Health and wellbeing

Introduction

Health and wellbeing are essential elements to increase and/or maintain employee performance, productivity, job satisfaction and engagement within the work environment. This article presents an overview of the differences in the interpretation of the terms, while acknowledging that these differences arise due to cultural and organisational interpretation of workplace practices. In addition, it highlights organisations' promotion of policies to improve or increase health and wellbeing in the workplace. Effective policies and practices could lead to healthy employees with a high state of wellbeing, which benefits both the organisation and the wider society.

Health and wellbeing: An overview

Concepts

Health and wellbeing are two concepts that are prominent within the field of occupational safety and health (OSH). There are different interpretations of these concepts across the European Union (EU) ^[1], which strengthen the importance of assessing it more consistently within the work environment. In considering the concept of wellbeing within the EU the following definition was proposed: Well-being at work means safe, healthy, and productive work in a well-led organization by competent workers and work communities who see their job as meaningful and rewarding, and see work as a factor that supports their life management^[1]. Although such definition is useful in understanding the concept, it should not be used as a definitive focus in moving forward with the term, as wellbeing seems also to rely highly on culture and organisational foci. Institutes across the EU are working together to gain consensus on the term and thereby gain a working definition.^[1] Any unified term would need to take account of the fact that:

a)‘Wellbeing at work cannot be brought about simply by way of health and safety policy: there are strong links with the way work equipment is designed, with employment policy, with policy on disabled people, and with other policies like transport and, of course, health policy in general, whether it be preventative or curative,’ ^[2] with wellbeing at work

b)‘…being taken to mean physical, moral and social wellbeing, and not just something that can be measured by an absence of accidents or occupational illnesses.’ ^[2]

Research has focused on the positive aspects of wellbeing at work, leading to the observation that facets such as self-acceptance, autonomy, growth, purpose in life, positive relationships with others, environmental mastery and personal growth could assist with a reduction in depression. ^[3] As such, when individuals are able to display more positive affects, such as enthusiasm and excitement rather than negative affects, such as nervousness and fear, this allows them to remain healthy and well.

The concept of health has a ‘cleaner’ perspective due to the established definitions by international organisations, such as the World Health Organization (WHO), which sees it as, ‘… a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.’ ^[4]. In addition, both the WHO and the International Labour Organization (ILO), have defined occupational health as, ‘…the promotion and maintenance of the highest degree of physical, mental and social wellbeing of workers in all occupations; the prevention amongst workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological capabilities and; to summarise: the adaptation of work to man and of each man to his job’. ^[5]. The concepts of health and well-being at work are closely linked and researchers tend to approach well-being at work as an expanded concept that goes beyond traditional occupational safety and health (OSH) and encompasses aspects that relate to quality of life and competence development^[6]. It is emphasised that this includes factors both at and outside the workplace, on organisational as well as on individual level.^[7]

Based on a literature review Chari et al.^[8] proposed a conceptual framework for worker well-being that includes five main domains:

• workplace physical environment and safety climate (physical and safety features of the work environment);
• workplace policies and culture (organisational policies, programmes, practices);
• health status (physical and mental health, welfare);
• work evaluation and experience (individuals’ experiences and evaluations relating to the quality of their work life).
• home, community, and society.

Benefits

There are many benefits that occur at the personal and organisational levels when individuals attain better wellbeing. These include increased job satisfaction, which could in turn lead to higher customer satisfaction as well as increased productivity and profitability; increased longevity, healthier immune systems resulting in resistance to diseases, lower levels of mental disorders and better social relationships. ^[9] Other benefits reported, include extended work careers, later retirement, a decrease in absence from work, workplace image, profit, quality, competitiveness, mutual respect, initiative, better career options, increased motivation, better work and leisure, and lower stress levels. ^[10]

Due to the ageing of working populations and a reduction in overall population growth, it is very important to address the health and wellbeing concerns of older workers, and this should be specific to the worker and his/her work situation. For example, one of the proposed ways to improve the health and wellbeing of ageing shift workers is by improving their occupational health care and to promote the use of appropriate coping mechanisms. ^[11][12] Another way is to assess the ‘workability’ of older workers, but this could be done at any age, as it considers the balance between an individual’s resources, such as health, values and attitudes and his/her work demands (physical and mental), thereby allowing her/him to work longer by decreasing work-related disability and premature retirement. ^[11][13]

There is sufficient evidence that psychosocial stressors (e.g. such as excessive work demands) could increase job strain and thereby adversely impact on health and wellbeing. ^[14] Other factors in the work environment that contribute to ill health and lower levels of wellbeing are the lack of control ^[15] and a ‘poor fit’ between the work schedule and individual preferences for working hours. ^[16]

The cost of ill health and poor wellbeing

Health is a basic human value, and within OSH, it should be seen as a business value and a value for employees. However, cost-benefit analysis is lacking within interventions^[14] so it is difficult to get a ‘true’ value of the costs of ill health and lower levels of wellbeing. Further, health and well-being policies in companies tend to focus on the output side of the process, such as disease, cure and return to work programmes as these provide short-term financial benefits, but may not necessarily lead to healthy organisations. Healthy organisations focus on the synergistic relationship between well-being at work and work performance and consider well-being at work as an asset and as a strategic value with OSH and well-being management core to their business excellence and sustainability. ^[17][18]

There is a suggestion to categorise the cost of health and wellbeing, to assess both macroeconomic costs and microeconomic costs. Macroeconomic costs occur at a national level or for a given economic sector. These costs are usually expressed as a percentage of the gross domestic product (GDP), i.e. as health care costs or as DALY (Disability Adjusted Life Years). Microeconomic costs recognise the sum of money that is spent by businesses (i.e. salary, insurance costs, lost productivity), and consists of two sub-categories: the cost of absenteeism and the cost of presenteeism. ^[19]

Despite these categories, it is important to note that the cost of health and wellbeing extends beyond the cost of absence or of poor performance, ^[20] but should be seen more holistically in achieving improvements within all aspects of the organisation. It has been estimated that in total, 123.3 million DALY are lost globally as a result of work-related injury and illness and 7,1 million in the EU. Work-related injuries and illnesses result in the loss of 3.9% of all work-years globally and 3.3% of those in the EU, equivalent to a cost of approximately 2,680 billion and 476 billion, respectively^[21].

The European Union considers people’s well-being as one of its principal aims. Promoting the improvement of living and working conditions, adequate social protection and social dialogue are shared objectives of the Union and underpin social and employment policies such as the European Pillar of Social Rights. These policies are also based on the acknowledgement that there is a mutually reinforcing effect of well-being and economic prosperity which underlines the importance of effective occupational health and safety policies at national and Union level^[22]. The OSH EU Strategic Framework on health and safety at work (2020 – 2027) is aimed at enhancing well-being at work and thus lead to positive effects on productivity, longer healthy working lives and the sustainability of social security systems.

Promoting health and wellbeing at work

This section will explore some typical programmes within organisations with a focus on the effects of such programmes and their limitations. The focus of wellbeing at the organisational level is especially useful as it facilitates a healthy work organisation, i.e. one wherein the culture, climate and practices produce an environment that ensures employee safety and health as well as organisational effectiveness. ^[23]

Various ways to improve on health and wellbeing have been promoted. These include those at the organisational level, such as looking at the person-environment fit (i.e. that the demands of the organisation correspond to the abilities of the employee), facilitating social support (i.e. supervisory practices), reducing ambiguity (i.e. structuring the organisation to ensure goal setting, work planning, performance appraisal and job and career planning are in place), and improving on coping behaviour (i.e. behavioural modelling to increase an employee’s coping strategies). ^[14] Interventions at the organisational level have dual functions, to reduce ill health as well as to promote positive wellbeing at work. ^[24]

When remaining at the organisational level, but this time taking a holistic approach and aiming for a healthy workplace, i.e. one with a focus on work-life balance, health and safety, employee growth and development, employee recognition, employee involvement and communication, has been endorsed as suitable in facilitating health and wellbeing among employees. ^[25] This holistic approach ensures that the employee is part of the process, i.e. the bottom-up approach, rather than having a stronger managerial perspective, i.e. the top-down approach. Worker involvement allows also the employees’ work experience to be examined, and this is based on the assumption that the quality of experiences at work, either positive or negative would have direct and indirect health consequences on the worker. ^[26] Employee involvement ensures that an intervention or programme will meet the needs of the worker, will achieve the desired outcome and will evolve as employees provide feedback to the process.^[25] However, employee involvement is less likely to occur when a) the organisational structure is one with centralised resources and hierarchical chains of command that reduce information dissemination, innovation, decision quality and the ability for employees to provide input into problem solving; b) a top-down management structure enforces managerial resistance that negates the positive impact of employee involvement practices; c) organisations have a cost-reduction strategy that leads to formulaic processes and predictable behaviours from employees; and d) organisations have a climate that does not promote employee involvement. ^[25]

Interventions at the organisational level may raise challenges for small and medium-sized enterprises (SMEs). While larger organisations may use external consultants to implement the interventions, or have in-house resources to facilitate this process, SMEs may have neither the resources nor the interest in such a process.^[24] Further, due to the limited numbers of employees in SMEs, this limits the types of screening methods that could be used, such as questionnaires, due to the ethical and statistical issues involved. ^[24]

When interventions are implemented at the individual level, they can include increasing job control for employees, which has been a core component in many of the work organisational models and that has been linked to improvements in mental health and absence rates.

The WHO healthy workplace model^[27] is based on the collaboration of workers and managers to use a continual improvement process (see figure 1) to protect and promote the health, safety and well-being of workers and the sustainability of the workplace. This process requires taking into consideration:

• the physical work environment;
• the psychosocial work environment including organisation of work and workplace culture;
• personal health resources in the workplace; and
• ways of participating in the community to improve the health of workers, their families and other members of the community.

Well-being at work requires a holistic approach and the workplace cannot be seen as an isolated event as it is also influenced by macro trends in society and by factors in the world of work. Therefore, health and well-being programmes need to be underpinned by systems-thinking and use a multidisciplinary approach to encompass the evolving nature of work as well as relationships between occupational and non-occupational factors^[6].

Conclusions

Work is important for individuals. It helps them to maintain their health and wellbeing and is essential for economies to survive. However, as conditions with the work environment may (in)advertently negatively impact on employees, it is essential that organisations continuously monitor their environment for unsafe and unhealthy work practices, as well as promoting a positive work environment to improve on and sustain the health and wellbeing of their employees.