Is it worthwhile to invest in workplace health and safety programs? The answer is a definite “yes” for some types of interventions, according to a new systematic review by the Institute for Work & Health (IWH). It is the first review to evaluate occupational health and safety (OHS) intervention studies on their economic benefits.
Ergonomic programs in the manufacturing and warehousing sector have both financial and health benefits, as do other programs designed to prevent musculoskeletal or soft-tissue disorders (MSDs) in this sector. Disability management programs – which aim to prevent re-injury or reduce disability in injured workers – also show a health and an economic benefit. These interventions were generally evaluated from the point of view of insurers, compensation boards or other system-level organizations.
The review shows there is strong evidence supporting these two types of interventions. Strong evidence means that at least three high-quality studies show a positive health effect and financial returns.
Resources are scarce, says Dr. Emile Tompa, IWH Scientist, who led the review.
Before investing money, time, equipment or other resources into any occupational health and safety program, most decision-makers want to know what the resource implications will be. One key motivation for conducting this review was to provide answers for decision-makers at workplaces, compensation boards, governments and elsewhere.
The review team did a comprehensive scan of research studies. They sought studies that analyzed both the effectiveness and economic impact of OHS interventions. Their search yielded 67 relevant articles, which looked at 72 interventions. Most were in ergonomics or disability management, with several in occupational disease prevention and health promotion.
Most interventions were found to be effective in preventing or reducing injury, illness or disability in workers by the researchers of each study. What was the impact of these interventions on resources, such as money or time? This varied, depending on the perspective of the study.
The perspective taken is important, says Tompa.
When considering the resource implications, you need to consider who benefits and who pays.
An economic evaluation can take the perspective of workers, employers, the prevention system or insurer, or society. In most cases the studies took the employer perspective. They considered costs such as equipment, services and staff time. And most looked only at the main financial benefits such as savings in workers’ compensation expenses. However, a few studies examined a broader range of financial consequences, including productivity improvements and health-care savings.
The review team was guided by practical input from representatives from the Workplace Safety and Insurance Board, Workers Health and Safety Centre, Ministry of Labour, Dofasco, University of Waterloo and the Ontario Service Safety Alliance.
This group was very helpful in identifying the kinds of information they needed, says Tompa. They also suggested organizing findings by sector and type of intervention, so that the findings would be presented in a more useful way to decision-makers.
In other sectors, there weren't enough high-quality studies to say the evidence was strong. However, in some cases there was enough information to say the evidence was moderate. The reviewers found moderate evidence supporting ergonomic and other MSD prevention interventions in three sectors: administrative and support services, health care and transportation. Studies were also identified in other sectors, including education, utilities, public administration, retail trade, accommodation and food, information and culture, and mining, oil and gas extraction. In these sectors, there weren’t enough studies and/or the study quality was too low to make a firm summary statement about the evidence.
Although our summary statements provide confidence in the financial benefits of several types of interventions, one should look at the detailed information tables from our review and the individual studies before making any decisions, to better understand the nature and context of interventions, Tompa says.
This is the first systematic review of intervention studies with economic analyses that uses a structured approach to identifying studies and synthesizing the overall results, he says. The review team included research associates Roman Dolinschi and Claire de Oliveira, as well as Emma Irvin, manager of IWH’s systematic review program.
Given the amount of research into OHS interventions, and that resource use is an important part of decision-making, Tompa says that researchers should be thinking about including economic analyses up front in future studies. As part of an effort to promote this field, Tompa is editing a “how-to” book on conducting an economic evaluation of OHS programs, written by experts from around the world. The book will be published in 2008 by Oxford University Press.