Policy Brief: Occupational health: Carrot or stick approach?

By Gemma Bray


One of the main principles of the International Labour Organisation’s (ILO) Constitution is that workers should be protected from sickness, injury and disease which arises from or is caused by their employment. This is not reflected in the statistics on work related accidents and diseases. The ILO has estimated that there are 317 million, work-related accidents each year and a further 160 million people are affected by work-related diseases.  For over 2 million people, such illnesses and injuries are fatal.

This is damaging for all parties involved. The immense distress caused by such accidents and diseases to workers and their families is clear. The employer must replace skilled staff and cover high insurance premiums. Economically, according to estimates by the ILO, 4% of global GDP (around US$2.8 trillion) is lost annually due to these occupational accidents and diseases.

It is possible to prevent many of these work-related accidents and diseases by putting into practice health and safety-related preventative measures. In 2003 the ILO implemented a global strategy aimed at improving occupational safety and health (OSH). The ILO standards on OSH offer tools for governments, employers and workers to incorporate this ethos whilst also providing technical assistance. Below are some examples of the different ways in which OSH standards have been achieved.

Examples of this at work:

Sierra Leone

In March 2014 it was confirmed that there was an outbreak of Ebola in Guinea. This quickly spread to the neighbouring countries of Sierra Leone and Liberia. By March 2015, 815 confirmed and probable cases of Ebola infected health workers had been reported. This showed that the risk of infection to health workers was up to 32 times higher than that of the general population.  Occupational Safety and Health (OSH) training for health workers had not been enforced prior to the outbreak, meaning procedures for cleaning and disinfecting equipment, hand hygiene and correct use and maintenance of Personal Protective Equipment (PPE) were not in place.

Once adequate supplies of PPE and appropriate OSH training were delivered and implemented, the number of health workers becoming infected dropped notably (Fig 1.).

Gemma Bray

Figure 1:  Number of confirmed and probable health worker EVD (Ebola virus disease) cases over time across the three main affected countries. Source:  http://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_379048/lang–en/index.htm

Alongside the provision of extensive international resources, the improved health and safety measures continued to be implemented and the last case of Ebola was recorded in Liberia in April 2016.

The countries involved have adopted OSH standards in an effort to prevent a similar situation from occurring again. A number of Country Managers have been trained in Environmental and Occupational Health (EOH) and a  hub of EOH research  has been established to enhance training for the region.


A significant proportion of the Thai workforce is employed in the informal economy.   Although the work they perform tends to have higher risks of occupational injuries and diseases, they are often unable to access occupational health services.  In an attempt to change this the Government of Thailand, with assistance from the ILO, has run a pilot programme which involved enabling local Primary Care Units (PCUs) to provide the training of Health Volunteers in basic OSH issues.  Health Volunteers are people in local communities who apply to work with public health officers to promote health and prevent disease.  For this programme the Health Volunteers were incentivised by an additional monthly payment of 600 Baht (approximately US$17) per month.

Staff from the PCUs are familiar with the communities in which they work and are well placed to have an understanding of workplaces where health and safety problems are likely to arise. In the programme, the key areas of Health Volunteer training focussed on workplace walk-through surveys to provide risk assessments and suggestions for sustainable improvements, surveillance for work-related diseases, promotion of health and provision of safety equipment.

A range of target enterprises within the informal sector which were involved in the study, included businesses in agriculture, textiles and the fish processing industries. Occupational health measures which were successfully implemented were often simple but effective and most importantly for their ongoing success, low cost.  For example, in the agricultural industry workers growing longans (a type of fruit) were encouraged to start using organic pesticides and fertilisers provided to the farm owners at no extra cost, replacing the more toxic variants they had used previously.

The fish processing industry also gave rise to implementation of successful OSH policies. Workers were provided with chairs and work benches to prevent back problems associated with working on the floor.  Floors were cleaned regularly to prevent people from slipping, trollies were used to avoid lifting heavy crates and workers using knives were provided with gloves to prevent accidental cuts.

For the small amount of funding required, the pilot study was deemed a success and is now being rolled out to other areas of Thailand.

United Kingdom

In developed countries where the economy is far more formalised, ensuring health and safety rules are implemented is easier to achieve and the laws of the country involved can ensure companies face penalties and company directors can even face imprisonment for a breaching the OSH standards. The United Kingdom has had laws pertaining to health and safety for over 150 years, and has become a model upon which other developed countries base themselves.

There is therefore far more onus on companies to ensure they are compliant with the relevant OSH standards in developed countries and workplace inspections are an eventuality every business must be prepared for. In recent years there are examples of large fines being levied and the imprisonment of company directors found guilty for corporate manslaughter.

An example of this is of a Bury based machining company which in 2015 failed to ensure the safety of a 16 year old government scheme apprentice. He had been employed by the company for less than one month when he was caught up in a machine and killed.  The subsequent investigation found a number of breaches in safety standards.  These included insufficient training as well as the override of safety mechanisms.  As a result rapidly spinning parts of the machine became accessible and the oversized overalls given to the apprentice were caught up in the mechanism, pulling his face and upper body into the machine.  The company was fined £150,000 and the company director was sentenced to eight months in prison.

One size doesn’t fit all

As can be seen from the three very different examples above there is not one clear way of ensuring that OSH standards are applied. The circumstances of a country will change the approach required.  Countries with more formalised economies are better equipped to ensure procedures are followed and given the higher levels of awareness and ability to provide such standards, it is deemed acceptable by society that companies which do not comply are penalised.

Similarly in order to get a country to begin implementation of OSH standards from a basic starting point, it is far more likely to be successful if the companies are incentivised to do so. Given the lack of labour standards in most informal economies, in order to engage with small enterprises it is important that they feel able to interact with the relevant bodies to obtain advice, without fear of punishment.  Working with communities and providing technical assistance where required means that implementation does not have to be an expensive process for the respective governments or employers.

Finally, some circumstances are severe enough to necessitate the immediate implementation of OSH standards. In these cases, help and provision of resources from outside the country are necessary.  If the new standards are to remain sustainable however, the schemes need continuing support from their relevant governments and employers.

In order for OSH standards to be successfully integrated into the working ethos of a country, government support is key, as is that of the employers. It is also essential that appropriate employee representative bodies i.e. trade unions are aware of how OSH standards can be used to promote a preventative health and safety culture.  The ILO’s tripartite structure puts it in the unique position to have influence over all sectors involved and it has developed methodologies for labour inspectors in both formal and informal economies with this in mind.


Gemma Bray is an MSc student in Data Science at the University of Sheffield’s Information School.


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