In most cases, social security institutions are not legally required to become involved in workplace health promotion (WHP). However, there are a number of compelling reasons to do so, including the following.
Not even the best rehabilitation and compensation arrangements can address the loss of quality of life following a work-related accident or ill health that prevents an employee from continuing to work. Social security institutions have a leadership role in preventing accidents and ill health and promoting well-being through the workplace.
The loss of the ability to work – whether as a result of age, illness, accident or unemployment – can reduce overall knowledge, skill and experience within the workforce. This has an impact on the employer, the community, the affected person and his or her family. In the future, worker health, the ability to work and employment rates must be stabilized at a high level so that social insurance systems can continue to function. Promoting well-being in the workplace facilitates better health, safer work and worker retention. This ensures a sustainable funding source for rehabilitation and compensation while reducing the need for expensive rehabilitation measures and compensation. Having a dedicated return to work/disability management programme can assist an affected person to get the resources and services they need to support a successful return to work.
Ensuring sustainability for social security systems in general, and workers’ compensation funds in particular, is irrevocably linked to a coherent approach to safety, health and wellbeing at the workplace. The ISSA’s international study Calculating the international return on prevention for companies (www.issa.int/rop) and on The return on work reintegration (www.issa.int/rowr) clearly show that there is value in investing in safety, health and wellbeing. The promotion of workers’ health is part of this holistic approach.
In order to facilitate the promotion of workers’ health, the ISSA’s Special Commission on Prevention has developed the Vision Zero approach, based on the view that all accidents are preventable and that wellbeing at the workplace can be promoted effectively. Vision Zero promotes a culture of prevention and a commitment to safety, health and wellbeing 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 and that the wellbeing of all employees is an important success factor for business undertakings.
Unemployment and employment that may harm health result from social patterns. Such patterns place those of lower socio-economic status at higher risk. The link between such employment and working conditions and a range of indicators of poor health is clear. Reducing health inequalities benefits a wide range of stakeholders, including governments, health systems, social security systems, employers and individuals. Indeed, employment contributes significantly to reducing health inequalities in several interrelated ways:
- Employment and economic policies have a major impact on a range of life chances, with paid work playing a major social role in adult life;
- Wages and salaries provide the main component of a person’s income. Low and insecure income affects health through material deprivation, unhealthy behaviours and stressful experience. Low income can have long-lasting negative effects across generations due to childhood antecedents of poor adult health;
- Adverse working conditions such as physical and chemical hazards, risk of injury, long or irregular working hours, shift work and physically demanding work can adversely affect workers’ health; furthermore, the return to work from occupational injury and disease is often hampered by the co-morbidities relating to preventable and non-communicable disease;
- Working life has changed tremendously in recent times. Workers now face psychological and socio-emotional job demands and threats stemming from insecure work and other adverse psychosocial work environments. These demands and threats directly affect workers’ health. New opportunities have emerged to strengthen “good” (health-promoting and protective) work through primary and secondary preventive measures.
- Temporary workers, vulnerable workers and young workers face greater risks and require more support and resources. Most temporary workers do not have access to company benefits, which creates health inequalities.
However, a report by the German Central Federal Association of Health Insurance Funds shows that workplace health promotion projects are unevenly distributed across sectors and enterprises. Workers in the service industries, women and migrant workers are much less likely to benefit from health promotion projects than workers in the manufacturing sector. Social security institutions, among other stakeholders, are clearly in a position to influence this situation and must advocate for equal access to WHP.
Ensuring the health and well-being of its employees is the responsibility of the employer. This principle is supported by most national occupational safety and health legislation. Other principles such as participation and consultation of the workers on these matters, as well as the fact that expert advice within or outside the company is needed to support company policies, are often part of the same legislation. Even though comprehensive workplace health promotion programmes often go beyond legal compliance, the actors carrying out and supporting company policies are often the same.
It is widely recognized that the most successful workplace health programmes at a company level are based on strong senior management commitment. The involvement of senior management is imperative if employees are to appreciate and recognize that their employer is committed to protecting and promoting the health and well-being of the workforce.
Furthermore, workplace health promotion programmes require the engagement and participation of workers and should be undertaken in partnership with all employees at all levels and across the organization. Finally, the planning, development and implementation of workplace health promotion also requires the driving force of a team (or person) to actively ensure the delivery of workplace health promotion within the company.
Social security institutions are important actors in workplace health promotion. Their role involves actively encouraging and supporting employers who set up workplace health promotion programmes in their companies. This support can also include investing time and resources in such developments.
The role of social security institutions in supporting and enabling workplace health promotion can be based on a legal and/or voluntary mandate. For social security institutions that are already closely linked to workplaces, and which will obviously benefit from the development of successful workplace health promotion programmes, fulfilling this supporting and enabling role is both logical and economically sound.
In many countries, workers’ compensation boards insure employees against the loss of income resulting from accidents at work and/or occupational diseases. Often the workers’ compensation boards are part of social security funds covering multiple branches of social security, such as unemployment, pension, health, or family benefits, in addition to work injuries.
Health insurance schemes are also concerned with health promotion and workplace health promotion in particular. The organization of these health insurance schemes is highly dependent on the national context, with the responsibility for compensating a worker who is in ill health/absent from work often being shared by the employer (who might usually cover the early days or weeks of the sickness absence) and the health insurance fund. This also applies to the provisions put in place by those national social security laws applying to disability and pension funds.