Preventing alcohol use in the workplace:A key initiative for healthy workplaces

Dr. Rokho Kim

World Health Organization

Regional Office for Europe

Outline

• Introduction

• Burden of alcohol-attributable diseases

• WHO responses to alcohol challenges

• Importance of health and safety at work

• Healthy workplaces – holistic paradigm

• Concluding remarks

Why healthy workplaces?

• Workers are half of the whole population

• Healthy workforce is a prerequisite for sustainable development and social wellbeing

• Preventable consequences

– Workers: loss of health and wellbeing

– Community: loss of solidarity and equity

– Company: loss of productivity and profit

– Country: loss of 4-5% of GDP

• A major social determinant of health and equity

Our target population: 'the global workforce'

Most of the world's 2.8 billion workers can benefit from a "healthy workplace" approach, and particularly…

– the 1.9 billion workers who are employed in unhealthy & unsafe workplaces…and that include 170 million children

– 400 million workers in the WHO European Region

6 October 2011

Shain M , Kramer D M Occup Environ Med 2004;61:643-648

©2004 by BMJ Publishing Group Ltd

 Personal health practices (“risk factors”), health costs, and productivity

Source: Joan Burton. WHO Healthy Workplace Framework and Model, 2010.http://www.who.int/occupational_health/healthy_workplace_framework.pdf

Alcohol-attributable disease and injury (1/2)

Chronic disease:Cancer: Mouth & oropharyngeal cancer, esophageal cancer, liver cancer, female breast cancerNeuropsychiatric diseases: Alcohol use disorders, unipolar major depression, primary epilepsyCardiovascular diseases: Hypertensive diseases, hemorrhagic strokeGastrointestinal diseases: Liver cirrhosisConditions arising during perinatal period: Low birth weight

Alcohol-attributable disease and injury (2/2)

Injury:Unintentional injury: Motor vehicle accidents, drownings, falls, poisonings, other unintentional injuriesIntentional injury: Self-inflicted injuries, homicide, other intentional injuries

Preventive effects:DiabetesIschemic heart diseaseIschemic stroke

Deaths among people aged 15–29 years related to selected risk factors, European Region, 2004

0 20000 40000 60000

Alcohol use

Unsafe sex

Illicit drug use

High blood glucose

Physical inactivity

Occupational risks

Iron deficiency

Low fruit/vegetable consumption

Child sexual abuse

Unmet contraceptive needs

Men Women

DeathsDeaths

Total disability-adjusted life-years (DALYs) lost due to selected risk factors, European Region, 2004

Global drinking and European drinking 2005

High exposure, high burden of mortality and disease

• For men between ages of 15 and 64, 1 in 7 deaths in 2004 were caused by alcohol (clearly premature deaths given the life expectancy in Europe)

• For women of the same age category, 1 in 13 deaths in 2004 were caused by alcohol

What works in alcohol policy: evidenceDegree of evidence

Action that reduces alcohol-related harm Action that does not reduce alcohol-related harm

Convincing • Alcohol taxes

• Government monopolies on retail sale

• Restrictions on outlet density

• Restrictions on days and hours of sale

• Minimum purchase age

• Lower legal blood alcohol concentration for driving

• Random breath-testing

• Brief advice programmes

• Treatment for alcohol use disorders

–

Probable • Minimum price per gram of alcohol

• Restrictions on the volume of commercial messages

• Enforcement of restrictions on sales to intoxicated and underage people

• Lower taxes to manage cross-border trade

• Training of alcohol servers

• Designated driver campaigns

• Consumer labelling and warning messages

• Public education campaigns

Limited/Suggestive

• Suspension of driving licences

• Alcohol locks

• Workplace programmes

• Community-based programmes

• Campaigns funded by the alcohol industry

Sixty-third World Health Assembly, 17–21 May 2010

Endorsed the global strategy to reduce the harmful use of alcohol in WHA63.13

European action plan to reduce the harmful useof alcohol (EAAP) 2012–2020 – 10 action areas

• Leadership, awareness and commitment, as sustainable intersectoral action requires strong leadership and a solid base of awareness and political will

• Health services’ response, as these services are central to tackling health conditions in individuals caused by harmful alcohol use

• Community action, as governments and other stakeholders can support and empower communities in adopting effective approaches to prevent and reduce harmful alcohol use in both communities and at workplaces

• Policies and countermeasures on drink–driving, as it is extremely dangerous to drivers, passengers and other people using the roads

• Availability of alcohol, as public health policies to regulate commercial or public availability have proved to be very effective in reducing the general level of harmful use and drinking among minors

EAAP 2012–2020 – 10 action areas

• Marketing of alcoholic beverages, as systems are needed to protect people, particularly children and young people, from advanced advertising and promotion techniques

• Pricing policies, as most consumers, particularly heavy drinkers and young people, are sensitive to changes in the prices of alcohol products

• Reducing the negative consequences of drinking and alcohol intoxication, in order to minimize violence, intoxication and harm to intoxicated people

• Reducing the public health impact of illicit and informally produced alcohol, as its consumption could have additional negative health consequences due to its higher ethanol content and potential contamination with toxic substances

• Monitoring and surveillance, as relevant data create the basis for the appropriate delivery and success of responses

New publication, launched on 27 March 2012.

Special chapter on Alcohol and the workplace

“The workplace provides several opportunities for implementing prevention strategies to reduce the harm done by alcohol, since the majority of adults are employed and spend a significant proportion of their time at work.”

Workplace services and legislationWHO survey in EU Member States (2011)

No of countries (N=29)

Prevention or counselling programmes at workplaces 18

National guidelines for prevention of and counselling for alcohol problems at workplaces

8

Involvement of social partners representing employers and employees in action to prevent and address alcohol-related harm at workplaces

11

Legislation on alcohol testing at workplaces 10

Occupational health risks diseases, injuries, deaths

• Occupational risks play a big role in chronic diseases:

• 26% CVD & chronic pulmonary disease

• 15% asthma

• 10% cancer

• 8% injuries

• 8 % depression

• 300 000 deaths from work-related diseases in the WHO European Region (4% GDP loss)

Health promotion: improved workers' health better performance

Workplace-based initiatives can help support, for instance:

• Work-lfe bakance

• Smoking

• Drinking

• Obesity control

• Cardiovascular health

• Exercise & physical activity

Enterprise community involvement social & environmental determinants

• Safe/healthy access to work – public transport, carpools, walking, cycling

• Voluntary pollution/waste control & cleanup

• Provision of primary health care and health education unavailable through health care services outside the workplace

60th World Health Assembly, May 2007 Resolution 60.26 "Workers' Health: Global Plan of Action"

•The Global Plan of Action developed by the Member States for the Member States •WHA60 endorsed the global plan of action on workers' health (2008-2017)•WHA60 urged Member States to take an number of measures on workers' health

WHO Model of Healthy Workplaces

Combining health protection & health promotion

24

Developed by leading occupational health experts out of systematic review of literature

October 2009 workshop involving 56 experts from 22 countries, international worker & employer representatives

Paradigm shiftFrom: Labour approach

Occupational healthTo: Public health approach

Workers' health

Action at workplaceAction to include workers'

families & communities

Work-related health issues only

Include all health determinants

Work under labour contractInclude all workers (self-employed, informal workers)

Employers' responsibilityAll stakeholders' responsible (insurance, health & environm. authorities, a.o.)

Negotiation between workers and employers Health protection is a non-

negotiable

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A holistic framework for action

1. Action in four realms:

• Physical work

• Psychosocial environment

• Personal health

• Community involvement

2. A model of continuous improvement

Psychosocial

work environm

ent

Enterprise community involvement

Personal health

resources

Physical work environment

Mobilize

Assemble

Improve

Evaluate

Do

Plan

Prioritize

AssessETHICS & VALUES

Leadership engagement

Worker involvement

• Eliminate a toxic chemical or substitute with less hazardous

• Install machine guards/exhaust ventilation

• Train workers on safe operating procedures

• Personal protective equipment such as respirators or hard hats

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Reallocate work to reduce workload

Zero tolerance for harassment, bullying, discrimination

Respect work-family balance

Recognize and reward good performance

Meaningful worker input into decisions that affect them

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• provide fitness facilities, classes or equipment for workers;

• provide healthy food choices (e.g., cafeteria)

• put no-smoking policies in place, provide smoking cessation assistance;

• provide information about alcohol and drugs, and employee assistance counseling

As an employer you can create or remove barriers to lifestyle changes!

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- Free/affordable Primary health care to workers/family members;

- Voluntary controls over pollutants released into the air or water;

- Financial support to worthwhile community causes;

- Minimize greenhouse gas emissions.

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Crosscutting principles for success

• Leadership engagement

• Involve workers & their representatives

• Do an effective gap analysis

• Learn from others

• Integrate activities

• Evaluate and improve

Healthy workplaces is inspired by the WHO definition of health as:

“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”

32

WHO constitution, signed on 22 July 1946 by the representatives of 61 States and entered into force on 7 April 1948

Outlook of WHO is based on its Constiution…

How to convince the business community

1. The 'right' thing to do: businesses are part of society and ethical/social frameworks

2. The 'legal' thing to do: in our globalized world, businesses that ignore or undermine workers' health are open to litigation and media scrutiny

3. The 'smart' thing to do: businesses that protect workers' health are among the most successful over time

Healthy companies are also profitable!

For every $ spent:

– Medical costs fall by $3.27

– Absenteeism costs fall by $2.73

“The wide adoption of wellbeing programs could prove beneficial for budgets and productivity as well as health outcomes”

(Baicker K, et al. Workplace wellness programs can generate savings. Health Affairs, 2010)

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A holistic framework for action

Psychosocial work

environment

Enterprise community involvement

Personal health

resources

Physical work environment

Mobilize

AssembleImprove

Evaluate

Do

Plan

Prioritize

AssessETHICS & VALUES

Leadership engagement

Worker involvement

Elements of good practices of health workplaces initiative at the company level

• Linking programmes to business objectives

• Top management support

• Employee advisory boards

• Effective communication

• Supportive environment

• Use of incentives

• Goal setting

• Self-efficacy

• Social environment, social norms and social support

• Tailored programmes

• Building effective programmes across the individual to environment continuum

Healthy workplaces model: an integrated approach

A comprehensive approach that embraces:

• Traditional & emerging occupational health – minimizing workers' exposure to job-related physical & psychosocial risks

• Health promotion – promoting healthy behaviours among workers, both job- and lifestyle-related

• Enterprise involvement in community – to address broader social & environmental determinants of workers health

Together, we can make a difference!

Thank you.Acknowledgements: Parts of this presentation were supported by my colleagues, Drs. Lars Moeller and Evelyn Kortum.

Email: kimr@who.int

www.euro.who.int/alcohol

http://www.euro.who.int/en/what-we-do/health-topics/environment-and-health/occupational-health

http://www.who.int/occupational_health/healthy_workplaces