resulted in positive outcomes, including reduced accident levels, occupational health risks remain a key challenge. Workers’ health is increasingly determined by both occupational and non-occupational factors, in particular as regards mental health. Global trends in occupational health reflect the changing nature of risks. Mortality rates from occupational accidents have reduced, while the impact of work-related health problems is growing in importance.

4. The societal context.
   In the social context social security plays an important role. Workers compensation boards, employers and workers should look into strategies on to successfully reintegrate and rehabilitate workers after an accident has happened.

In view of the above described new complexities and trends, traditional prevention measures are no longer sufficient to effectively reduce occupational risks. Existing structures, frameworks and management tools addressing occupational risks, such as regulations, enforcement and guidance, OSH policies, risk assessment or OSH management systems are a cornerstone of a functioning occupational safety and health system that looks at the risks emerging from the workplace, but there is also a clear need to look at the health of the person in a holistic prevention context.

Increasingly, both occupational and non-occupational factors determine health and performance at work. Many of the risks, today’s working population is exposed to are no longer “traditional” occupational risks, but rather a multitude of emerging work- and non-work related health challenges. This could be symptoms of stress, backache, burnout or other psychosocial factors. In order to address both, occupational and non-occupational risks at the workplace, a series of new measures linked to prevention would need to be promoted by all actors involved. These include i. e.:

• Promoting a prevention culture by raising awareness, involving all relevant actors and building partnerships;
• promoting health and healthy lifestyles at work;
• promoting and supporting employability and activity, including through early intervention and return to work measures; and
• empowering the individual by focusing on the individual’s resources, i. e. health, self-awareness to risk exposure, professional qualifications, family situation, the social environment, etc.

A holistic prevention approach: Safety, health and well-being at work

As the focus in prevention is widening from a traditional technical risk management approach to the promotion of a more holistic prevention culture, the International Social Security Agency (ISSA), Geneva/Switzerland, has developed a three-dimensional approach to prevention, consisting of risk management, as well as health promotion and return to work measures (Figure 1).

Promoting the health of workers has become a crucial factor for the sustainability of social security schemes. To improve health is not only something that can be addressed at the workplace, but it is also the main driver for medical treatment and rehabilitation efforts. Ensuring healthy lives and promoting well-being for all at all ages is one of the 17 sustainable development goals. Good health and well-being is essential for sustainable development. It is a basic requirement for being able to work and not to fall into the poverty trap.

Focusing on health at the workplace means that the approach needs to be person-centered. Any prevention measure must be beneficial for the individual and must not only address occupational risks, but also promote the health, well-being and employability of the individual. Safety, health and well-being are interrelated. This broad and integrated approach requires the involvement of diverse societal actors, and a unified approach to prevention. In consequence, prevention measures should not stop at the workplace but must expand and also reach the lifestyle and social environment of the employee. The person, not the workplace, should be the center of prevention.

Socio-economic benefits of prevention

Investment in prevention has led to a significant decrease in occupational accidents and diseases. It has saved millions of lives and avoided enormous human suffering. Investment in prevention also makes economic sense. Cost-benefit studies in the areas of occupational safety and health, workplace health promotion and return to work document – those investments in prevention have a significant return. Increased health and productivity of workers are strategic assets, not only for companies in local and global markets, but for societies as a whole.

• The ISSA together with German member organizations – German Social Accident Insurance (DGUV) and Employers’ Liability Insurance Association for Energy, Textile, Electrical, Media-outlets (BG ETEM) – has recently carried out the first international study on the Return on Prevention (RoP), which has documented a RoP factor of 2.2:1. That is a potential return of 2.2 e for 1 e invested, or a net return of 120 % (1). Other studies, such as from the European Commission (2) or from the French Organisation for Prevention of Occupational Hazards in the Construction Industry (OPPBTP) (3) come to similar RoP factors.
• A Meta-evaluation comparing different studies on workplace health found that the average reductions in sick leave, health plan costs, and workers’ compensation and disability costs amount to 25 % due to workplace health promotion (4).
• Investing into return to work programs can also provide an economic advantage. According to the Social Security Organization (SOCSO) from Malaysia, the benefit-cost relation is 2.4:1 or 2.4 Malaysian Ringgits for 1 Ringgit invested, which is a return on investment of 140 % (5).

From “payer” to “player”

Social Security institutions can positively influence prevention outcomes by contributing to safe, healthy and inclusive workplaces. The ISSA has published a set of three prevention guidelines, which address the areas of occupational risks, workplace health promotion and return to work (Figure 2). The guidelines illustrate how an institution can develop its institutional capacities from simply paying out work-related compensation claims to also providing prevention services, which would eventually decrease the number of accidents and in consequence, also the number of compensation claims.

• One tool commonly used to increase awareness for occupational risks and thus contribute to the reduction of incidents and accidents are incentives. Employment injury schemes can provide employers with economic incentives related to their contributions to mandatory occupational injury insurance systems, either to reflect safety and health performance through bonus/malus systems, where the premiums are increased and/or reduced according to injury figures and costs, or to support investments in more healthy and safe equipment and processes, e. g. amongst small and medium enterprises (SME).
• Financial and non-financial incentives are also used by social security schemes to support and acknowledge the workplace health promotion efforts of employers. The National Employment Accident Insurance Institute of Italy (INAIL) i. e. reduces the premiums of its insured enterprises if they promote occupational safety and health measures that guarantee decent working conditions, and increase the wellbeing of workers (6).
• There are also many ways to help workers to return to an active work life. Return to work and disability management systems ensure that injured workers can make it back to work. Social security institutions, such as the Swiss National Accident Insurance Fund (SUVA) provide prompt and comprehensive care for accident victims. This case management approach includes medical and vocational rehabilitation as well as job placements and claims settlements (7). The introduction of case management systems has lately been increasing steadily both in developed and in emerging economies, mainly due to the positive impact on the worker and his or her family in terms of income and quality of life, but also because the employers and social security systems benefit as well.

The ISSA Centre for Excellence

The ISSA’s guidelines programme consists of eight sets of guidelines covering key business areas in social security administration. New sets of guidelines were presented in November 2016 during the World Social Security Forum. These guidelines form the backbone of the ISSA’s Centre for Excellence. The key objective of the Centre is to provide member organizations with knowledge and practical support, including capacity building, in order to develop excellence in social security administration. It provides guidance and tools for administrative excellence for social security administrations, it offers self-assessment tools to prepare action plans, support the implementation of the guidelines, including technical advice and capacity building, and also comprises a recognition scheme.

ISSA Special Commission on Prevention and its international sections

The ISSA’s Special Commission on Prevention and its 13 international sections represent a unique worldwide network of occupational safety and health expertise, working to promote a global culture of prevention, placing occupational safety and health high on national agendas. Building on a unique history of activities, the Special Commission on Prevention fosters the prevention of occupational risks and promotes improvements in the delivery of social security among ISSA members and other stakeholders. The Special Commission works closely with other ISSA technical commissions concerned by workers’ health, including the Commissions on Medical Care and Sickness Insurance, and on Insurance against Employment.

It is the ISSA’s driver behind Vision Zero, a strategy for preventing workplace accidents, based on the view that all accidents are preventable and that a world without fatal and serious accidents is possible. Vision Zero promotes a culture of prevention and a commitment to safety by all people at the workplace. Importantly this culture must be an integral part of management systems, based on the philosophy that in principle no single accident is acceptable, as this provides a basis for learning from accidents and improving processes to avoid similar incidents in the future. The ISSA is committed to Vision Zero and encourages social security institutions to actively contribute to this approach.