Health and Workplace NRW strategy to improve health at work

1. Health and Workplace NRW strategy to improve health at work Health Inequalities: Engagement in health - What can be done at local level? Conference on 11-12 May 2011, Budapest Dr Eleftheria Lehmann NRW Institute of Health and Work Düsseldorf, Germany www.liga.nrw.de

2. Outline • Background • Health and workplace - What can be done at local level? • The case of North Rhine-Westphalia (NRW) • Strategic approach • Interventions • Exemplary actions • Conclusions Dr. E. Lehmann

3. Background • Trends and challenges in the changing world of work: • Global operating enterprises • Knowledge based services increasing • Employment in production decreasing • Up-coming new work patterns and industrial relations • Last but not least • Ageing population • Recent scientific findings on core determinants of health: • A clear social gradient is identified in most health areas • Health inequalities result both from socio-economic inequalities and other determinants of health (physical environment and the person’s individual characteristics and behaviours) at many levels Dr. E. Lehmann

4. Background • Strategic role of regions in improving health: • Reduction of health inequalities requires action across the whole of society and a multifaceted approach across sectors • Inter-sectoral cooperation is essential to overcome fragmentation and is particularly important in times of economic recession as health risks increase • Communities are among the key actors in improving living and working conditions. Using the capacity of the sub-national level (regions and municipalities) is crucial • The development of a vision and strategy based on (sub)national level is needed Dr. E. Lehmann

5. Health and workplace - What can be done at local level? • Linking health and work – key issues • Policy should: • Respond to • key challenges of ageing populations • competition resulting from globalisation • new work patterns and industrial relations • Take account of emerging health risks in the workplace • Tackle health inequalities • Understand and communicate the benefits of health at work • Last but not least • Take a cross-sectoral approach integrating common objectives in health, employment and social interventions Dr. E. Lehmann

6. Health and workplace - What can be done at local level? Framing a strategic approach based on the Investment Triangle: Health Social development Economic development (WHO Verona Initiative, 1998) The case of North Rhine-Westphalia: Concepts, initiatives and activities at local and regional level Dr. E. Lehmann

7. The case of North Rhine-Westphalia • North Rhine-Westphalia NRW • Facts and figures (2009): • Population: 17.9 millions • Workforce: 8.05 millions • (male: 4.42/female: 3.63 millions) • Enterprises: 1.25 millions • Unemployment rate 8,5 % (March 2011) • Long history of primary industries and engineering (coal mining, steel production) • Over 3 decades of struggling with deindustrialization and restructuring • Responsibility for occupational health: NRW Ministry of Employment, Integration and Social Affairs • Member of the WHO Regions for • Health Network Employment Rate (%) Federal Republic of Germany Dr. E. Lehmann

8. Health at work in NRW • NRW employment and health at work policy* - overall scope: • Policy is embedded in • WHO and EU strategies on occupational health • The renewed EU Social Agenda • German Strategy on health and safety at work (H&S) • Policy recognises the need to • Improve workers’ qualifications and skills • Enhance flexibility and promote health at work • Increase impact of H&S • Emphasise that prevention pays off and improves productivity * For detailed information, see www.arbeit.nrw.de Dr. E. Lehmann

9. Health at work in NRW - Strategic approach • Six main elements: • Setting priorities and building capacity • Involving the workforce • Building partnerships • Endorsing preventative interventions and good practice • Monitoring and assessing the impact • Strengthening enforcement of OSH provisions Dr. E. Lehmann

10. Health at work in NRW - Cross-sectoral framework * In alignment with the targets of health at work policy Dr. E. Lehmann

11. Health at work in NRW - Planning • Programmes and activities at regional or local level: • Address issues of main concern • Ground on scientific concepts, e.g. • workability concept by Ilmarinen, • demand-control model by Karasek and Theorell • Use evidence based information for setting priorities, e.g. • Monitoring data Dr. E. Lehmann

12. Health at work in NRW Work ability concept by Ilmarinen Work environment WAI Values Competence Health Illustration by Richenhagen, 2007 Dr. E. Lehmann

13. Health at Work in NRW Monitoring data* NRW Health Report 2009 NRW Health at Work 2009 * See also: Lehmann, E. (2010): Gesunde Beschäftigte, gesunde Betriebe, gesunde Gesellschaft – wo stehen wir heute? In: Praktische Arbeitsmedizin, S. 16-22 Dr. E. Lehmann

14. Health at work in NRW 2009 • Stress and strain at work - main findings of surveys: • Psychosocial work load and stress have increased; workers in service sectors are stronger affected than others • Data unravel health inequalities associated with gender and social status • Still a limited number of enterprises is engaged in workplace health promotion Dr. E. Lehmann

15. NRW Health at Work 2009 – an example Gender- disaggregated data in nursing and healthcare (N=144) Types of employment Full time male female Part time Marginal employment Respondents (%) Dr. E. Lehmann

16. NRW Health at Work 2009 - an example Gender- disaggregated data in nursing and healthcare (N=144) Perception of work load (fairly strong and strong load) Risk of Infection High time pressure High responsibility Excessive work load Heavy physical work Unfavourable working hours Forced postures Restructuring Conflicts with clients/patients Dirty working condition male female Proportion of respondents (%) Dr. E. Lehmann

17. NRW Health at Work 2009 – an example Gender- disaggregated data in nursing and healthcare (N=144) Employees‘ prognosis of reaching full retirement age very likely male female more likely less likely unlikely Proportion of respondents (%) Dr. E. Lehmann

18. NRW Health at Work 2009 - an example Gender- disaggregated data in nursing and healthcare (N=144) Employees perception of additional burden by activities outside work Caring for or educating children Caring for elderly/disabled relatives Second job Voluntary or charitable activity/ political activity Sporting activity Not applicable Proportion of Respondents (%) Dr. E. Lehmann

19. Health at work in NRW - Interventions • Focus of activities: • Employment and productivity • Organisational design of work and work life balance • Health promotion, prevention and rehabilitation • Education and training • Acquirement of knowledge Dr. E. Lehmann

20. Interventions at the workplace Multidimensional design Human resources Qualifications and skills Attitudes Health Organisational resources Work organisation Leadership Corporate culture Dr. E. Lehmann

21. Health at work in NRW - Interventions • Involving the workforce • Employees’ participation to improve working conditions and develop health literacy and competence • Involvement of trade union representatives at company level • Building partnerships • Strategic alliances with social partners, insurers, health professionals and other beneficiaries • Innovative networks to provide health support locally, regionally or by sector Dr. E. Lehmann

22. Health at work in NRW - Interventions • Preventative interventions • Proactive management of health risks and health promotion • Raising awareness and stimulating demand • influencing small organisations (particularly SME) and other hard to reach groups • Getting people back to work through emphasis on rehabilitation as a contribution to employment • Strengthening enforcement of OSH provisions • Developing a risk oriented inspection strategy • Providing support and advice to enterprises, particularly SME (Internet services, recommendations, guidance, robust instruments for practitioners) Dr. E. Lehmann

23. Health at work in NRW - Exemplary actions • Initiative Successful Work* • Support and advice • Counselling and development of action plans at company level, e.g. implementation of flexible working arrangements like part time, tele-working • Network of demography consultants at regional level to support age management at company level and increase employment of aged people • MobbingLine NRW (counselling against bullying and harassment, NRW-wide) • Education and training • Training cheques for employees, e.g. to promote employability or to enable early return from parental leave of women • Course “Master of Workplace Health Management“ for supervisors (university grade) to enhance awareness of managers and develop leadership skills * Actions co-financed within the framework of the European Social Fund; focussing on SMEs Dr. E. Lehmann

24. Health at work in NRW - Exemplary actions • Initiative Successful Work* • Designing of a healthy work environment • Innovative projects to develop models of good practice; activities include health promotion of unemployed as well as of employees in precarious work • Acquirement of knowledge • Research studies, e.g. on indicators for measuring social and human capital and emerging health risks (focus: mental ill health) * Actions co-financed within the framework of the European Social Fund; focus on SMEs Dr. E. Lehmann

25. Conclusions • Lessons we learned in NRW • Tackling health inequalities at work is not a matter of individuals and businesses alone • Health at work needs a wide social and cultural approach; it requires • formulating and focussing wide ranging health policy priorities • promoting inter-sectoral activities and addressing both social and economic issues • The local and regional levels have smaller but more flexible structures that enables them to undertake basic groundwork and to develop and test model solutions - in cooperative structures Dr. E. Lehmann

26. Links for further information • www.liga.nrw.de • www.mais.nrw.de • www.mgepa.nrw.de • www.arbeit.nrw.de • www.gib.nrw.de Dr. E. Lehmann

27. Thanks for your attention! Mit 100 zur Rente ist genug! Retiring by 100 is enough! Dr. E. Lehmann