Workplace illnesses are on the rise, yet many companies miss key health metrics, write the AIOH’s Carmen Naylor and Jane Whitelaw

WHS performance indicators are important to ensure effective management and to contribute to organisational decision-making processes regarding risk mitigation. Recent articles on the increasing prevalence of silicosis and resurgence of “black lung” has increased awareness of work-related health impacts, and understanding occupational health impacts is critical to maintaining a healthy and productive workforce. Safe Work Australia (SWA) estimates workers are eight times more likely to die from work related illness than an injury. Yet despite the critical impact of occupational illnesses and disease, a minority of companies include intentional occupational health performance indicators in their WHS reporting.

The Australian WHS Strategy recognises the importance of monitoring and addressing prevalence of worker health impacts, however barriers such as less than adequate tracking of occupational illness and disease and reporting to Australian workplace regulators remains an issue.

The need for better tracking of occupational health impacts
The introduction of an occupational disease registry, as outlined by the Australian Occupational Health and Safety National Dust Disease Taskforce was an initiative to enhance tracking and reporting of occupational illness and disease. With an initial focus on silica, a register compiling data on occupational respiratory disease such as this is an opportunity to enhance regulators’ ability to quantify the prevalence, trends, and potentially the root cause of workplace-related health conditions.
Due to this lag period the cause of the health impact is also often difficult to determine when the health impact does manifest. What this means is we need meaningful lead indicators that direct towards positive health outcomes for our workers.

What does good health look like?
Health in the workplace can be seen as a triangle, made up of the three intersecting spheres of occupational hygiene, wellbeing and occupational health. The World Health Organisation defines “health” as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. So drawing on this definition, occupational health is not just the absence of disease but the promotion and maintenance of the highest degree of physical, mental and social wellbeing of all workers – at work, at home and in retirement.

AIOH strategic working group
To improve how organisations evaluate worker health protection, the Australian Institute of Occupational Hygiene (AIOH) has formed a working group to help enable businesses establish occupational health performance indicators to ensure a balanced approach to monitoring performance in the WHS space.
The understanding of occupational health indicators, particularly indicators in the leading part of the health spectrum is very mixed. In the space of occupational health performance measurement lagging metrics are often used to track when an illness, disease or exposure has occurred. It is important that there is no overemphasis on lagging indicators as this may not accurately reflect current occupational health performance measurement due to the lag period between exposure and health impact.
Both lagging and leading performance indicators serve a purpose for monitoring critical controls and can be used by companies to monitor occupational health performance. These indicators can be quantitative, such as using health and exposure monitoring data, or qualitative, such as ascertaining opinions regarding occupational exposures.

Leading vs lagging indicators 

The spectrum of occupational health indicators
The spectrum of occupational health indicators spans from leading indicators such as, health risk assessment, training participation in health hazards such as asbestos awareness to lagging indicators which includes indicators which include incidence rates of occupational illness and disease.
For example, the Australian Nuclear Science and Technology (ANSTO) has been reporting on health performance indicators for many years, and their WHS reporting frameworks include a combination of both lagging and leading performance indicators. “At ANSTO we strive for a balanced approach in health as well as safety reporting,” said Carmen Naylor, leader of human health monitoring at ANSTO. “Examples of health indicators we report on include the status of occupational hygiene and radiation protection surveys, health surveillance programs, exposure monitoring results benchmarked against both external and internal review levels, promotion of good health management standards, and the effectiveness of control measures such as respiratory protection programs.”

Literature on high quality leading health performance indicators is scarce, with a focus on low order controls such as personal protective equipment. However, some industries like nuclear, oil and gas, have been developing performance indicators in health and in 2020 the American Industrial Hygiene Association (AIHA) provided a best practice guide for leading health metrics to support health management in the workplace. It was great to see although leading indicators are less commonly measured and understood, that more discussion on this topic is occurring.

A leading indicator is prospective and can be a predictor of future health and safety performance. There is increasing recognition of the value of leading indicators is that they can be preventative and provide warning that something may be wrong. If established effectively leading occupational health indicators provide critical insights into what will influence adverse occupational health impacts and assist with the prevention of illness and disease.

Leading health performance indicators are “measurable, meaningful, actionable, and evidence-based that can be used to monitor, predict, influence or manage exposures, hazards, actions and conditions of work that may impact worker health and wellbeing.”
As an example, Breathe Freely Australia provides a simple self-assessment tool to help workplaces identify the key areas and then introduce, manage and improve their worker health protection programmes.

So, what do you say are strong health performance indicators?
As part of this research, we would like to develop a questionnaire that is tailormade to support health management of health hazards based on our industry/sectors and are reaching out to OHS professionals to gain their opinion and experience on what good worker health looks like. This will then be refined into a list of high-quality leading indicators.

We need your input to identify some key leading health indicators that we can use as part of our broader online survey. The survey can be accessed by scanning the QR code below and should take less than five minutes to complete.

Key messages
Effective management of health hazards in the workplace requires a proactive approach. The common saying, “you can’t manage, what you don’t measure” supports the idea that OHS measurements can assist companies in identifying and controlling underlying risk factors.
We recommend a balanced approach to the management of health and safety in the workplace, and the integration of leading occupational health performance metrics into health and safety reporting practices is critical to help protect the health of our workers and is an important component of occupational health and safety management systems. By doing so, organisations can truly demonstrate their commitment to a safe AND healthy workforce.
Leading and lagging indicators should co-exist without over emphasis on past (lagging) indicators. Good quality leading indicators will ultimately be more effective in helping reduce or eliminate serious adverse health outcomes in our workers.