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Prof Lin Fritschi
The hierarchy of control - can it work for health?
2014
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Talk outline
Hierarchy of control
Traditional use to control hazards
Use of the hierarchy in healthy workplace programs
Combining OHS & HP
Improving productivity
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Hierarchy of control
A systematic approach to manage safety in your
workplace by providing a structure to select the most
effective control measures to eliminate or reduce the risk
of hazards
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http://www.qualitysystems.com/support/pages/hierarchy-of-controls
Hierarchy of Control
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Hierarchy of control
Elimination – removes the cause of danger completely.
Substitution – controls the hazard by replacing it with a
less risky way to achieve the same outcome.
Engineering – using engineering controls
Administration – use policies and procedures to lessen
the risk
Behaviour – follow safe work practices
Personal Protective Equipment
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Traditional use of the hierarchy to control
hazards Diesel exhaust
UV radiation
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Diesel exhaust
Good evidence of health effects
• Cancer, heart disease, lung disease
Many locations of exposure
• Transport (road, rail, sea),
• Mining
• Construction
• Farming
• 28% of Australian male workforce*
* Carey et al, 2014
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Diesel engine exhaust
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Driver Farmer Construction Miner Mechanic
None
High
Medium
Low
Possible
* Carey et al, 2014
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Diesel engine exhaust – control
Elimination – stop using diesel engines?
Substitution – replace diesel with petrol/LPG engines?
Engineering – particulate filters, oxidation catalyst,
exhaust systems
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Implementation schedule of global on-highway heavy diesel duty diesel engine emission
standards.
Scheepers P T J , and Vermeulen R C H Occup Environ
Med 2012;69:691-693
©2012 by BMJ Publishing Group Ltd
..
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Implementation schedule of global nonroad heavy diesel duty diesel engine emission
standards.
Scheepers P T J , and Vermeulen R C H Occup Environ
Med 2012;69:691-693
©2012 by BMJ Publishing Group Ltd
..
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Honda News, Whayne Parts, Gencat Co
..
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Diesel engine exhaust – control
Elimination – stop using diesel engines?
Substitution – replace diesel with petrol/LPG engines?
Engineering – particulate filters, oxidation catalyst,
exhaust systems
Administration – regular servicing
Behaviour – closed cabs, exhaust hoses, not running
engines in enclosed spaces
Personal Protective Equipment – respirators?
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UV radiation
Good evidence of carcinogenicity
IARC Group 1
Many locations of exposure
Any outdoor work, welding arcs
37% of Australian male workers*
* Carey et al, 2014
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UV
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Driver (n=328) Construction(n=191)
Farmer (n=158) Electrician (n=79) Mechanic (n=78)
None
High
Medium
Low
Possible
* Carey et al, 2014
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UV radiation – control
Elimination – stop outside work?
Substitution – replace outside workplaces with inside
ones?
Engineering – shade screens, indoor work where possible
Administration – policies
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Administration controls - UV
No.
employees
Sunscreen Protective
clothing
Hat Sunglasses Reorganize
work
>=200 1.0 1.0 1.0 1.0 1.0
20-199 0.6 0.5 0.5 0.4 0.7
5-19 0.6 0.3 0.4 0.3 1.1
<5 0.5 0.3 0.4 0.3 1.1
SafeWork Australia 2010
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UV radiation – control
Elimination – stop outside work?
Substitution – replace outside workplaces with inside
ones?
Engineering – shade screens, indoor work where possible
Administration – policies
Behaviour – seek shade etc
Personal Protective Equipment – hats, long sleeve
shirts, sunglasses, sunscreen
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UV radiation - PPE
Cancer Council SA
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Use of the hierarchy in healthy workplace
programs How does this help?
Model for thinking about the issue.
Reverse of usual health promotion
How do we control the hazard?
30.07.2010 Footer text - slideshow title
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Lack of exercise
Elimination – parking availability
Substitution – substitute incidental physical activity
Engineering – building design
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Engineering - exercise
http://www.fast-exercises.com/stairs/
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Engineering
Likelihood of stair use increases with:
Naturally lit stairs
Stairwell visibility
Stairs close to entrance
Skip-stop elevators
Effective area or occupant load of each stair
Volume of space visible from the stair
Integrated pathways
Ruff et al, 2014; Nicoll et al, 2009, Nicoll, 2007
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http://sourceable.net/fusing-architecture-and-health-opt-for-stairs-over-lifts/
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Lack of exercise
Elimination – parking availability
Substitution – substitute incidental physical activity
Engineering – building design, stairs,
Administration – policies, gym membership
Behaviour – encourage physical activity
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Behaviour – exercise
Greensense
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http://www.qualitysystems.com/support/pages/hierarchy-of-controls
Hierarchy of Control
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Combining OHS & HP
Occupational Health and Safety - the discipline concerned
with protecting the health and safety of all stakeholders in
the workplace from exposure to hazards and risks
resulting from work activities.
Health Promotion - the process of enabling people to
increase control over their health and its determinants, and
thereby improve their health
Wikipedia
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Why combine the two approaches?
Exposures on the job may be perceived as posing a
greater risk than personal health behaviours
Risks in the workplace are seen as involuntary, undetectable, outside
personal control and unfair
Suspicion that employers are shifting the burden for occupational health
onto the worker
Workplace hazards and poor personal health behaviours
are both important health risks and may be synergistic
E.g. smoking and asbestos exposure
Sorensen, 2011
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Why combine the two approaches?
Reducing health risks at work may increase receptivity to
messages about personal behaviours
Workers at highest risk for exposure to occupational
hazards are also those with risk-related behaviours
Sorensen, 2011
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Randomized controlled trial
Worksite health promotion only
Tobacco and nutrition
Consultation to management about policies and catering
Individual and group communications on individual behaviours
Worksite health promotion and OHS intervention
Worksite assessment
Individual and group communications integrating OHS and HP messages
Sorenson et al, 2002
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Results – randomized controlled trials
Program Results
WellWorks-1, Sorensen 1998 ↑ smoking cessation
↑ fruit and vegetable consumption
↑ fibre consumption (labourers)
WellWorks-2, Sorensen 1998 ↑ smoking cessation (hourly workers)
Brabantia Project, Maes 1998 ↑ serum cholesterol
↑ ergonomic conditions
↓ psychological demand
↓ absenteeism
Healthy Directions, Sorensen 2011 ↑ physical activity
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Total Worker Health
NIOSH (US)
“a strategy integrating occupational safety and health
protection with health promotion to prevent worker injury
and illness and to advance health and well-being.”
The Research Compendium: The NIOSH Total Worker
Health™ Program: Seminal Research Papers 2012
http://www.cdc.gov/niosh/docs/2012-146/
www.cdc.gov/niosh
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Improving productivity
Growing evidence that integrated programs can reduce
health-care costs, increase productivity and reduce
absenteeism
Sorensen, 2011, Goetzel 2001
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Goetzel, 2011
30.07.2010
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Goetzel, 2011
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Combined approach
Advantages
Avoid duplication and improve efficiency
Develop common metrics
Easier to comprehend a complex issue
Barriers
Turf protection by managers
Integration takes time and effort
Different regulations in different departments
Change resistance
Unsure about cost-effectiveness
Goetzel, 2011
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Johnson & Johnson – Health and Wellness
Program which integrates health promotion activities,
disability management, occupational health, employee
assistance and work-life programs.
Personal health risk assessment and followup risk
reduction interventions
>90% participation
Goetzel, 2011
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Johnson & Johnson – Health and Wellness
Reductions in smoking, sedentary lifestyle, high
cholesterol, high blood pressure, nutrition, seat belt use,
and drinking and driving.
Worsening of high body weight, high fat intake, risk for
diabetes, and cigar smoking.
Financial impact analysis
Saving of $225 per employee per year in medical care utilization costs
Savings from administrative streamlining of the program
Reduced lost workday injuries
Prevented 6700 vehicle accidents
Goetzel, 2011
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Economic analysis
Economic gains will result from integrating health
promotion and OHS if there are spillovers between the
effects of occupational and nonoccupational risk factors on
health.
E.g. Fitter workers less likely to be injured, effort to increase health in the
workplace made workers more committed to maintaining good habits at
home
Seabury, Lakdawalla and Reville, 2011
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Summary
Hierarchy of controls may be a useful framework for
thinking about improving non-traditional risks in the
workplace
Combining OHS and Health Promotion may result in better
outcomes for the worker and the employer.