the hierarchy of controls - can it work for...

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Prof Lin Fritschi

The hierarchy of control - can it work for health?

2014



Talk outline

Hierarchy of control

Traditional use to control hazards

Use of the hierarchy in healthy workplace programs

Combining OHS & HP

Improving productivity




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



http://www.qualitysystems.com/support/pages/hierarchy-of-controls

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



Traditional use of the hierarchy to control

hazards Diesel exhaust

UV radiation



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



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



Diesel engine exhaust – control

Elimination – stop using diesel engines?

Substitution – replace diesel with petrol/LPG engines?

Engineering – particulate filters, oxidation catalyst,

exhaust systems



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

..



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

..



Honda News, Whayne Parts, Gencat Co

..



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?



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



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



UV radiation – control

Elimination – stop outside work?

Substitution – replace outside workplaces with inside

ones?

Engineering – shade screens, indoor work where possible

Administration – policies



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



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



UV radiation - PPE

Cancer Council SA



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



Lack of exercise

Elimination – parking availability

Substitution – substitute incidental physical activity

Engineering – building design



Engineering - exercise

http://www.fast-exercises.com/stairs/



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



http://sourceable.net/fusing-architecture-and-health-opt-for-stairs-over-lifts/



Lack of exercise

Elimination – parking availability

Substitution – substitute incidental physical activity

Engineering – building design, stairs,

Administration – policies, gym membership

Behaviour – encourage physical activity



Behaviour – exercise

Greensense



http://www.qualitysystems.com/support/pages/hierarchy-of-controls

Hierarchy of Control



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



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



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



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



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



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



Improving productivity

Growing evidence that integrated programs can reduce

health-care costs, increase productivity and reduce

absenteeism

Sorensen, 2011, Goetzel 2001



Goetzel, 2011

30.07.2010



Goetzel, 2011



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



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



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



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



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.

the hierarchy of controls - can it work for...

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