The role of Vision Zero and related occupational safety & health strategies, interventions, and tools in reducing EU work related fatalities, accidents and ill health

​​ Introduction

The current EU strategic framework on health and safety at work 2021-2027^[1] builds on previous strategies that have seen substantial improvements in occupational safety and health (now referred to as; OSH). Between 1994 and 2020 there has been an overall reduction of about 70% in OSH accidents that have resulted in fatalities^[2],[1]. Despite this success, the number OSH fatalities, accidents, and ill health remains far too high and this preventable and incalculable human suffering endured by EU workers regrettably continues. In 2020, there were 3,358 fatal accidents at work reported and over 2.7 million accidents that resulted in four or more days off work^[3]. In addition, OSH related illnesses cause an estimated 200,000 workers to lose their lives  each year^[2].

The imperative to further drive down OSH related fatalities, accidents, and ill health remains the single most important expectation of the EU strategic framework on health and safety at work 2021-2027 (now referred to as the; EU-OSH 2021-27 strategy). In addition, the European Commission and the Advisory Committee on Safety and Health at Work^[1],[2] recognises that these OSH related fatalities, accidents, and ill health impose enormous financial and productivity burdens on EU enterprises. Therefore, these incidents also represent opportunities to reduce costs and improve profits. In terms of lost finance and productivity, the costs of OSH related fatalities, accidents, and illnesses in the EU are substantial.  For the EU-27 in 2019, the total costs were at least EUR 460 billion and costs from work-related cancers were circa EUR 120 billion each year^[1],[4].

The current EU-OSH 2021-27 strategy has an overarching theme of further reducing OSH related fatalities, accidents and ill health. As part of this strategy, the European Commission and the Advisory Committee on Safety and Health at Work  have chosen to promote the use of Vision Zero to further reduce OSH related fatalities, accidents, and ill health.

The Vision Zero concept

Vision Zero-themed approaches are from a family of similarly named strategies that have existed since the 1960s and include Zero Defects, Zero Waste, and Zero Harm^[5],[6],[7].  The Vision Zero concept is now also mainstream in the sustainability community with strategies such as Net Zero Emissions and Nearly Zero Energy Buildings.

Enterprises and other organisations that adopt a Vision Zero strategy as promoted by the EU-OSH 2021-27 strategy, will have a principal and underlying belief that fatalities, accidents, and ill heath at work are preventable. This belief leads to a commitment to implement those OSH related conditions and behaviours that will ensure this prevention, and thereby result in the required reduction in OSH related fatalities, accidents, and ill health. Vision Zero using enterprises and other organisations will therefore strive to prevent OSH related risks that arise from all relevant biological, chemical, physical, and psychosocial risks. 

The earliest example of a Vision Zero  based OSH  strategy involving  an EU Member State  at national level, was a transport safety initiative implemented by Sweden in the late 1990s^[5]. This Vision Zero example was aimed at road traffic fatalities and injuries as well as improving safe and equitable mobility for all citizens. The success of this Swedish initiative was notable. Since the year 2000, Sweden’s adoption of this Vision Zero version saw a circa 50% fall in road traffic fatalities as well as a reduction to very low levels of fatalities in the commercial transport sector^[5].

The closely aligned Zero Accident Vision which has emerged from industry, is a well-known and widely adopted accident prevention strategy found across a range of global industries^[8],[6].  Zero Accident Vision as the name suggests, refers to workplace accident prevention and various studies have reported the beneficial effects of this particular Vision Zero strategy. This includes an aluminium smelting enterprise that adopted this strategy being named as the world’s safest smelter^[9]. A further study of 27 European companies that adopted Zero Accident Vision^[10] found that they all had high levels of safety communication, safety culture and learning as well as a well-developed organisational and individual commitment to the strategy.  

There are a number of organisational features exhibited by enterprises and other organisations that adopt Vision Zero strategies. Ahamad et al in a recent systematic literature review^[8] presents the most important variables within enterprises that have adopted Zero Accident Vision strategies as being: an occupational safety management system, organisational leadership, safety culture, safety communication, risk assessment, and compliance with safety legislation. DGUV, the influential German social accident insurance association^[11] presents “7 golden rules” (adopted from ISSA^[12]) that enterprises need to exhibit when implementing Vision Zero being: take leadership and demonstrate commitment; identify hazards and control risks; define targets and develop programmes; ensure a safe and healthy system of work and be well organised; ensure safety and health regarding  machines, equipment and workplaces;  improve workforce qualifications and develop competence.

Why adopt Vision Zero

As will be listed below, there are many strategies, interventions and tools that can be adopted by Member State enterprises in order to reduce current rates of OSH related fatalities, accidents, and ill health. However, there are strong reasons for relevant EU and national stakeholders to support and encourage enterprises to adopt Vision Zero strategies.

Vision Zero aligns with the legal requirements of the Framework Directive (EU 89/391/EEC, 1989)^[13] which has long been transposed into EU Member State legislation. Therefore, the Framework Directive’s emphasis on the prevention of OSH related fatalities, accidents, and ill health by enterprises will be met by a well-implemented Vision Zero strategy. In particular, Vision Zero allows for the legally required preventative ethos that fully utilises the hierarchy of controls. Vision Zero enterprises would therefore be expected to eliminate OSH risks in the first instance. Where this is not possible, enterprises would prioritise collective initiatives over those aimed at individual workers. Furthermore, the necessary commitment to prevention as required by Vision Zero has long been understood to be a central precursor to the successful implementation of effective safety management systems^[8],[10].

Vision Zero also has the scope to ensure that the full spectrum of chemical, physical, biological and psychosocial risks that can manifest themselves in enterprises will be appropriately managed. This will ensure that cross discipline issues, for example bullying, harassment, violence, stress, gender based effects and all detrimental OSH related health outcomes, are equally subject to the required preventative ethos of the Framework Directive.

Vision Zero has national, European, and international credibility, recognition, support and widespread presence as an OSH strategy. Vision Zero has also been recommended for use by the European Commission, the Advisory Committee on Safety and Health at Work, the International Labour Organisation (ILO), Finland’s and Germany’s Vision Zero Forums, the UK-based Institute for Occupational Safety & Health, the Swiss-based International Social Security Association, the ILO’s Global Coalition for Safety and Health at Work and the World Health Organisation. In particular, strong support for this strategy is given by Finland’s Vision Zero Forum who report the beneficial and sustainable collaborative effects for both employers and workers from this approach^[14],[15]. Vision Zero also aligns very well with a 2020 European Parliament resolution (2020/2084(INI))^[16] that calls on the Member States to commit to eliminating work-related deaths and substantially reduce work-related illnesses.

This widespread adoption of Vision Zero is well known by European Union Labour Inspectorates and enforcement agencies. They will therefore recognise the contribution to compliance with relevant OSH legislation, that well-implemented Vision Zero strategies will bring. In addition, the Vision Zero concept is sufficiently flexible to enable compatibility with all OSH related certifiable standards, such as ISO 45001.

It should be noted however that there is an ongoing academic debate surrounding Vision Zero. There are notable scholars as well as some OSH related professionals who recommend alternatives to Vision Zero^[17],[18]. These alternatives are also listed in section 6 below. This debate centres on the theory that OSH should now move away from the more traditional approach of looking for compliance issues and continually monitoring OSH related incidents. This move should encompass how well work-related tasks are usually carried out given the realities workers face. It also includes how these same workers can be better enabled to adapt and thereby create safer working conditions. Both sides of this complex and robustly contested academic debate are summarised by Cooper^{[19],[20],[21],[14]}.

What Else is the EU Asking For

The EU-OSH 2021-27 strategy calls on Member States and their Labour Inspectorates, social partners, employers, and workers to collectively support Vision Zero as part of the drive to further reduce OSH related fatalities, accidents, and ill health. But what the EU-OSH 2021-27 strategy and the Advisory Committee on Safety and Health at Work are also calling for is as follows:

• A strengthening of compliance with OSH legislation; this increased compliance, whether implemented by Labour Inspectorates or preventative services engaged by enterprises will again serve to reduce OSH related fatalities, accidents, and ill health and thereby support the EU-OSH 2021-27 strategy.
• More thorough investigation and accident analysis to uncover the causes of OSH related fatalities accidents and ill health; this information will deliver learning opportunities for enterprises and prevent similar occurrences.
• An increase in the awareness of risks from OSH related fatalities, accidents and ill health; this will strengthen the knowledge base of enterprises as they select strategies, interventions, and tools to reduce OSH related fatalities, accidents, and ill health.
• An increase in preparedness for future health crises; The recent global pandemic has underlined the need for enterprises and public institutions to exhibit greater resilience in the face of as yet unknown health crises.

Choosing Safety Strategies, Interventions and Tools

It is not the function of this discussion paper to recommend any one strategy, intervention, or tool over any other when an enterprise or any other organisation considers how to reduce OSH related fatalities, accidents, or ill health. The complexity and wide-ranging characteristics of the EU’s 26.3 million enterprises with its 131 million workers^[22]  means that the most appropriate OSH related strategy, intervention or tools will vary greatly. There is no one size fits all approach and careful analysis will be needed regarding this selection.

However, this does not overshadow the overall decline in OSH related fatalities accidents, and ill health between 1990 and 2019^[2],[1]. A proportion of this reduction can be attributed to the successful implementation of various OSH related EU and national legislation, strategies, interventions, and tools. Rapid advances in the management of OSH since the 1960s also means that there are now a large number of evidence-based strategies, interventions and tools available which are summarily listed in section 6 below. In addition, digital resources including Artificial Intelligence  and Big Data applications are increasing on a daily basis^[23]. These are now widely available to enterprises as well as OSH professionals looking to incorporate Vision Zero or any other strategy, intervention or tools. Therefore, this discussion paper is designed to inform the decision making process for those enterprises professionals and worker advocacy groups considering improvements to reduce  OSH related fatalities, accidents and ill health. It should also be noted that this paper has been written after extensive consultation by the author with the EU’s social partners, national representatives, OSH experts, EU-OSHA, the European Commission and the Advisory Committee on Safety and Health at Work. This consultation involved meetings and workshops, as well as a review of relevant OSH related literature.

A notable contribution to the management of OSH is a recent and comprehensive literature review from EU-OSHA on improving compliance with occupational safety and health regulations^[24]. This literature review details evidence-based strategies, interventions and tools that have improved OSH. This review also listed five cross-cutting themes that individually as well collectively affect this level of compliance being;  

• Legislation and enforcement as delivered by National Labour Inspectorates
• Social norms: moral and ethical expectations towards providing appropriate OSH conditions including, certifiable standards (eg ISO 45001), Corporate and Social Responsibility, reporting initiatives and media influences
• Economic incentives: including publicising the costs and productivity losses from OSH related fatalities, accidents, and ill health.
• Supply chain influences: including SMEs being tied into the safety management systems of larger enterprises.
• Preventative OSH services including web-based tools (eg OiRA and BeSMART, (see for example Hrymak^[25]) or provided by internal OSH professionals as well as external consultancy businesses

One of the many recommendations from this review concludes that competent enforcement authorities are better placed to provide leadership to support compliance than most other actors. An example of a successful Member State led intervention is the Irish smoking ban implemented in 2004^[26]. In another recent literature review^[27] on the prevention of accidents at work, the authors recommended prioritising those organisational level interventions that foster safe OSH environments and apply the hierarchy of controls, over individual worker initiatives.

A further consideration is the size of enterprises selected for particular OSH strategies interventions or tools. Basically the smaller the enterprise, the more difficult it is for them to achieve appropriate levels of compliance with OSH legislation due to resource, knowledge and capability constraints^[28],[22]. For these smaller enterprises, research has suggested that regulatory interventions, and the provision of easily accessible, clear, and unambiguous advice is advantageous^[26].

Strategies, interventions & tools

What will be presented now, is a collection of strategies, interventions, or tools that have been published by EU-OSHA, or the academic literature and are considered pragmatically capable of reducing OSH related fatalities, accidents and ill health.  

Risk assessment methods

• Various guides to risk assessment, safety auditing, systematic visual inspection methods and walkabouts^{[29],[30],[31][23],[32],[33],[34]}
• Asking OSH related questions of workers and employers^[35].
• Published EU-OSHA guidance (e.g., for SMEs^[26]).
• Web based tools and platforms such as OiRA and BeSMART^[23],[36].
• Checklists, questionnaires, surveys and templates (e.g., for MSDs^[37]).

Strategies and Interventions

• Certifiable OSH management systems and standards e.g., ISO 45001; 2018 and related Plan Do Check Act strategies.
• Unionisation, safety representatives, champions, and worker advocacy groups^[38],[39].
• Human factors & ergonomics-based approaches^[40],[41].
• The increasing use of Artificial Intelligence and Big Data for safety monitoring and analysis^[21].
• Increasing OSH education in primary schools, secondary schools, and universities^{[42],[43],[44]}.
• Behavioural safety and goal setting programmes with the important provision that workers as a whole are the focus of such interventions, and not individuals^[45].
• Human error, near miss recording^[46].
• Safety culture and climate-based interventions^[47],[48].
• Change management and nudge theory^{[49],[44],[50]}.
• Safety II (and related approaches)^{[17],[18],[19]}.
• High reliability organisations^[51],[52].
• Resilience engineering^[53],[54].
• Publicising negative outcomes such as prosecutions, fines, or adverse OSH conditions^[55].

Tools

• Promotions, awareness and enforcement campaigns eg the Irish smoking ban of 2004^[24].
• Accident analysis methods e.g., investigations, root cause analysis, the swiss cheese model, bow tie analysis, etc^[5].
• The use of  Machine Learning, Cloud Computing, and the Internet of Things^[21].
• Health education e.g., the Italian metal workers and eye injuries study^[56].
• Digital training platforms e.g., OiRA and BeSMART^[23],[33].
• Risk management software e.g., Sweden’s IA system.  (See https://iasystemet.se/en).
• EU-OSHA’s OSH Barometer^[57].

Examples of Good Practice

• Extensive EU-OSHA publications listing (https://osha.europa.eu/).
• National and International OSH Labour Inspectorate websites and campaigns (e.g., https://hsa.ie).
• National Codes of Practice, Standards, and Guidance Documents (e.g.,https://hsa.ie).
• Health and safety at work-related Social Insurance enterprises websites and campaigns (eg DGUV.ie).
• Cross UK; a confidential system for the architectural engineering and construction community.  This is used to nationally inform of fire and structural safety problems uncovered by relevant professionals[58].
• Workplace safety related professional bodies (eg’s IOSH, ISSA, ILO, WHO).

Labour inspectorate policy & practice

Labour Inspectors play a central role when it comes to positively influencing enterprises they come into contact with^[59].  Some commentators for example^[60],[61] report that Labour Inspectors are the most important actors in terms of compliance with OSH legislation. Therefore, it is appropriate that EU Labour Inspectorates are referenced by the EU-OSH 2021-27 strategy as well as the Advisory Committee on Safety and Health at Work Opinion on Vision Zero^[2]. Both these publications recommend further EU Labour Inspectorate initiatives to continue their existing support for compliance with OSH legislation. Further engagement with OSH related researchers is also recommended by a recent EU-OSHA publication^[53].

Conclusions

The overall aim of this paper is to take stock of where the European Union is at the moment in terms of OSH and consider where it needs to go in order to substantially reduce OSH related fatalities, accidents and ill health. This reduction is an absolute and immediate necessity given the consensus on the immense and unimaginable human suffering caused by current OSH related fatalities, accidents and ill health^[62].  In this regard and echoing the call from EU-OSHA^[22] the necessity for a greater empirical evidence base detailing what will reduce OSH related fatalities, accidents and ill health is paramount. Pragmatic research to underpin which strategies, interventions and tools should be prioritised. This is not a luxury, but a necessity.

There are many possible evidence-based strategies interventions and tools available to reduce OSH related fatalities accidents and ill health.  The following non-exhaustive listing presents a compilation aimed at providing evidence-based options. This listing has been compiled after consultation and is considered to enable better compliance with OSH legislation and thereby reduce the unacceptably high number of OSH related fatalities accidents and ill health:

• Implementing more research into what supports successful compliance with OSH legislation.
• Discussions with the Senior Labour Inspectors Committee on the need for further Labour Inspectorate based research.
• Enterprises using web-based tools such as OiRA and BeSMART should be approached to further collaborate on research into the effects achieved.
• Potential further use of EU-OSHA awards for enterprises using OSH related innovative strategies, interventions, and tools.
• EU-OSHA could present and further publicise pragmatic, evidence-based strategies, interventions, and tools that have achieved OSH improvements.
• EU-OSHA could trial a national and European wide initiative for safety professionals to anonymously raise OSH problems they encounter, in a manner similar to the successful and highly informative Cross UK web site^[54]
• EU-OSHA’s OSH Barometer should collect additional evidence prioritising sectors and gender issues^[63] that can significantly contribute to reducing OSH related fatalities accidents and ill health.
• There is a case for prioritising sectors with the highest rates of fatalities and SMEs within national OSH strategies (including gender categories) given their dominant position regarding OSH related fatalities
• Further promoting EU-OSHA activities on national OSH websites.
• Further harnessing supply chain, Corporate and Social Responsibility and social norm influence for example publicising prosecutions and closures
• Further publicising accident investigation and analysis methods
• Further publicising evidence-based improvements for visual inspections, risk assessment and safety auditing methods