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Hazards 121, January- March 2013
Well, then? Healthier workplaces deliver healthier workers
Employers who create healthy workplaces can benefit from reduced employee absence and increased productivity, according to a TUC well-being guide. But Hazards editor Rory O’Neill says the new union blueprint differs from that of lifestyle evangelists, advising that the best way to improve well-being is to make the whole job healthier.

Health and safety representatives are increasingly involved in “well-being” initiatives, according to the TUC. It says these are often popular with members and can be a way of demonstrating to employers the value of the union role.

HEALTHY CYNICISM  Poor jobs lead to poor health, and bad jobs lead to bad habits, says the TUC. Well-being programmes shouldn’t overlook work-related risk factors.

But there can be pitfalls. Hundreds of employers have signed up to the government’s ‘public health responsibility deal’, agreeing to an health at work action pledge in at least one area such as alcohol, exercise or nutrition – although far few have backed this up with submission of an action plan. And TUC says many of the pledges have been written by business interest groups, including food manufacturers, and might not place much value on union involvement.

The union body, which has published a ‘Work and well-being’ guide, also warns: “Sometimes there can be dangers of being dragged into an approach which can be seen as allowing employers to interfere in what workers do in their own time, or ‘well-being’ can be used as an alternative to prevention.”

According to TUC general secretary Frances O’Grady: “Healthier lifestyles are something we should all be aspiring to, and given the amount of time we spend at work, the workplace is a good place to start.” But she added: “Work can create a lot of health issues such as back problems, and it can also be a cause of stress which is linked to the increased use of tobacco and alcohol.”

TUC says some employers will look to bypass the union when they introduce well-being programmes. It says union reps should make sure they are involved and push “a positive approach to developing ‘good work’.”

This must include addressing the workplace factors making workers ill, it says. TUC points to official figures that show of the 170 million sick days taken in Great Britain each year, a fifth are due to work-related ill-health or injury.

Resilience warning

There has been a recent boom in management consultants claiming the way to improve productivity is to make staff more “resilient” to stress and work demands. It has spawned a new resilence industry.

But TUC says the issue is not how you change the worker to help them cope with pressure, but how you change the workplace to remove unreasonable stress and demands. It notes work can encourage ‘lifestyle’ related health problems. There is a strong link between stress and the use of tobacco, recreational drugs and alcohol (Hazards 100). Having a job that involves sitting down all the time or only having access to junk food during a 20 minute lunch break can lead to obesity and increase the chances of heart disease and diabetes (Hazards 104).

A 2012 US report confirmed it is no bad habits but bad jobs that make workers’ fat. ‘Obesity/overweight and the role of working conditions’ found that hotel housekeepers, janitors and other blue collar workers who rarely sit during the day have neither the time nor the energy to benefit from traditional healthy lifestyle recommendations.

Associate professor Nicole Champagne of the UMass Lowell Department of Community Health and Sustainability, a study co-author, commented: “This report shows what an important impact the conditions of a person’s workplace can have on their health. When we are only looking at individual behaviours, such as diet and exercise habits, as a way to improve health, we are missing a big piece of the puzzle.”

Both low job control and low wages have been linked to hypertension, casting further doubt on the worth of workplace health promotion interventions by employers that concentrate solely on lifestyle factors. A study published in February 2013 in the Canadian Journal of Public Health found the proportion of cases of hypertension among men that could be attributed to low job control was 12 per cent, which is higher than the proportion of cases that could be attributed to poor health behaviours such as smoking, drinking, not getting enough exercise, and not eating enough fruits and vegetables.

Recent US research has also confirmed another component of a bad job – low pay – is linked to higher rates of workplace injuries and hypertension. The US government backed study on hypertension – which is linked to heart attacks and strokes – found doubling the wages of younger workers was associated with a 25 to 30 per cent decrease in the risk of a hypertension diagnosis, and doubling the wages of women was associated with a 30 to 35 per cent decrease in the risk of a hypertension diagnosis.

Unions believe that the best way to prevent these problems is to address the root cause, while supporting anyone whose health is affected [see: Low pay is bad for your health].

The job did it

Bad jobs lead to bad health, says TUC. Workplaces where less attention is paid to risk assessments and stress prevention - and where there is poor management overall - will generally have higher rates of absence and illness.

The government agency ACAS suggests that there are six indicators of a healthy workplace:

line managers are confident and trained in people skills
employees feel valued and involved in the organisation
managers use appropriate health services (eg. occupational health) to tackle absence and help people to get back to work
managers promote an attendance culture by conducting return to work discussions
jobs are flexible and well-designed
managers know how to manage common health problems such as mental health and musculoskeletal disorders.

TUC says this means that, to improve well-being, the first step must be to look at the management of the workplace, how work is organised and how workers are supported.

Management’s bad habits

Improved well-being at work will be difficult without a consideration of issues such as management style, workload, work pace, hours of work, worker involvement and the level of control a worker has over their work. “Unfortunately, many employers prefer to look at changing the behaviour of the workers rather than the workplace,” says TUC. “They seem to think that, rather than remove stress in the work, they should introduce on-site massage or after-work yoga classes.

“This approach is little to do with promoting well-being in the workplace and instead is using the workplace to promote changes in how workers live their lives.”

If the US is anything to go by, it an approach awash with problems. In US firms with more than 200 workers, 94 per cent had well-being programmes in 2012. A significant minority penalised workers who didn’t meet specific biometric outcomes, such as a cholesterol number or body mass index (BMI), and most imposed penalties if workers refused to participate [see: Warning on ‘coercive’ wellness programmes].

Health screening

Providing annual health screening can make people aware of any potential health problems and allow them to obtain advice on how to reduce the risks, the TUC guide says. Testing heart and lung function and weight can be a useful part of smoking cessation or exercise programmes. But tests must be relevant, necessary and non-intrusive.

Some health providers offer health screening, paid for by the employer, but then try to get the worker to pay for additional tests privately, such as an h-pylori test (for a bacteria linked to stomach ulcers) or a PSA test (for prostate cancer). Often these tests are unnecessary and are available for free through a GP.

TUC says health screening needs to be linked to prevention programmes to ensure work-related risk factors are investigated and addressed.

Unions should be wary of one-size-fits all approaches. For example, having a high BMI can indicate one worker requires obesity-related medical attention, but another might be fit and fat. Firms can help a worker who wants help to control their weight, but should not be allowed to create a working environment where overweight people feel stigmatised.

Similarly, drug and alcohol misuse may affect the performance of a person in the workplace or put at risk workers or the public, says TUC. Good employers will assist an affected employee. But the employer should not seek to police drug or alcohol use outside of work that doesn’t affect performance.

The biggest lifestyle gains can be made through reducing stress, long hours and introducing policies that promote “work-life balance,” TUC says.

Union involvement

Where employers are introducing changes to promote healthier lifestyles, like exercise classes, gym access, cycling schemes and healthy eating programmes, TUC says unions must be involved [see: Promoting health through work].

“There are positive things that an employer can do to assist in the promotion of good health through introducing measures such as making fruit available and promoting exercise, but if the employer is going to be involved in lifestyle issues then they should do it in partnership with the workforce and their unions rather than on behalf of the workforce,” it says.

Checklist for union representatives

The TUC says there are four simple things union reps should consider when an employer seeks to introduce well-being initiatives.

•  Does your employee have prevention measures in place for stress, musculoskeletal diseases and other occupational health issues? If not – that should be done first.

•  Have you surveyed your members to find out what health problems they have and are they related to work? This can be done jointly with management.

•  Is management involving the union, through its union representatives, in the development of a health and well-being programme?

•  Is there an evaluation planned and are there reliable baseline figures available for comparison before the programme starts?

TUC says union reps should remember that well-being at work initiatives can be very popular with workers and unions should also use them as a way of recruiting new members and getting new activists.

If there are union safety representatives recognised in the workplace then they have to be consulted on any health and safety matter.

“The law is very clear on this,” says TUC. “Unfortunately some employers are saying that this only applies to health and safety and that well-being is a different issue because it is not about protecting the workers’ health or safety it is about promoting health and well-being.” As a result they may set up non-union “well-being” committees or appoint non-union “well-being ambassadors”.

Whether this is legal depends on the issue, but TUC says most well-being issues relating to work organisation are clearly health and safety issues. TUC adds that health and well-being initiatives can benefit from the involvement of learning representatives, stewards and equality representatives. “Some union branches have even set up a health and well-being committee,” it says.

The Northern region of the TUC has set up a Healthy Workplaces Project as a way of using the workplace to involve employees in health improvement activities [see: Healthy workplaces up north]. Unions PCS , Unite, NASUWT and Prospect have all taken positive steps at head office level [see: Unions in action].

“Employers who side-step the union are losing the benefits that a union can give. They are also showing a very patronising approach to their workers – more or less saying ‘we know what is best for you’.

“If your employer is resisting union involvement then the first thing to do is ask ‘what are they scared of?’ Is what they are trying to do something that the union is likely to have concerns about?”

Work and well-being, TUC guide, February 2013.



Low pay is bad for your health

Low waged workers injured or made ill at work face multiple disadvantages, with poor employment protection and health care costs compounding their suffering, recent US studies have found.

‘Mom’s off work ‘cause she got hurt: The economic impact of workplace injuries and illnesses in the US’s growing low-wage workforce’ was published in 2012 by researchers from George Washington University School of Public Health and Health Services (SPHHS). Co-author Celeste Monforton said: “Workers earning the lowest wages are the least likely to have paid sick leave, so missing work to recuperate from a work-related injury or illness often means smaller pay cheques.

“For the millions of Americans living pay cheque to pay cheque, a few missed shifts can leave families struggling to pay rent and buy groceries.”

Monforton and co-author Liz Borkowski point out low wage workers often get an unexpected surprise after an on-the-job injury or illness, even where they have insurance: Insurers generally do not have to provide wage replacement until the worker has lost between three and seven consecutive shifts. And workers at the low end of the wage scale are often discouraged from reporting on-the-job injuries as work-related - which leaves them with no insurance benefits at all. This means lost wages and health care costs – which can be considerable – are not covered.

Both low job control and low wages have been linked to hypertension, casting further doubt on the worth of workplace health promotion interventions by employers that concentrate solely on lifestyle factors.

Research by Canada’s Institute for Work & Health (IWH) and the Institute for Clinical Evaluative Sciences (ICES) published in February 2013 found that among men reporting low job control, 27 per cent were diagnosed with hypertension during a nine-year period. This compared to 18 per cent among men reporting high job control. Furthermore, the study found the proportion of cases of hypertension among men that could be attributed to low job control was 12 per cent, which is higher than the proportion of cases that could be attributed to poor health behaviours such as smoking, drinking, not getting enough exercise, and not eating enough fruits and vegetables.

“Primary prevention programmes to reduce hypertension are largely aimed at changing unhealthy behaviours,” says IWH scientist Dr Peter Smith, who led the research, published in the Canadian Journal of Public Health. “But this study suggests that prevention strategies might also assess the potential for modifying work environments as a hypertension control intervention.”

Another 2012 US study, part financed by the US government’s National Institute for Occupational Safety and Health, found low wages are a risk factor for hypertension, which raises the risk of heart attack and stroke. ‘Are low wages risk factors for hypertension?’, published in the European Journal of Public Health, found doubling the wages of younger workers was associated with a 25 to 30 per cent decrease in the risk of a hypertension diagnosis, and doubling the wages of women was associated with a 30 to 35 per cent decrease in the risk of a hypertension diagnosis.


Warning on ‘coercive’ wellness programmes

Employer-created wellness programmes are cropping up everywhere in the US, and it is frequently bad news for the workers being ‘helped’.

A 2012 survey found in firms with more than 200 workers, 94 per cent had these programmes. US publication Labor Notes, commenting on the findings, warns that more coercive programmes are on the rise, with 11 per cent of these larger firms requiring workers identified with a risk factor – for example, obesity – to participate in a wellness programme because this would reduce the firm’s insurance costs.

Nine per cent of the large firms requesting that employees complete a health risk assessment say they are financially rewarding or penalising workers based on whether they meet specific biometric outcomes, such as a cholesterol number or body mass index (BMI).

According to Labor Notes, the most coercive programmes require workers to meet health targets or pay a penalty.

Refusing the intrusive tests is no escape, since another survey, by benefits consultant Aon Hewitt, found even more companies impose penalties for that. Seventy per cent penalise workers who don’t take a health risk questionnaire and more than half punish those who don’t undergo biometric screening. One-fifth impose some form of consequence if targeted workers don’t participate in lifestyle modification classes like weight management and quitting smoking.

“If employers are really concerned, why don’t they start with something they can control and provide a safe and healthy workplace?” said Nancy Lessin, a health and safety specialist with the Steelworkers union. “As they are required to do by law.”

Labor Notes: www.labornotes.org


Promoting health through work

Initiatives aimed at encouraging workers to get or stay healthy can have a mixed response from workers.

At times workers will welcome them as a sign that their employer is taking an interest in their health. Other workers may feel that their employer has no business getting involved in what they consider to be their private life.

It is therefore important that any activities are introduced in a way that makes it clear that there is no compulsion and that employees are not necessarily expected to take part. Involving the union at an early stage can help this.

Among the activities that might be considered are:


Putting on exercise classes at lunchtime - There are a wide variety of classes to choose from that are aimed at improving peoples strength, flexibility or cardiovascular fitness. These range from circuit training, through jazz dance, pilates and yoga to step classes.  If taught properly these have the benefit of being able to involve a variety of people across the age range and from both sexes.  Make sure they are taught by a qualified instructor and that there is sufficient space. However it is also important that people have time to have something to eat after the class rather than having to rush back to work.

Provide access to a gym - This can either be a gym on the employer’s premises which is available to staff or negotiating an agreement with a local fitness centre so that employees get a reduced rate. This has the benefit that people can go at a time that suits them. Morning, lunchtime or after work. If the employer provides a gym on its premises it will have to ensure that the equipment is properly maintained, and that instruction is available so that people know how to use the equipment effectively and safely.

  Look out for..... Some deals through an employer are more restrictive or lock you in to a contract for longer. Check this out. Also, if the employer makes an arrangement with an outside fitness centre then the subsidy they pay is likely to be taxable.

Cycling - This is a good exercise for the heart and lungs, and it actually does not rain in Britain as many days as people seem to think. Employers can help by providing safe provision for cycle parking. The government has a scheme called “cycle to work” that allows employers to sign up to a scheme that means that their employees can get a bike and accessories at discounts of around 40 per cent. On the down side, although cycling is great exercise, riding a bike in heavy traffic can be a scary and dangerous experience so employers can distribute maps of local cycle routes. Many local authorities and cycling organisations produce these.

Sponsorship of sports and social activities
- Employers can support and help finance a range of activities such as competitive sports, swimming clubs. They can also provide equipment or allow their premises or grounds to be used for training. They can also support staff involvement in sponsored events such as cycle runs or “fun-runs” by providing sponsorship or time off. They should also consider sponsorship and time off for any employees who are involved in competitive events outside work such as amateur athletics, martial arts competitions or other sporting meets. Employers can also be asked to provide more flexible working to those who are training at competitive level.

Provision of showers
- One of the biggest factors preventing people cycling or running to work, or exercising at lunchtime is if there are no provisions for showering. Simply providing facilities to shower can make a major difference to people’s ability to exercise.

Healthy Eating
- Far fewer employers provide canteen facilities than in the past. This is partly to do with the fact that we have less large employers, but it is also because many employers fail to see the benefits of providing workers with good wholesome food and encouraging then to eat together rather than at their desks or a local park. As a result far more people are eating fast or junk food at lunchtime. Also people are now taking, on average, far less of a break at lunchtime. Both these factors can harm people’s health and employers can do a lot to encourage healthy eating. This can include providing a range of good wholesome food in a subsidised canteen. Failing that they can provide a separate area for people to take their rest breaks or eat meals (this is actually a requirement under the Workplace Regulations), and if there are no canteen facilities they can provide access to a microwave and other preparation facilities. Even small initiatives like having a regular supply of free fruit can encourage people to swap the chocolate bar for the apple.

  Look out for..... If your employer does provide canteen facilities make sure that changes are not introduced without consultation and that healthy options are an addition. No union representative wants to have to deal with hundreds of complaints because the traditional fried breakfast has suddenly been replaced by muesli.


In addition to these there are also initiatives that are organised or managed by workers themselves. Many of the most successful workplace social and sports events are those organised by unions or groups of workers. These have usually grown from a few union members organising lunchtime exercise club or five a side football team. Often employers have been persuaded to subsidise these or provide facilities. Where they exist they have become the focus of social activities in the workplace and are often the only regular exercise that some people get. By organising social events unions can recruit a range of new people into the union and also show that they are active in all aspects of working life. Not just pay and conditions.


Employee Assistance Programmes

Many employers, especially larger employers give their staff access to an Employee Assistance Programme (EAP). These are intended to help employees deal with personal problems that might adversely impact their work performance, health, and well-being. It is estimated that over eight million people have access to an EAP and around 10% of these will use it at some time in their working lives.

EAPs can often offer advice on a range of issues such as money problems, domestic issues, and difficulties with work colleagues. They can act as a confidential way for people to report and seek help for bullying, harassment and stress. Most EAPs offer an element of individual counselling although these are often restricted to a limited number of sessions. Some also allow family members to use the service. Most are provided by an outside contractor with the first point of contact being a confidential phone line.

Usually the EAP provider will supply the employer with details of the types of problems that are dealt with. This can allow them to see whether there is a significant problem in some area such as bullying which needs addressed. EAPs can also act as a go-between a worker and the management on a confidential issue.

Unions will usually welcome any provision such as this although there are occasionally concerns over a lack of impartiality where an employee seeks assistance due to a work-related problem. Also the level of support is usually limited by the contract and at the end of the contracted number of sessions the EAP provider may try to get the employee to pay for further sessions privately or refer them to a commercial provider, even where free services may be available through a CAB or the NHS.

A review of EAPs conducted in 2012 by researchers in Sheffield showed that there was little evidence that EAPs actually made any difference to either the well-being of the workers in general, or to sickness absence or performance. Nevertheless, it is clear that, for some people, access to a service such as an EAP can be of major help in supporting them to deal with a problem.

Look out for..... Employers sometime use an EAP scheme as being an alternative for introducing effective policies on stress and bullying. They are not. Instead they are a last resort if prevention fails.


Healthy workplaces up north

The Northern region of the TUC has set up a Healthy Workplaces Project as a way of using the workplace to involve employees in health improvement activities. It is a partnership between the unions, employers and the NHS. So far around 200 employers have been involved 30 of them intensively, and around 60 union workplace representatives have taken part. An evaluation of the project showed that 90% of the employers and employees said the project encouraged the employer to implement health and well-being initiatives that otherwise would not have been introduced. 40% of employers reported a fall in sickness absence as a result of the project while more that 70% of employers and 90% of employees reported the workplace is now a better place to work.

As well as the health and productivity benefits, 50% of employees and employers felt that relationships between the management and workplace had improved. The Northern TUC has also reported that they have managed to recruit and train more union representatives, and strengthened positive perceptions of unions among both the workforce and management.

One of the key elements used to promote workplace involvement in public health was the creation by the regional NHS of the “North East Better Health at Work Award “ and workplace “Health advocates”. These advocates, who volunteer from within the workplace, have responsibility for driving health initiatives forward in conjunction with the NHS/TUC, in response to employee demands. These advocates are not seen as being an alternative to traditional health and safety representatives although many Union representatives have successfully volunteered for the role of Health advocate. The Northern TUC has been a key partner in the award since its inception. Workplaces have to demonstrate that they fulfil the criteria of Bronze, Silver and Gold standards over a three year period. Assessment takes place once a year and full consultation and involvement of Trade Unions is an essential component.


Unions in action

The trade union PCS has produced a Well-being at work toolkit that aims to help activists in all parts of the union to push the government and the contracted companies that deliver its services towards adopting personnel management practices that create healthy and supportive workplaces.

The toolkit covers: Health and attendance; learning and skills; performance and appraisal; and worklife balance. The union hopes the toolkit will help union representatives resist the attacks on good personnel practice that have resulted from the government’s efficiency agenda and to improve policies, procedures and working conditions for all members across the public and commercial sectors of the union.

Unite has produced a negotiators’ guide on Women’s health safety and well-being at work. This covers a wide range of well-being issues and is available on their website.

Teaching union NASUWT has produced a number of resources to help both their members and head teachers promote wellbeing at work. Along with producing guides to managing well-being and managing mental health and well-being, they have created a “Well-being at work” survey that members can fill in to assess their well-being at work”.

Using the responses, they can also produce anonymised reports on the conditions within a particular workplace. This can identify areas of common concern and allow union representatives to raise issues with the school management. To try to ensure action by schools they have used a statutory requirement for maintained schools in England and Wales to “Promote the safety and well-being of pupils and staff” and “lead and manage the school’s workforce with a proper regard for their well-being and legitimate expectations, including the expectation of a healthy balance between work and other commitments.”

The union Prospect, in response to their members concern over how management were dealing with organisational change, produced a guide, ‘Fair Change’, for their members. This outlined how best to deal with organisational change. One of the main recommendation was simply involving the workforce through their union.


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Well, then?

Employers who create healthy workplaces can benefit from reduced employee absence and increased productivity, according to a TUC well-being guide. But Hazards editor Rory O’Neill says the new union blueprint differs from that of lifestyle evangelists, advising that the best way to improve well-being is to make the whole job healthier.


Resilience warning
The job did it
Management’s bad habits
Health screening
Union involvement
Checklist for union reps

More Stories

Low pay is bad for your health
Warning on ‘coercive’ wellness  programmes
Promoting health through work
Employee Assistance Programmes
Healthy workplaces up north
Unions in action

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