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From Risks To Vision Zero

Proceedings of
the International Symposium on
Culture of Prevention Future Approaches

From Risks To Vision Zero

Proceedings of
the International Symposium on
Culture of Prevention - Future Approaches

Helsinki 2014

2014 Finnish Institute of Occupational Health, and the authors

Editors: Markku Aaltonen, Arja yrvinen, Harri Vainio
English Language Editor: Alice Lehtinen
Layout: Tuula Solasaari

ISBN 978-952-261-428-5 (PDF)

- Harri Vainio, Markku Aaltonen 5
Symposium opening speech
- Leo Suomaa 9
Opening speech for the International Symposium on a Culture of Prevention
- Hun-ki Baek 12
Opening speech
- Philippe Jandrot 14
Opening remarks
- Hans-Horst Konkolewsky 15
Opening Speech for International Symposium on Culture of Prevention
- Korean Embassy in Finland 19

Keynote speeches
Prevention culture as culture: Can we achieve it, and is it enough?
- Schulte PA, Guerin RJ, Okun AH 21
Evidence of the benefits of a culture of prevention
- Gerard I.J.M. Zwetsloot 30
Challenges and Barriers to Promoting Safety Culture
- Marianne Levitsky 36
Future approaches to a culture of prevention
- Walter Eichendorf, Ulrike Bollmann 43

Selected articles
Taking prevention beyond the workplace
the role of social security institutions
- Bernd Treichel 54
The health, safety and health promotion needs of older workers
- Jane White 59
Industry-specific Development Programme for improving well-being at work
- Marika Lehtola et al 65
A European Guide on Economic Incentives for Prevention
- Dietmar Elsler 68
National working life development strategy to 2020 in Finland
- Ismo Suksi 74
Vocational education providers network promoting occupationalsafety
during on-the-job learning
- Sari Tappura 78

OSH Culture and accident risk in European Countries

- Heikki Laitinen 82
A review of health and safety in CSR frameworks
- Deborah Walker 87
Large regional variations in occupational health care costs in Finland
- Timo Hujanen 92
Addressing a fire safety culture in the garment industry in South Asia:
A collaborative approach
- David Gold et al 97
Vision Zero The New Global Strategy for Safe Mining
- Helmut Ehnes 104
Summary of the Learning Caf on Future Approaches 109


Markku Aaltonen, Harri Vainio
Finnish Institute of Occupational Health
Fortunately, many statistics indicate that workplace health and safety
has improved over time. Occupational injury rates in the European Union, the United States and elsewhere have shown a steady decline over
the past 100 years, and exposure to chemical agents in the United States
and Europe has also decreased considerably in the past forty years or so.
However, uncertainty about what specific preventive interventions led
to these improvements makes it difficult to select appropriate interventions in countries in which high rates persist. Moreover, some occupational health statistics remain unfavorable. Noise-induced hearing loss,
work-related musculoskeletal disorders, stress-related complaints and
skin disorders continue to be prevalent. Other less predominant conditions (for example HIV and HBV) have serious consequences, and so
protecting workers from these communicable hazards remains a high
The well-being of a nation is dependent on the work of its people and on
the health of its population. For this purpose, national health and safety
policies are required to support and promote sustainable development
in society. Prevention is better than cure; this has been a well-accepted
notion for centuries, and it remains at the core of the future emphasis
on prevention culture.
On 29 June 2008, at the XVIII World Congress on Safety and Health at
Work, the Seoul Declaration on Safety and Health at Work was signed.
The declaration included statements concerning national governments
responsibility for perpetuating a national preventative safety and health
culture, for systematically improving their national safe workplace performance, and for providing a health standard with appropriate enforcement to protect workers. International co-operation continued in
the area of prevention culture when the ISSA International Section for a
Culture of Prevention was launched in 2011 in Istanbul, Turkey, and will
continue in the XX World Congress in Frankfurt, Germany 2014.

International Symposium on Culture of Prevention Future

As an integral part of this international co-operation, the Culture of Prevention Future Approaches Symposium was held on 25 27 September 2013 in Helsinki, Finland. The Symposium was a memorable event
that deepened the understanding of a culture of prevention, and set the
Road Map to the Frankfurt World Congress 2014. Here are some key
figures regarding the Symposium:

175 participants from 24 different countries

5 keynote speeches
59 oral presentations
25 poster presentations
4 World Caf reports on:
Prevention culture as culture
Evidence on the benefits of a culture of prevention
Challenges and barriers in promoting a safety culture
Promotion of a prevention culture

The aim of the Symposium was to bring together researchers, experts

and European as well international networks in the field to discuss the
aims, means and solutions for developing a culture of prevention in organizations and workplaces. The Symposium discussed the culture of
prevention related to occupational risks, such as accidents, workplace
violence and psychosocial risks at work. It also focused on organizational
culture and modes of operation in organizations, and on the attitudes
and behaviour of individual employees.
The executing organizer of the Symposium was the Finnish Institute of
Occupational Health (FIOH), in close collaborating with the Korea Occupational Safety and Health Agency (KOSHA), LInstitut national de recherche et de scurit (INRS), France and the International Social Security Association (ISSA), Special Commission on Prevention. Other partners
also involved in the organization of the Symposium were the Ministry
of Social Affairs and Health, Finland, the Central Organisation of Finnish Trade Unions (SAK), the Confederation of Finnish Industries (EK), the
Social Insurance Institution of Finland, the Federation of Accident Insurance Institutions in Finland (FAII) and the International Commission on
Occupational Health (ICOH).
The Symposium programme covered the following areas:

revention culture as a culture

Evidence on the benefits of prevention
Ways to promote a culture of prevention
Challenges and barriers to promoting a safety culture
Sources of support for prevention, health promotion and social
accident insurance
Developing a safety and prevention culture from research to
implementation and dissemination
Promotion of a culture of prevention
Comprehensive management of safety and health: from leadership
to initiative
Good practices, case reports and evidence-based policies
Future of the culture of prevention.

Helsinki Onion and the Culture of Prevention

The image of an onion, consisting of different layers, is often used
to visualize organizational culture, using the analogy of a core and
several surrounding layers (Schein 2004). The onion model can also be
applied to prevention culture (EU-OSHA 2011):

Artefacts comprise the visible and verbally identifiable elements at workplaces. Examples are safety posters, messages
and slogans, documents and reports related to safety (audits,
accidents, etc.), work procedures and instructions, dress codes
(wearing of personal protective equipment), etc.
Adopted values include the aspects stated or aspired to by
the organization. These are the written or spoken statements
made by the employer or business manager. Values also include
workers safety attitudes towards behaviour, people and issues
related to safety practices.
Basic assumptions are the underlying, shared convictions
regarding safety among the members of an organization. These
assumptions are implicit and invisible, but evident to the members.
These could be about what is safe and what is not.

On the basis of this common concept, the theoretical framework for the
Symposium (Helsinki Onion) was developed (see Figure 1). The Symposium programme consisted of presentations about these different levels.
The Symposium opened up viewpoints to these different aspects related
to the culture of prevention.

Figure 1. Helsinki Onion and the Culture of Prevention

The Symposium proved to be a useful forum for the exchange of ideas,
generating research and collaboration, networking, and social interaction. This Proceedings of the International Symposium includes the key
presentations and selected papers of the programme. The publication is
freely available on the website of the Finnish Institute of Occupational

International Symposium on Culture of Prevention Future Approaches. www.ttl.fi/cultureofprevention2013
Seoul Declaration on Safety and Health at Work. www.seouldeclaration.org/en/
Schein, E. H. (2004) Organizational culture and leadership, 3d Ed. San Francisco: Jossey-Bass.
EU-OSHA European Agency for Safety and Health at Work (2011). Occupational Safety and
Health culture assessment - A review of main approaches and selected tools.

Symposium opening speech

Leo Suomaa, Director-General
Ministry of Social Affairs and Health, Finland

Ladies and Gentlemen,

It is a great pleasure and honour for me - on behalf of the Minister and
Ministry of Social Affairs and Health - to wish you all warmly welcome to
Finland and to this International Symposium on Culture of Prevention.
The aim of the Symposium is to bring together researchers, experts and
European and international networks in this field of expertise to discuss
the aims, means and solutions for developing the culture of prevention
in organizations and workplaces.
The Symposium will discuss the culture of prevention related to occupational risks, such as accidents, workplace violence and psychosocial risks
at work. The focus will also be on organizational culture and modes of
operation in organizations, and on the attitudes and behaviour of individual employees.
The Symposium promises to be an excellent forum for exchanging ideas,
generating research and collaboration, networking, and social interaction.
Its my privilege to deliver the opening speech of the Symposium. It gives
me an opportunity to pose and elaborate a couple of questions without knowing the answers or making any concluding remarks. However, I
hope that the deliberations and informal discussions held in the Symposium also touch on these questions.
First of all, Im going to ask whether an organization is a culture, has a
culture or lives in a culture. Then Ill make a couple of points as regards
a number of various cultures. Thirdly, Ill ask what kind of a thing is a
culture. Finally, Im going to say a couple of words about the purveyors
of a culture.
This is a Symposium on Culture of Prevention. We are discussing for
instance risks, accidents and violence. These words bring to my mind
the concept of Safety Culture. As Cox and Cox put it twenty years ago:
Safety culture is the ways in which safety is managed in the workplace,
and often reflects the attitudes, beliefs, perceptions and values that employees share in relation to safety.
The theme of safety culture emerged after the Chernobyl disaster. The
term safety culture was first used in INSAGs Summary Report on the
Post-Accident Review Meeting on the Chernobyl Accident (1988). The
concept was introduced to explain how the lack of knowledge and un9

derstanding of risk and safety among the employees and organization

contributed to the disaster.
According to this approach an organization has a safety culture. Thats
one way of thinking about culture.
In fact, I believe that the inventors of the concept of safety culture were
basically of a different opinion. According to that concept, an organization lives in a culture. There is as real or perfect a culture somewhere
outside as there is inside an organization. Regulations, inspections and
all kinds of interventions are means of implementing or infusing the surrounding culture into an organization.
A third approach states that an organization is a culture. According to
this approach, an organization cannot buy, steal or borrow a culture. An
organization does not own a culture. A culture develops according to its
own principles. This approach also explains how difficult it is to change
the basic culture of an organization by the interventions of authorities.
If an organization is a culture or has a culture, it is self-evident that there
are several cultures.
The title of this Symposium refers to a culture of prevention. It highlights
the aspect of prevention. If the title were focused, for instance, on a
Culture of Punishment, Culture of Protection or Culture of Promotion,
what would be the main differences in the concluding remarks of the
Is it possible to use a culture of punishment as a means of promoting
a culture of prevention? I take one example from Finland. Quite often
someone demands tougher punishments in order to decrease the number of occupational accidents. Indeed, can we increase safety, health,
and well-being at work by greater deterrence?
This brings me to one basic question. What kind of a thing is the culture
that is discussed in the Symposium. Is there a kind of an eternal core, and
if there is a core, what is that core?
As former head of the legislation unit it is easy for me to fancy that the
Penal Code indicates the core of a preventive culture. In the Penal Code
there are the principles describing what is right and wrong. If a person
does not observe occupational health and safety legislation, he or she
will be charged and punished according to the Penal Code.
On the other hand, I can imagine a strong culture that shows the place
for various instruments, including education, science, legislation and
jail-houses - as necessary. Both of these approaches take it as given that
there is a single core, a real hard core of the culture. The task of researchers and experts is to discover or unveil it.
The third approach proposes that a culture is a social construction. It is a
man-made phenomenon. It is a narrative construction. In this symposium we are telling stories about Culture of Prevention. We are constructing a Culture of Prevention.

Now we come to my final point. If culture is a social construction, who

are the constructors? If there is a culture of prevention, is it a mass culture and high culture?
Are the purveyors of mass culture creating a culture that glorifies the
vulgar and the mediocre at the expense of high culture? And to continue asking: who might be the purveyors of mass culture in the field of
safety, health and well-being at work.
No doubt, we are purveyors of high culture in this field. It is quite obvious that we have a vested interest in preserving the realm of high or
elite culture against the surrounding environment of kitsch and trash.
We try to produce a culture of prevention that includes difficult and
complex skills and a lot of hard work. On what grounds do we believe
that high culture, differing from all other cultures in the field of culture of
prevention, would overcome mass culture? Or are there means to edify
and educate the mass culture?
Ladies and gentlemen
As I promised, I didnt answer the question whether an organization is a
culture, has a culture or lives in a culture. I am quite sure that there are
and will be several cultures, and some kind of co-existence is needed.
In any case, as regards the culture of prevention, we are the purveyors.
After consulting the list of participants in the Symposium, I take it guaranteed that the issue is in good and competent hands.
I would like to thank you for coming to this event and for contributing
to the success of the Symposium. It is also up to you to fully utilize the
exchange of information and make the most of the networking opportunities during the breaks and social events of the meeting.
Cordial thanks are due to the organizations that have contributed to the
organization of this Symposium: Finnish Institute of Occupational Health
(FIOH); Korea Occupational Safety and Health Agency (KOSHA); French
National Institute of Occupational Health and Safety (INRS), and International Social Security Association (ISSA). The Symposium is organized in
co-operation with Ministry of Social Affairs and Health, Central Organisation of Finnish Trade Unions (SAK), Confederation of Finnish Industries
(EK), Social Insurance Institution of Finland, and Federation of Accident
Insurance Institutions (TVL), all from Finland, and International Commission on Occupational Health (ICOH). The Symposium is supported by
Federation of Accident Insurance Institutions (TVL) and Federation of
Finnish Learned Societies, both from Finland.
With these words I open the Symposium.


Opening speech for the International

Symposium on a Culture of Prevention
Hun-ki Baek, President
Korea Occupational Safety and Health Agency (KOSHA)

Good morning!
I am Hun-ki Baek, President of the Korea Occupational Safety and Health
Agency. As the president of KOSHA and chairperson of the ISSA International Section for a Culture of Prevention, I am extremely glad to be here
with you on this special occasion of the International Symposium on a
Culture of Prevention.
Honorable Director Leo Suomaa of the Finnish Ministry of Social Affairs
and Health, Director Seiji Machida of the ILOs Program on Safety and
Health at Work and the Environment (SafeWork), Secretary General
Hans-Horst Konkolewsky of the ISSA, Director General Harri Vainio of
the Finnish Institute of Occupational Health, Director Philippe Jandrot
of the INRS (Institut National de Recherche et de Scurite, National Research and Safety Institute) of France, Deputy Director General Dr. Walter Eichendorf of the DGUV (Deutsche Gesetzliche Unfallversicherung,
German Social Accident Insurance) of Germany, Korean Ambassador to
Finland Dong-hee Jang, and distinguished representatives and experts
from safety and health organizations!
I am truly happy to see you all in this beautiful city of Helsinki, the center
of the Baltic Sea and Scandinavia.
As you know, the Safety and Health Summit held in Seoul, Korea on
June 29, 2008 on the occasion of the 18th World Congress on Safety and
Health at Work adopted the Seoul Declaration.
The declaration, which was adopted by 46 representatives of workers,
employers and governments is the first in history to declare safety and
health a fundamental human right and a means of economic development.
The Seoul Declaration is the basis for the Istanbul Declaration, which was
adopted in the Labor Ministerial Meeting at the 19th World Congress on
Safety and Health at Work in Istanbul, Turkey in 2011. This declaration
reaffirmed governments commitment to occupational safety and health.
Thanks to these efforts, the ISSA International Section for a Culture of
Prevention was established on the basis of active support and cooperation with the ILO and the ISSA.
Since its inauguration, the Section has been engaged in various activities including successfully hosting the Inaugural General Assembly at


the 19th Congress to establish a cooperative network between relevant

organizations and the 1st Bureau Meeting in Cancun Mexico in 2012.
Furthermore, as a secretariat of the Section, KOSHA has been trying its
utmost to promote a culture of prevention through various safety and
health events.
We all know that when we protect workers health and make workplaces
safe and healthy, we are showing respect for humanity, which should
come before everything else.
I believe that the first step against occupational accidents is a legal and
institutional framework, the second step a systematic management incorporated with an overall business process, and the last step is a cultural approach that drives positive changes in workers mindsets and
As we make efforts to lay a firm foundation for a prevention culture, we
are contributing to decent work, business competitiveness, and global
economic development.
A culture of prevention is an important tool for improving the quality of
work and for survival in this highly competitive world.
I hope that the safety and health experts and specialists here can share
important experiences and best practices on cultural approach based
accident prevention. They will serve as the foundation for a successful
20th World Congress on Safety and Health at Work, to be held in August
next year in Frankfurt, Germany.
For its part, the Korea Occupational Safety and Health Agency will spare
no efforts or resources in taking a leading role in laying the groundwork
for a culture of prevention across the globe.
I would like once again to express my gratitude to everyone who has
made this symposium possible and wish everyone here the very best of
luck and good health.
Thank you.


Opening speech
Philippe Jandrot, Director
Institut National de Recherche et de Scurit (INRS)
The concept of a culture of prevention is fairly new in the field of occupational health and safety. Twenty years ago, in France, social partners did
not accept any kind of reference to a culture of prevention. The reasons
for rejecting this term were quite different among employers and workers unions, but there was a very strong common opposition.
We can now see that the idea of a culture of prevention has rapidly become widely accepted, through a few important dates:
11 March, 2003 Communication of European Commission - Community strategy on health and safety at work (2002-2006) set the principle of A real culture of prevention
29 June, 2008 Seoul Declaration The summit participants commit
to taking lead in promoting a preventative safety and health culture,
placing safety and health high on national agenda.
September 2011 ISSA created Prevention culture section
Today everyone uses the concept of a culture of prevention. Each of us
has developed our own understanding of this concept, but how common are these understandings?
Should we understand that there is only one culture of prevention or
that there are several, depending on regional cultures or other factors?
What are the components of a culture of prevention? Knowledge? Beliefs? Behavior? Ethic rules? Moral values? Competencies? Concepts?
Does a prevention culture have tools?
How do we create a culture of prevention? Education and training are
natural ways to do this. Can the implementation of a management system also be a way to implement or develop a culture of prevention?
How do we evaluate the level of a culture of prevention?
All these questions have to be addressed. The objective of this symposium was to start answering some of these questions and to prepare for
the ISSA XX world congress in Frankfurt on 24 - 27 August 2014.
I believe that the good quality of the work and discussion during the
symposium in Helsinki will make September 2013 an important date in
the development of a common understanding of the Culture of prevention.


Opening remarks
Hans-Horst Konkolewsky, Secretary General
International Social Security Association (ISSA)

Distinguished delegates, Ladies and gentlemen,

Dear colleagues and friends
It is a great honour and pleasure on behalf of the International Social
Security Association (ISSA) to participate in the opening session of this
International Symposium on Culture of Prevention here in beautiful Helsinki.
Let me first of all thank our hosts, the Finnish Institute of Occupational
Health (FIOH) and the national organising committee for providing us
with such an excellent venue and exceptional conditions for our symposium.
I would also like to thank the co-organisers the Korean Occupational Safety and Health Agency (KOSHA), the French National Institute of
Research and Security (INRS) and the ISSA Special Commission on Prevention.
Allow me to extend a special thanks to speakers and participants from
ISSA member organisations and to congratulate our International Section on Prevention Culture, under the leadership of KOSHA, for its leading role in the organisation of this symposium on future approaches as
regards a prevention culture.
Ladies and gentlemen,
Our symposium topic, prevention culture, is in my opinion of the greatest strategic importance for a much needed further improvement in
working conditions and in particular for the health and safety of current
and future working populations. But more than this, the development
of a prevention culture is also of significant importance for the future of
our economies and societies. In my opening remarks I will briefly outline
The world of work is changing dramatically as a consequence of globalisation, demographic change, increasing migration and a growing number of workers in informal, vulnerable employment. New technological
and organisational developments have contributed to reduce certain
traditional safety risks, but at the same time have also brought about
new health risks adding to the complexity of prevention challenges at
the workplace.
The global situation as regards safety and health levels remains critical:
The ILO estimates that a devastating 2.34 million people die each year

due to work-related accidents and diseases which account for the major
part of fatalities. This means that more people are killed due to their
work than due to conflicts and wars.
Positively, a trend towards lower incidents of fatal work accidents can be
observed both in Europe and globally, while fatal occupational diseases
incidents however continue to increase.
Besides the unacceptable human losses, there are huge economic consequences which have been estimated at 4 % of global GDP as millions
of workdays are lost and billions have to be paid by workers compensation boards, pension systems and society at large.
The nature of occupational health problems is changing too: According
to European and national surveys the ranking of reported health problems is headed by ergonomic and psychosocial conditions. It is therefore
not surprising that, according to the OECD, between 40 and 50 % of new
invalidity cases amongst member countries are caused by mental health
This adds another element to the previously mentioned complexity of
prevention, as the causes of mental health problems can be both workand non-work related.
Ladies and gentlemen,
This is why, in the view of the ISSA, a new prevention approach is needed
where traditional collective prevention measures at the workplace are
supplemented by measures that focus on the individual and that also
take into account a persons social setting and resources.
This holistic prevention concept not only requires new competencies,
tools and collaboration structures for those involved, but it also calls
for an increased focus on health and health promotion at work, and for
workers who have suffered an accident or disease, systematic return-towork programmes.
As a consequence, prevention systems and actors find themselves at a
critical crossroads:
If authorities, organisations and professionals in charge of prevention at
the workplace do not react to these evident developments in workers
health and embrace a more holistic and integrated prevention approach,
they risk being criticised for not being able to manage and reduce the
increasing negative health impacts and the related economic consequences.
They also risk that the positive recognition in society of the added value
of investing in work- related prevention structures and efforts might be
weakened severely.
However, if the same actors decide to embark on the development of
new, supplementary prevention concepts, tools and the related competencies and collaborative structures, the value of prevention and the
important role of the workplace in achieving more inclusive labour mar16

kets and productive societies will become even more evident and thus
contribute to the development of a prevention culture at the workplace
and in society.
For the ISSA there is no doubt about the choice of strategic direction
to be taken. In our view, the introduction of supplementary holistic and
person-centred prevention approaches is both an obvious necessity in
view of the dramatically changing nature of workplace health challenges
and an historic opportunity to further strengthen prevention and to turn
the development of a genuine workplace prevention culture into an economic and social development strategy for our societies.
This is why we, over the past two years and in line with our initial commitment as co-initiators and signatories of the Seoul Declaration for
Safety and Health at Work - which has identified the involvement of all
actors in society as a key condition for the development of a prevention
culture - have developed three sets of Prevention Guidelines for social
security administrations. Our objective is strengthening the role of social
security both as regards workplace risk prevention, health promotion
and return-to-work measures.
These Guidelines will, together with good practices and reference literature, be presented in November 2013 at the ISSAs World Social Security
Forum in Doha, Qatar.
A new Centre for Excellence will be established in 2014 to offer member
organisations expert advice and practical support, training and recognition related to the successful implementation of these Guidelines.
The ISSA and its global membership are committed to developing proactive and preventive social security and look forward to collaborating
closely with other actors in the workplace and beyond in the formation
of national and global prevention cultures.
Ladies and gentlemen,
I have in my opening remarks briefly outlined,
(1) that the development of a prevention culture has become more necessary than ever due to the increasing complexity of safety and health
challenges at work, with a strong growth in health conditions that can be
both work- and non-work related,
(2) that in order to develop supplementary individual and holistic prevention approaches, traditional barriers between the workplace and society need to be overcome, and new concepts, tools and collaborative
structures between relevant actors in both domains need to be developed, and
(3) that this offers an historic opportunity for prevention to be even
more highly valued and recognised as a prerequisite for inclusive labour
markets and productive economies, and consequently for prevention
culture to form a key element in the social and economic development
strategy of countries and regions.

During the coming 2 days we have an excellent opportunity to further advance our thinking as regards future approaches for a prevention
I look forward to a very interesting programme with many exceptional
speakers and to fruitful exchanges about the different dimensions that
should be reflected in a definition of a prevention culture, and how this
strategic concept can be made operational both at the workplace and
beyond, which will be one of the key topics of the World Congress for
Safety and Health at Work that will take place in August 2014 in Frankfurt, Germany.
I wish you a successful meeting and very much look forward to the results of the symposium.
Thank you for your kind attention.


Opening Speech for International

Symposium on Culture of Prevention
Korean Ambassador to Finland Dong-hee Jang
Korean Embassy in Finland

Distinguished Guests, Ladies and Gentlemen, Good Morning

Mr. Leo Suomaa, Director General of the Ministry of Social Affairs and
Health, Finland,
Prof. Harri Vainio Director General of FIOH (Finnish Institute of Occupational Health),
Mr. Hans-Horst Konkolewsky, Secretary General of ISSA (International
Social Security Association),
Mr. Philippe Jandrot, Director of INRS (Institut national de recherche et
de scurit : The National Research and Safety Institute for the Prevention of Occupational Accidents and Diseases, France),
Mr. Hun-ki Baek, President of KOSHA(Korea Occupational Safety and
Health Agency),
Honorable Occupational Safety and Health representatives,
I am truly glad to meet you, the distinguished representatives of the
international community responsible for the prevention of occupational
accidents and the promotion of occupational safety and health.
I am most honoured to have the opportunity to deliver a congratulatory speech at the International Symposium on Culture of Prevention
because it is held in Helsinki in close cooperation between KOSHA and
FIOH in the year when our two countries commemorate the 40th anniversary of establishing diplomatic ties.
It is my great honour to be present at the venue where the implementation and achievements of the Seoul Declaration on Safety and Health
at Work are presented, and I appreciate all your efforts in the excellent
Five years have passed since the signing of the Seoul Declaration on
Safety and Health at Work.
Despite many improvements during the past years, countries around
the world are still concerned about the ways and means to in which to
prevent traditional types of accidents, which are frequent in small and
middle-sized enterprises.
Also, rapid changes of sequences in the work environment create new
risks and hazards. We are constantly facing unpredictable challenges.
The levels of occupational safety and health at work in different con19

tinents, countries, regions, and enterprises, show great disparities, depending on the degree of economic and social development.
Furthermore, many workers are still in the blind-spots of occupational
safety and health.
Now your achievements enable us to minimize the blind-spots of safety
and health and help employers and workers fulfill their responsibilities in
order to improve safety at work.
Honorable Occupational Safety and Health representatives!
Ensuring the safety and health of workers translates into upholding the
noble value of human respect. Occupational safety and health is the
most essential means to ensure workers welfare, and it should take priority over everything else.
We cannot emphasize too much the importance of prevention in occupational safety and health, as prevention is not only more effective but
also less costly than treatment and rehabilitation.
The statement by ILO Director-General Guy Ryder on the World day for
Safety and Health last April eloquently attests to this: Occupational disease impoverishes workers and their families and may undermine whole
communities when they lose their most productive workers. Meanwhile,
the productivity of enterprises is reduced and the financial burden on
the State increases as the cost burden of health care rises.
Let us remind ourselves once again that, as stated in the Seoul Declaration on Safety and Health at Work adopted in 2008, safety and health
is the basic right of workers as well as a means with which to achieve
economic development.
I would like to ask all of you to show your insights into and commitment
toward safety and health, so that the principles and basic ideas of the
Seoul Declaration can have far-reaching effects in industrial sites around
the world.
Before I finish, I would like to express my sincere appreciation to the
Finnish Ministry of Social Affairs and Health, and the Finnish Institute of
Occupational Health for providing this excellent venue at which distinguished representatives can gather together.
I hope this Symposium bears fruitful results and contributes to improving our workplaces.
Thank you very much.


Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

Prevention culture as culture:

Can we achieve it, and is it enough?
Schulte PA, Guerin RJ, Okun AH
National Institute for Occupational Safety and Health (NIOSH), USA
As the 2008 Seoul Declaration on Safety and Health at Work states,
[a] Prevention Culture is one in which society as a whole promotes
high levels of safety and health at work. A national preventive safety
and health culture acknowledges and supports the right to a safe and
healthy work environment that is: respected at all levels; actively participated in by governments, employers, and workers; [and] defined in
systems of responsibilities and duties. It is a culture where the principles
of prevention are accorded the highest priority (1).
So what does prevention culture as culture mean? Culture is defined in
many ways and generally refers to that complex whole which includes
knowledge, beliefs, acts, laws, morals, customs, and any other capabilities acquired by man as a member of society (2). Anthropologist Clifford
Geertzs definition of cultureone that is widely cited in organization
studies (3)argues for a complex and dynamic conception of culture
that is

essentially a semiotic one. Believing, with Max Weber, that
man is an animal suspended in webs of significance that he himself has
spun, I take culture to be those webs, and the analysis of it to be therefore not an experimental science in search of law, but an interpretative
one in search of meaning (4).
As Geertzs description implies, because of its meaning-centered and
dynamic nature, culture is mutable, and humans can act collectively to
change it to reflect shared norms and beliefs. As Geertz envisioned, the
social web we weave can be expansive and simultaneously limiting, depending on the collective choices we make. The public health community can foster the expansion of a conception of culture that includes a
focus on protecting and promoting the health of the whole person in
all of his or her environmentsfrom home, to work, to the community.
Many organizations and standard-setting bodies have already taken important steps in advancing a culture of prevention, including the
European Commissions Advisory Committee on Safety and Health
at Work. Although promoting a culture of prevention is critical to the
health and safety of all individuals, the question remains, Is preventing
risks enough? People do not live just to be unencumbered by injury

and disease; they live to pursue dreams, to build relationships, and to

experience personal achievements. Scholars and practitioners in a variety of disciplines commonly ascribe these aspirations to the construct
of well-being, which encompasses both work- and non-work-related
factors and has been defined at the individual, organizational, and societal level (5, 6). Within the field of public health more generally, and
occupational safety and health specifically, the workplace has become
an important site for discussions of well-being (7). Though there is no
consensus on how to define well-being (related to work or to life in
general), some common elements are in evidence. In their expansive
definition, Waddell and Burton describe well-being as the subjective
state of being healthy, happy, contended, comfortable, and satisfied with
life (8). Well-being is thus aspirational (9), characterized by flourishing,
happiness, wherewithal, positive emotion, and self-determination (1016). Well-being may be fostered by different sources (friends, family,
employers, co-workers, community, health, wealth, social class, human
and natural resources, and personal freedom, among many others) (6,
11-13, 16-23). Moreover, work per se is generally a promoter of well-being, whereas unemployment presents a threat to well-being (24, 25). In
sum, well-being is both an absence of negative circumstances and the
presence of an abundance of positive aspects in an individuals life.
To fully realize a culture of prevention in the broadest sense, it should
thus foster the prevention of direct threats to well-being; increase the
avoidance or mitigation of factors that may lead to the absence of
well-being; and promote the factors that increase well-being. To foster a
well-being culture, both prevention and promotion measures need to be
advanced as constructs that align with values, norms, actions, policies,
customs, and beliefs. To help achieve such alignment, six necessities bear
further investigation and discussion:
1) Reduce the tendency to compartmentalize work from the rest of life.
2) Understand the value of good jobs to a culture of well-being.
3) Integrate into educational systems a focus on career and job readiness
that promotes skills for risk prevention.
4) Advance evolved notions of work, health, and prevention.
5) Advance a preventative approach to chronic disease.
6) Identify the means to make both prevention and promotion integral
parts of a culture of well-being.

1) Reduce the tendency to separate work from the rest of life.

The separation between work and non-work domains is historical,
political, and due in large part to the labor/employment contract and
its intent to limit liability (26). Given that injuries and illnesses that result
from work affect our home lives, and vice-versa, the false dichotomy
between work and life leads to an underreporting of occupational injury
and disease and an incomplete characterization of the societal burden

of work-related injuries and illnesses. Moreover, work in the 21st century

is rapidly evolving to include new methods for organizing the workplace
that further erode the work/home divide. These include non-traditional
work schedules, extensive labor contracting, expansion of service and
knowledge sectors, increased worker mobility, and increases in small
businesses (27). A culture of well-being must therefore span work and
non-work environments and address both areas together and their

2) Understand the value of good jobs to a culture of well-being.

Scholars have long contended that work gives meaning to life and dignity to the individual (28). However, the fundamental shift in the global
economic order that has occurred over the past several decades has
resulted in fewer good-paying jobs, a situation exacerbated by advances
in technology and automation (29, 30). The effects of precarious employment (i.e., work that has no implicit promise of continuity) and longterm unemployment are explored in a large, growing body of literature
(31-37). However, job creation is not the only issue; research indicates
that the quality of those jobs is also critical (38). Any focus on increased
access to good jobs for all workers must be concerned with a range of
policy-related issues that affect job quality and thus have an impact on
health and well-being of individuals who work. In the United States (and
elsewhere), these issues include the value of the minimum wage, the
erosion of health and retirement benefits, and the declining bargaining
power of workers (39).

3) Integrate into educational systems a career- and job-readiness

focus that promotes skills for risk prevention.
Promoting and sustaining a culture of well-being would require use of
all available means to increase general awarenessas well as understanding of hazards and risks and how these might be prevented or
controlled (40). Research indicates that attitudes toward risk are mutable (41); thus, education pathways provide an invaluable opportunity
to facilitate a change in values, norms, and beliefs about the importance
of prevention. To be most effective, education and training should not
be restricted to the prevention of occupational hazards but should be
integrated with the whole person by extending coverage to all areas of
hazards or risks that an individual, whether an adult or child, is likely to
face (40). This training should begin in early childhood to establish good
habits and preventative reflexes that continue to serve the individual
throughout life, especially in novel situations (42). In Europe, numerous
efforts are under way to integrate basic workplace safety and health
skills into education pathways (43). In the United States, the Safe-SkilledReady Workforce Initiative (SSRWI) recently developed by the National
Institute for Occupational Safety and Health (NIOSH) focuses on creating the foundation for a culture of prevention. The ultimate goal of the
SSRWI is that every person in the United States, before entering the
workforce, will have the knowledge and skills to stay safe and healthy

at work and to contribute to a safe, healthy, and productive workplace.

There are eight foundational workplace safety and health competencies
promoted through the NIOSH SSRWI:

Recognize that although work has benefits, all workers can be

injured, become sick, or even be killed on the job. Workers need to
know how workplace risks can affect their lives and their families.
Recognize that work-related injuries and illnesses are predictable
and can be prevented.
Identify hazards at work and predict how workers can be injured or
made sick.
Recognize how to prevent injury and illness. Describe the best
ways to address workplace hazards and apply these concepts to
specific workplace problems.
Identify emergencies at work and decide on the best ways to
address them.
Recognize employer and worker rights and responsibilities that
play a role in safe and healthy work.
Find resources that help keep workers safe and healthy on the job.
Demonstrate how workers can communicate with othersincluding people in authority rolesto ask questions or report problems
or concerns when they feel unsafe or threatened.

Central to the SSRWI competencies are the understanding and application of the concepts of hazard, risk, and control to all areas of a persons
work, home, school, and community life.

4) Advance evolved notions of work, health, and prevention.

Evolved notions of work, health, and preventionwhich provide the
foundation for a culture of well-beingmay find their theoretical moorings in the salutogenic perspective on work, organization, and organizational change (44), which is based on a sense of coherence (SOC)
framework. This model posits that how an individual makes sense of his
or her world has a significant impact on how he or she manages stress,
stays healthy, and achieves well-being (45, 46). A systematic review of
the knowledge base on salutogenic research indicates that the SOC
framework has demonstrated utility as a health-promoting resource
(47). The application of this framework to public and occupational health
interventions at the individual, organizational, and societal level has potential to inform and inspire the development of sustainable policies that
promote a culture of well-being.

5) Advance a preventative approach to chronic disease.

Chronic disease is the leading cause of death in the world; by 2020, the
burden is predicted to increase (48). The social impact of chronic disease
is far-reaching and often not quantifiable (49). Chronic disease places a
burden on a nations health, quality of life, productivity, and econom24

ic growth. As populations age and the incidence of chronic disease increases, so does its prevalence. Socio-cultural determinants of health
have an impact onand are impacted bychronic disease, and these
interrelations are varied and complex (50, 51). There is a pressing need
to intervene in this trend by moving from a palliative medical model
to a prevention-based approach (52). Preventing chronic diseases can
provide better quality of life, reduce unnecessary medical costs and lost
productivity, strengthen national economies, and advance a culture of

6) Identify the means to make preventionand well-beingan

integral part of culture.
To make prevention an integral part of culture requires a multi-pronged
approach aimed at changing values, norms, beliefs, and policies at all
levels of society. As mentioned previously, programs provided in kindergarten through 12th grade in various countriesincluding the United States, through the SSRWIfocus on creating the foundation for a
culture of prevention. Central to the SSRWI competencies is an understanding of the concept of hazard, risk, and control, which is important
throughout a persons life and in all environments in which that individual will live, work, and play. Broadening the concept of prevention to address well-being and demonstrating the relationship between workforce
well-being and national productivity are also important ways to influence policymakers to develop policies and laws supporting prevention
and well-being.
A positive relationship between workforce well-being, variously defined,
and productivity has been reported, but the literature supporting such
a relationship is not robust (5). More work must be done in this area to
establish the links between well-being and productivity. Also essential
to promoting workforce well-being is for nations to maintain a viable
dependency ratio, defined as the number of persons of dependent age
(under 20 years or over 64 years) to those of economically productive
age (20 to 64 years) in the population (53). Though this concept has its
limitations (for example, it does not take into account that many people
over age 64 are still active in the workforce), it is generally considered
a valuable indicator of a countrys economic health as well as an indication of a populations well-being (5). A viable dependency ratio can
be maintained by considering the needs of aging workers (54) and by
creating sensible immigration policies that increase the number of new
entrants to the labor force (55).
To fully integrate prevention and well-being into culture, business leaders must place a high value on workforce well-being, and government
leaders and regulators need to support the inclusion of well-being in
risk assessments, guidance, policies, and laws. These approaches require
the operationalization of well-being in the workplace, even though this
effort will confront numerous definitional, logistical, legal, and financial
challenges and constraints. A coherent, conceptual framework for pro25

moting well-being and a robust evidence base related to the determinants of well-being are required for the concept to be more forcefully
addressed in various policy areas (56). At the organizational level, contemporary practice calls for a paradigm shift in occupational health
from a treatment orientation to a holistic approach focused on mitigation of the causes of ill health and the promotion of well-being (57).
How to do this is the question. There is a need for public health and
occupational health intervention strategies to come together to create
a holistic approach to workforce well-being. Both the U.S. Total Worker
Health (TWH) initiative and the European Healthy Workplaces initiative, have begun to build up the linkages between work and non-work,
while helping to tear down the artificial divide between them. These approaches promote a culture of prevention in the workplace but also advance the well-being of the workforce. However, more etiologic research
is needed to investigate the interaction of occupational and personal risk
factors (ORFs and PRFs) (5). At the societal level, promoting the health
(in all of its facets) of every person who works is vital to the welfare of all
people, both in and out of the workforce. Creating and sustaining a culture of well-being ensures that the social fabric that binds us promotes
the highest possible quality of life for every individual.



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Evidence of the benefits of

a culture of prevention
Prof Dr Gerard I.J.M. Zwetsloot1

From safety culture to prevention culture

The first references to safety culture were made in the 1980s after the
Chernobyl (1) and the Piper Alpha disasters (2). References were made to
intangibles such as information difficulties, violations, failure to recognise emerging danger, role ambiguity, management complacency, poor
communication, low prioritisation of safety, etc. (3). There are many
definitions of safety culture (4). The concept is complex and ambiguous. Nevertheless safety culture is today is widely recognised as a crucial
factor in accident prevention. It is important to note that the evidence
stems from the tradition of learning from past experience (of what went
wrong), not from any tradition of predicting and developing experimental evidence. The evidence of the benefits of interventions in safety culture stemming from prospective studies is still very limited.

The concept of prevention culture

According to the literature there is also a dilemma about whether an
organisation has a culture or is its culture. I regard prevention culture
as potential element of the identity and mission of organisations (it is
its culture), at the same time as the organisation also has a vision of
accident prevention, and has long-term ambitions and strategies, and
programmes for tactical and operational risk reduction and control. An
organisational culture concerns what and how people believe, feel, think
and how they behave (over time) and how this is reflected in collective
habits, rules, norms, symbols and artefacts. It is important to realise that
there are formal determinants (e.g. espoused values, policies, rules and
prescriptions) as well as informal determinants (e.g. trust, credibility, rituals, risk perceptions, beliefs, stories) of safety culture (4).
It is often implicitly assumed that many characteristics of a good safety culture are also relevant for prevention culture. Three main characteristics in this respect are (a) genuine management commitment and
leadership (b) learning, improving and trust and (c) being informed and
having open communication (5).
A general description of (organisational) culture or subculture is: this is
how we do things around here. This implies that there is a prevention
culture, where prevention is the way we do things around here, i.e. when


Gerard Zwetsloot is senior research scientist at the Netherlands Organisation for Applied Scientific Research, TNO (NL), and honorary professor at the University of Nottingham (UK).

prevention and promotion of health, safety and well-being at work are

mainstreamed into business practices or macro policies and the behaviour of key agents. The latter is the internalization of prevention into the
mind-sets; the values as well as behaviour and actions of policy makers,
managers and employees. The former includes the implementation of
preventive and promotional programmes and activities. Prevention culture has a business ethics dimension associated with corporate social
responsibility (CSR). Avoiding shifting consequences (to others, to society, to future generations), including the prevention of accidents and
harm, is the key principle.

The complexity of culture and the generation of evidence

An organisational culture has several layers, ranging from basic assumptions to the expressions thereof in behaviour, policies etc. (6). In contrast
to the basic assumptions, expressions are simple to measure objectively.
This explains why most evidence concerns expressions of safety culture.
An organisational culture should be regarded as a complex social system. According to Snowdens CYNEFIN framework (7) experimental evidence requires a known or knowable context (normal problems) where
causes and consequences are understood and can be anticipated or determined when sufficient data is available. For complex social systems
this is not the case (wicked problems). This means that causes and
consequences can (only) be fully determined after the event. Prior to
that, rational decisions can be made by analysing the situation, exploration of alternatives, problem formalizing and setting, and implementing
flexible strategies. It is thereby vital to leave room for joint reflection,
evaluation and learning, and for adapting the process or redefining the
desirable outcome.

Developments in the definitions of health and safety

Another factor that contributes to the difficulty of generating evidence
is the tendency to redefine the concepts of safety and health as abilities.
The first development in this respect was that in Finland the concept
of workability became an explicit element of the legal requirements for
health and safety. In the safety discourse, the concept of resilience is
now a hot item. It is defined as the ability of a system, process or organisation to adjust its functioning prior to, during, or following changes
and disturbances, so that it can remain functioning even if unexpected disturbances occur (8). Weick and Sutcliffe (9) clearly make the link
with prevention culture, using the concept of organisational mindfulness as a prerequisite for managing the unexpected. In 2011 the Dutch
Health Council proposed to redefine health as the ability to adapt and
self-manage in the face of social, physical, and emotional challenges
(10). The main reason is that in todays world many people suffer from
chronic diseases and the main challenge for doctors is to help them be
able to function well in their daily life and work, rather than to achieve a
perfect state of physical, social and mental well-being.


Traditional scientific and practical evidence

The concept of a prevention culture forces us to rethink the types of evidence that are feasible and relevant, and to acknowledge the limitations
of what is often regarded as the gold standard for scientific evidence:
the randomised controlled trial (RCT). RCTs are at best partially applicable to complex social systems; they also imply a preference for (i.e. bias
towards) instrumental interventions rather than processes of organisational development or change. They are of limited relevance for issues
such as the precautionary principle, managing the unexpected, or the
deeper layers of prevention culture.
Table 1: The complementary characteristics of tradition scientific and
practical evidence
Traditional scientific evidence

Practical evidence

Based on experimental research

Based on practical experimentation or

learning from experience

e.g. Randomised controlled trials

e. g. Case studies

Theory based

Practice based

Potentially universal knowledge

Local and context dependent knowledge

Not always practically applicable

Not always theoretically sound

Ideally the basis for practical implementation

Often precedes scientific knowledge

Useful for normal problems

Useful for wicked problems

High credibility for researchers

High credibility for practitioners

For evidence of the benefits of a culture of prevention, smart combinations of scientific and practical evidence are most useful. Table 1 gives
an overview of the characteristics thereof.

The benefits of a prevention culture

The (potential or actual) benefits of a prevention culture can be easily
summarised: fewer health and safety problems and associated costs,
and more productive employees; fewer quality and delivery problems,
higher reliability, flexibility and productivity in production and work processes; a better status in society and attractiveness in the labour market,
greater profitability and several social and economic benefits for society
at large.

The evidence of the benefits of a prevention culture

In the next section a selection of scientific and practical evidence of the
benefits of a culture of prevention will be given.


Prevention through proactive risk assessment and participatory action-oriented approaches (11)
In small-scale and informal workplaces step-wise participatory approaches are effective for primary prevention. The steps are: 1) learn
good local practices; 2) identify significant risks and effective measures;
3) jointly plan locally feasible improvements; 4) implement prioritised
measures and record the achievements; 5) review the performance and
sustain step-by-step progress. Locally feasible, low-cost options, as well
as the design and use of locally adjusted action tool-kits, were shown to
be effective in many sectors and by several intervention studies. In the
local context, a networks of trainers are essential for sustaining improvement activities.
2) Prevention through occupational health and safety training (12)
In this comprehensive systematic review of the effectiveness of OSH
training, strong evidence was found for the effectiveness of training on
worker OSH behaviours, positively affecting worker practices and primary prevention. However, there was insufficient evidence of effects on
health (i.e. illnesses, injuries, health symptoms).
The prevention of work-related cancer, dust-related diseases, asthma, chronic pulmonary diseases, noise, and injuries in low and middle income countries (13)
This systematic review clarified that incentives, regulation, and enforcement of regulation are effective in stimulating implementation of the
available effective (technical) tools. Feedback and rewards help to prevent occupational injuries. Personal protective equipment has potential,
but its use is difficult to put into effect, while no conclusive evidence was
found that education and training, preventive drugs or health examinations are effective.
4) Core values that support a prevention culture (14)
While health, safety and well-being at work (HSW) represent values in
themselves, other values can support them. In a literature overview of
values and value-laden factors that support HSW, seven core values were
identified and grouped into three value clusters. The first value cluster comprises the values of interconnectedness, participation and trust.
The second cluster comprises justice and responsibility. The third value
cluster comprises the values of growth and resilience. These core values
can be regarded as basic value assumptions that underlie a culture of
5) Networking, zero accidents vision and accident prevention (15)
Increasingly companies feel their identity and reputation do not allow
for accidents and work-related diseases, and that zero (accidents, harm)
is the only ethically sustainable goal for health and safety (16). Membership of the Finnish Zero Accident Forum, where companies share best
practices and inspiration with each other and with FIOH, was associated
with significant improvements in their accident rates in the period 200533

2008, while those in the national statistics levelled off, even-though the
member companies already performed much better than the national
6) Accident prevention through safety leadership (17)
In a comprehensive literature review it was shown that transactional and
transformational leadership does make a change for safety. The main
effective elements were: (a) having and disseminating a clear vision; (b)
acting as role models and showing concern; (c) motivating employees,
encouraging worker involvement; (d) communicating consistent safety
messages; (e) setting clear goals and standards; (f) monitoring and recognising positive safety behaviours; and (g) providing resources.
7) Accident prevention through a good safety climate (18)
This meta-analysis demonstrated that (a good) safety climate has a positive, but weak, effect on safety compliance (adherence to procedures)
and a somewhat stronger effect on participation (employee commitment and involvement in safety). The latter, however, will vary across
occupational settings and work environments.
8) Prevention of fatal accidents through life saving rules (19)
In 2009 Shell introduced twelve life-saving rules as part of pursuing
goal zero world-wide. The twelve rules were not new, but were now especially promoted, emphasising that compliance was mandatory for all
Shell employees and contractors while on Shell business or sites. An important principle, communicated explicitly, was: If you choose to break
these rules, you choose not to work for Shell. The fatal incident rate in
Shell was reduced by 71% between 2008 (baseline) and 2011 (last year
of the evaluation) implying around 21 lives saved in 2.5 years, while the
average for the sector was a reduction of 39%. The lost time incidents
frequency rate dropped by 40%, compared to 21% in the sector.

A prevention culture is dynamic and complex, which makes it difficult to
generate hard scientific evidence of the benefits through traditional research methodologies. Innovative types of research, combining practical
evidence with rigorous scientific methods are key. It cannot be a surprise
that evidence of the effectiveness of the internalisation of prevention
into the mind-sets, the values as well as behaviour and actions of policy
makers, managers and employees, is very limited. The majority of available evidence is for the effectiveness of the implementation of preventive and promotional activities. There is evidence of the effectiveness of
regulation, enforcement of regulation and incentives, participatory stepwise approaches, leadership and genuine management commitment,
OSH, training, networking for zero accidents and harm, safety climate,
and organisational enforcement of compliance to essential rules or principles (life saving rules).



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should we define health? BMJ 2011; 343: d4163.
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Environ Health 2012, 38, (3): 193-232.
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support Health, Safety and Well-being at Work. SH@W, 2013: 4: 187-196.
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research into the zero accident vision, Safe Science 2013, 58: 41-48.
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safety. Buxton: Health and Safety Executive, RR952: 2012.
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accidents. SPE 2012: 157465-MS.


Challenges and Barriers to

Promoting Safety Culture
Marianne Levitsky1, MES, CIH, ROH
Workplace Health Without Borders, Canada
The Seoul Declaration on Safety and Health at Work states that promoting high levels of safety and health at work is the responsibility of society
as a whole and all members of society must contribute to achieving this
goal by building and maintaining a national preventative safety and
health culture (1).
Building a safety culture at the workplace level is not easy; building it at
the society level as called for in the Declaration is an even more daunting
challenge. We have few guideposts, as most knowledge and research
on safety culture is focused at the workplace level, while research on effecting social change has generally not focused on workplace safety. In
order to develop effective strategies for building a social safety culture,
we may be able to learn and apply knowledge from other arenas. This
paper will examine some research evidence on social change that may
point to approaches we can test, evaluate and refine in efforts to identify effective means of building a national safety culture.
From experience and research at the workplace level we can characterize safety culture as the shared values, attitudes and beliefs that shape
health and safety practices. If we extrapolate from the workplace to the
societal level, the goals of the Seoul Declaration require that we address
the safety values, attitudes and beliefs of the society at large.
The concept of safety culture maturity (2) has been invoked as a framework for analyzing how closely an organizations culture meets the ideal
state. Safety culture and climate surveys (3) have been used widely as
indicators of an organizations level of safety culture, and such surveys
can provide valuable benchmarks at the outset of a safety culture intervention.
It has been well documented that at the workplace level, management
commitment is key to advancing safety culture maturity. In an organization where management and supervisors do not demonstrate commitment to safety, efforts aimed at influencing worker attitudes and
behaviour may backfire by engendering cynicism and a sense of futility.
An organizations safety culture maturity level can point to intervention
priorities for example, where the level of safety culture maturity is low,
it may be wise to give priority to influencing management and supervisors before focusing on worker attitudes and behaviour.


This presentation is a personal view and does not necessarily represent the opinions of Workplace Health
Without Borders.

Can culture surveys and the safety culture maturity concept be applied
to influencing safety culture at the societal level? Just as a safety culture
survey in a workplace can provide a baseline on which to judge the success of an intervention, can we design a social survey to benchmark societal safety culture? There is limited experience in this area for example,
the Ontario, Canada Workplace Safety and Insurance Board conducted
public surveys before and after its social marketing campaigns (4) and
the UK Health and Safety Executive (HSE) (5) conducted a survey of public attitudes to safety. Responses to such surveys may point the way to
priority audiences for building a public safety culture. For example, the
HSE survey found that employers were slightly less likely than workers
and the general public to agree with the statement, health and safety
requirements are a cornerstone of a civilized society. Such results may
suggest that safety culture promotion efforts may need to start with
efforts to influence employer buy-in and responsibility.
Much effort has gone into validating and standardizing safety culture
and climate surveys at the workplace level. Similar efforts to develop
valid social surveys indicative of safety culture at the society level could
prove a valuable contribution to building national safety cultures.
Establishing a baseline measure of culture and prioritizing audiences are
good first steps in planning a strategy to build safety culture. Deciding
how to influence the audience can prove even more challenging.
Social marketing campaigns and motivational messages have been used
in efforts to influence social attitudes and behaviours with respect to
other public health and environmental goals. (Social marketing is the
use of marketing and advertising techniques to promote socially beneficial objectives.) Occupational health and safety (OHS) practitioners may
be able to learn from research on social marketing, motivation, influencing and decision-making related to other social objectives.
Much of this research emerges from the sphere of behavioural economics a deviation from classical economics that, in the words of leading
theorists (6) represents the combination of psychology and economics
that investigates what happens in markets in which some of the agents
display human limitations and complications. Behavioural economics contradicts classical economics in showing that people dont always
make decisions based on rational cost-benefit considerations. It teaches
us that we need to take into account the very human quirks and tendencies that influence everyones choices and actions.
Compilers and popularizers of research on behavioural economics, social marketing, motivation, influence and decision-making (7, 8,9,10,11)
point to a number of findings that may be useful in developing strategies for building safety culture. Five areas of research with promising
implications for safety culture are outlined below.
1. Framing: Kahneman and Tversky (12) have demonstrated the importance of how an issue is presented -- showing that framing the same
problem as a loss rather than a gain can significantly change the out37

come. They further articulated this as a principle of loss aversion quantifying it in the formulation that the pain of losing something is two
times greater than the pleasure of gaining it.
Framing has been invoked in health promotion endeavours, with experiments measuring the effectiveness of health promotion messages
framed in positive or negative ways. (13) According to this research,
negatively framed messages e.g. you could permanently lose your
hearing are more effective in promoting detection behavior such as
taking a screening test, while positively framed messages, e.g. you can
guard against permanent hearing damage are more effective in promoting prevention behavior such as wearing protective equipment. The
UK HSE (13) reported on a test of positively and negatively framed messages in informational brochures. Results indicated that the previous
history of the audience affected the potency of positively versus negatively framed messages. For example, those who knew someone with
hearing damage or had regularly used hearing protection were more
likely to be influenced by a positive message, while the converse was
trued for negative messages.
The HSE study also suggested that negative, i.e. fear-based messages
had more emotional impact than positive messages, but are not necessarily more successful in eliciting desired behaviour. In a British Columbia
study of OHS social marketing campaigns aimed at young people, Lavack
(14) found that more than half of the campaigns were fear-based. Her
team analyzed the factors that influenced the success of the campaigns,
applying the Extended Parallel Process model that has been developed
in the context of other health promotion campaigns. According to this
model, four components of a fear-based health promotion message are
key to motivating desired behaviour to avoid an unwanted outcome:
susceptibility (the audience must believe that the outcome could happen to them), severity (the outcome must be severe enough that the
audience wants to avoid it) self-efficacy (the audience must believe they
can perform the desired behaviour) and response efficacy (the audience
must believe that the desired behaviour will be effective in preventing
the outcome).
Lavacks results indicated that a combination of self-efficacy, susceptibility, and severity in a campaign greatly increased its effectiveness.
The HSE and Lavack results suggest that framing does matter but must
be applied in conjunction with other message features, and take audience characteristics into account. The best approach may be to use
different messages, some positive, some negative to be effective with
different audience segments.
2. Present Bias Preference: Behavioral economics also points to an
abundance of research illustrating that future outcomes are less potent
than more immediate outcomes in influencing behaviour. Present-bias
preference is especially germaine to occupational health, in view of the
many hazards such as those causing chronic disease, that exert their effects at some uncertain point in the future. Zohar (15) suggests that immediate feedback is a tactic that can counteract present bias preference

in an occupational health context. He tested this hypothesis with an

intervention to promote use of hearing protection through information
feedback, taking advantage of the phenomenon of temporary threshold shift (immediate, temporary loss of hearing acuity). In the intervention, workers were given hearing tests before and at the end of their
shifts. As expected, hearing levels were found to be poorer at the end of
the shift among workers not using ear plugs. This information was fed
back to individual workers. Over a period of five months ear plug usage
among the test group increased to 85-90%. In a control group, workers
were given lectures on hearing conservation augmented by disciplinary
threats. No more than 10% of the workers in the control group wore
earplugs over the five month period.
3. Social Norms: A third area of research focuses on our relationships
with other people and our desires to fit in with our peers. Robert Cialdini, in his influential book, Influence (10), refers to this principle as social
proof; in social marketing campaigns it has been referred to as social
norms marketing. Unlike the approach of social marketing that focuses
on the undesired behavior, advocates of social norms marketing argue
that we are more likely to do the right thing if we know that most of our
peers are doing it too. Too often, these advocates say, people misperceive the prevalence of the unwanted behavior. Social norms marketing
aims to correct this by informing people of the prevalence of the desired
behaviour. This principle has been adopted by the U.S. state of Montana
in a variety of campaigns under the rubric Most of Us(16) , whose web
site explains that social norms marketing is based on the central concept that much of peoples behavior is influenced by their perceptions
of what is normalwe often severely misperceive the typical behaviors
or attitudes of our peers. For example, if people believe that the majority of their peers smoke, then they are more likely to smoke. Using
social norms marketing to inform people that the majority of their peers
do not smoke, can potentially lead them to avoid smoking. In a 2007
article, Schultz (17) noted that social norms marketing has had mixed
results, sometimes backfiring or boomeranging, because people may
actually increase their undesired behavior if they think that the norm is
to do it more than they do. As with framing, the research has shown that
the stratagem can be successful if messages are carefully crafted and
tailored to the audience.
4. The Endowment Effect: A fourth category of behavioural effects focuses on ownership and commitment. Research has demonstrated that
people value something much more when they own it than when they
dont (18). Norton (19) expanded this concept to include the IKEA effect, demonstrating that people value something even more when they
have made it themselves, even if the amount of creativity and personalization are minimal, as when baking a cake from a mix. While research
in this area has focused on ownership and production of objects, conceptually it has been broadened to include intangibles such as programs
and plans. An example is provided by the innovative infection control
programs pioneered by Michael Gardam of the University Health Net39

works in Toronto. Dr. Gardams approach is to encourage ownership of

infection control programs by staff. He is quoted as saying, If you really
want to bring about lasting, sustained change, people have to come up
with the ideas themselves and they have to implement the ideas themselvesThere are all sorts of things we can start doing with this. Our
job is to show them all the stuff they can do, and then allow them to
go wild. (20) In his book on safety culture, Antonsen (21) has a similar
emphasis, stressing that worker participation is key to unlocking the
organization. He cites an intervention that achieved higher compliance
levels by engaging workers in development of safety procedures.
5. Foot in the Door Technique: there is considerable research showing
that when people take a small step toward a desired behaviour, they are
more likely to take a larger step in the future. In a 1966 study, Freedman
and Fraser (22) demonstrated this by asking homeowners to put a large
sign on their lawns advocating safe driving. The test group of subjects
were first asked if they would put a small sign in their windows and a few
weeks later asked to display the large sign; the control group was asked
to display the large sign on the first request. Results showed that people
were more likely to agree to the large sign if they had first agreed to
the small sign. The Foot in the Door Technique, as Freedman and Fraser
dubbed this effect, has been replicated in myriad studies since then (23).
This approach has been used in health promotion campaigns (24), but
there is little research on its application to occupational health and safety. Nevertheless, we can point to promotion strategies that employ this
approach, and whose effectiveness can be tested. For example, public
agencies can use this effect by asking executives to sign a pledge or
statement (for example, the Seoul Declaration (25)) as a signal of their
commitment to health and safety. Signing a statement by itself is a small
step, but once that commitment has been made, Foot in the Door theory
suggests that the signers are likely to take bigger steps in the future.
Research and experience in behavioural economics, decision making
theory, social marketing, and health promotion offer some promising
avenues for strategies to influence societal safety culture. By testing and
evaluating approaches based on this experience it is hoped that effective
strategies can evolve and be shared among those dedicated to building
safety culture. However, it is important to remember a key distinction
between workplace health and safety objectives and those of many other social change efforts: that the desired change can rarely be achieved
through individual behaviour alone, but is determined by the social context and importantly, the support for health and safety from a societys
and organizations leaders.
This distinction emerged in the study by Lavack (14). As described above,
her team found that three of the four factors in the Extended Parallel
Process model did indeed enhance the effectiveness of marketing messages. However, the fourth factor, Response Efficacy, did not have an
impact in these messages. The young workers who were the audience
for the campaigns did not believe that their actions would be effective in

making them safer on the job. As Lavack stated, there are often environmental elements that preclude the individual from performing safety
behaviours. This brings us back to a main challenge in promoting workplace safety culture: it is not something that can be achieved through
individual changes alone, but is a product of the surrounding social environment and shared values and attitudes that foster safety. That is why a
key goal in changing safety culture must be to bring societys leadership
on board in demonstrating commitment to safety.
Recent tragedies that have taken place on the world stage have served
to elevate workplace health and safety on the international social agenda. This is exemplified by comments in a 2013 Toronto Globe and Mail
article (26)following a factory collapse in Bangladesh: In 1997, in response to reports about horrendous working conditions in Vietnam, a
Nike spokeswoman was quoted saying What is Nikes responsibility?
These are not our factories.Over the course of that year, the public reaction became scathing enough to warrant a stronger reaction. Companies quickly realized that they would be held directly accountable even
for conditions at sub-contracted facilities.
In his drama All My Sons, playwright Arthur Miller created the character of a factory owner who manufactured substandard equipment and
realizes at the plays end that those who died as a result were all my
sons - that he was as responsible for their safety as he was for the safety of his own children. Similarly, people around the world are realizing
that those to whom we outsource production of our goods, who make
the clothes we wear and the food we eat, are all our sons, daughters,
siblings and workers. The dawning of this awareness will help build a
society, in the words of the Seoul Declaration (1), in which the right to
a safe and healthy working environment is respected at all levels, where
governments, employers and workers actively participate in securing
a safe and healthy working environment through a system of defined
rights, responsibilities and duties, and where the principle of prevention
is accorded the highest priority.


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Future approaches to a culture of prevention

Walter Eichendorf, Ulrike Bollmann
German Social Accident Insurance (DGUV)
The passing of the Seoul Declaration (1) on the 29th of June 2008 at the
XVIII World Congress on Safety and Health at Work in Seoul (Korea) represented the first time that the International Labor Organization (ILO),
the International Social Security Association (ISSA) and the Korea Occupational Safety and Health Agency (KOSHA) had jointly expressed their
will to create a worldwide culture of prevention. The Declaration was
signed not only by representatives of international organizations and
associations, but also by representatives of national governments, social
security providers, professional organizations and associations representing employers and employees. 379 institutions have since signed
the Seoul Declaration, thus clearly demonstrating a shared will to establish a worldwide culture of prevention.
The board of the newly formed International Section of the ISSA for a
Culture of Prevention first met on the 12th of September 2011 at the XIX
World Congress in Istanbul. This section represents a structural spearhead able to push forward the implementation of the Seoul Declaration
and the dissemination of a worldwide culture of prevention.

On the path towards a culture of prevention

The XX World Congress on Safety and Health at Work Global Forum
for Prevention is set to take place in Frankfurt in August 2014. We will
use the occasion not only to review the results of the work carried out
over the last six years, but also to pave the way for the implementation of a culture of prevention. The path which takes us to the Congress
2014 will have included two important milestones: The 3rd International
Strategy Conference on Occupational Health and Safety held in Dresden in February 2013 (2) and the International Symposium on Culture of
Prevention in Helsinki in September 2013. The 3rd Strategy Conference
concluded with the agreement of a roadmap from Dresden via Helsinki
to Frankfurt. The roadmap includes the following action plan: 1. Definition of the term culture of prevention; 2. Development of indicators for
the measurement of a culture of prevention; 3. Collation of examples of
good practice.

The Culture of prevention an independent concept?

We have now been familiar with the concept of organizational culture
for nearly 30 years (3), whilst the concept of safety culture has been
around for 25 years (4). After 34 years of research into the safety climate,
this concept has proven itself to be a robust indicator of the safety culture within a company (5). Why should we now also need a concept for
a culture of prevention?

Dov Zohars criticism of the ambiguity of the concepts presented to

date gives us an opportunity to discuss a theoretical foundation for a
culture of prevention. Let us begin with the principle of prevention defined as a priority in the Seoul Declaration. In particular, is the principle
of prevention even a suitable foundation for the establishment, intellectual comprehension and grouping of an area of practices, as well as the
differentiation thereof from other areas? (6) Is a culture of prevention
even suitable for use as an independent concept? Or should we now
assume that the concepts mentioned can be used interchangeably as
recently proposed by the British Health & Safety Laboratory (7)?
The term prevention alone makes things difficult for us. How can we
base a culture on something geared towards defence, prophylaxis and
avoidance? That would make a culture of prevention a type of dynamic non-event: We would constantly be working towards a situation in
which something doesnt happen (6). Paul Schulte called it in Helsinki:
To keep something from happening.
As such, we can already conclude that the term culture of prevention
cannot be assimilated into the term risk prevention. A culture of prevention has to be something more. A simple reference to the avoidance
of risk would be to underestimate the significance of a culture of prevention. At the same time, we should not simply affirmatively assume a
positive culture of prevention. As Gerard Zwetsloot (8, 9) notes in this
context: safety in itself is a value-laden concept.
A first building block for a possible definition of the term culture of
prevention will be proposed as follows:

A culture of prevention is not a condition, but a continuum

(10). It requires constant adaptation and mindfulness or, to look at
it another way, constant analysis and reflection.

Let us first return to our initial question, that of a theoretical foundation

for a culture of prevention as an independent area of practice: What
makes a culture of prevention an area of practices which can be set apart
from other areas? What differentiates it from other concepts?

With human beings at its heart

The human being is at the heart of the culture of prevention. But not
as the Lord and Master defined in modern anthropocentrism and the
instrumentalism which has emerged from it (the human being as a ruler
over nature; a rationality reduced to the application of the means-end
category). On the contrary, when viewed within the context of a culture
of prevention the human being can be regarded as a point of convergence or intersection of various biographical and social lines (Michel


Pattern for preventative action

A culture of prevention is therefore always a matter of collective practices. Dov Zohar (5) analyses the safety climate within an organization in
a similar way to the process of pattern recognition: Safety climate perceptions should be viewed from the perspective of procedures-as-pattern rather than individual safety practices or procedures viewed in
isolation. According to Zohar, such patterns can be recognized on the
basis of the prioritization of safety and health in comparison with other
priorities, the size of the gap between the priorities defined and those
actually pursued, and the degree of consistency between individual policies, procedures and practices within an organization. In line with Zohar
Seong-Kyu Kang asked for an integrated pattern of awareness, attitude
and behaviour in Helsinki.

The forms and levels of a culture of prevention

With this in mind, how can we develop an overall concept for a culture
of prevention which encompasses both the individual and the collective?
Karl E. Weick (11) draws on James T. Reason in his differentiation between three forms of culture: shared culture, subculture and individual
culture. Each of these forms corresponds to a different perception of
culture: shared culture to a so-called integrative perception, subculture
to a differentiative perception and individual culture to a fragmentative
perception. All three forms are present in Weicks concept for a culture
of mindfulness. Paul Schulte named it pretty similar the dual nature of
culture and its interdependence.
It is therefore to be examined whether or not this type of multi-perspective differentiation can be used to make the process of developing a
culture of prevention comprehensible. To give an example, an integrative
perception could be maintained throughout all levels (individual, group,
organization, society) without losing sight of either differentiation according to various groups (for example age, gender, peer group, department within a company) or the plurality of individuals.

The leading paradigm for a culture of prevention

Let us have a look on a second building block for a possible definition of
the term culture of prevention:

If a society is assumed to create its own complexity, the leading

paradigm for a culture of prevention is no longer one of planning
and control, but instead a paradigm of uncertainty and flexibility.

What is the consequence of this?

A possible first answer may refer to organizational theory: On the one
hand, the function of an organization is to reduce complexity and uncertainty, and to put its members in a situation in which decision-making is
easier. To do so, the organization develops mechanisms such as expedient programmes (a defined goal is to be achieved, the means required

are to be identified) and conditional programmes (standardized work

processes in similar situations) []. Such an organization resembles, in
an exaggerated sense, a trivial machine consisting of parts which can
be replaced when faulty (12).
This can lead to both the problem of simplification and the problem
of sticking to routine or standardized structures. Human beings have a
tendency to block out or ignore contradictory information: They only
perceive that which confirms their original expectations (blind spot, W.
Stekel). They follow existing routines and infer security.
In contrast to this type of model of rationally planned safety, Karl E. Weick
(11) draws on James T. Reasons concept of informed safety culture in
developing an approach to the management of the unexpected.
As Gerard Zwetsloot (13) pointed out (in agreement with Weick, 14), this
does not focus on the organization, but on the process of organizing
itself, which is described as a stringing together and connection of interactive processes: Safety is therefore a dynamic event which can only be
achieved by means of continuous adaptation.
Building on analyses of high reliability organizations such as aircraft carriers, fire service units and medical emergency teams, Weick (11) develops a five-stage model of mindful management. The five stages are:

Detect minor mistakes and errors, and take them seriously (preoccupation with failure)
Resist sweeping simplification complex systems are not simple
(reluctance to simplify interpretations)
Closely monitor internal processes nothing can be taken for
granted (sensitivity to operations)
Promote willingness to be flexible, thus ensuring that system
functionality is quickly restored after error and the system emerges
stronger from crises (commitment to resilience)
Prioritize expertise over hierarchy: respect specialist knowledge
and ability (underspecified structuring).

In this case, being mindful means fundamentally accepting uncertainty

and consciously attempting to come to terms with expecting the unexpected (15). In other words, managing the unexpected requires human
beings to show strong reactions to weak signals a type of behaviour
which goes against our grain and does not appear particularly heroic
As such, the opportunity to learn and therefore to change is founded
on pro-active behaviour, which in this case is understood in the sense of
reflection on mistakes [] and can eventually lead to the prevention of
new sources of mistakes at both an individual level and across society as
a whole (15). This is very close to the present ISSA approach of a proactive and preventative strategy.


What is really important to you?

Let us now look at the third building block in a possible definition of
what a culture of prevention might be:

A culture of prevention is never simply a question of content or

knowledge, but instead always a question of stance.

If you know everything about prevention and the culture of prevention,

you do not yet realize its meaning and value (16).
Gerard Zwetsloot (8) has worked it out systematically on our behalf: The
prerequisite for the establishment of a culture of prevention is commitment to health and safety, one strong example being commitment to
the Vision Zero strategy. This type of commitment strategy is different
from a simple control strategy. In the case of a control strategy, the management of safety and health is restricted to a problem-solving activity:
Commitment can only be expected as long as the problem remains unacceptable. Formal processes, such as the introduction of an OSH management system, are not enough. Systems of that type may be a management tool, yet when compared to Vision Zero, for example, they do
not express anything about management desires or objectives.
How can something like Vision Zero become a commitment which is
shared by all? How can Vision Zero be given meaning? How can it become a common, shared value?
We have followed the mantra of leaders create climate since 75 years,
firstly proclaimed by Kurt Lewin in 1939 (5). This nevertheless does not
represent an answer to the question of how and when the individual
commits to health and safety, and why that commitment makes sense to
the individual. It is not decisive that management-level employees play
a central role in the field of health and safety at work, but that a process
of social sense-making based on a continuous interpretive process occurs, a continuous exchange of health and safety perceptions between
manager and employee, as well as between employee and employee.
This interpretive process is a social learning process. Individual meaning
constitutes itself as social meaning.
Comments made by Gerard Zwetsloot (8, 9) on the subject of corporate
social responsibility (CSR) refer to the notion that commitment to health
and safety at work is not restricted to the workplace, but also has implications outside of the workplace, for example the external consequences
of accidents and occupational diseases and the way in which they affect
the individual employee, their family and society as a whole.
Commitment to health and safety therefore also represents a window on
the outside world

A culture of prevention as a concept for society as a whole

Looking out of the window we talk about safety and health at work, at
home, on the road and the whole society. Consequently the first item
in the Seoul Declaration on Safety and Health at Work (1) refers to the

responsibility of society as a whole for occupational safety and health.

It is to be noted here that the Declaration targets the establishment of
not only national cultures of prevention, but also a worldwide culture of
The integrative approach adopted by a culture of prevention as a phenomenon involving society as a whole touches on all areas of social security. The culture of prevention as a concept relating to society as a
whole must therefore be inclusive: it not only takes care of the health
and safety of all those, who are in work, but also supporting those who
have not yet found work, or have become workless, to enter or return
to work (17).
What exclusively differentiates the culture of prevention from other concepts is not that it devotes increased attention to the protection or promotion of health at work, but that work acts as a catalyst for public
health within the context of a culture of prevention. Dame Carol Black
hit the nail on the head at the 3rd Strategy Conference: Work is the best
place for health.
That is the essence of the fourth building block in a possible definition
of what a culture of prevention might entail:
(4) On the level of society as a whole, a culture of prevention is a joint
OSH institutions, public health organizations, pension schemes and other areas in and outside of social security need to work together if a culture of prevention is to be realized throughout society. Viewed logically,
a culture of prevention can only become a reality once strategies for the
promotion of health in the workplace (also) contribute to an improvement in the general health of the working population. (18) Or as Paul
Schulte said, we have to overcome the tendency to separate work from
the rest of life.

Indicators for a culture of prevention

Our concept for a culture of prevention needs to be not only theoretically plausible (first-order evidence), but also empirically proven (second-order evidence). Gerard Zwetsloot (23) called this research evidence
vs. practical evidence different wording, but the same meaning.
But how do we know we are measuring the right thing? How can we
identify relevant indicators for a culture of prevention?
In order to measure the existence and maturity of a culture of prevention (7), we need to define not only indicators at organizational level
(as is often the case in studies on safety culture), but also indicators
which capture the individual (in order to do justice to the role of the
person as a key agent within a culture of prevention) as well as social
indicators which cover the culture of prevention at societal level. It is to
be noted here that all three levels are essentially interdependent. The
appendix at the end of this paper is listing a number of indicators for a
culture of prevention that have been published in recent literature.

Developing a culture of prevention

Let us return to the question of how a culture of prevention might develop. The decisive issue is the form that living and working conditions
must first take if something like a prevention habitus is to develop.
According to the French philosopher and sociologist Pierre Bourdieu
(20), habitus is a principle for the generation of strategies which facilitate the counteraction of unforeseen and constantly new situations.
This habitus is shaped/formed by the way we grow up. It gives us room
to manoeuvre in terms of our behaviour, yet it also defines behavioural
boundaries we cannot cross. We are therefore unable to change our
lifestyles as easily as we flit between fashions.
According to Bourdieus concept of habitus, a switch to a healthy, safe
lifestyle is only possible if preceded by a change in the education system.
If we succeed, for example, in changing schools and institutions of higher education in a way which sees teachers recognize health and safety as
a contribution to the quality of their pedagogical work, then we can say
we have won. It is only through education that the foundations in this
case those for a youth culture of prevention can be laid.

On the path to Frankfurt

To summarize we must admit that we hesitate to already propose a definition for the culture of prevention. We had a huge input from the excellent keynote lectures and all presentations as well as from the Learning
Caf at Helsinki conference. There are a few facts that we still have to
explore in more detail, e.g. the discussion in the Learning Caf to what
extent a culture of prevention must follow or does not need to follow the
regional culture of living.
We did try to include most of that in the four proposals for a possible
definition as well as into the appendix with possible indicators.
As of today we would call this a common understanding a common
understanding of employers and employees, employers associations
and trade unions, researches, practitioners, social security experts and
everybody in the field of occupational safety and health. Reaching this
common understanding we have done a huge step during the 2.5 days
in Helsinki.
The final step of the roadmap towards Frankfurt has to be done at the
XX World Congress on Safety and Health at Work - Global Forum for
Prevention. In the best case we will end up with a commonly agreed set
of definitions and indicators in Frankfurt!


Appendix 1: Possible indicators for a culture of prevention

We already have a set of traditional indicators for
occupational safety and health:

Social security legislation;

Number of labour inspectors per company;
Number of accident clinics;
Level of and trends in occupational accidents;
Level of and trends in occupational diseases;
Number and frequency of control and consultancy visits carried
out per company;
Employer attitudes towards health and safety at work;
Effects of societal change (e.g. demographics, migration, economic
conditions) on health and safety at work;
Effects of technological developments (e.g. internet, new materials)
on health and safety at work;

A culture of prevention also necessitates indicators for:

at an individual level:

Implicit basic assumptions regarding safety and health (5), e.g.

positive attention to mental health helps to develop an innovative
corporate culture (13);
Individual perception of interactive communication patterns on
the topic of safety and health, e.g. strong reaction to weak signals,
mindful practices;
Human losses, e.g. a cut in salary further to an accident or illness,
or negative effects within the social environment and family of the
affected employee (21);
Strain resulting from the rehabilitation process which may
affect the individual both positively and negatively e.g. additional
stress and difficulties (21);

at an organizational level:
Explicit commitment to the health and safety of all, e.g. active
adherence to Vision Zero;
A strategy of pro-active behaviour at organizational level, e.g. prevention as a principle applied throughout all phases of the value
chain (22);
Employee participation in decisions concerning health and safety
within the company, e.g. the endowment effect (23);
The frequency and density of communication between manager
and employee as well as amongst employees on the subject
of safety and health, e.g. how a manager looks after the mental
well-being of an employee (5);


The number and frequency of health circles per company;

The number and frequency of consulting sessions on psychosocial topics, e.g. those led by a labor inspector or external consultant;
The number and frequency of workplace health promotion
The number and frequency of stress reduction programmes, e.g.
Mindfulness-Based Stress Reduction (MBSR);
Extent and outcome of return-to-work activities (RTW);
Number of companies pursuing a strategy of corporate social
responsibility (CSR), e.g. responsibility for the environmental
impact of entrepreneurial action or responsibility for working
conditions at foreign locations;

at a societal level:
Impact of issues of public and work-related health on the
company, e.g. workplace health promotion, rehabilitation (13);
Health capabilities, e.g. basic capabilities such as the availability
of a doctor and clean water (24);
Number and size of companies and institutions certified as
family friendly;
Implementation of guidelines, here: ISSA guidelines on prevention, workplace health promotion and return-to-work activities;
Integration of health and safety into general and vocational education (nursery school, school, initial vocational training, higher
education, continuing vocational education and training), e.g.
the Good, healthy school initiative, the smoothing of the transition between school and working life or the integration into
higher education content;
Integration of health and safety into (public) media, e.g. articles
in daily newspapers, news reports, films;



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Taking prevention beyond the workplace

the role of social security institutions
Bernd Treichel
Technical Specialist in Prevention
International Social Security Association (ISSA)

Towards Safety Culture

When Charles C. Ebbets took the famous picture called Lunch Atop a
Skyscraper (1) in New York, Manhattan in September 1932, he was portraying fearless workers who were sitting on a steel joist without any
safety gear and looking 69 floors down during their lunch break (http://


They were admired for their courage and therefore heroic. Over the
years, the heroes have lost quite some of their glory because they were
careless enough to risk their lives over a sandwich. The picture beautifully portrays how times and values have changed, safety technology has
changed, culture has changed and prevention culture has changed, too.
Along with the technical progress, our knowledge, our skills, our behaviors and habits have also changed over the years. Today, we rarely
discuss safety hazards, because solutions are available. But we discuss
well-being at work instead. We try to identify the sources for our stressful lives and get stressed thinking about it. Psycho-social issues at the
workplace were not even considered a source of ill-health or a potential
source for accidents in 1932. And to top it all off, today, we may be faced
with new safety and health threats that we might not even know yet.
We explore new production methods of outsourcing or insourcing, new
forms of work organization, such as tele- and flexi-work, and new technologies, such as nano- or biotech. We have 24 hour work-connectivity
on our smart phones and welcome wifi and phone radiation, while trying
to eliminate old health hazards, such as smoking. Who knows, maybe
we are still sitting on that steel joist, without realizing it.

From Safety Culture to Prevention Culture

While the last decade of the 20ieth century was marked by safety culture debates at enterprise level, the introduction of occupational safety
and health management systems, as well as technical and organizational
progress in preventing occupational risks, the first decade of the 21 century clearly looked more into the health of the worker and prevention
culture at societal level. It is important to understand the differences
between the two. Literature limits the definition of safety culture to the
workplace and all its related risks. It is understood as the constellation

of shared values, attitudes and beliefs that shape health and safety practice (2). Also the original definition for a prevention culture as stated in
ILO Convention No 187 focused on the risks at the workplace; and the
role of the tripartite partners, but the Seoul Declaration (3) then extended the term prevention culture beyond the workplace, by stating that
workers health [was] the responsibility of society as a whole (4).
With the Seoul Declaration, the focus in prevention had been widened
from the traditional work safety approach to a broader prevention approach where health and safety is seen as an integral part of work and
lifestyle. The steady increase in mental health issues and musculo-skeletal diseases is an example, indicating that the borders between workers
health and public health are dissolving and the links between work life
and private life become more fluid.

What is Prevention?
Different professions have a different understanding of prevention. Preventive medicine, risk prevention, crime prevention, prevention of social
injustice, prevention in social security, etc. The list is endless. The word
prevention was probably used first in the context of medicine, but already in 1894, the Permanent International Committee on Social Insurance (CPIAS), which operated on a permanent basis in Europe between
1891 and 1914, had an item on the agenda at its Congress in Milan, Italy
on the prevention of occupational risks (5).
Over the years, different definitions of prevention have been proposed.
Commonly, these definitions stem from varying expectations with regard to the role that prevention should play in society. Prevention in the
world of work can have a considerable variety of meanings, depending
on what particular area one looks at: working conditions, industrial relations, occupational safety and health; or even employment (6). It also
links to pension and disability pension schemes, or - since the 2010 financial crisis- even to the financial risks that can be encountered at the
workplace. Prevention in the most general meaning of the word can be
understood as a measure to avoid an undesired event through early
intervention (4).
McKinnon, who reviewed various definitions of prevention in social security argues with Hjort that a modern concept of prevention includes
both prevention of diseases, accidents, risks and risk factors and promotion of health and well-being (7). His statement is supported by an Sinfield, who distinguishes at least three different levels of prevention (8):
Primary prevention limits the incidence of disease by controlling causes
and risk factors; secondary prevention aims to cure patients and reduce
the more serious consequences of disease through early diagnosis and
treatment; and tertiary prevention aims to prevent complications, reduce
disabilities and minimize pain. The ISSA has adapted Sinfields approach
by classifying it into three dimensions (and not levels) of prevention, as
all of them must be given the same priority; that is risk management,
health promotion/maintenance and return to work /rehabilitation.

Source: International Social Security Association, 2014

These three dimensions clearly illustrate that at the center of all prevention related activities is the health of the individual and that for each
dimension, a proactive effort is required in order to protect, maintain or
restore the health of the worker.

Promoting a Prevention Culture

Promoting a prevention culture includes safety culture elements at the
workplace, as well as additional factors that can influence culture at the
workplace. Three main goals can be identified that derive from common
denominators of safety culture circulating in literature. These goals are:

1. Reducing accidents and injuries (through a top down

Safety culture is defined as the product of shared values, beliefs, attitudes and patterns of behavior based on a top-down approach practices that are concerned with minimizing the exposure to conditions
considered dangerous or injurious to the entire group members on a
self-regulatory basis(9).

2. Improving organizational proficiency (and personal

Safety culture is the product of individual and group values, attitudes,
competencies and patterns of behavior that determines the commitment to, and the style and proficiency of, an organizations health and
safety programmes. Organisations with a positive safety culture are
characterized by communications founded on mutual trust, by shared
perceptions of importance of safety, and by confidence in the efficiency
of preventive measures (10).

3. Encouraging behavioral norms, values and beliefs

Safety culture is defined as shared values and beliefs that interact with
an organisations structures and control systems to produce behavioural norms (11).
From a safety culture perspective, the above mentioned three goals are
situational (e.g. minimizing the exposure to conditions considered dangerous or injurious through organizational systems, technological progress, etc.), personal (e.g. values, beliefs, attitudes) and behavioural (e.g.
competences, patterns of behavior) aspects which must be addressed at
the workplace. However, as the broader definition of prevention culture
covers health and accident prevention not only at the workplace but also
beyond, a fourth component needs to be added, as stipulated in the
Seoul Declaration: The societal level of prevention.

4. Taking safety and health prevention beyond the workplace

(societal level)
Taking a more global view on the health and employability of workers,
it is necessary to also include other prevention actors, especially those
in the field of insuring occupational injury, health and invalidity. The
important contribution that social security institutions can make to risk
prevention, health promotion and return to work must be acknowledged and partnerships should be sought with them in order to address
todays challenges in prevention.
With these four elements identified, promoting prevention calls upon
the traditional safety and health actors, but also upon other institutions
and initiatives. It must therefore be understood as a multidimensional
and integrative approach, where actors in safety and health and in society play an important role by doing what they can do best: Defining
the rules of the game, and applying the tools they dispose of to shape
prevention culture. However, while laws may set the framework, the real
prevention culture actually happens at the heart of society and in the
heart of the people participating in it. One of the main drivers of societal
change is intrinsic motivation. People do prevention because they are
obliged by law to play by the rules. But people live prevention because
they believe in it, they are motivated to live it, they are convinced of the
benefits, they have positive associations with prevention and finally, because they have successfully applied prevention principles at work and
in their free time as part of their lifestyle.



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The health, safety and health promotion

needs of older workers
Jane White
IOSH - Institution of Occupational Safety and Health

Whats the problem?

Were all designed to get older thats part of life. However, statistics
show that were living longer now than we did before. In 1999, there
were some 593 million* people in the world, aged 60 years or above.
The number of people in this age group rose to 737 million in 2009 and
is set to increase to around 2 billion by 2050. There are many benefits
that come with an ageing population. For instance, the opportunity to
stay on longer in the workforce is beneficial to older people we know
that good work has a positive effect on individuals. However, there
are other reasons for older people to stay on in work, such as to relieve
financial restraints and help businesses retain valuable skills and experience. In the UK and other comparable countries, plans are under way
to extend working lives to reduce the burden on the state and the social
security system.
Keeping people over the age of 50 at work is becoming increasingly important, but we need to understand the impact of age on the health and
wellbeing of the working population to do this. So we commissioned Dr
Joanne Crawford and her team at the Institute of Occupational
Medicine (IOM) to look at what evidence is available on occupational
health, safety and health promotion interventions to help manage the
health and wellbeing of older workers, specifically those aged 50 and
over. The research had three key goals:

to establish whether the health, safety and health promotion needs

of older workers are different from those of other age groups
to review research on interventions, such as policies, initiatives or
programmes designed to bring about improvements in health,
safety and health promotion of older workers
from the above, to identify information and develop guidance to
help with managing health, safety and health promotion for older

What did our researchers do?

The team at IOM carried out a systematic review of research. Firstly,
they needed to understand the ageing process among older workers.
To do this they looked at agerelated physical and psychological changes
and their potential impact on health, safety and health promotion. The
team searched various electronic databases and websites using defined

terms. To help them decide which publications were relevant, they initially screened each abstract before ordering the full publication. The
researchers next reviewed the publications of each research study. The
team looked at how the research was carried out and they also assessed
the quality of the research papers using the following star rating system:
*** Strong evidence, provided by consistent findings in multiple, high
quality scientific studies
** Moderate evidence, provided by generally consistent findings in fewer, smaller or lower quality scientific studies
* Limited or contradictory evidence, produced by one scientific study
or inconsistent findings in multiple scientific studies No scientific evidence
Finally, our researchers summarised the information collected, including
a description of the research, evidence statements and the quality of
evidence. The review looked at research that covered:

ageing and physical changes

ageing and psychological or mental wellbeing factors
ageing and work organisation factors
ageing and accidents and ill health
intervention studies

What did our researchers find out?

In each area of research, the team came to a number of conclusions as a
result of the literature review.
Ageing and physical changes


Changes to physical factors, such as reduced aerobic capacity and

height and increased body weight, do occur, but in some cases,
changes can be prevented or reduced by physical activity.
Muscle strength generally reduces with age but this reduction can
be slowed or even reversed by training. There was limited evidence
that a training effect exists for specific muscle groups in individuals involved in heavy physical work, including waste handling and
power line technicians. Grip strength was found to be reduced in
the over-50s.
There was moderate evidence that the need for recovery is greater
in older workers and is associated with high psychosocial demands
involving aspects of both social and psychological behaviour
and high physical demands.
The nature and extent of self-reported musculoskeletal disorders
increases with age although the studies did not all use the same
measuring techniques and older people have probably been exposed to risk for a longer time.
Theres limited evidence that chronic neck and shoulder pain
increases with age, although work conditions eg repetitive work,
time constraints and poor posture can cause these problems
regardless of the age of the worker.

Balance (postural and functional) reduces with age. Functional

balance is also linked to both age and occupation: where individuals require balance to carry out their work, eg construction workers
or firefighters, there appears to be a training effect as balance
improves compared to other occupations.
Heat intolerance is not directly related to age, but is linked to
changes in the cardiovascular system. Those with chronic illness
such as diabetes may have reduced temperature control.
Sensory abilities including vision and hearing change with age, but
through personal aids and a workplace assessment of the environment many of these changes can be accommodated.

Ageing and psychological or mental wellbeing factors

Peoples reactions get slower with age but this is offset by increased accuracy, accumulated knowledge and experience. Even
though certain cognitive processes ie perception, memory, reasoning and judgement can slow down, the impact on individuals
varies and workers can make up for this in other ways.
Regular intellectual stimulation and cognitive exercise, among
other things, are linked to the maintenance and improvement of
intellectual ability.
In one large study, the vast majority of participants over the age of
65 showed no sign of cognitive impairment.
There is limited research on mental wellbeing in older workers, but
social support and risk reduction strategies for stress and improving coping strategies are important issues.
Older workers want to maintain and update their skills and have
access to training, just as workers in general do.

Table 1. Factors explored in relation to age physical, psychological,

sensory and organisational
Physical factors

Psychological and
psychosocial factors

Workplace organisational

- Aerobic capacity the

- Reaction time
- Shift work
amount of oxygen used by - Accuracy
- Overtime
the body during exercise
- Knowledge
- Muscle strength
- Experience
- Grip strength the force
- Social support
used by the hand to pull
- Learning
or hold on to objects
- Functional balance, eg
when engaged in activity
- Postural balance, eg
normal standing posture
- Heat intolerance
- Height
- Body weight

Sensory abilities
- Vision
- Hearing

Ageing and work organisation factors


There was limited evidence to show that working excessive overtime in physically demanding jobs has an adverse effect on older
Limited evidence also showed that work ability reduced sooner
in female healthcare workers carrying out shiftwork than in male
healthcare workers this could be due to the dual role women in
the survey had at home and at work.

Ageing and accidents and ill health

Older male workers were less of an accident risk but females over
55 were found to have the highest estimated incident rate. This
could be because the occupations this group of female workers
were involved in were more physical.
The risk of non-fatal serious injury was lowest in the older worker
group but the injuries sustained eg sprains, strains, fractures
and dislocations were more severe and recovery took longer.
Employer engagement was vital in the recovery process. There is
an increased risk of developing chronic diseases with age, but this
doesnt necessarily mean that work shouldnt be allowed. Diseases
such as diabetes or heart disease can be controlled and workplace
adjustments can be.
Short-term non-certified absence is the largest recorded category
of sickness absence. Workers over 55 take more days off through
self-reported ill health relating to work. The health issues they
report include musculoskeletal problems and stress, anxiety or

Intervention studies
The second stage of the review evaluated studies on interventions in
safety, occupational health and health promotion. However, these types
of study were limited in both number and quality. The team established


there were no interventions found relating specifically to safety

and older workers
occupational health interventions, eg health checks, rehabilitation
and mental health support, are viewed positively by older workers
consultations and action plans involving various professionals (eg
occupational physicians and other health professionals, HR staff
and line managers) working together can reduce the likelihood of
sickness absence and early retirement for health reasons
improvements can be made relating to health promotion activities,
including encouraging workers of all ages to take part, allowing
time to attend them during the working day and considering the
views of older workers on age-specific interventions.

What does the research mean?

Age-related physical and psychological changes can reduce the

ability to work but there are large differences in how individuals
may be affected and improvements can be made by physical and
mental activity.
Individuals compensate for reduced speed with improved accuracy
and increased knowledge and experience this may matter more
in certain work environments.
Although the risk of chronic illness increases with age, this can be
accommodated so that the people affected can still work.
Its important to ensure that job demands do not outstrip ability and any recovery time required this should be built into job
Policies for promoting health should consider physical interventions, dietary advice and intellectual stimulation.

Dont forget
Like most studies, this one had some limitations, including the lack of
good research on which to base guidance. In particular, areas for further
research could include:

further analysis of the causes of accidents and of how theyre

exploration of the reasons for slower recovery from injury
consideration of the need for targeted treatments to speed up
recovery and return to work (including the possible impact of
psychosocial factors)
data collection on changes in physical and mental capacity in this
age group
evidence on how best to encourage the maintenance of physical
and mental capabilities
understanding how best to offset the impact of agerelated musculoskeletal disorders on work ability so that older workers can stay
in work
exploring the gender-related reduction in shift-work tolerance and
the possible need for flexible working arrangements to accommodate this.


Whats next?
This project is the first in a research series commissioned by IOSH to
look at a diverse working population, focusing on age as a particular
subgroup. A second report in the series, from Brunel University, will investigate the experiences and views of workers over retirement age on
safety risks and practices.
* United Nations. The world at six billion. www.un.org/esa/population/
United Nations. Population ageing and development 2009. www.un.org/
Zhan Y, Wang M, Liu S, Shultz K. Bridge employment and retirees
health: a longitudinal investigation. Journal of Occupational Health Psychology 2009; 14 (4): 374389; Waddell G, Burton AK. Is work good for
your health and well being? The Stationery Office, 2006.


Industry-specific Development Programme

for improving well-being at work
Marika M Lehtola1, Kari Ojanen1, Ilari Pirttil2, Marja Viluksela1
1) Finnish Institute of Occupational Health, FIOH
2) Metsmiesten Sti Foundation
Finland is about 34 million hectares (187888 lakes included) in area, of
which 72% (26 million hectares) is covered by forests. In 2011, 23000
employees worked in forestry (providing raw material mainly for the forest industry and power plants). This is about 1% of the total number of
Finnish employees.
In less than seventy years, logging techniques have changed from manual labour (frame saws, chain saws) to mechanical harvesting (1). During
this time, the Metsmiesten Sti Foundation has played an important
role in the well-being of forestry workers. First, a Food Provisioning Office was established to provide food supplies to forest worksites during
World War II: depression and food rationing created concerns about the
deteriorating physical condition of hard-working lumberjacks. (2) When
conditions improved, the Office was no longer needed. It was closed
down in 1948, having made a profit of over 42 million Finnish marks
(about 1 million euros). In order to put the money to good use, the
Metsmiesten Sti Foundation was established in 1948 to take care
of the well-being of forestry workers: its idea was the sustainable use of
forests and people.
Forestry laws have recently changed in Finland, and new laws are being
constantly introduced. Furthermore, the logging concept, management,
organizations and work tasks are changing, causing growing concern for
the shortage of skilled harvester operators and new forestry workforce.
The Metsmiesten Sti Foundation took up these issues and commissioned a preliminary study (Preproject) to determine the main topics
needing development in 2011. Information was gathered through national literature searches and workshops. Four main topics emerged (3):
1. The effects of changes on well-being
2. Future skill development in forestry
3. Occupational health services in forestry
4. Well-being indicators in forestry.
In 2012, the Metsmiesten Sti Foundation started a well-being at
work Development Programme. The foundation annually invests about
300,000 euros in development projects. Including the self-funding of
participating organizations, the total contribution to the fields well-being at work rose to over 1,000,000 EUR during the first two years of the

The Development Programme is co-ordinated by the Finnish Institute

of Occupational Health. A steering group monitors the Programme and
creates strategies. The well-being of workers is developed by launching
practical projects in the field. Ten projects began in 2012, four in 2013
and further new projects will start at the end of March 2014. Topics include individual well-being, organizational changes, occupational health
services, future logging concepts, occupational exposure during chipping, and finding appropriate well-being indicators for the field.
As the problems that forestry workers encounter differ, the well-being
of the different worker groups has been approached through different
types of projects. This is also because well-being at work is a complicated system there is no one particular factor that can single-handedly
fix all kinds of situations. (4) The following three issues are important:
knowledge (information available), willingness (do we want to change
the situation?) and skills (being capable of deciding what to do). Improvements can be made by affecting the following factors: climate,
future, know-how, management, mental health, organization, physical
health, and safety. In this Programme, we have wanted to collect data,
examples and experiences from the field to be able to better develop the
well-being of its workers.
Many of the fourteen projects will end during 2014 - 2015. The results
will be published in a short, useful form and be made available to everyone on the internet (www.metsahyvinvointi.fi). Some examples of the
development projects results:

A booklet for small-sized enterprises and occupational health

service providers (what one should know in order to use/buy or
provide required health services more efficiently)
The concept of a well-being at work seminar that has an interesting structure and uses appealing terminology (well-being at work
equals know-how, business perspective, well-being as an investment what are the costs and benefits in euros?)
Concrete health measurements of workload (strain and recovery).
These can be a wake-up call for improving lifestyle conditions (e.g.
a good nights sleep)
The finding that roadside wood chippers are exposed to huge
amounts of aerosols/microbes. It is very important to take good
care of the machines air filters, for example.

The next aim is to get people in the field to use the gathered information, to develop their well-being together, and make this a permanent
mindset and part of their everyday life. How does the Program succeed
in this? First of all, the forestry field is of a suitable size not too large
and not too small. It is important that there is a well-known and respected instigator for the cause, i.e. the Metsmiesten Sti Foundation. In
addition, the Finnish Institute of Occupational Health has provided the
field with a great deal of objective know-how concerning well-being at
work. The Programme also provides networking possibilities. Forestry


workers were already involved in the Preproject; since then, they have
represented the needs and suggested project proposals. The steering
group is active and knowledgeable, and is willing to change things.
Moreover, the atmosphere during the Programme has been enthusiastic;
people are eager to learn, constructive and think of the common good.
Finally, all the result have been and will be shared with everyone, even
beyond the field itself.
(1) Strandstrm M. Timber Harvesting and Long-distance Transportation of Roundwood 2011 (Background Information and Long Term
Trends of Finnish Wood Supply). Metstehon tuloskalvosarja [serial on
the Internet]. 2012; 3b [cited 2014 Jan 30]. Available from: http://www.
metsateho.fi/files/metsateho/ Tuloskalvosarja/Tuloskalvosarja_2012_3b_
(2) Metsmiesten Sti Foundation. Taustatietoja Stist [Background Information on the Foundation] [homepage on the Internet].
[cited 2014 Jan 30]. Available from: http://www.mmsaatio.fi/www/fi/
(3) Ala-Laurinaho A, editor. Metstalouden tyhyvinvoinnin T&K-ohjelma: Metsmiesten Stin hankevalmistelu. [Research and Development
Program for Improving Well-being at Work in Forestry: preliminary program plan of Metsmiesten Sti Foundation]. Metstehon raportti
219. Helsinki: Metsteho Oy; 2011.
(4) Pkknen R. Models for well-being at work. List of accepted oral
presentations. International Symposium on Culture of Prevention Future approaches 25-27 September 2013 [homepage of the internet].
[cited 2014 Jan 30]. Available from: http://www.ttl.fi/en/international/


A European Guide on
Economic Incentives for Prevention
Dietmar Elsler
European Agency for Safety and Health at Work, Bilbao, Spain
European countries could benefit from introducing more economic incentives to promote workplace health and safety, rewarding those organisations that work hardest to protect their employees. That is the
message of the economic incentive project, undertaken by the European
Agency for Safety and Health at Work (EU-OSHA). Some EU Member
States already offer various kinds of financial rewards for businesses that
invest in keeping their employees safe. These rewards range from state
subsidies and grants, through to tax breaks, preferential terms for bank
loans, and lower insurance premiums for the best-performing businesses. A practical guide based on the findings of the economic incentives
project has been developed by EU-OSHA and is intended to serve as a
practical and user-friendly tool to help incentive providers to create or
optimise their own economic incentive schemes.
Keywords: economic incentives, cost-benefit analysis, prevention

Research has shown that external economic incentives can motivate further investments in prevention in all organisations and thus lead to lower
accident rates (1) (2).
The EU-OSHA project on economic incentives gives the clearest indication yet that these types of incentives are effective, encouraging organisations to improve their occupational health and safety. According to
Elsler (2), for every euro spent through incentive schemes, up to 4.81 is
saved at societal level through reduced accident and disease rates, and
lower rates of absenteeism as working conditions improve.
Besides this business case for the incentive-providing organisations,
there are further arguments to introduce an economic incentive scheme,
especially for private or state-run insurance companies:

improvement of corporate social responsibility (especially in large

improved reputation of the insurance company
creating winwin situations with clients
competitive advantage (for private insurance companies).

The project was inspired by the European OSH Strategy 20072012,

which aimed to reduce occupational accidents by 25%. In its first (20072010) phase several products were delivered:

A dedicated web portal on economic incentives in OSH in 24 languages: http://osha.europa.eu/en/topics/economic-incentives

a comprehensive report titled Economic incentives to improve occupational safety and health: A review from the European perspective (EU-OSHA, 2010)
a fact sheet (summarising the report in 22 languages)
two articles in a peer-reviewed scientific journal (Scandinavian
Journal for Work, Environment & Health, Elsler & Eeckelaert (2010),
Elsler, Treutlein, Rydlewska et al (2010)).
a series of expert group workshops, documented in our events
a collection of case studies to in our good practice data base

The second phase (2010-2012) of the project is now delivering more

practical products for organisations that are interested in developing or
optimising their own incentive scheme:

a practical guide for incentive-giving organisations, available at:

sectoral compilations with preventive solutions that can be incentivised. , available at:

The practical guide is based on the findings of the economic incentives

project and is intended to serve as a practical and user-friendly guide
to help incentive providers to create or optimise their own economic
incentive schemes. The primary target audience is organisations that can
provide economic incentives to improve OSH, such as insurance companies, social partners or governmental institutions. These organisations
are regarded as important intermediaries to stimulate further efforts in
OSH in their cooperating enterprises; for example as clients of insurance
One conclusion from the EU-OSHA project is that incentives schemes
should not only reward past results of good OSH management (such as
accident numbers in experience rating), but should also reward specific
prevention efforts that aim to reduce future accidents and ill-health (3).
Experts from the project therefore suggested the development of compilations of innovative and evidence-based preventive solutions, starting
with the three sectors construction, health care and HORECA (hotels,
restaurants, catering). The preventive measures from these compilations
are worth promoting in their own right, as well as being applied in economic incentives schemes. These preventive solutions can be used as a
basis for incentive-providing organisations to develop their own incentive scheme, adapted to the specific situation in their sector and country.
So far, the economic incentives project has already encouraged different EU Member States to learn from each other, and to exchange good

practice in designing incentive schemes. All in all, the project shows that
economic incentives can be effective in nearly all countries, despite the
wide differences in their social security and accident insurance systems.
The project and its results have been presented at conferences and
workshops in numerous European countries, including Bulgaria, Cyprus,
the Czech Republic, Germany, Italy, Sweden, Slovenia and the UK. Some
practical consequences have already been observed. For example, the
Italian workers compensation authority INAIL has developed a new
incentive scheme which takes into account the experiences and good
practice of other countries and is therefore based on the best available international knowledge. In Italy INAIL is responsible for the workers compensation of 3.8 Mio enterprises and 17.8 Mio workers. With a
budget of over 850 million the INAIL scheme is targeting small and
medium-sized enterprises in particular. Experts estimate that it could
lead to benefits worth 2.55 billion at society level.

Types of incentives
The following economic incentives to promote occupational safety and
health can be found in European countries (3):

Insurance premium variations, for example dependent on

Occupational accidents and diseases (experience rating)
Specific risk of sector
Prevention activities such as training, investments, personal
protection measures
State subsidies, for example for innovative investments or reorganisation
Tax incentives, such as better write-off conditions
Better banking conditions, for example lower interest rates
Non-financial incentives, for example certification of OSH management systems or awards

Many common incentive schemes in Europe are based on insurance
premium reductions. If the premium reductions are simply calculated
according to the risk of the company, taking into account past accident
insurance and disease rates, this so-called experience rating process is
very easy to apply. In addition a large number of companies can take
part in this incentive scheme, as it applies to all insured companies. Research about the effectiveness of experience rating found evidence (1)
that a lower rate of accidents is achieved. The effect of experience rating
is analysed in depth in the incentive scheme of the Finnish agriculture
sector. Using administrative data, Rautiainen et al. (4) conducted interrupted time series analyses which showed that the premium discount
reduced the overall claim rate by 10.2%, meaning the reduction of more
than 5000 accidents. However, the authors do not exclude the possibility that under-reporting could have contributed partly to the claim
reduction, although actually no farmer would benefit economically from
such a practice. The possible bonus in the insurance premium would

always be much lower than the cost of an accident which would not be
reimbursed if it was not reported. Under-reporting is often discussed
as a possible negative side effect of experience rating. As the Finnish
example shows, such a practice hardly ever leads to a positive economic
benefit for the under-reporting company, if the incentive scheme is designed in the right way.
Kohstall et al. (5) propose that both positive and negative incentives
should be used in an incentive system. Through negative incentives (or
disbenefits), companies that remain significantly above the sectors average accident rate can be obliged to pay an augmented insurance premium. This would increase the visibility of bad OSH performance and
therefore raise awareness in the enterprises concerned. The normal insurance premiums are usually planned into the budget of companies. A
positive variation is of course welcomed, but only a negative variation
will force companies to adapt their budget planning and therefore make
them think more deeply about taking preventive measures. Further negative deviation in insurance premiums can serve as a psychological foot
in the door for labour inspectors or safety representatives trying to persuade an enterprise to put more effort into OSH.
Overall, research literature provides convincing evidence for the positive
effects of experience rating, i.e. accident insurance premiums depending
on the individual accident record of a company, but nevertheless there
are some potential shortcomings connected with this method. Small and
medium-sized enterprises (SMEs) in particular rarely profit from such incentive schemes and therefore the insurance schemes of FBG (Germany)
and INAIL (Italy) combine an experience rating system with a funding
system that rewards specific prevention activities as well. The statistical
evaluations of both case studies have proven the effectiveness of such an
approach, leading to significantly lower accident rates and better health
outcomes among participating enterprises. For SMEs it is important to
create a direct link between OSH activities and a reward, such as an insurance premium reduction. Therefore, effort-based incentive schemes
are more effective for SMEs than pure experience rating approaches.
Possible adaptations of this type of incentive scheme could be a start,
with high premiums that are reduced annually if no accidents occur (as
in car insurance). Another idea could be to reward increased reporting in
order to receive more detailed information on accidents/diseases.
Incentive scheme of the German Butchery Sector Accident Insurance (3)
Premiums are reduced in participating companies for preventive measures, for example those concerning knife accidents, falls and slips, machines and traffic safety. The economic incentive can reach up to 5% reduction of the insurance rate. An OSH audit is also offered, which checks
the proper implementation of an OSH managemen system and in which
more than 40 companies participated in 2008. During the period evaluated (2001 to 2007) target fulfilment of the participating companies
improved continually. Starting at a similar accident rate in 2001 (92 per

1,000 full-time workers) the six-year participants reduced their accident

rate to 65, compared to only 78 per 1,000 FTE in non-participants. A
costbenefit analysis comparing the costs of premiums granted and the
theoretical accident cost reduction showed that financial benefits were
significant on the side of the insurance. As a positive side effect the
collected data can serve as a benchmark for other companies and as a
foundation for scheme development.

Economic incentives in different social security systems

Of course European countries have different social security systems and
this has implications for the possible application of economic incentives
to promote OSH. Most European countries have a Bismarckian social
security system in which the accident insurance institutions are organised in a state-run monopoly. Other Member States have a competitive
market in a Beveridgean system, and some countries have mixtures of
both these systems.
This means that there is a fairly limited range of accident insurance and
social insurance systems on the continent, which should make it easier
to implement and transfer economic incentive models.
According to Elsler & Eeckelaert (6) the following incentives should be
theoretically possible in all EU countries:

Subsidy systems
tax incentives
non-financial incentives

Experience-rating approaches can be found in both competitive and

monopolistic markets. However, there are differences when it comes to
the funding of future-oriented prevention efforts, such as training or
OSH investments.
This should be no problem for monopolistic approaches, because the insurance company can be sure it will benefit from the positive effect that
investments will have on the claims rate. In a competitive market, however, the insurance company runs the risk that companies could switch
insurers at short notice so that investments in prevention efforts benefit
its competitors. A possible solution for competitive markets could be the
introduction of long-term contracts lasting several years or the creation
of a common prevention fund which is financed equally by all insurers.



Tompa, E., Trevithick, S., McLeod, C. (2007), A systematic review of the prevention incentives of insurance and regulatory mechanisms for occupational health and safety, Scandinavian Journal of Work, Environment and Health, 33(2): 8595.


Elsler, D., Treutlein, D., Rydlewska, I., Frusteri, L., Krger, H., Veerman, T., Eeckelaert, L.,
Roskams, N., Van Den Broek, K., Taylor, T.N. (2010), A review of case studies evaluating
economic incentives to promote occupational safety and health, Scandinavian Journal of
Work, Environment & Health, 36(4): 289298. Available from http://osha.europa.eu/en/topics/economic-incentives/review-case-studies-econ-incentives.pdf


EU-OSHA European Agency for Safetz and Health at Work (2010), Economic incentives to
improve occupational safety and health: A review from the European perspective. European
Agency for Safety and Health at Work, Bilbao, Spain. Available from


Rautiainen, R.H., Ledolter, J., Sprince, N.L., Donham, K.J., Burmeister, L.F., Ohsfeldt, R.,
Reynolds, S.J., Phillips, K., Zwerling, C. (2005), Effects of premium discount on workers
compensation claims in agriculture in Finland, Am J Ind Med, 48(2): 100109.


Kohstall, T. et al. (2006), Schlussbericht, Projekt Qualitt in der Prvention. Teilprojekt:

Wirksamkeit und Wirtschaftlichkeit finanzieller und nicht finanzieller Anreizsysteme, Teil 2:
Finanzielle Anreizsysteme. DGUV: Berlin.


Elsler, D., Eeckelaert, L. (2010), Factors influencing the transferability of occupational safety
and health economic incentive schemes between different countries, Scandinavian Journal
of Work, Environment & Health, 36(4): 325331. Available from http://osha.europa.eu/en/


National working life development strategy

to 2020 in Finland
Ismo Suksi
Ministry of Social Affairs and Health,
member of the secretariat of the action plan Working Life 2020
We all know that competitive and productive enterprises create new jobs.
Successful workplaces develop new products, services and practices.
They succeed in this by investing in management and supervisory work,
cooperation, new practices, as well as by strengthening engagement in
work and the aspects of work that constitute a source of strength.
The working life development strategy was launched by the Finnish Government in 2012. (1) It was written together with social partners and
major institutions. The strategys main vision is finding ways of developing working life and productivity simultaneously. The strategy challenges workplaces to develop working life from their own starting points.
Society, various actors and service providers are tasked with providing
companies and organizations with ever greater opportunities to reform
their activities and support development in the workplace. The focus
areas are innovation and productivity, trust and cooperation, health and
well-being at work and competent workforce (see the figure).


Instead of dealing with only certain types of workplace organizations,

the strategy, by way of examples, describes three possible intermediate
goals on the development path towards achieving the minimum of a
good basic level before moving on to the level of developer (level 2),
and from there to the level of forerunner (level 3). The message sent out
by the development strategy and development paths is that improving
practices in workplace communities is possible in all workplaces and all
fields of work.
We define these three categories (levels) of workplaces in the following

the basics in order, everyday work and attending to the duties run
development efforts at first carried out through separate projects,
then through a versatile and systematic approach;
excellent or world-class products, services, operational concepts
and workplace communities, and their continuous development.
The categories are defined more specifically at the end of the strategy
paper (1).
The strategys dream or vision is that in future all workplaces will have
achieved at least a good basic level. Successful workplaces will invest in
the quality of working life and have a well-functioning workplace community, and competitive and productive enterprises will generate new
In the autumn of 2012 the Working Life 2020 action plan (project) was
launched for implementation of the strategy. Its home base is in the
Ministry of Employment and the Economy but it is cooperating broadly
with the Ministry of Social Affairs and Health, the Ministry of Education
and Culture and the Ministry of Finance. The key actors also include
all social partners and some main expert organizations, nineteen actors
During the year 2013 we were building the project organization and the
networks. In the years 2014 and 2015 we will be intensifying cooperation
between the key actors and starting several kinds of measures.
The goals of the Working life 2020 project are:
coordinating, steering and monitoring the working life actors
development operations;
strengthening the working life actors opportunities for reaching
ever more workplaces and for finding out their needs to move
from one development phase to another;
encouraging and inspiring the actors to develop working life quality and productivity at the same time;
creating and ensuring operational preconditions for the project.
The projects implementation has five paths. The main path consists of
the promises of cooperation made by the key actors and other organizations. In those promises the actors have given answers to the question


Which are such solutions for improving the working life in Finland that
workplaces need and where your organization, by this promise of cooperation, can have the greatest influence? Every actor has given 2 - 5 key
objectives which, when achieved by them, will contribute to reaching
the goals of the national working life development strategy. By defining
the key objectives the actors crystallize their operations in the project
in only a few issues that aim at improving the working life quality and
productivity. This brings out the critical functions/special areas that help
the workplace get from the present working life level to the target level.
The key objective may be targeted farther in the future than the annual
action plans made for achieving to it. It is also advisable, as far as possible, to place the target group workplaces on development levels in
accordance with the working life strategy (basic level, developers and
forerunners). The means of achieving the key objectives are thus only a
small part of each actors normal service and/or product selection and
strategy. When defining the means, it is also advisable to consider how
to best reach the target group workplaces.
The second implementation path consists of cooperation networks. The
most important of these are the regional networks. Within this project
we have built up fifteen networks. These networks are composed of the
regional authorities and the key actors regional organizations. Not less
important than the regional network is the Unions and sectoral network.
The aim of those two networks is to develop measures at the regional
and the Union level. The project also has a science and an international
network. Their goal is to find new methods and measures for improving
the quality of working life.
At the governmental programmer We have two governmental development programmes: Forum for Well-being at Work and Leadership
development network. The objective of the first one is to distribute information and good practices, to strengthen cooperation, to promote
access to services and their visibility, to promote development work at
workplaces and to disseminate information on well-being at work.
The objective of the Leadership development network is to identify,
compile and distribute good management practices, to create quality
standards for good management in the public sector, to improve age
management and to develop the quality of and equal access to management training.
Tekes the Finnish Funding Agency for Technology and Innovation
(Tekes) has its own project: Liideri programme for business operations,
productivity and joy at work. (2) The objective is to help companies renew their business operations by developing leadership, new forms of
working and employee competence.
By the Working life 2020 project we aim at finding a lot of new best
practices and good examples. To distribute these we have a knowledge
management system. It is supported by communication. Its main goals
are to create a dialogue and achieve understanding of the needs for


change in working life. By communication campaigns we try to promote

positive public discussion on working life and its values. We indicate the
desired direction for working life development.

The project had its kick off in April 2013. We are still in the very beginning. It is too early to say anything about the results. The strategy paper
provides a solid foundation for us to succeed . It is also clear that we
now have broader cooperation in the field of working life development.
We have never before had so many key actors and other collaborators
working for shared goals.

Reference list:

National Working Life Development Strategy to 2020, link to the strategy paper:


Link to Liideri homepages on the Internert:



Vocational education providers network

promoting occupational safety during
on-the-job learning
Sari Tappura
Center for Safety Managements and Engineering, Industrial Management, Tampere
University of Technology

Occupational Safety and Health (OSH) regulations prescribe the essential occupational safety requirements in Finland. The regulations are also
applied to students work in connection with vocational education. The
Finnish National Board of Education (FNBE) funds OSH development
projects in vocational education annually. Several vocational education
providers (VEPs) received funding for OSH development projects in
20092013. The Finnish Ministry of Social Affairs and Health (FMSAH) initiated cooperation between these subprojects by providing funding for
their coordination and networking. This paper introduces a networking
project that aims to promote OSH awareness, competence, and practices in vocational education. The subprojects results have been presented
and discussed in seminars and workshops.
Keywords: Vocational education, Vocational education provider, Occupational safety, OSH, On-the-job learning

Vocational education provides students with the necessary knowledge
and skills to gain vocational expertise, and the capabilities to find employment or become self-employed (1). In Finland, vocational education
requires three years of full-time study, and it includes theoretical education and a supervised on-the-job learning period. During on-the-job
learning, students familiarise themselves with the practical requirements
of an occupation and achieve the core objectives of the occupation. (2)
Vocational education providers (VEPs) are responsible for organising education in their respective regions. There are over 80 VEPs in Finland,
involving thousands of students and several educational branches (2).
VEPs operate under occupational safety and health (OSH) regulations,
since the Finnish OSH Act (3) also applies to work done by students in
connection with their education. According to the Vocational Education
Act (1), students have the right to a safe learning environment, which
also applies to on-the-job learning.
However, the OSH requirements are quite demanding for vocational

teachers who direct and supervise on-the-job learning. The teachers

need information and guidance in complying with the OSH requirements
and in ensuring the occupational safety of the students during on-thejob learning (4, 5). The Finnish National Board of Education (FNBE) annually funds OSH development projects in vocational education. Several
VEPs received annual funding for their OSH development projects (subprojects) in 20092013. The networking project was initiated and funded by the Finnish Ministry of Social Affairs and Health (FMSAH), which
wanted to promote cooperation between these subprojects.

The aim of this study is to present the networking project as an example of how VEPs and teachers are informed and guided with respect to
the OSH requirements. The objectives of the networking project were to
coordinate the VEPs OSH development projects, to discuss and learn
from the good OSH practices developed and to promote their application within on-the-job learning, and to increase OSH awareness and
the competence of different parties responsible for on-the-job learning
(VEPs, teachers, students, and supervisors in work places).

To commence the networking project, the FMSAH granted funding for
coordination to Tampere University of Technology (TUT), and nominated
the author to work as an OSH specialist and coordinator of the project.
The networking project was directed in cooperation with the FNBE and
FMSAH. At the beginning of the project, the network of subprojects was
established, and the objectives of the network were set. During the project, OSH procedures were developed within the subprojects. The subprojects were presented and discussed in workshops, wiki pages (6), and
seminars. Feedback on the networking project was collected from the

In 20092010, the networking project started with four VEPs and their
subprojects. As part of the network project, new VEPs were activated to
apply to the FNBE for annual funding for their projects. In 20122013,
as many as 10 large VEPs got funding and participated in the network.
During 20092013, nine workshops and two large outcome seminars
were arranged at different VEPs estates. In all, more than a hundred vocational education professionals participated in the workshops and seminars. In the subprojects of 20092010, the OSH guidelines were developed, especially related to social and health, construction, and heating,
plumbing, and air-conditioning sectors. Moreover, the risk assessment
procedures in a large vocational training organisation were developed.
In 20112013, the subproject dealt, for example, with the on-the-job
learning agreements, statutory reporting on the young students working with dangerous conditions, orientation, training of the on-the-job

learning supervisors, and reporting the hazards.

In the network meetings, the participants reported to each other on
knowledge, experiences, and good practices, and they brought together
the subproject outcomes. Other OSH experts were invited on demand.
The network participants felt that the cooperation between the other
VEPs and teachers was very advantageous for they OSH work. They
hoped for even more VEPs to participate in the network. However, they
still felt the need for further support with the OSH issues, and hoped
that this kind of cooperation would continue.

In Finland, the regulations state the essential OSH requirements for VEPs
with respect to students work in connection with education (1, 3). These
requirements are quite demanding for the VEPs and teachers supervising on-the-job learning, because they have almost all the fields of business under their operation. The VEPs and teachers need information and
guidance on OSH issues in order to ensure the occupational safety of
students. The networking project provided them assistance and support
from experts and each other in developing their OSH procedures.
The network participants did not have the sufficient resources or competence necessary to continue with the OSH issues all alone, and thus
they hoped that the networking project and cooperation between VEPs
would continue in the future. The long-term development of OSH issues
was seen as a very important aspect of vocational education, not merely
a topic for annual seminars and separate development projects.
In addition to the networking project, the FNBE actuated a compilation
project of 15 brand-specific OSH guidebooks for VEPs and teachers supervising and directing on-the-job learning in vocational education (4).
The OSH guidebooks project also actively promotes OSH awareness and
competence of the VEPs and teachers involved in vocational education.
The networking among the 10 VEPs started to work independently, and
currently, it does not need to be pushed further. However, new VEPs
should be persuaded to participate in the network and to further apply
funding for OSH development. Recruiting new VEPs into the network
would still improve the awareness of occupational safety issues in the
whole vocational education sector. In the future, the VEPs also need
more focused consultation related to their projects.



Finlex Data Bank. Vocational Education Act 630/1998 [homepage on the Internet]. [cited
2014 Jan 13]. Available from: http://www.finlex.fi/fi/laki/ajantasa/1998/19980630. (in Finnish)


Finnish National Board of Education. Performance indicator for initial vocational education
and training in Finland 2011 [homepage on the Internet]. [cited 2014 Jan 13]. Available
from: http://www.oph.fi/download/132466_Performance_Indicator_for_initial_vocational_education_and_training_in_Finland_2011.pdf.


Finlex Data Bank. Occupational Safety and Health Act 738/2002 [homepage on the Internet]. [cited 2014 Jan 13]. Available from: http://www.finlex.fi/en/laki/kaannokset/2002/
en20020738.pdf. (Unofficial translation)


Tappura S. Promoting Occupational Safety Awareness in Vocational Education. Proceedings

of the 10th International Conference on Occupational Risk Prevention ORP 2012. Bilbao;


Tappura S. Occupational safety development in vocational education. In: Antonsson A-B,

Hgg GM, editors. Proceedings of the 44th Annual International Conference of the Nordic
Ergonomics Society NES 2012. Ergonomics for sustainability and growth. Stockholm: KTH
Royal Institute of Technology; 2012.


Vaaka-networking project [wiki pages on the Internet]. [cited 2014 Jan 13]. Available from:
http://vaaka.wikispaces.com/. (in Finnish)


OSH Culture and accident risk

in European Countries
Heikki Laitinen1
3T Results Ltd, Kerava, Finland

Occupational safety culture has been mainly discussed and analysed at
the corporate level. The main approaches utilized are the psychological
and the engineering approaches (1). The first focuses on how workers
feel about and perceive the safety and health management system, and
on their attitudes towards and behaviour regarding safety. The latter is
more concerned with the managerial aspects, systems, and procedures
that may have an influence on safety. The same approaches can be used
when safety culture is analysed at the national level.
European legislation on occupational safety and health (2) sets certain
safety management requirements for all member countries. The main
mandatory management procedures are: 1) performing a systematic risk
assessment at the workplace including risk identification, worker participation, and adequate safety measures; 2) developing a prevention policy
3) informing workers about the risks and training them on work safely;
4) ensuring the right of the workers and their representative to take part
in any measures that may substantially affect safety and health at the
workplace in an equal manner; and 5) providing health surveillance for
workers. The occurrence of occupational accidents should be minimized,
when these safety management procedures are properly implemented
at the workplace.
EU-OSHAs European survey of enterprises on new and emerging risks
(ESENER) explores the views of managers and workers representatives
on how health and safety risks are managed at their workplace. The
Pan-European opinion poll on OSH investigated the opinions of the
general public on contemporary workplace issues in 2011-2012. In this
study, the national results of these surveys as well as the national statistics on occupational accidents published by the statistical office of the
European Union (Eurostat) are utilized.
The purpose is to determine whether the national implementation rate
of various safety management procedures correlate with the national
rate of occupational accidents. A high negative correlation may indicate
the procedure to be effective in safety work, while a high positive correlation may suggest the procedure to be relatively ineffective.


Heikki Laitinen is Senior Advisor at 3T Results Ltd and Adjunct Professor at Lappeenranta University of

Implemented in 2009, ESENER is a European telephone survey that explored the views of company managers and workers representatives on
how health and safety risks are managed at their workplace. The survey
includes 36,000 interviews that were carried out in 31 countries.
ESENER dataset is available free of charge on the Internet (3). The results
of 28 questions concerning OSH management activities were used in
this analysis.
The Pan-European opinion poll on OSH was EU-OSHAs survey on the
views of the general public on occupational health and safety. 35,540
interviews were carried out in 36 European countries in 2011-2012. Two
of the questions were used in this study.
European statistics on occupational accidents cover non-fatal accidents
at work resulting to over 3 days of absence from work as well as fatal accidents. There is wide variation in under-reporting of non-fatal accidents
in different countries, which reduces the reliability of the accident rates.
Thus, only the rates of fatal accidents were used in this study. The data
was available on the Internet (4), and the average accident rate of three
years (2005-2007) in each country was used in the analysis.

Ten out of 30 questions showed a statistically significant negative correlation with the fatal accident rate, which means that these practices
are more common in countries with a low accident rate (Table 1). The
question concerning OSH issues in high level corporate management
meetings showed the highest correlation; they are regularly addressed
in meetings in countries with a low fatal accident rate. The involvement
of the line management in OSH was more common in safe countries
also, as was the use of ergonomics and psychological consultation services, and the existence of procedures to deal with OSH problems within
the company.


Table 1. OSH management questions with a significant negative correlation with the fatal accident
rate, n=28 countries.

Average %


with fatal

OSH issues are raised in high level management meetings of the

workplace regularly




The workplace has a procedure to deal with work-related violence




The workplace takes actions if individual employees work excessively long or irregular hours




The workplace supports employees return to work following a

long-term sickness absence




The workplace uses an ergonomics expert (in-house or external)




Workers have been informed about whom to address in case of

work-related psychosocial problems




The workplace has a procedure to deal with work-related stress




Line managers are highly involved in the management of OSH




People have confidence in action to address workplace OSH

problems (POLL)




The workplace uses an psychologist expert (in-house or external)




Pearsons correlation

*** p<0.001

** p<0.01

* p<0.05

The dots in Fig. 1 show the fatal accident rate and the average percentage of companies with a positive answer to the ten most relevant questions (Table 1) in each of the 28 countries. In the Nordic countries (Sweden, Finland, Norway, and Denmark), United Kingdom, Ireland, and the
Netherlands at least 50% of companies on average have implemented
these OSH practices. These countries have a low fatal accident rate also.

Figure 1. The average implementation percentage of the ten most relevant OSH management activities and the rate of fatal occupational
accidents by country, N=28 countries.

Table 2. OSH management questions with a not significant or significant positive correlation with
the fatal accident rate, n=28 countries



with fatal

People are very well informed about safety and health risks at
workplace (POLL)




The workplace analyses routinely the causes of sickness absence




The workplace has arrangements of confidential counselling to

deal with psychosocial risks in the last 3 years




There is a documented OSH policy or action plan in the workplace




The workplace has changed working time arrangements to deal

with psychosocial risks in the last 3 years




The workplace uses an occupational health doctor

(in-house or external)




The workplace has set-up a conflict resolution procedure to deal

with psychosocial risks in the last 3 years




There is an OSH committee in the workplace




The workplace has changed the way work is organised to deal

with psychosocial risks in the last 3 years




There is an OSH representative in the workplace




The workplace has trained employees to deal with psychosocial

risks in the last 3 years




The workplace uses a general health and safety consultancy (inhouse or external)




Safety and health of the workplace is regularly checked by risk

assessment or similar measure




There is a works council in the workplace




There is a trade union representation in the workplace




The workplace informs employees about psychosocial risks




The health of Employees of the workplace is monitored through

regular medical examinations




The workplace has redesigned the work area to deal with

psychosocial risks in the last 3 years




The labour inspectorate has visited the workplace in the last 3





Pearsons correlation

*** p<0.001

** p<0.01 * p<0.05


Four questions showed a significant positive correlation with the fatal

accident rate, which means that these issues were more common in unsafe countries (Table 2). One of these was the visits of safety inspectors in the companies. The existence of workers safety representative
and safety council had no correlation with the fatal accident rate in the
country. Although the existence of a documented OSH policy was more
common in safe countries and the implementation of a regular risk
assessment at the workplace was more common in unsafe countries,
these correlations were not statistically significant.

Many management practices that are obligatory in EU countries seem to
have no relation with their safety level. Typical examples include an OSH
policy, risk assessment, and medical examinations. They are relatively
commonly implemented in all countries but do not separate low fatal
accident rate countries from high accident rate countries.
Rather than to the obligatory procedures, the issues that separate the
low and high accident risk countries are linked to the participation and
motivation of the companys top and line management.
The explanation for the results may be that the motivation of the management to enforce OSH at the workplace has a major impact on the
effectiveness of all procedures including the obligatory ones. If the motivation is weak, the workers representatives have no real influence, and
risk assessments are carried out only as a matter of form. In countries
where the motivation of the managers is high, also the general public
is more confident in taking safety actions when problems arise. This is
further indication of a good safety culture.
Safety inspectors visit companies more actively in high accident rate
countries, which may have several explanations. These countries may
have directed more resources to combatting safety problems. Hopefully
the inspections will have the desired outcome and the safety situation
will improve in future.




Antonsen, S., Safety culture: theory, method and improvement, Ashgate Pub Co, UK, 2009,
172 pp.


The European Framework Directive on Safety and Health at Work (Directive 89/391 EEC)


http://www.data-archive.ac.uk/Introduction.asp (cited 2013 Sept 10)


main_tables (cited 2013 Sept 10)

A review of health and safety

in CSR frameworks
Deborah Walker, Lecturer in Occupational Health and Safety Management
School of Business and Economics, Loughborough University, United Kingdom

CSR is based on the integration of economic, social, ethical and environmental concerns in business operations. Commitment to CSR by organisations may be demonstrated by the participation in publicly available
CSR frameworks or performance indicators. This paper explores a number of these frameworks. The specific health and safety indicators, which
vary for each framework, are outlined and the contribution these frameworks make to health and safety management is discussed.

Corporate Social Responsibility (CSR) is an instrument of positive change
taking place in organizations. Fidderman (1) notes that it reflects an increasing interest in issues such as globalization and large-scale industrial change, environmental damage from economic activity and social
criteria affecting investment decisions of individuals and institutions.
CSR sets the framework and defines the method with which organizations must operate to be able to meet the ethical, legal, commercial and
public expectations that a society has of any enterprise. The European
Agency for Health and Safety at Work (2) defines CSR as: A concept
whereby companies integrate social and environmental concerns in their
business operations and in their interactions with their stakeholders on a
voluntary basis European Agency for Safety and Health at Work. The UK
Health and Safety Commission (3) suggest that CSR can be seen, as an
approach to good business, which takes into account the social impact
an organization has on the community both locally and globally. IEER (4)
notes that the principles of CSR and Sustainable Development overlap
in many areas. At a practical level both CSR and Sustainability involve an
organizations operational values, policies and practices, management
of environmental, social and softer issues and voluntary contributions to
community development.
There is a growing movement in larger organisations in particular, to
demonstrate their commitment to CSR and Sustainability. An indication
of this commitment may involve the participation in publicly available
CSR or Sustainability frameworks and performance indicators. A number
of these frameworks exist, each focusing on different aspects of reporting depending on the needs of the community they serve, Montero, (5).
This paper reviews a selection of these frameworks including the Glob87

al Reporting Initiative, the Corporate Responsibility Index, Responsible

Care, and the Dow Jones Sustainability Index.

The Global Reporting Initiative

GRI (6) is a not for profit organisation that has developed a Sustainable
Reporting Framework. The aim of the framework is to elevate company reporting in sustainability to the same levels as financial reporting.
Reporting is based on 3 areas economic, environmental and social.
Reporting guidelines, sector guidance and other resources enable organisational transparency and accountability in the Company publicly
available Sustainability Reports. Reporting is based on the principle of
Materiality companies choose to report on aspects that reflect on
their economic, environmental or social impacts. Occupational Health
and Safety Indicators based in the social area include: Percentage of total
workforce represented in formal joint management-worker health and
safety committees that help monitor and advise on occupational health
and safety programmes; Type of injury and rates of injury, occupational
diseases, lost days, and absenteeism, and total number of work-related
fatalities by region and gender; Worker with high incidence or high risk
of diseases related to their occupation; and Health and safety topics covered in formal agreements with trade unions.
External assurance/verification of the data is recommended, but is not
a requirement.

Dow Jones Sustainability Indices (7)

These indices provide long term global sustainability benchmarks for
investors and asset managers. Companies are selected for inclusion in
the indices following a comprehensive assessment against sustainability criteria. Criteria for assessment include Economic, Environmental and
Social dimensions. Work place health and safety indicators are included
in the Social dimension as part of Labor Practices. Indicators, which are
based on ILO Worksafe codes of practice include: Tracking of safety performance, work-related fatalities and near-misses or similar crisis events.
Other indicators (specified) and where no such indicators are used.
Health and safety management for the supply chain is also assessed.
The assessments are based on company responses to an in-depth questionnaire supported by company and third party documents and interviews. Verification is carried out by Sustainable Asset Management and
Deloitte provides assurance reports.

Responsible Care
This is a voluntary global initiative of the International Council of Chemical Associations (ICCA) (8). The aim is to drive continuous improvement
in health, safety and environmental (HSE) performance across the chemical sector, and to encourage open and transparent communication with
stakeholders. The initiative operates in nearly 60 countries through Na88

tional Associations, for example the Chemical Industry Association in

the United Kingdom (UK). Global performance indicators for health and
safety are reported at a national level and include: Number of fatalities,
LTI rate expressed as number of lost time accidents with at least one
day out of work per million working hours and Number of transport
At national levels, member associations are responsible for the detailed
implementation of Responsible Care in their countries. Individual countries programmes are at different stages of development with different
emphases, and are monitored and coordinated by ICCA Responsible
Care Leadership Group. In the UK companies in Responsible Care report
on lagging indicators according to UK legal requirements this includes
LTI injury rates, reporting of Occupational Diseases and Reporting of
Dangerous Occurrences. Some Leading indicators have been developed
including behavioural safety measures, amount of health and safety
training. Verification of data by peer review is being developed, ICCA, (9).

The Corporate Responsibility Index

Offered by the UK based charity Business in the Community (BITC), The
CR Index is described as framework to help particularly large organisations integrate and improve on Corporate Responsibility. Companies
can use the tool on a public or private basis. A public index (available on
the BITC website) groups companies in performance bands Platinum
(overall index score > 95%), Gold (90%), Silver (80%) and Bronze (70%).
Participating organisations must disclose against 4 sections Corporate
Strategy, Integration, Management and Performance & Impact. Employee Health, Safety and Well-Being is an optional elective in the Performance and Impact section. Options are selected based on relevance to
the business. Indicators for health safety & well-being include evidence
for: Health and safety management system, Health and well-being strategic committee, Absence management, Health and Well-being employee programme, Impact measurement and reporting, and Performance
improvement (employee engagement). Organisations have to complete
an on-line self-assessment which is then validated by BITC. All participants receive a feedback report explaining their performance and comparing it with their sector and overall average, BITC, (10).

The health and safety indicators described in these frameworks fall into
two main categories; reactive indicators which include fatalities, lost time
injury rates and ill health data; and proactive indicators which demonstrate effective management and include certification of management
systems, evidence of strategic commitment, education and training and
consultation. There is some variation for example the focus of Dow Jones
Index may be reactive indicators, as the investment market may be specifically interested in headline data. Difficulties rise in making such data
meaningful across a range of countries with varying reporting systems.


CSHS (11) identified that the information disclosed must be meaningful

to achieve transparency.
The information publicly available from the indicator organisations is
variable and may be described as high level, for example CRI. This could
be used to aid investment decisions and further data may be available for fee paying members of an indicator organisation. However the
standardisation and increased transparency of reporting in company reports, as exemplified by GRI and Responsible Care is valuable.
There has been some criticism that many of the indicators rely on data
provided by the company. The requirement and quality of verification of
the data is variable between indices with the GRI recommending verification, Responsible Care developing a process of peer review and Dow
Jones providing a rather more rigorous verification process, Hope and
Fowler (12). Given the self-interest of companies to disclose favourable
data and the principle of materiality and use of optional indicators the
credibility could be of concern.
However, ultimately these indicators can provide an organisation a
framework for improvement. Indeed Zairi and Peters (13) suggest that
a link exists between those organizations that pay attention to, and report CSR issues and improved overall performance including health and
safety performance.



Fidderman. H CHaSPI: the Corporate Health and Safety Performance Index. Health and
Safety Bulletin 327 13-23 2004


European Agency for Safety and Health at Work Corporate Social Responsibility and
Health and Safety at Work. Luxembourg: Office for Official Publications of the European
Communities 2004

3. HSC, Corporate responsibility and accountability for occupational health and safety. A
progress report on HSC/E initiatives and measures.2003

Institute for Ecological Economy Research.Significance of the CSR debate for Sustainability
and the requirement for companies. IOEW, Berlin 2004


Montero, M., Araque, R. and Rey, J. Occupational health and safety in the framework of
corporate social responsibility. Safety Science 47 1440-1445 2009


Global reporting Initiative [homepage on the Internet] available from https://www.globalreporting.org accessed 21/2/2014


Dow Jones Sustainability Indices. [homepage on the Internet] available from http://www.
sustainability-indices.com accessed 21/2/2014


ICCA [homepage on the Internet] available from http://www.icca-chem.org/en/home/responsible-care/ accessed 21/2/2014


ICCA, Responsible Care Progress Report: Growing Our Future, 2012, International Council
of Chemical Associations, Brussels, Belgium 2012

10. BITC [homepage on the Internet] available from http://www.bitc.org.uk/our-services/

benchmarking/cr-index accessed 21/2/2014
11. Center for Health and Safety Sustainability, Current Practices in Occupational Health and
Safety Reporting, Illinois, USA 2013
12. Hope C, Fowler, S. A critical review of Sustainable Business Indices and their impact. J of
Business Ethics 76 3 243-252 2007
13. Zairi, M., & Peters, J. The impact of social responsibility on business performance. Managerial Auditing Journal, 17, 174-178 2002


Large regional variations in occupational

health care costs in Finland
Timo Hujanen, Researcher, M.Sc.,
Hennamari Mikkola, Chief of health research
The Social Insurance Institution of Finland

The Finnish system where tax-funded municipal health services co-exist with private services and with occupational health services (OHS)
is unique. This multi-channel system may lead to inefficiencies and to
sub-optimization between organizers and providers and to high regional variation. Data on health spending conceal these variations.
Employers are required (under the Occupational Health Act) to arrange
at their own expense OHS for employees in order to prevent work-related health risks. They also have the possibility to arrange medical care on
a voluntary basis. Employers can purchase OHS from a municipal health
centre or other organizations offering OHS, such as private medical centres, or operate OHS themselves or in co-operation with others. By filing
a claim with the Social Insurance Institution (Kela), employers can have
part of their OHS expenses reimbursed. The reimbursement is equal to
60% of the costs of preventive services provided in the form of workplace assessments and check-ups, and 50% of the costs of necessary and
reasonable medical care offered as general practitioner-level treatment.
In Finland, regional comparisons of health care costs are possible. The
only exception to this are occupational health services, utilization data
for which are scattered across many different employer registers. As OHS
costs are not identified by region and employers have responsibility for
arranging the services (whereas municipalities mainly arrange tax-funded local health care), OHS is invariably left outside the scope of structural
and financial reforms in health care.

Materials and methods

We combined employer reimbursement claims submitted to the Social
Insurance Institution in 2009 (43 264 claims for a total of about 1.8 million employees) with Statistics Finland data on employees place of residence.
We got results from extensive data which allowed us to focus on the extent to which employers OHS costs affect the provision of local primary
health care by municipalities (Hujanen & Mikkola 2013).


Looking at the average costs of preventive OHS we see a fairly even distribution among the municipalities (Figure 1).

Figure 1. Preventive care costs in OHS (Finland, 2009): %-difference

from average costs per municipality (43 per capita). The largest
urban areas are indicated on the map as black circles
In terms of the average costs of medical care there is a much stronger concentration in certain areas such as those with high population
density (Figure 2). The variation in average medical costs (12103) by
municipality is almost twice that in the average costs of preventive care


Figure 2. Medical care costs in OHS (Finland, 2009): %-difference from

average costs per municipality (72 per capita). The largest urban areas are indicated on the map as black circles.
The beneficiaries of the OHS system are the municipalities in the Helsinki area as well as other metropolitan and urban areas (Figure 3). As for
costs, in rural, poor and sparsely populated areas, the employers OHS
benefits are negligible. The average costs of preventive care and medical
care are strongly interdependent.


Figure 3. Preventive health care and medical care costs in OHS

(Finland, 2009): %-difference from average costs per municipality.
Occupational health costs show large regional variation, ranging between 10% and 40% of the cost of outpatient primary care in individual
municipalities. Areas with the lowest OHS costs have nearly the highest,
combined costs for outpatient primary care, and vice versa (Figure 4).
The combined total costs included OHS and outpatient primary health
care provided by municipalities.

Figure 4. Total costs of OHS and of outpatient primary care in Finland,

by municipality, /capita (2009).

Health centres provide services at a cost that is 1/3 lower than that of
other providers. Small employers (> 20 employee.) spent 1/3 less on
health care than bigger employers.

Metropolitan and urban areas, where employers have the greatest ability
to pay for OHS, will benefit the most and may have no need to provide
the same level of outpatient primary care for residents as municipalities
where OHS presence is modest.
The results of this study can be used to evaluate the regional allocation
of resources and the significance of OHS in the primary health care.

Hujanen T, Mikkola H. Tyterveyshuollon palvelujen kustannusten alueelliset erot. [Regional
differences in the costs for occupational health services]. Helsinki: Kela, Nettitypapereita
42; 2013. Available from: http://hdl.handle.net/10138/38194


Addressing a fire safety culture in the

garment industry in South Asia: A
collaborative approach
David Gold, PhD, MOEd, CMIOSH
Jane White, MSc, CMIOSH
Britta Klemmer, MSc, Fair Labor Association

Historically, workplace fires have been a significant cause of death, injury, disability and severe economic losses.

The Triangle Shirtwaist Factory fire

Figure 1: Triangle Shirtwaist Fire (March 2011)

One of the most significant workplace fires that had a dramatic influence
on legislation was the Triangle Shirtwaist Factory Fire in New York City
on 25 March 1911. There were 146 deaths (123 women and 23 men)
and 71 individuals injured. It was estimated that there were over 1,650
workers (mostly women) in the factory at the time of the fire. There was
no audible alarm. Locked and obstructed exits attributed to many of the
deaths and injuries. A number of workers, unable to use the stairs, ended
up jumping to their death.

The Kader Factory fire

More recently, on 10 May 1993, a major fire occurred in Thailand at the
Kader Factory, which produced dolls and stuffed toys. This fire resulted
in 188 deaths and 469 individuals injured.

Figure 2: The Kadar Factory Fire (May 1993)

According to reports by the International Labour Organization (ILO) and
the National Fire Protection Association (NFPA), the Kader Factory complex had inadequate fixed fire protection systems, poor arrangements of
fire exits and a lack of fire safety training.
When the fire occurred on the first floor, smoke rose to upper floors.
Workers, not hearing an alarm but concerned about smoke, started to
evacuate from the upper floors using the emergency stairway. Members
of the security staff, thinking the fire was small, sent evacuating workers back up the evacuation stairway. The confluence of the descending
evacuating workers and the workers forced to return to the upper floors
caused a number of deaths.

Recent Workplace Fires in Asia

Table 1: Recent fatal fires in Asia



25 February 2010

Gazipur, Bangladesh


24 December 2010

Dhaka, Bangladesh


11 September 2012

Karachi, Pakistan


24 November 2012

Dhaka, Bangladesh


26 January 2013

Dhaka, Bangladesh

27 February 2013

Kolkata, India


8 May 2013

Dhaka, Bangladesh

3 June 2013

Mishazi, China


In the last few years, a number of fires with significant fatalities have
occurred in Asia. Table1 shows some of the more disastrous recent fires.
Although not a fire, another noteworthy accident is the factory collapse
in Dhaka, Bangladesh on 24 April 2013, which caused 1,126 deaths.

The impact of many of these accidents could have been minimised had
there been a promotion of prevention and safety culture. Unfortunately,
many resources are still going towards inspection and enforcement and
few towards prevention. In South Asia today, one of two scenarios are
frequently seen.

Scenario 1: Culture of compliance

A culture of compliance is where workers and management are following the rulesnot because they want to or in the interest of protecting
othersbut because they are rules. This can manifest itself in scenarios
such as the following:
An inspector or an auditor arrives at the factory gate. The security guard
politely asks them to wait. During the wait a signal is given in the building to quickly clear and unlock exits, clear passageways, remove excess
waste and sources of ignition. After 15 minutes the inspector is summoned.

Scenario 2: Culture of prevention

Ongoing training has raised the awareness of workers, managers and
staff regarding the need for a fire safety programme. People are aware
and frequently discuss fire safety. Information is generated and workers
are encouraged to bring the message home to their families. Everyone
strives to reduce the fire load and control possible sources of ignition.
They consciously keep primary and secondary exits clear of obstruction.
They expect that the alarm system and fire protection systems function. There are evacuation wardens, fire drills and emergency assembly
points. When the systems do not function, there are urgent and frank
discussions with management.

Figure 3 The DuPont Bradley model depicting the move from

compliance to culture
The DuPont Bradley model graphically demonstrates the impact on injury rates when a company moves from instinct (when workers engage
in safety and health issues from instinct because its the law and they are

told) to a safety culture where teams of workers share common safety

and health values, therefore the movement towards a culture of prevention. The model can also be applied to moving from complying with fire
safety regulations to building and sustaining a fire safety culture.

The aim of the ongoing project by the Fair Labor Association (FLA) is to
develop and implement a collaborative approach between management
and workers through a fire safety initiative to address basic fire safety.
The ultimate goal of the project is for factories to have a workplace fire
safety culture in place where all workers share a common set of knowledge, attitudes, perceptions and beliefs about workplace fire safety.

Fire safety is defined in the project as both fire protection and fire prevention.
Fire prevention is ensuring that the elements that are required for combustionheat, fuel and oxygendo not come together. This is done by
eliminating one or more of the elements. For example, measures such
as restricting open flames, prohibiting smoking in the workplace, or
ensuring appropriate storage of flammable materials.
Fire protection translates into material, equipment, resources and procedures to evacuate personnel and extinguish or mitigate the effects of
the fire. For example, every workplace should have:


A fully operational evacuation alarm that everyone can see and

hear (taking into consideration ambient noise levels), which is regularly inspected, tested and maintained, including a backup system
should the alarm system fail
Emergency evacuation routes that are clearly marked, continually
unobstructed, well lit (equipped with emergency lighting that will
continue to function in the event of a power failure), designed and
arranged so as not to pass through or near any hazardous area,
provided with doors that are equipped with panic hardware and
are not locked
One or more marked external assembly points in an area of safety
away from where fire-ground operations might occur
A group of fire evacuation wardensin each area and on each
working shiftshould be selected, trained and regularly drilled in
guiding employees from their workstations to the external assembly point, ensuring that everyone has evacuated the work area
Adequate fire protection equipment, including automated systems
and fire extinguishers and hoses, where appropriate

Fire protection also provides a means for dealing with emergencies including:

Emergency evacuation (life safety)

Emergency action planning
Emergency operations: emergency operations centre
Emergency operations: workplace fire response team

The FLA designed and is implementing a project that:

Developed, validated and shared 39 Fire Safety Competencies2

Developed, validated and shared a self-assessment checklist for
employers and factory owners, based on the above-mentioned
Developed, validated and accredited with the Institution of Occupational Safety and Health (IOSH) a robust training course with a
view to train individuals as change agents, in factories, known as
Workplace Fire Safety Facilitators4
Developed, validated and accredited with IOSH a robust training
programme to train both master trainers and local trainers to deliver the Workplace Fire Safety Facilitator course5
Built collaboration with the National Fire Protection Association
(US) for technically reviewing the accuracy of contents
Received a Development Grant from IOSH (UK) for building the
infrastructure to support the rollout of the initial educational activities

In this programme, guidelines, lesson plans and materials are standardised. There are robust training infrastructures and fixed evaluation
mechanisms which included pre-tests, post-tests, and assessments of
presentations and reports.

The Workplace Fire Safety Facilitator Course
The five-day Workplace Fire Safety Facilitator course was finalized, accredited and implemented for the first time in November 2013 in Sri
Lanka for 17 participants representing four countries and four major
garment brands. The course consisted of an initial 3 days during which
the participants actively addressed:

The basis of fire safety

Changing behaviour through information exchange
Basic presentation skills and discussion techniques
Fire hazard assessment techniques






Figure 4: Exercise on External Assembly Points during the Workplace

Fire Safety Facilitator Course in Sri Lanka
During a one-month gap, the participants were asked to conduct a hazard assessment at their workplace and carry out a presentation and discussion in their workplace on a fire safety issue. In the final two days of
the course, the participants reported on the gap exercise and developed
means of action to promote fire safety.
The mean score of the pre-test of the Workplace Fire Safety Facilitator
course was 55%, which rose to a post-test score of 77%.

The Train-the-Trainer Course

Beginning on the day before and the day after the two segments of
the Workplace Fire Safety Facilitator course, candidate master trainers
representing four countries (national master trainers) and four brands
(corporate master trainers) were trained.
Eleven trainers completed the course (the Workplace Fire Safety Facilitator course was embedded in the Train-the-Trainer course therefore
affording the opportunity to the trainers to complete both courses).
The interactive Train-the-Trainer course addressed topics such as:

How adults learn

The structured lesson plan and learning objectives
Instructional methods
Teaching and learning resources
Micro-teaching assignments
Participant assessment
Administrative and reporting requirements and evaluation

The candidate trainers were required to complete the same gap assignment as the Workplace Fire Safety Facilitators as well as to prepare to
present a course module during the sessions after the gap.


The mean score of the pre-test of the Train-the-Trainer course was 59%,
which rose to a post-test mean score of 90%.
Upon completion of the Train-the-Trainer course, the trainers are required to complete the (UK) National Examination Board for Occupational Safety and Health International Fire Safety and Risk Management
Course as well as successfully instruct the Workplace Fire Safety Facilitator course under the observation and evaluation of a master trainer.
National master trainers have been trained in three countries, Bangladesh, India, and Sri Lanka. Four widely-known international garment
brands have trained two master trainers each. The cascading effect has
started regionally and will quickly reach factories and workplace in the
targeted countries and brands.
Evidence of the cascading effect is apparent. The first national course
where two candidate national master trainers are being evaluated and
additional brand trainers are being trained was be held in Bangladesh in
February and March 2014.

The programme is building capacity and prompting prevention based
on identified competencies. The gap exercise of the Workplace Fire Safety Facilitator course in Sri Lanka on its own promoted fire safety messages in 17 different enterprises, located in six countries, delivered in seven
different languages, impacting over 200 workers.

The authors would like to acknowledge the enthusiastic support from
the Fair Labor Association, the (UK) Institution of Occupational Safety
and Health, and the (US) National Fire Protection Association.

Works Cited
Fair Labor Association, n.d. Fire Safety Competency Assessment. [Online]
Available at: http://www.fairlabor.org/sites/default/files/fla_fire_safety_self-assessment_
[Accessed February 2014].
Fair Labor Association, n.d. FLAs Fire Safety Initiative. [Online]
Available at: http://www.fairlabor.org/sites/default/files/foundationalcompetencies.pdf
[Accessed February 2014].
The Institution of Occupational Safety and Health, n.d. Workplace Fire Safety Facilitator Training
Programme. [Online]
Available at: http://www.fairlabor.org/sites/default/files/workplace_fire_safety_facilitator_training_syllabus.pdf
[Accessed February 2014].
The Institution of Occupational Safety and Health, n.d. Workplace Fire Safety Facilitator Trainthe-Trainer Course. [Online]
Available at: http://www.fairlabor.org/sites/default/files/workplace_fire_safety_facilitator_
[Accessed February 2014].


Vision Zero
The New Global Strategy for Safe Mining
Helmut Ehnes, Secretary General
ISSA Mining Director Prevention BG RCI

Eyes on reality: a vast potential throughout the world

The International Labour Organization (ILO) estimates that more than
330 million accidents at work happen world wide every year, only counting those leading to more than four days absence. More than 350,000
end fatal. Two million people more die every year due to work-related
diseases. To sum this up: around 2.4 million people die every year because of work conditions.
What do these figures stand for? Human fates, families losing supporters, businesses losing tremendous amounts of money.
Among many risky industries, mining stands out. While mining represents just 1% of employees globally, it unfortunately represents 8% of all
occupational fatalities.
Thousands of miners die at work every year. Many more get severely
hurt. What does this mean?

It means a tremendous loss of productivity and extremely high

It means enormous problems in quality.
It means a lack of motivation due to unsafe work conditions.
It means a disastrous public image of the whole trade, and of many
particular businesses.

And, most of all, it means human suffering, families losing their loved
ones and their suppliers!
Mining operations go along with a variety of hazards. Not only in large
operations, as they first come to mind, but also in the manifold small
scale mines, with an estimated 13 million labourers worldwide exposed
to substances such as dust, mercury and other chemicals, while also
dealing with poor ventilation, inadequate space and overexertion. But
is the number of severe accidents and diseases inevitable, or can we
change this situation?

Vision Zero the strategic approach to safe mining

How to face the challenge of massive numbers of accidents and occupational diseases occurring throughout the world?
We can make mining sustainably safer, but we need a successful strate104

gy, and we should learn from the way the best are doing. In doing so, we
will notice that a high potential lies in Vision Zero.
Firstly defined as early as in the 19th century by Eleuthre Irne du Pont,
its very successful elements were adopted by many European countries
first aiming at road safety, then extended to safety and health at work.
Du Pont established E. I. du Pont de Nemours and Company, a gunpowder mill in Delaware/U.S.A. in 1802. A number of severe accidents caused
by explosions, including three wagonloads of explosives detonating in
the city centre leaving several people dead and numerous buildings destroyed, showed du Pont the need for prevention. In 1811, he established safety rules and transferred responsibility to his managers, now
required to live on the site premises together with their families. The
decision to document and analyze all accidents and near-misses properly; the credo that every accident is avoidable; and the creation of an
error-forgiving work environment led to vast improvements in safety. To
this day, the DuPont group is a global leader in occupational safety and
health. The findings and groundbreaking success of DuPonts measures
are today a vital element of Vision Zero.
Vision Zero is a prevention strategy for a safe future without fatal or serious accidents. By focussing on severe and fatal accidents, its application
increases the level of safety and health overall.
This aim is neither unrealistic, nor over ambitioned. High-risk industries
such as chemical plants or airlines deal with significant risks, but show
that they are controllable. Large and economically successful mining
corporations prove that even operations in difficult environments, such
as large depths, can be run safely and without endangering the health of
miners. Vision Zero in mining can be achieved it requires knowledge of
the tried and tested tools and the motivation to act on all management
and operational levels.
The promising approach has been implemented in respects to road safety by several European countries, beginning with Sweden in 1990 with
remarkable success! Countries applying the Vision Zero strategy to improve safety in traffic achieve significant better results in the accidents
statistics measured against the number of inhabitants.

Nothing is more important than life! Vision Zeros aims

Vision Zero aims at four vital aspects in mining:

Ethics: Human life and health are paramount and take priority over
all other objectives
Responsibility: providers and regulators of the mining sector share
responsibility with users;
Safety: mining processes should take account of human fallibility
and minimize both the opportunities for errors and the harm done
when they occur; and
Mechanisms for change: providers and regulators must do their utmost to guarantee the safety of all stakeholder in mining, including

miners, contractors and people living in the surrounding of mines ;

all together must be ready to change to achieve safety.
Vision Zero accepts that peoples actions sometimes involve error. Thus,
the system has to be adapted in a way that these errors will not lead to
injuries or even fatalities.

How to transfer the Vision Zero strategy into

everyday mining operations?
Vision Zeros holistic elements cover technology, workplaces, rules, and
people as fields of action. What does this mean for mining?
To analyze blasting safety as an example, all of these four aspects must
be viewed. The example leads us to
- Explosives
- Detonators

- Substitute of Gun Powder


- Blasting Accidents Prevention Regulations


- Computer-aided Borehole Measuring

- Quarry Design


- Education of Blasting Experts

- Computer-aided Training

Only covering each field adequately brings the chance to work without
any accident or incident.

Tried and tested tools for the systematic transfer into

mining processes:
The Seven Golden Rules
When analyzing accidents and diseases resulting from mining work, it
becomes clear that the majority of causes is comparable regardless of
the mined mineral, region, depth, and other factors. The International
Section of the ISSA on Prevention in the Mining Industry (ISSA Mining)
derived seven key recommendations for the mining industry forming the
basis for safe operation and in many aspects adaptable by industries
other than the mineral extracting one.
1. Leadership and commitment
2. Identify hazards and risks
3. Set safety and health targets
4. Ensure a safe system
5. Use safe and healthy technology
6. Control and improve qualification and knowledge of your staff
7. Invest in your most valuable asset: motivate your employees

This set, labelled Seven Golden Rules for Safe and Economic Mining, has been filled with hands-on advice for each one of the seven
aspects, explaining the underlying principles, arguments for adaption, advice on operational implementation, models of good practice as found in the industry, and a list of checkpoints for managers.


2 3 4 5 6 7

Is safety and health amongst your personal top priority

as CEO / employer and how do you show this?

Did you set a written company policy showing

the significance of OSH amongst your company values?

3 Do you communicate the value of safety?


Is the top management committing to the level

of safety and health amongst the companys values?

Do all managers at every level know about the priority

of safety and health?

Do all the managers know exactly upon their

personal obligations and responsibilities?

Do you have financial incentives for good

or bad safety performance for employees and managers?

Checkpoints aid in implementing the recommendations as given by the

Seven Golden Rules: excerpt of the checkpoint set for Leadership


No one should get severely hurt, let alone be killed in mining. To change
the current situation, there is no better way than to apply Vision Zero
for the mining industry, by utilizing well proven prevention tools and
methods systematically and throughout. The key to success is a set of
practical tools to support managers in implementation, suitable for both
large corporations and small-scale mines as given by the Seven Golden Rules.
Efficient prevention will increase productivity beyond the investment.
But first and foremost: Life and health can never be exchanged for any
other benefits within society!


International Symposium on Culture of Prevention

Summary of the Learning Caf

on Future Approaches
Markku Aaltonen, Minna Tuominen-Thuesen*, Eeva Juntunen*, Arja yrvinen

Learning Caf method

The idea of the Learning Caf working method was to gather as many
inputs as possible from the participants in a very short time. It is based
on an open and encouraging atmosphere in which all participants have
equal opportunities to express their views and opinions. The success
of the method is entirely dependent on the thorough preparation and
commitment of the key persons and participants in the working session. The chairpersons made sure that all discoveries, observations and
results were recorded as agreed and also represented the results to the
The working method included four phases:
1. Welcoming the participants to the caf tables and the presentation
of the chairperson and participants
2. A short introduction to the issue at hand by the chairperson and the
opening of the discussion
3. After 15 minutes, the discussion the next issue under the same theme
moved to the next table . There were three moves during the working
4. Presentation of the Summary of Results. The results of the discussion
were recorded on a flip chart. Each topic had one chairperson, whose
task was to present the results of their particular theme to the Sym-

Minna Tuominen-Thuesen is Senior Advisor and Partner and

Eeva Juntunen is Advisor, Manager at KPMG Oy Ab.


Learning Caf session themes

Prevention culture as a culture, Evidence of the benefits of a culture of
prevention, Challenges and barriers to promoting a safety culture, and
Promoting a culture of prevention. Altogether 20 questions were discussed under the four themes.

Questions and answers extracts from the Learning Caf results

Theme: Prevention culture as a culture
In what way does the legislation on occupational safety and health create a culture of prevention?

Legislation is needed to give a basic framework and minimum

What is the role of education and training in a culture of prevention?
Education and training is needed at all levels from kindergarten
to universities and workplaces, and the next generation will be
much more prevention-oriented than we are.

Theme: Evidence of the benefits of a culture of prevention

What should be done in research? Are there areas that could be researched differently?
Research on evidence of business benefits.
Research on social economic factors in a culture of prevention.
How should the evidence of benefits be gathered and delivered?
By forming best practices, e.g. Zero accident forum.

Theme: Challenges and barriers to promoting a safety culture

What are the difficulties in promoting safety culture?
Talk is not the same as actions.
Act as you talk!
How could OSH be taken into account in education to create a culture of
prevention and who should bring this issue forward?
Life-long safety model day care, elementary school etc.
Teachers are examples and role models.

Theme: Promoting a culture of prevention

How can a culture of prevention be launched in small and medium-sized
Health and safety issues introduced at kindergarten should continue throughout life then OSH is familiar when you work in an SME.
Economic incentives and direct financial support for preventative

The Learning Caf method proved to be a successful way to involve participants in collecting and exchanging ideas on various culture of prevention themes.


Proceedings of the International Symposium on Culture of Prevention
Future Approaches

Aaltonen, Markku
Finnish Institute of Occupational Health
Topeliuksenkatu 41 a A
00250 Helsinki
Bollmann, Ulrike
Institute for Work and Health of the
German Social Accident Insurance
Koenigsbruecker Landstr. 2
D - 01109 Dresden
Ehnes, Helmut
ISSA Mining
Theodor-Heuss-Str. 160
30853 Langenhagen
Eichendorf, Walter
German Social Accident Insurance
Alte Heerstr. 111
53757 Sankt Augustin
Elsler, Dietmar
Gran Via 33
48009 Bilbao
Gold, David
Gold-Knecht Associates
Chemin des Cerfs, 4
1272 Genolier

Guerin, Rebecca J. MA
Project Officer
Safe-Skilled-Ready Workforce Initiative
National Institute for Occupational
Safety and Health (NIOSH)
Centers for Disease Control and
Prevention (CDC)
4676 Columbia Parkway MS # C-10
Cincinnati, OH 45226
Hujanen, Timo
The Social Insurance Institution of
Nordenskildinkatu 12 /PO Box 450
00101 Helsinki
Juntunen, Eeva
Tlnlahdenkatu 3 A
00100 Helsinki
Laitinen, Heikki
3T Results Ltd
Ainontie 12 B
04230 Kerava
Lehtola, Marika
Finnish Institute of Occupational Health,
P.O.Box 310
70101 Kuopio


Levitsky, Marianne
Workplace Health Without Borders
6130 Tomken Road
L5T 1X7 Mississauga, ON

Tappura, Sari
Tampere University of Technology
P.O. Box 541
FI-33101 Tampere

Mikkola, Hennamari
The Social Insurance Institution of
Nordenskildinkatu 12 /PO Box 450
00101 Helsinki

Treichel, Bernd
International Social Security Association
Post Box 1
1211 Geneva

Okun, Andrea H. Dr.P.H.

Associate Director for Global
National Institute for Occupational
Safety and Health (NIOSH)
Centers for Disease Control and
Prevention (CDC)
4676 Columbia Parkway MS # C-14
Cincinnati, OH 45226
Schulte, Paul A. PhD
Director, Education and Information
Manager, Nanotechnology Research
National Institute for Occupational
Safety and Health (NIOSH)
Centers for Disease Control and
Prevention (CDC)
4676 Columbia Parkway, MS-C14
Cincinnati, OH 45226
Suksi, Ismo
Ministry of Social Affairs and Health
P.O. Box * 33
FI-00023 Goverment


Tuominen-Thuesen, Minna
Tlnlahdenkatu 3 A
00100 Helsinki
Walker, Deborah
Loughborough University
School of Business and Economics
LE11 3TU Loughborough
United Kingdom
White, Jane
IOSH Institution of Occupational Safety
and Health
The Grange, Wigston
LE18 1NN Leicester
United Kingdom
Zwetsloot, Gerard
TNO Safe & Healthy Business
Postbus 718
2130 AS Hoofddorp

Finnish Institute of Occupational Health

Topeliuksenkatu 41 a A
FI 00250 Helsinki

ISBN 978-952-261-428-5 (PDF)