Management and Governance of Occupational Health and Safety in Five Countries: NOHSAC Technical Report 8
SECTION SEVEN Summary and Conclusions
This review provides an overview of the management and governance of OSH in five countries: the United Kingdom, the United States of America, Finland, Canada and Australia. The workplace is known to contribute to diseases and injuries, and many causes and contributing factors have already been identified. Further actual or potential factors will be identified through ongoing research, such as through the use of surveillance systems.
All five countries under consideration are western industrialised nations with many similarities to New Zealand. However, there are a number of differences. The US, Canada and Australia are all conglomerates of separately governed states or provinces, with a federal government that has a less unique role than in nation states with a single governmental structure such as Finland. The UK lies somewhere between these poles, with partially devolved government structures, yet still maintaining a strong centralised executive structure. However, it is also part of the EU, which is now the largest federation of nation states in the world.
The OSH systems in use are, in general, based on relevant civil and criminal law. The most common principle is one of hazard identification using some form of risk assessment based on an agreed rule or “standard”. This approach rests on a sequence of assumptions. First is that risks and hazards are known and understood. Second is that they can be accurately identified in practice. Third is that, once they have been identified, they can be eliminated, or at least reduced, and this will yield a subsequent reduction in cases of injury or illness. Unfortunately, this sequence of assumptions does not always hold true in its entirety. For this reason, there is a lack of agreement over what constitutes an effective OSH system. Different countries and states within those nations take different approaches to legislation, regulation and enforcement.
There is a single governance body (HSC/HSE) with enabling legislation and regulations. The HSE drives policy, via the HSC, directly to the government. However, the role of EU directives has become more relevant, with the HSE now acting as a portal for the EASHW. The major bonus from this is improving harmonisation with other European systems, allowing greater comparability and data pooling. The HSE and local authorities have responsibility for OSH, but the HSE is the final authority. Both the HSE and local authorities conduct inspections and employ inspectors. Currently about 38% of the HSE’s staff is inspectors. Enforcement is through the issuing of notices, and prosecutions when required. There is a lack of a cooperative or collaborative approach, and the main focus is on employers, with much less on employees. The HSE provides information, but is relatively passive with respect to education. Current data collection systems are fragmented, with low capture rates. This represents a major and ongoing disadvantage, with little apparent opportunity for remedy in the near future. There are modest research facilities, although these are primarily laboratory based. However, substantial external research projects are regularly contracted. There is no workers’ compensation system per se. Instead, there is a sole reliance on compulsory employers’ liability insurance and state-funded social security benefits. Litigation has been playing an increasing role in British society. The HSE’s national programmes strongly emphasise hazard identification and enforcement. However, there has been a more recent emphasis on managing sickness absence and lost time at work, but it remains to be seen if this will translate into effective and practical programmes. The major goals and aspirations are to reduce fatalities, occupational disease and injury rates. Unfortunately, a current evaluation of these goals is based on data that are unreliable due to low capture rates. The evaluation of strategic projects and policy is not conducted in a systematic manner.
There is a single federal governance body, OSHA, but there are many others involved state by state, especially with implementation. There are enabling federal legislation and regulations, but also a plethora of local state legislation. Policy is strongly driven by the federal approach set out by OSHA in setting standards and methods to enforce these. NIOSH conducts research, and OSHA and NIOSH are supposed to work together. However, it is not entirely clear how effective this relationship is and whether, in practice, ideas and concepts derived from NIOSH research actually end up assisting to develop policy with OSHA. OSHA has responsibility for most non-governmental employees in the US, and there is also MSHA which works in collaboration with the mining sector. Some states administer their own safety and health programmes, although they are obliged to use standards and enforcement at least as effective as federal requirements. In theory, OSHA is the final authority. Both OSHA and MSHA have inspectors. Effort is made to achieve compliance through cooperative programmes aimed at getting employers on-side. However, enforcement is through inspections, usually without notice, and these may be followed with citations then penalties. There is a greater emphasis on employers and less on employees. OSHA disseminates information and provides some education and training. Data collection is quite fragmented, with mixed capture rates, and these are more often low. NORA drives the NIOSH research approach. There is also an initiative aimed at getting research into practice. The workers’ compensation system is mandatory, but is applied at state level. There is wide variation in these systems between states. There is also social security, and this is largely a social insurance approach. There is a large personal injury litigation sector. The research programmes conducted by NIOSH are comprehensive, but there is a strong emphasis on hazard and risk identification. OSHA’s national programmes emphasise standards’ development and employer compliance. The major goals and aspirations are to reduce fatalities, and the occupational disease and injury rates. Evaluation of progress toward these goals is based on data that may be less reliable due to mixed capture rates. The evaluation of strategic projects and policy is not systematic.
There is a government department that has major responsibility, and this is delegated to the Finnish OSHA. There are national enabling legislation and regulations. The Finnish OSHA drafts and develops policy, and this is contributed directly to the responsible ministry and government. Finland contributes to EU directives and policy development. The Finnish OSHA is given responsibility for OSH and has enforcement powers. Inspectors work for the ministry supervised by the Finnish OSHA. Enforcement is conducted through issuing notices and fines. SF collects and collates data from all sources, and there are modest to high capture rates. The FIOH conducts research and provides education and training. There is a very large and active research centre. Compensation comes from social insurance and statutory accident insurance (which covers both work-related disease and injury). The FAII oversees it. National programmes are proactive and include strategies aimed at wellbeing in the workplace as well as prevention. Emphasis is placed on both employers and employees.
Goals are also to reduce fatalities and the occupational disease and injury rates. The evaluation of progress toward these goals is based on data with moderate to high capture rates. Strategic programmes are externally evaluated, and this appears to be moderately systematic.
There are multiple governance bodies. These are federal for some workers and provincial for others. There is a large body of enabling legislation and regulations. Provincial statutes are based on the federal Code, but there is a lot of variability. Safety and health is often made into a part of the workers’ compensation system. The HRSDC is a federal department that has responsibility for OSH. It develops policy. The CCOHS disseminates information and provides some education and training. The AWCBC is not a designated authority, but serves as a bridge between provincial workers’ compensation boards. Each province has its own legislation.
Inspections are empowered by the federal Code. However, inspectors are employed in provinces, under separate systems that are usually driven by the provincial workers’ compensation system. Data is collected centrally by SC, but there appear to be only low or inconsistent capture rates. There are four major research organisations, but these are not necessarily well coordinated. The workers’ compensation system is mandatory, but it exists at the provincial level, with considerable variation in form and structure. There is also a social security system and a personal injury litigation sector. The HRSDC runs national programmes, and many of these are multifactorial, aimed at collaboration with workplaces, with an emphasis on high-risk sectors and employers and the development of partnerships with employers and employees. The overall goals and aspirations are to reduce fatalities and occupational disease and injury rates, but there are also shorter-term pragmatic goals of improving information quality, usability and user satisfaction, and to increase awareness of services. Evaluation of progress toward goals is currently based on data that are likely to be unreliable, due to lower capture rates and a lack of comparability between different provincial systems. The evaluation of strategic projects is more systematic.
The ASCC acts as the federal body that can declare standards and codes of practice, but these need to be adopted by states and territories before they have legal force. There are enabling legislation and regulations, but these are complicated by a plethora of statutes and regulations from states and territories with large variations and a lack of harmonisation. The major policy focus for OSH is derived from the workers’ compensation approaches, which differ for each state or territory. The ASCC is not a regulatory body but seems designed to influence federal policy-making. State and territory governments are the final authorities in their areas of jurisdiction and run the inspection and compliance systems. The greatest emphasis seems to be on employers. Data collection is fragmented, with variable capture rates, and there is an inevitable tendency to emphasise workers’ compensation data because of this. The research sector appears weak, lacking a national focus or strong leadership to provide coordination. Workers’ compensation insurance is mandatory for all employers, but the rules and conditions vary between states and territories. There is a personal injury litigation sector. The ASCC is starting to demonstrate strong leadership, and has undertaken long-term planning with a systematic approach. An important goal is to harmonise systems within Australia. Current evaluation of progress toward these goals is based on data that currently seem unreliable, due to low capture rates and a lack of comparability between states and workers’ compensation systems. The evaluation of strategic policy has not been systematic, but is showing clear promise that it will be under the leadership of the ASCC.
Countries with devolved or separate legislatures functioning within a federated group seem to suffer important disadvantages resulting from the lack of harmonisation between the various OSH systems that they have. This extends from more simple matters, such as incongruent definitions between systems, right through to the complexities of legislation and regulations.
The UK stands alone among the countries reviewed in lacking an identified workers’ compensation system. It is possible to speculate on any number of reasons for this. Perhaps the presence of an NHS delivering healthcare free to the user across the whole population has reduced the practical pressures to develop such a system.
Whatever their historical origins, the governance of safety and health systems in the countries reviewed all currently acknowledge there is both a moral and a practical dimension. It is widely recognised that employees should not have to risk life or limb when engaging in work activities, nor should others be adversely affected by their working. No doubt the influence of international movements such as the ILO and WHO have contributed to a convergence of opinion about this issue. Governments also realise that low-quality OSH performance adversely affects their economies, both directly and indirectly. The pragmatic political choice is always to attempt to manage a potential threat, and this has been potent motivation for the development of both OSH systems and workers’ compensation methods.
The classification of a work-related problem that impacts on an employee’s health as either an illness or an injury clearly has an arbitrary component. This seems to rest firmly, at least in part, on contextual aspects of the relevant system. Thus, the systems that provide incentives for a health problem to be classified as an illness, rather than as an injury, report much higher rates of work-related diseases. Arguably, the UK is again a stand-out in this regard, with 61% classified as ill health and only 39% as injuries. This is in stark contrast to the US, for example, with only about 6% of cases classified as occupational illnesses and 94% as work-related injuries. Clearly there are not such huge differences in the workforces of each country so as to arrive at such marked differences in rates. Rather, this is an issue of classification and attribution, which, in turn, are influenced by the subtle forces within each system.
There is a resounding congruence in the underlying philosophy for OSH between all five countries under consideration, namely a reliance on the assumption that identifying risk factors, or potential contributors to occupational disease and injury, is the foundation of effective prevention strategies. Furthermore, this hazard identification approach needs to be acted on directly at the actual workplace by employers, and employers need to be motivated to participate in this approach, making it necessary to have some form of inspection and enforcement system. There are some differences in strategies and methods to get employers to participate, and these range from those that use a cooperative model through to sole reliance on punitive measures. Also, there are some differences in the weight placed on employee involvement. Some systems adopt the simple approach of merely giving employees rights to complain, while others take the view that the active involvement of employees in hazard identification and risk reduction is more effective.
Currently there does not seem to be any reliable evidence as to what enforcement or compliance system is the most effective. It seems reasonable to propose that motivating either employers or employees, or both, to participate is always going to be a complex business. Motivation is well understood to have a “carrot” and a “stick” aspect, that is, multifactorial approaches are intuitively the more appealing, yet they have been the more rare to date.
There is a uniform lack of consistency in the type and manner of application of sanctions applied (usually to employers) if safety and health rules are broken or not followed. There is a universal reliance on punitive sanctions, without attempts to apply positive rewards, for example after rapid remedial action has been taken.
Therefore, it seems likely that an approach embracing a mixture of methods will be the more successful overall. This should probably incorporate a mix of:
- a set of mandatory, but reasonable, workplace requirements with a legislative basis
- an information dissemination and educational initiative
- encouragement for a collaborative approach between the OSH system and the workplace
- involvement of both employers and employees
- a monitoring approach that involves inspections
- the use of inspections that are prioritised toward truly dangerous jobs and workplaces. It is clear there are uncomfortable work conditions, unpleasant jobs and some truly dangerous jobs. The most effective system, in terms of preventing fatalities and serious work-related injuries or diseases, would emphasise the latter.
- sanctions for lack of compliance with mandatory requirements
- a mix of sanctions that can be applied both positively and punitively
- careful monitoring of the effects.
None of the systems themselves seems to actively be questioning the possible limitations of the hazard identification model, or the assumption that a high level of avoidance of all risk will have only beneficial effects. However, this debate about the potential effects of safety and health legislation is more commonly being held in the public domain in western countries. For example the Guardian newspaper in the UK reported in an article entitled “School trips under threat from ‘litigious’ parents” on 1 November, 2004 that “the National Association of Schoolmasters/Union of Women Teachers (NASUWT) is recommending that none of its members take school trips because of the risk of being sued”. The current advice from NASUWT has subsequently been modified to state, “Because of the great personal and professional risks involved, members should consider carefully whether or not to participate in non-contractual educational visits and journeys. If members ignore this advice then every effort should be made to minimise the risk”. In the US, the OSHA model, which relies heavily on the threat of punitive sanctions, is widely perceived by both employees and employers as onerous to comply with, but even worse, as largely ineffective. There is an overt lack of “ownership”, and the system seems almost perversely designed to pit employees and employers as antagonists on the industrial battlefield rather than as collaborative partners who both have vested interests in safety and health. This is true to a lesser extent in the UK system also. Of course, social and political circumstances constantly change and evolve within our modern societies.
Close integration between data systems, including surveillance, research and analysis, sophisticated programme implementation and policy development, seems to be an elusive goal within the countries reviewed. Perhaps it is best achieved currently in Finland. This may be an artifact of the size of the country, with a population not too dissimilar from New Zealand’s. However, it is more likely the result of careful planning to construct systems that are able to integrate with each other. To be fair, the larger countries may achieve this equally well at regional, state or provincial level. However, they have yet to arrive at consistent policy and systems and methods across their whole populations.
Identifying hitherto unknown risks and hazards or potential contributing factors remains a major challenge. The lack of consistency within systems over time and between the various systems has seriously hindered the ability of researchers to collect and aggregate data in a meaningful way. Significant efforts are currently underway to harmonise data collection, which will provide an important boost to statistical power in the quest to detect the relevance of suspected factors and perhaps their subtle interplay with other factors.
It can be argued that OSH may be fruitfully linked with public health initiatives and strategies. This is because there are often overlapping areas of interest and similar applicable methodologies. However, in practice, this rarely occurs, for reasons that are not always clear. Anecdotal information from those inside the respective systems suggests it is not just a matter of simple territorial or boundary issues. Rather, it seems there is a general perception that health and injury issues that involve work either are better funded or have a specific tagged funding stream. Hence, there is a general reluctance on the part of those involved in public health matters to use any of their scarce resources in areas that may attract better funding. Furthermore, those involved in work-related health and injury issues are usually constrained by some form of mandate to remain firmly in an arena where work relatedness is demonstrable.
When safety and health systems fail to prevent injury or illness, as they inevitably will do since they cannot be perfect, some form of support and compensation is generally made available to the worker. This varies widely in many details. However, there are three common methods for delivery: insurance-model workers’ compensation; social welfare/security benefits; and recourse to appeal and/or litigation.
The impact a compensation system might have on OSH initiatives is not entirely clear. The most common method to inform prevention strategies is to feed back claims’ history in an attempt to identify problem areas. However, the effectiveness of this lacks an evidence base. There is consistent anecdotal evidence from those involved in direct management of such systems that a frequent outcome is merely behaviour modification, such as reclassification or recoding of cases by GPs or others, rather than a reduction in total claims. However, this may only hold true for less severe injuries or illnesses. Feedback on work fatalities, for example, seems to have a more robust effect. That is, the relationship between systems and prevention initiatives may be complex and vary across spectrums, such as severity.
The effectiveness of OSH initiatives is hard to quantify for a number of reasons. These include changes within systems, over time, and a lack of comparability between systems. An important and valid question is whether OSH systems function better when they are run as a stand-alone department or embedded within another agency. There is no clear evidence on this matter. However, observation indicates that independent, or at least semi-autonomous, departments may well function more effectively with greater focus and the ability to evolve more rapidly in response to changing needs.
This question leads naturally to a further important issue, namely, how good the available evaluation research is. Despite substantial and well intentioned efforts, the evidence base on the effectiveness of prevention strategies remains weak and equivocal. All the systems reviewed do place a strong emphasis on research, and this is perfectly appropriate and understandable. However, the best method for efficiently delivering research is not immediately clear. Many countries have given the task to a single, large research organisation. However, all seek external and independent research providers. Perhaps it can be argued that the most flexible and effective approach is to have a semi-autonomous research organisation that is required to drive a research agenda based on expert and stakeholder consultation, and that manages and coordinates a number of specialised groups that conduct the actual research. This should be augmented by overall independent evaluation of the research outputs.
The near future may be an exciting time for development within OSH systems, since there is a rapidly maturing approach based on more comprehensive data systems that are harmonised so as to allow more powerful comparisons, and there is a growing recognition that more sophisticated methods targeted at key areas identified by the stronger data sets will yield more effective prevention strategies.