Time to re-think ‘workplace health’

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Something has really been bothering me recently about ‘workplace health’ initiatives.

We seem to have got into a real mess about the PURPOSE of this type of focus.

The employer perspective is of the importance of PRODUCTIVITY and the WASTAGE caused by people being ill or off work.    As a result the initiative’s success is measured in terms of sickness absence, rather than in terms of employee wellbeing as a positive condition.  The questions shifts from – what can we do to enable people’s wellbeing? (the salutogenic perspective) to – what can we do to stop people being off-sick? (the pathogenic perspective).  Back to the use and abuse of measurement issue – what we get is a punitive system that performance manages levels of sick leave and game playing starts – people take annual leave or use flexi time, rather than reporting a sick day.  Or presenteeism – people coming to work and pretending to work even when they are not fit to be there, perhaps passing on infections to colleagues in the process. Recorded sick leave goes down, employers herald this a success, but the wellbeing of the workforce has not improved.  Public health professionals are complicit in this, they make the case for workplace health initiatives in terms of the cost of days work lost.

The other thing that bugs me is that workplace health initiatives purely see the workplace as a site of health promotion or traditional public health ‘lifestyle’ interventions.  We use the workplace to tell people about the importance of eating 5-a-day but then don’t give any thought to whether or not they can get affordable healthy food during their working day.  We use the workplace to train people in emotional resilience – telling them they have to be resilient to stress – this means that if they go off with stress it becomes the employees fault for not being resilient enough (nothing to do with workplace stressors at all!).  So in essence we are telling people to be healthy and happy (and therefore productive and not waste employer’s resources) but give very little thought to the physical, social and economic conditions in which they are doing their work.

The bottom line is – we need to re-think workplace health.

Public health needs to call attention to the EQUITY and FAIRNESS angles – the HUMAN perspective of this story.  It is true that healthy, happy employees will be more productive, but if you make productivity the primary driver, we will always get it wrong. So perhaps we need to pitch the issue as one of ‘social responsibility’ or ‘shared value’, rather than one of efficiency and productivity.

The Marmot review draws attention to wellbeing and health being formed through the conditions in which people grow up, live their lives and grow old.  If you think that a working adult spends a huge chunk of their time in a workplace setting – that setting must be one of the biggest influences on their wellbeing and health – not just during the time they are working in that setting but it will create a legacy impact on their wellbeing and health into their post-working years.  If we have unhealthy workplaces, then people are less likely to age healthily and are more likely to need health and social care services for longer.  That’s something society can’t afford – now or in the future.

The weird thing is we ‘get this’ when looking at traditional factory-like ‘industrial’ workplaces.  We look back aghast at the historical conditions in coal mines or  cotton mills.  At the impact of asbestos handling or white finger or industrial causes of pulmonary illness.  We are astonished and indignant when we look at ‘developing’ countries and think about the neurotoxins used in factories or issues of child labour.  We know these things damage wellbeing and health of the workforce and of wider society.

But what do we do when we look at the average ‘knowledge economy’ office environment – a call centre, a room of 6 people, an open plan office, people sitting at computers, people having meetings and interacting?  Let’s face it other than a little nod to the ergonomics of a desk, concerns for repetitive strain injury, trip hazards, or whether people may need to lift a heavy box, we become oblivious to the way in which the economic, physical and social make-up of those workplaces influences employees’ wellbeing and health (or perhaps we aren’t oblivious to it, we just turn it into the employees problem – it is their responsibility to remain healthy and happy and productive, whether or not the context is conducive to it).

So recently I’ve been scouting around – looking for insights into workplace health – from a settings perspective – and it is time to gather my thoughts together.

Let’s start with the PHYSICAL aspects – two years ago there was a documentary on Channel 4 called the Secret Life of Buildings.  It aimed to show how architecture of buildings affect the humans who use them – it drew on neuro-science and psychology and made the case for architects to think more about the wellbeing of the building users’ rather than iconic external design.  The second programme in the series included work places.  Unfortunately the films are not available on 4OD – but you can get a glimpse into what the show covered in the Episode Summary.  This was the first time I became consciously aware of how the buildings we work in not only affect us both psychologically and physiologically, but also the structure of our brains and the degree to which new brain cells regenerate  (see the small clip available from the Episode summary).  A key feature of the episode was looking at open plan office spaces which are often portrayed as the quintessentially efficient and productive office environment – not so, said this show.  They are actually stressful places to be – they are de-humanising – they mean you can’t concentrate – you are around people, but can’t necessarily socialise with them.  They are dull and not very stimulating.  So much for a healthy, creative, knowledge economy!

Bristol City Council have prepared a briefing note drawing on a literature review of what academic research reveals about the health impacts of modern day workplaces – they summarise what they have found on hot-desking; open plan offices; remote working; and home based working.  Good research is quite thin on the ground but nevertheless the briefing note reveals insights into negative health impacts of these ‘modern day workplaces’.  But, employers are moving in an almost leming like fashion, touting these practices as ‘good’ and ‘benchmarked against other employers’, without taking any of these sorts of research findings into account in a proper wellbeing and health impact assessment.

See all that already and I haven’t even touched on the ‘lifestyles’ angle and how workplaces can enable health-promoting behaviours or ‘frustrate’ health-harming behaviours.  This is written about more often so the only thing I want to mention is workplace canteens.  Sure there are a huge range but on the whole I bet they are barely better than school dinners were before Jamie Oliver alerted us to their quality – not just in turns of the food offer but also the environment they offer to eat the food, socialise and take a break.

Moving on more to the SOCIAL aspects

The organisation of work is also important to wellbeing and health.  The original Whitehall studies carried out by Marmot showed that the more control you have over your work, the better your health (in terms of risk to cardio-vascular problems).  The nature of ‘control’ varies a lot – control over what you do and don’t do in a working day; being able to innovate and be creative as to how you go about things; being able to manage your own workload; and choosing your own working hours (flexi-time). A systematic review by the Cochrane Collaboration concluded that initiatives that give employees more choice and control over their working hours are likely to have positive effects on wellbeing and health.

But ‘flexible’ working can also be something used to give management more control e.g. the expectation that you will be able to stay later when needed which then leads to enforced or hidden overtime.  But also arrangements that are only ‘flexible’ for the employer e.g. part-time contracts or temporary contracts.  Once again, colleagues in Bristol City Council have helpfully summarised what academic research there is about flexible working patterns and their impact on wellbeing and health in a briefing note.

It seems that flexible working patterns are only helpful to wellbeing and health when they put the ball in the employees court – not the employers.  This seems to me to be all about the exercise of power and power relations in the workplace.

I was at a talk not long ago being delivered by someone from The Work Foundation.  In the discussion afterwards the speaker mentioned that they often think that the biggest threat to your wellbeing and health in a workplace is your manager.  Your line manager is the most immediate way in which you experience power and power relations – there are some that exercise this responsibly but not all do.

Managers are involved in coaching staff.  An interesting study into coaching by Boyatzis et al (2012) reminds of the need to think about the ‘growth and development’ of an individual in the workplace, rather than just getting people to comply with the organisation’s perspective.  The abstract says:

Compassion involves noticing another’s need, empathizing, and acting to enhance their well-being. In response to another’s pain, the motivation is to increase hedonic well-being or the absence of pain. In response to another’s desire to grow, the motivation is to increase eudaimonic well-being or helping them develop. We argue that compassion includes both. Our expanded view suggests that coaching with compassion will lead to desired change, enhanced health, and well-being. We propose a model saying coaching with compassion invokes a psychophysiological state that enables a person to be open to new possibilities and learning. In contrast, coaching for compliance (i.e., toward how the coach or the organization believe the person should act) and deficiency-based coaching invoke the opposite state—resulting in a person being defensive, reducing cognitive functioning. We theorize how coaching with compassion can enhance adaptability of the organization through creating norms and relationships of caring and development.

Boyatzis, R.E., Melvin L. Smith, M.L. and  Beveridge A.J. (2012) “Coaching With Compassion: Inspiring Health, Well-Being, and Development in Organizations” Journal of Applied Behavioral Science published online 1 November 2012 DOI: 10.1177/0021886312462236 The online version of this article can be found at:

Problem is – even the best managers are subject to the expectations that the organisation sets up in terms of what they will do.  The behaviour of line managers are shaped by the culture/climate of the organisation and what it values…if it goes wrong, it is rarely the individual line manager’s fault, more the ‘system’.

And so back to ‘performance management systems’ which shape the manager’s behaviour towards ‘coaching with compliance’.  Performance management systems aren’t ‘neutral’ – I’ve gone on before about the fact they can be bad for performance, but they are bad for wellbeing and health too…the Scottish Trades Union Congress recently published the report of a three year study into performance management and its impact on employees carried out on their behalf by Prof Taylor at the University of Strathclyde.  The title ‘Performance management and the new workplace tyranny’ says it all.  Managers who were interviewed noted the ill-health outcomes of relentless performance management.  The report is well worth a read – whilst the study happened in the financial and telecom sectors – the results certainly resonate with my public sector experience.

Whilst the ‘line manager – subordinate’ relationship gets special attention, we can’t forget that ultimately we have tonnes of different relationships at work.  Our colleagues can be our greatest support system, they can be people we want to socialise with outside work, they can add to our own ‘social capital’.  The work setting can enable social support networks to develop – or it can make that hard.  I was particularly struck in the Bristol City Council briefing note that home workers have less of a support system and that can increase stress levels.  In large organisations, you can’t know and trust everyone – you need your set of trusted colleagues – the ones you talk to about difficult meetings, the ones who listen to your angst – if you work at home or in an office setting where it is hard to develop those trusted networks, it can’t be good for us.  We’re well aware of ‘bad’ relationships – bullying policies, complaints etc all allow us to do something when it goes ‘wrong’ BUT often no-one is working creating the setting where it is more likely to go ‘right’.

Now the ECONOMIC angle.

The extent of income inequality in our society is one of the factors that affects wellbeing and health.  At one end of the spectrum we have the Minimum Wage which is considered lower than a decent Living Wage – at the other end we have huge salaries accompanied with huge bonuses. Not only does having less money give you less ‘purchasing power’ for healthy food, healthy social life, transport and caring for yourselves (massage or gym membership anyone?) but the inequality itself creates psycho-social stresses that harms wellbeing and health of everyone in society (not just the poorest).  This is a societal issue but ultimately the societal issue is the collective outcome of the decisions of organisations that decide the differential economic value of the work that people do.   As the Equality Trust shows – in the UK our income inequalities are getting wider – “UK income inequality increased by 32% between 1960 and 2005”

So if employers were really thinking about wellbeing and health, they wouldn’t be merely putting a poster up advising on 5-a-day, they’d be thinking fundamentally about their contribution to the wellbeing and health of society as a whole and making radical changes.

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