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CHRISTASEDLATSCHEK Director, EU-OSHA,the European Agency for Safety and Health at Work Call to action

For managers, investing in efforts to prevent and reduceworkplace risks makes unassailable good sense. Help is available to get started

rotecting employees’ health and safety is amoral and legal As an EU agency,weface challenges in health and safety just like any imperative. But good practice can also help attract the best staff other employer.Weare arelatively small organisation, so work pressure Pand even help win market share. Companies wanting to increase can build very quickly —itonly takes acouple of urgent requests to productivity,improve profitability or enhanceworkforcewellbeing come on top of our usual commitments and our workload mounts. We should, therefore, take acloser look at occupational safety and health. work closely with staffhealth and safety representatives, who survey In Europe we can be proud our working conditions arethe best in staffatEU-OSHA to help management establish priorities. the world, but thereisalotthatweneedtodo. The most recent survey Recently we have been working to manage the workload better by the European Agency for Safety and Health at Work (EU-OSHA), through improved planning and efficiency and better definition of roles covering 50,000 establishments across 36 countries, showed over three- and responsibilities. We provide coaching over the phone to EU-OSHA quarters of workplaces report one or morepsychosocial risks such as employees and —prompted by interest from staffmembers —have excessive workload, working with difficult customers or job insecurity. started short mindfulness sessions once aweek as well as regular Yetonlyone-thirdhave aplan in place to prevent work-related stress. voluntary stretching sessions. Adecade ago, we started replacing fixed- Work-related stress and work-related musculoskeletal disorders such leg desks with ones with height-adjustable legs. as back pain areamajorconcern in Europe: 37 per cent of workers in the EU report working all or almost all of the time to tight deadlines; 62 per cent carry out repetitive hand or arm movements; and 34 per Policiestoensureadequate training cent almost always have to work at high speed. In 2015-16, according to and good staff relations have more statistics from the UK Health and Safety Executive, stress, depression or anxiety accounted for 45 per cent of working days lost to ill health in impactthan ‘fruit and Pilates’ Britain, and work-related musculoskeletal disorders for 34 per cent. Even leaving aside avoidable pain and suffering, the economic cost of work-related ill health and injuries is estimated to equate to 3–5 per cent Our official campaign partners, which include companies and of the EU’s GDP.Ill health and injuries arealso responsible for about organisations in the public and private sector,are just as active. 4,000 avoidable deaths, due to accidents and about 160,000 deaths due In March this year,for example, abranch of German software to work-related illness every year.Over the years we have seen asteady multinational SAP received our Good Practice Awardfor its Run Your decrease in occupational accidents, but the same cannot be said of cases Health initiative. Height-adjustable desks introduced into its offices of work-related illness, such as occupational cancers, mental health reduce the risk of staffdeveloping musculoskeletal disorders and problems or musculoskeletal disorders. encourage employees to move morefrequently throughout the day.The The good news is something can be done to reduce this burden. We company has offered fitness trackers to help staffmonitor their progress. spend athird of our life at work, so it is only sensible to think about PSA Group Spain won recognition for the development of age- promoting good health in the workplace, through steps such as raising sensitive risk assessments. The aim is for eachtask to be completed by awareness of the benefits of good nutritionand regular exercise. However, as many different workers as possible, regardless of physical limitations thereisarisk of focusing on the individual, rather than taking action at or age. Such interventions can help organisations tackle the challenges the organisational level. Policies toensureamanageable workload, good posed by an ageing workforce. staffrelations and adequate training requiresignificant management For Europe’s managers, investing in efforts to prevent and reduce commitment but have afar greater impact and coverage of all staffthan workplace risks to safety and health makes unassailable good sense. the provision of “fruit and Pilates” that will only be taken up by afew. The costs of not doing so aregreater than the costs of taking action. EU-OSHA runs two-year campaigns; the current one promotesa Thereare tools available to help organisations analyse and tackle risks; healthyand safe environment throughout workinglivesinthe context agood place to find these is the EU-OSHA website (osha.europa.eu). of the ageing workforce.These campaigns promote action.Persuading For policymakers, arange of strategies areavailable, including managers andworkerstoparticipate is an importantprecursor to success: providing incentives and making recommendations for good effective interventions areneither top-down nor bottom-up, but involve occupational safety and health management. We have some good the whole organisation. examples to share.

FT.COM/HEALTH-WORK | 3 CONTENTS

6 BENEFITS ALLROUND Why wellness schemes aregood for staffand profits

10 BEST OF BRITISH Britain’s Healthiest Workplace winners

12 DRIVEN TO DESPAIR Working in the gig economy comes with health risks

16 BULGE BRACKET Obesity among nurses in the UK is on therise

20 ADOSEOFREALITY Opioid abuse in the US is costing employers billions

24 SLEEPING ON THE JOB Anap at work can boost staffhealth and productivity

26 THE FIGHTONFLAB How Singaporeisgetting its office workers intop sha e

29 INTERVENTION STRATEGIES Screening, healthyeating,physical tests, mental health

34 BROUGHT TO THE SURFACE Mining companies held to account for lung diseases

36 MEETING OF MINDS? The impact of robots on human workers’ wellbeing

38 REWARDS FORTHE TAKING 50 AUKregion explores incentives for companies

40 BURNING PROBLEM China starts to turn the tide on smoking at work

42 DANGER SIGNALS What companies and staffcan do to reduce suicide risk

47 ESCAPING DEBT Ways to help employees in financial difficulty

48 OUT OF THE FIRING LINE When aculture of training and support can save lives

50 BEHIND THE CURVE Silicon Valley’s addiction to business parks

54 CHAIN REACTION BLOOMBERG

Ensuring health and safety standards among suppliers S;

56 THE PRICE OF SUCCESS IMAGE Figures paint apictureofpoor worker health in Asia TY ET /G 58 THINKING HOLISTICALLY CHAMBERS TT ZELEY

Why employee wellbeing is not just about safety CO DA :S PETER S:

Sign up for your free weekly global health briefing www.ft.com/fthealth TO PHO ILLUSTRATIONS

4 |FT.COM/HEALTH-WORK Editor SEPTEMBER2017 Emma Boyde

WORK H- LT EA Production editor OM/H .C FT GeorgeKyriakos Designers HarrietThorne, KostyaPenkov Picture editor Michael Crabtree Sub editor Philip Parrish

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FT.COM/HEALTH-WORK Special Reports editor COVER ILLUSTRATION Leyla Boulton BY NANETTE HOOGSLAG Account director IanEdwards Director FT2 Forfurther stories online Alexis Jarman see ft.com/health-work Projectmanager FT2 32 Nathalie Ravier Advertising production Daniel Macklin 50 Sebastien Ash, freelance journalist; Hasan Chowdhury, freelance journalist; David Crow, senior US business correspondent; AndrewJack, FT head of curated content and member of Britain’s Healthiest Workplace advisory board; Emma Jacobs, FT work and careers writer; Siona Jenkins, Curated Content writer/editor TomHancock, consumer and leisureindustries correspondent; Edwin Heathcote, FT architecture critic; Aimee Keane, interactive journalist; JoeLeahy, Brazil bureau chief; Neil Munshi, FT NewYork correspondent; Hannah Murphy, companies reporter; Sarah Neville, global pharmaceuticals editor; BRITAIN’S HEALTHIEST WORKPLACE IS OVERSEEN Sarah O’Connor, FT BY AN ADVISORYBOARD COMPRISING: employment correspondent; Naomi Rovnick, Live Desk Dame CarolBlack, principal of Newnham College, Stephen Bevan, head of HR reporter; Christa Sedlatschek, University of Cambridge research development at the Institute EU-OSHA director; Peter Gina Radford, deputy chief medical officer for of Employment Studies Simpson, Anglian Water chief England, Public Health England Martin Roland, emeritus professor of Health executive; Jeevan Vasagar, Justin Varney, national lead for adult health and Services Research, University of Cambridge freelance journalist wellbeing, Public Health England TheresaMarteau, director of the Behaviour and Sir CaryCooper, professoroforganisational Health Research Unit, University psychology andhealth, ManchesterBusinessSchool of Cambridge All editorial content in this Andrew Jack, editor of FT curated content Louise Aston, director of wellbeing, report is produced by the Steve Boorman, director of employee health for Business in the Community FT.Our advertisers have no Empactis, honorary professorial fellow of the Shaun Subel, director of corporate wellness influence or prior sight of the Royal Society of Public Health strategy,VitalityHealth content.

FT.COM/HEALTH-WORK | 5 Be al E re to access and desks treadmill massages, weekly membership, gym subsidised offers sector es oal n tmksbsns sense.” business makes it and morally sense We Donnelly says ourselves,” live people helps that everything offic with the chat in to desks their leave to encouraged or club book the Employees join work. can to cycling as such encourage exercise to physical showers of provision awareness the health and mental training up, standing used desks be to can classes that mindfulness and yoga free from range th tackle or to depression drugs pain, just than rather sessions gym doctors prescribing as such healthcare, effective to proven approaches but innovative supporting in specialises It has paramedics, including and staff, nurses 70 employs that Service Health National productivity. boost to order and in workplaces better promote to They ar ways alike. public, sectors the non-profit in and sizes private all of employers from executives top rmtshatirlvn o t staf its for living healthier promotes ensur help to overseen has of she one is move The executive. chief ar they hours, aiyadhave and family have morning. weekday next the until them sending lutainby By Illustration bring. they boost productivity the re Healthiest Britain’s 6 etyluce netne ev rgam for programme leave extended an launched cently Ther staf to offered Help Network, Innovation Health approach Her “W |F ons h au fwlns cee o staf for schemes wellness of value the cognise edt okatrte n epte.I makes It them. keep and them after look to need re ac ew ,t ansaf upr hi elhad nteprocess, the in and, health their support staff, tain noei eemndt rt esgsotof out messages write to determined is anyone ar staf the the throughout weekend, and 7pm after day working very eh T. o Skyscanner oo. re for urfew ee n omk sur make to ant COM/H sbe iia hnigotietehealthcare the outside thinking similar been as eg lr cuae odsnaewt mi.If email. with disengage to ncouraged re.“tfeel “It arden. eu re ad rg ne re EA lcsta of that flects dt aete ndatadhl off hold and draft in them save to ed igit charging. ed fatH LT ,ani ldtx”says detox,” al fat ep evelopmen H- ru ou .“ sv at noainNetwork Innovation ealth ntern nnin ol wthof owe so off, switch eople aet Hoogslag Nanette WORK u nyasti u staff. our is asset only Our He ap am r appropriate ery Yo eh lhInvto Network Innovation alth au riua justification. articular ag gc un ttae erhsite, search travel et indf er ah ro i fteUK’s the of nit u,adare and lub, se tofc e ob ihyour with be to eed fa organisation ignme of number wing fi atylifestyle ealthy Wo ulne ea initiatives veral sw Ta rncillnesse hronic aDonnelly ra l sclients. as ell ss klc survey rkplace ee p.It app. nd co ts th xploring lleagues re tw do we at cruit ,t he s. onr wher country for and country staf home any their in back weeks three spend employees, longer-serving organisations. generated year re this and interventions and such extent of the impact identify to seeks survey The consultants. Mercer and Cambridge of the Europe, re Rand with association in produced and survey ar and others cultur design, office our of parts employee talent Clement, director Julia says thrive,” can employees which entakdi rti’ Healthiest Britain’s in tracked been pne rmnal 200epoesi 167 in employees 32,000 nearly from sponses Financial the institute, search “The “W h nrae wrns mn mlyr has employers among awareness increased The eb ea And ,d re .“ fm re leei’ u uyt provide to duty our it’s elieve dva nd vsdby evised ha oeo u ntaie aebe rvnby driven been have initiatives our of Some re me owr o pto up for work to ember sb el employers veals ussadsgetos oear some suggestions, and quests et lues ee re ecmayhsoffices. has company he na as wJ Vi rwhi inte in growth talit ab us Hat,tehat insurer, health the yHealth, fb ack ,t ines ac ehuman he han talso ut s.” Ti efreptitsto expatriates for ce me re Wo am st,” ,teUniversity the s, re aw rkplace ed nhi another in onth says source rpaein orkplace ie your by riven en Shaun atural Wo st klc sur rkplace Britain Ri cycling aff fo h direction ght rw va ’s lu ligor alking Healthiest es to ve upport wo ys rk ho ws

PHOTO:AFP/GETTY IMAGES F T . C O M / H E A L T H - W O R K | 7 STRESSES ANDSTRAINS ON BRITAIN’S WORKFORCE

Additional days per year lost to illness and other risk factors

2.6 4.0 5.0 5.8 31.0 0.8 days days days days days days Insufficient physical Chronic disease Being bullied at work Money worries Moderate or severe activity diagnosis depression Musculoskeletal pain

Note:Additional productive days lost per year afteremployeereports newcondition Source:VitalityHealth/Rand Europe;Britain’s Healthiest Workplace

Subel,directorofstrategy at VitalityHealth, whichhas has jumped from below 4per centtonearly 6per cent built asignificant businessmodel in severalcountries this year.Two-thirds of employees said they have at by offeringhealthinsurance and providing incentives to least some financial concerns —which the survey also encourage the take-upofactivitiestoimprove wellbeing. identifies as asignificant cause of stress. Dame Sally Davies, the UK government’s chief Furthermore, these patterns arelikely to be medical officer,isone leading figurewho has been underestimates, given the data arebased only on trying to raise awareness of the benefits of workplace employers and employees who voluntarily complete wellbeing programmes. Public Health England, which the questionnaires and aretypically already convinced advises and supports national health services, has of the value of workplace health interventions. Many of developed toolkits and is analysing online health apps the least healthy staffand least enlightened employers to encourage best practice. simply do not participate. In the private sector,associations such as Business in The responses suggest that wellness programmes the Community,abusiness-led charity that promotes have apositive impact. Among initiatives to promote ethical and sustainable behaviour,and the British Safety physical wellbeing, the survey shows that staffvalue Council have become moreactive, issuing guidelines on-site gyms, fitness breaks and classes, runningclubs and holding events to spread the message. Companies and support for walking or cycling to work. For mental such as GlaxoSmithKline, the pharmaceuticals group, health support, respondents said massage or relaxation have started to develop benchmarks to try to assess the impact over time of wellbeing programmes they offer. Thereislittle question that an even greater focus on wellness is required. Asobering fact to emerge from Britain’s Healthiest Workplace is that over the HOWTOENCOURAGE PARTICIPATIONINWELLNESS SCHEMES past four years, the state of the national workforce has been deteriorating. The average number of annual working days per staffmember lost to absenteeism or Actions taken and number of health provisions presenteeism —whenemployees come to work but are employees use as aresult not productive —has risen from 23 to 30. That mirrors arise in unhealthy lifestyles. While the proportion of people smoking and reporting excessive alcohol consumption and insufficient physical activity has dropped slightly since 2014, the number not eating healthy diets has jumped from 52 per cent to 62 per 0.62 0.62 cent. Equally,the number of those getting less than 0.18 seven hours’ sleep anight has risen from 26 per cent to Provision for Board-level nearly 30 per cent. family members discussion Mental health problems can lower productivity significantly,and even relatively minor concerns, such Allow as employees feeling they lack control over their work, participation or that their manager does not support them, can have during work anegative impact. The proportion of respondents who Source:VitalityHealth/Rand Europe; reported suffering from moderate or severedepression Britain’s Healthiest Workplace

8 |FT.COM/HEALTH-WORK ‘Employees should be on the balancesheet in the same wayasyou account forcash. People think it’s abolt-on’

which the BHW research suggests would have the greatest impact because of mental health’s disproportionate effect on productivity —are less so. Subel at VitalityHealth warns that simply adding additional wellness programmes will not necessarily provide acorresponding benefit. “There’s not alinear link,” he says. Employees who arealready committed will often be responsive when offered moreoptions, but companies can achieve far bigger returns if they can accomplish the harder task of getting those who are unengaged to participate. Subel says incentives for employees —rewards of some kind for choosing salads rather than chips, for example —are fundamental to achieving the best results. Engagement of senior executives in the initiatives is also an indicator for success. Peter Simpson, chief executive of UK utility company Anglian Water,agrees. “Wellbeing is written into our business plan and our annual reporting,” he says. “It has become astrategic boardroom issue. Employees should be on the balance sheet in the same way as you account for cash. People think it’s abolt-on, but we say this is part of our business strategy.” He recalls a

ES two-day boardmeeting at which afullday focused on employee development and wellbeing. IMAG He has changed the type of food in the canteen, TY

ET provided adjustable desks and personal “resilience /G training” for managers to teach them how to bounce FP

:A back from adverse events.

TO He has also promoted health checks for staffand

PHO encouraged “walking meetings” rather than seated ones around atable. He calculates the result has been classes, cognitive behavioural therapy and training in an eight-fold return on investment, measured through time management would help them most. factors such as areduction in absenteeism, improved But thereisnosimplemenu from which employers customer satisfaction with staff, and falling illness can pick to transform their workforce. The first claims, which have halted inflation in private healthcare challenge is the difficulty in gathering rigorous data premiums. on how effective any particular intervention might Afinal difficulty with expanding wellness be in comparison with another.When companies do programmes is finding the resources to pay for them. try to improve their employees’ health, they tend to Some policymakers have called for tax write-offs or employ several approaches simultaneously,rather than business rate deductions for those who provide support. just one. In addition, the interventions that staffand Authorities in the UK’s West Midlands have decided theirmanagers might value the most do not appear to to pursue another route, and areeven exploring the correlate closely with the actual impact. idea of “early adopter” grants for employers willing “Thereisanabsence of evidence,” says Theresa to test the impact of different programmes by the 2.25 Marteau, director of the behaviour and health research start of next year,according to Sean Russell, director unit at the University of Cambridge. She is researching of implementation for West Midlands Mental Health Incentives the impact of calorie labelling, portion sizes and the Commission. Russell says the focus will be on two of the and rewards prominence given to healthier food as a“nudge” to biggest burdens: workplace stress and musculoskeletal better eating at workplace canteens. conditions. “In lots of organisations, people won’t talk Asecond challenge is uptake. Evenamong participants about mental health but they will talk about abad in Britain’s Healthiest Workplace, while 62 per cent of back,” he says. employers offered wellness programmes, only 28 per As the UK economy shows signs of slowing down, cent of employees used them. Although physical fitness wellbeing initiatives that could boost productivity in the facilities prove popular,mentalhealth provisions — long runmight start to become morewidespread.

FT.COM/HEALTH-WORK | 9 Best of British

Our annual survey of companies and staff shows the country’s healthiest workplaces. By Andrew Jack

omura, Adidas UK and Forster Communications have once Nagain been recognised as Britain’s healthiest places to work. Alongside some newcomers, the bank, sports apparel and public relations companies earned first place in the large, medium-sized and small company divisions, respectively,inBritain’s Healthiest Workplace survey —now in its fifth year.The ranking recognises organisations with the healthiest workforces that also make the best efforts to improve staffhealth. LARGE This year,31,950 employees from 167 organisations participated in the survey, Nomura covering large, medium-sized and small companies —defined as those employing more Johnson &Johnson than 1,000 people, between 250 and 999, and Arqiva less than 250 —fromacross the public and private sectors. By adjusting for demographic profile and examining cultureand leadership, the survey not only captures those companies that have recruited healthy and productive workforces, but also those that help employees to improve their health and productivity. The winners have not only achieved high healthiest employee scores —compiled by BRITAIN’S gathering data on nine different risk factors, including smoking habits, nutrition and HEALTHIEST physical activity —but have also scored highly in the healthiest employer category, WORKPLACE which takes into account workplace wellness MEDIUM-SIZED interventions, facilities and services. This year the researchers also recognise Adidas UK for the first time Britain’s Healthiest New SweatyBetty SMALL Entrant, also in large, medium-sized and small companies. The Most Improved Workplace Gilead Sciences Forster Communications awardtakes into account only repeat participants in the survey. Ruffer The annual assessment was developed by Health Innovation Network VitalityHealth, and is produced in partnership with the Financial Times, Rand Europe, the research consultancy,the University of Cambridge, and Mercer,the human resources consultants.

10 |FT.COM/HEALTH-WORK LARGE MEDIUM-SIZED ASCOUK Neovia Logistics Dixons Carphone MB AerospaceHoldings SkanskaUK Britain’s Healthiest Workplace Top-quartile companies Fareham College LARGE MOST Nomura Johnson &Johnson Arqiva IMPROVED UniversityofAberdeen United Utilities SkanskaUK ORGANISATION Siemens Rail Automation NATS CH2M HILL Pinsent Masons BelfastHealth&Social Care Trust Mott MacDonald Wrightington Wigan &Leigh NHS Foundation Trust Dell Corporation AggregateIndustries SMALL

MEDIUM-SIZED FirstAdvantage Europe Adidas UK Sweaty Betty AcademyMusic Group Gilead Sciences PayPal DNOWUK Phoenix Group AbbVie Skyscanner Trowers&Hamlins Thames Tideway Henderson Global Investors

SMALL ForsterCommunications Ruffer Health Innovation Network Slalom MHFAEngland CIC Eversholt Rail NBA Hampton Knight LARGE Alliance Pharmaceuticals ROQ NATS

Pinsent Masons See the advisory board Belfast Health &Social Care Trust overseeing Britain’s Healthiest Workplace on p5

HEALTHIEST NEW ENTRANT MEDIUM-SIZED SMALL Skyscanner Health Innovation Network ThamesTideway Slalom Sika&Everbuild Building Products MHFAEngland CIC

FTFT.C.COMOM/H/HEAEALTLTH-H WORK | 11 S oeas e h e.Ther fee. the set and also work, some the the monitor but and want, control they often when companies work to on” “log allow to usually people They platforms. online via customers to a explode.” like to it’s waiting honestly: bomb effect, long-term The with stress. traffic, this London all with driving box, your inside you very “It’s health. physical mental drivers’ and to done being damage slow-burn the worked had elsewher who day him like people about know not day per work could re for driving been people have to a who messages though sends app, company the the to says in spokesman logged be can London in drivers currently not because does it’s Uber 10 tiredness.” of of out times nine accidents; in] drivers see Soho, will Shoreditch, you to London], night [in at Clapham go you “If says. he it,” and airport wer the some at discovered drivers Uber stop. fellow to to when talked them He telling one no app and an company only for have who drivers exhausted with up to Dr lassy“h lxblt” h rms fbigable ofbeing promise The flexibility”. almost “the they say and always them attracted what economy gig the employer largest country’s UK the sa in economy gig the in working the says he economy”: “gig so-called is says, 29-year-old the This, nowhere of air middle fresh the get in sometimes, car to the had stop “I to wheel. myself the force at asleep falling himself found he wer hours long the But app. 12 okhv enso oades By address. to the slow of been providers have the work that risks the carries in economy’ life ‘gig hazards… physical fatigue, stress, Isolation, idte fteiprac ftkn breaks. taking of importance the of them mind enumbe me i-cnm opne ieUe onc workers connect Uber like companies Gig-economy people hours of number the limit did Uber if Even nobody shocking; quite “It’s |F nohscradlgsrih nt h ride-hailing the to on straight log and car his into of at clock shift could eight-hour He it. make to a way like good seemed Uber and money needed ami T. CO rasin eb M/ efor HE iv h ainlHat evc,the Service, Health National the ,S de el ew AL m as h opn would company the says, ami gigo.H lowrisabout worries also He on. ogging ,g TH rigfr1 r1 hours 15 or 14 for orking Te tRdBl,js something.” just Bull, Red et ea .A a“ ea -W c,tesprakt hop supermarket, the sco, ,v ah ero re ksmoewowrsin works who someone sk en rlne”pro to period prolonged” r lonely ery re tuge Sometimes struggle. ORK de agro the of danger idden lykosabout knows ally gl .mpeople 1.1m ughly al ro to [Uber of ot re sp —a d ar ads tittetime the strict —i otthe bout ’ just t’s efi fa lling tran fter ad af ull ay. air rpryteptnilrsso ggeooy work. economy” But “gig of risks potential the properly is not is that But good]. sick is daughter to be your when flexibility around “The workers. economy the gig not outweigh for do risks benefits health these Health, and boar and psychologist the told virtual secretary one fantastic,” absolutely is That childcare. if matter holiday doesn’t school it on sick; she’s she’s if matter doesn’t it and factor home from clients for administrative tasks do who workers economy” “gig collar of two or hou hour working an “take to option the and 35 show in countries) workers 44,000 covers (which Survey Conditions European long-running the from data London, says College University at work economics of education professor and Green, Francis health. one’s for good being thing.” not one confidence, on my for good was he “It freeing”, says. was“quite Deliveroo via flexibly income after wer Deliveroo, hours company deliver his ‘gig’ to for up bicycle signed his he on said food named, be to want not did be disempowering. can and options inflexible job other whose workers lower-paid for is work to when choose to matters”. hsstr this ab cuainlhat xet aeytt investigate to yet have experts health Occupational Joanna for But is flexibility genuine that shown have studies Multiple University Leicester at student 21-year-old One ‘T bomb ap aa O’Connor Sarah nfto okn for of working enefit .“ eln-emeffec long-term he prpbihdb h mrcnCleeof College American the by published aper tstefeiiiyo t I’mher it. of flexibility the It’s A2 st aecar take to rs 1 td fvrulsecretaries virtual of study 015 es ec wa ut ar Wi re :honestly s: nhi in mral ikbtenwellbeing between link emarkable searchers. lde ab tn to iting dd .Ih ,a sb nfto okn o br that forUber; of working enefit rco fteCuclfor Council the of irector eof oslatorganisational consultant rjob. ar ag ap vntgtt ai about panic to got aven’t —fl o opn, h says. she company,” ood wru n,particularly one, owerful esnlo family or personal ge hssm positive same this agged To —a eal otpu his up top to able be ex ef ,i sltl [that’s bsolutely rm daughter my or plode’ t’ fd tofa Wo sl uring —w rking ik re hite- ,w li ea Wo ll ant ho rk Li contac belie elhsuffer health the ke Ya Sa enAlm(pictured) Aslam seen st ve cus Pr mi, ra tw st ess no in to ha t olausand colleagues ith fo mer ur rm td fs sf ep crn high ecuring river rUe driver Uber er ro ra mal oints ti ngs s’ mental ac kof

PHOTO:ANNA GORDON F T . C O M / H E A L T H - W O R K | 1 3 11

Occupational and Environmental Medicine in April —what Wildecalls “slow accidents”. She says any gig called on the profession to start worrying about it. The job that combines alack of control over how the work article pointed out that “both offline gig work in is done, insecurity of income, low pay and isolation transportation and services and online gig work are represents an “absolute recipe for astress-related characterised by anumberofhealth and safety hazards”. illness”. She adds: “You couldn’t treat ahuman being in In thecaseoffood-delivery bike riders, demand often away that is moreguaranteed to generate some sort of peaksattimeswhen conditionsare most hazardous. mental health problem.” People will often order takeaway mealswhenitiscold, Kevin Daniels, professor of organisational behaviour dark and wet. One winter night in Brighton, south-east at the University of East Anglia, says isolation is 1 Deliveroo is recruiting England, in near-freezing temperatures, aDeliveroo particularly hazardous to health. “Hundreds of high- ‘operations liaison’staff cyclist called EugeneZakharenkowas cycling up ahill quality studies” show that social relationships are to whom itsriderscan talk when he felt asharp pain in his stomach. He phoned a critical to wellbeing and safety at work, he says. He has about safetyconcerns doctorwho concluded he had hypothermia. “I tried to published astudy on the health and safety of “remote” 2 learn from it —ifyou sweat, you immediately get cold.” workers that shows being able to talk,preferably face- Uber does not restricthow long driversinLondon can Part of the problemisthe waiting outside in badweather to-face, with alinemanager is also critical. be logged intoits appbut is for Deliveroo’s algorithm to assign riders an order. Yetone of thedefining features of gig-economy work planning to introduce alimit Then there arethe longer-term health consequences is the lack of human line managers. The platforms

14 |FT.COM/HEALTH-WORK ‘You’re sitting thereall day, you’re not talking to anyone, you’re isolated —itdoesget to you’

classify the workers as “independent contractors” and Some of the platforms aremaking changes in most communication is done via the app or email. response to growing concerns. Aspokesman for Uber When Yaseen Aslam first switched from atraditional says the company is planning to introduce alimit “later minicab company to Uber in 2013, this was one of the this year” on the number of hours adriverinLondon things he loved about it. Unlike at the cab company, can use the app within agiven period. Uber also wherehefelt favouritism led to some drivers being started offering discounted illness and injury insurance given morejobs, the Uber algorithm played fair.“If a to UK drivers this year.“With our app, drivers are job comes, you would get it,” he says. But as time went totally free to choose if, when and wherethey drive, on, Uber cut the fares and he had to drive for longer to with no shifts or minimum hours so they can balance maintain adecent income. He says he was driving about driving with other commitments,” says Fred Jones, 40 hours aweek initially and earning about £1,000 after head of UK cities at Uber.Hesays drivers’ average expenses; two years later,justbeforehestopped driving fares are£15 an hour after Uber’s fee “and, even after for Uber,hewas sometimes working about 70 hours a costs, the average driver took home well over the week and taking home about £500. national living wage” of £7.50 an hour. He also felt stressed by the customer-rating system. Meanwhile, Deliveroo is hiring 50 “operations liaison” Uber “deactivates” drivers whose average ratings staffwho will be “named, physical points of contact drop too low,though the company says they aregiven that riders can approach whenever they have safety “several opportunities” over atwo-month period to concerns”. “As apoint of principle, Deliveroo believes improve their rating beforethey aredeactivated. that the people who ride with us should be kept as safe Aslam began to miss the social aspects of his old as possible,” says aDeliveroo spokesman. “Weprovide minicab job. “When the work was quiet, you’d go back all of our riders with helmets and lights free of charge into the office: all the drivers would be there, you’d and give them safety guidance beforeworking with us.” mingle, you’d have alittle chit-chat.” Uber was lonely Will Shu, Deliveroo chief executive, has said he would by comparison because everyone was operating on their like to do morefor couriers. “I’m the first to admit there own, often with fixed costs such as car-loan repayments aresome anxieties out thereabout this new way of hanging over them. working —inparticular,whether certain benefits and He thinks many Uber drivers have depression but protections, like sick pay or insurance, should be on avoid seeing adoctor for fear it would go on their offer,” he said earlier this year.But he went on to say medical recordand affect their ability to drive. “You that if Deliveroo weretooffer such benefits, the courts go in the morning to work and you need to earn ‘X’ would view Deliveroo riders as “workers”, who would amount of money; you’resitting thereall day,you’renot requirepre-arranged shifts. “This would not only put at talking to anyone, you’reisolated —itdoes get to you,” risk the flexibility our riders cherish but would limit our he says. “You notice these low mood swings; there’s ability to respond to customer demand,” Shu added. times whereyou can’t talk properly,you’reshaking, Aslam believes the best way to help Uber drivers you’renot thinking straight.” is to force the company to treat them as “workers” Butwhat obligation, if any, do gig-economy companies rather than “independent contractors”. Last year,he have to protect these workers’ health and safety? and another Uber driver called James Farrar took this argument to an employment tribunal. The judges 2 ruled in their favour,saying it was “faintly ridiculous” for Uber to present itself as “a mosaic of 30,000 small businesses linked by acommon platform”. Because Uber controlled the fees and funnelled the work to the drivers, the three-person panel pointed out, the drivers had no power to “grow their business” other than to “spend morehours at the wheel.” Uber is appealing against the ruling. Aspokesman for the Health and Safety Executive, which enforces UK health and safety law,says the CHARLIE BIBBY

G; “changing natureofemployment is an area we are following closely in order to identify and explore possible health and safety impacts”. Aslam says people who feel under pressureshould BLOOMBER

S: ask for help.” Not talking about it means it’s not being

TO dealt with,” he says. “And these guys aregettingworse 2 PHO and worse.”

FT.COM/HEALTH-WORK|15 Bulge bracket

Far from being paragons of health, many UK nurses areobese, the work environment being asignificant factor.BySarah Neville

tisajarringimage: thenurse whoistreatingusand Australia and New Zealand. However,they say thereis whom we might expecttoexemplify ahealthy lifestyle, alower prevalence of obesity among nurses compared Iis him or herselfnot justoverweight but obese. with the general population in the US. As the conditions associated with carrying too Christine Hancock, who runs C3Collaborating for many extra kilos exact an ever greater toll on stretched Health —anon-profit body that along with London’s health budgets, the irony of clinical professionals whose South Bank University,the UK’s Royal College of own weight is further straining limited resources is Nursing (RCN) Foundation and the Burdett Trust for becoming harder to ignore. Nursing makes up WIN —says that, to deepen its Yettackling so delicate asubject is never going to understanding, her charity interviewed morethan be easy,nor is the task of working out what to do. Is 400 obese nurses. it simply amatter of individual willpower,oristhe “Almost without exception they want to lose weight environment in which nurses work playing asubstantial and have tried to, and avery high percentage think it role, putting an onus on employers to do more? affects their work: either their ability to do their work What is notinquestion is the scaleofthe problem. [or] how they communicate with patients about eating Researchcommissionedbythe Healthy WeightInitiative morehealthily,”she says. for Nurses (WIN), amulti-agency project, found 25 per Given the sensitivity of the issue, “we werevery centofUKnurses haveanestimated body massindex surprised at the enthusiasm with which nurses wanted of more than30. This places them in theobese category to talk about this”, adds Hancock, who for 12 years, andisinline withthe British population overall —an until 2001, was general secretary of the RCN. Her equivalence that“provides littlesolace, given that charity subsequently set up focus groups of obese prevalenceissoworryingly high”, say academics nurses to investigate potential solutions “that nurses RichardKyleand Iain Atherton, who carried outthe themselves think might work”, she says. research lastyear.Even more concerning,theysay,isthe Hancock says the discussions threw up “some higher prevalenceofobesity amongunregisteredcare really quite shocking anecdotes” about hospitals and workers:almost athirdare estimated to be overweight. other health premises wherethereisnowhere to store In Scotland, almost 40 per cent of nurses areobese, food, or canteens that areeither too far from wards to asignificantly higherproportion than the general allow nurses to get thereeasily in their breaks or are population wherethe figureisabout 30 percent. closed during night shifts. “Some people wereeven While the data may suggest the environment of a saying they didn’t have access to drinks or water while hospital or other healthcaresetting is “obesogenic” for working,” she adds. its staff, other health professionals arenot overweight The groups came up with the idea of aserviceto to the same degree, according to the researchers. They deliver healthy food to hospitals, but the charity ruled point out, however,that the proportion of doctors, it out as unworkable within the timescale and budget 1 physiotherapists and other professionals indicated to be of the project. However,asecond, and unexpected, The UK healthcaresystem’s obese is still “notable” at 16 per cent. idea has gained traction, Hancock says: the notion that obesityproblem maynot This is not only aBritish problem. Kyle and Atherton weight should be afactor in career appraisals. be justacase of lack of say previous work has found nurses in other countries Far from seeing this as an intrusion, the nurses in the individual willpower 2 arealso morelikely to be obese than the general focus groups envisaged it as away to seek the support One in four UK nurses working population. of their line managers in addressing the issues at is classed as obese, as Other academic researchers, they say,have found work that might be hindering them from shedding the defined by the body mass asimilar pattern of obesity among nurses in the UK, pounds, she says. indexmeasure

16 |FT.COM/HEALTH-WORK 2

‘Because of pressureon the system, nurses’ shift patterns have gone to pot’

Some hospital executives arelooking favourably on the plan, she says, although the high degree of consultation through which any changes to appraisal regimes have to pass means it might be tricky to spread the approach widely. The squeeze on the finances of Britain’s National Health Service (NHS) is also making it harder for nurses to live healthily,suggests Kim Sunley,senior employment relations adviser at the RCN. “Because of pressureonthe system at the moment, our members tell us shift patterns have gone to pot.” Nurses might be called in do anight shift, then two days later find themselves back on an early shift. “Thereisnotimeto rest and recuperate”, Sunley says. Alack of resources has also affected whether nurses have somewheretokeep food or eat ameal during a break, she suggests, since in some hospitals rest facilities have been commandeered for use as storerooms or clinical areas. Meanwhile, thereisa“hidden workforce” of community nurses, who lack aphysical base and often end up buying unhealthy snacks as they drive between patient appointments. Sunley welcomes ascheme that has been introduced by NHS England to combat the number of sugary

LAMY snacks on sale in canteens by introducing an NHS-wide /A “sugar tax”. However,she adds that “you can have all the healthy options in the canteen, but if work is so pressurised that you can’t get to that canteen or have breaks”, its impact will be limited.

MARK THOMAS While staffmake their own decisions about any food S; they bring to work, “hospitals across England arenow being incentivised to offer healthy,tasty and affordable IMAGE meals, [and] health and exercise facilities, and to TY

ET work with retailers to ban the sale of sugary drinks in /G hospitals and curb the sale of unhealthy foods”, NHS

ZLEY England says.

DA Atotal of £250m has been made available over three years for all NHS providers that improve food and ETER

:P drink on their premises, with hospitals receiving a

TO percentage of the contract value to spend elsewhereon

PHO their budgets if they meet their targets.

FT.COM/HEALTH-WORK | 17

of Ad A tr iePic,wode rma cietlopioid year accidental last an overdose from died who Prince, like stars rich the or famous vulnerable and and poor the either for problem figures. CDC to according opioids, violence gun together from put or accidents car in than overdoses Mor Control Prevention. 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CO ,a —p an ab dmor nd ao enol M/ toa pdmcb elhofficials. health by epidemic ational e— ol h iei rie ak rpop or parks trailer in live who eople c injury ack ef ii dito rssta a been has that crisis addiction pioid .B re HE ro ,b ne effective. onger ta ilBte’ aeadthose and case Butler’s Bill as ut eA —h it mt et AL ttepikleshsdco had doctor his painkillers the ut re me ose a .mar 2.6m han ,t kn o uhmethadone much too aking lyipce me.” impacted ally vn lasfudta the that found always aving TH- ecii usars l strata all across cuts crisis he ,t iasno ricans epouto mor of product he as WO .“ re oywudppup pop would tory .A Ther al RK otdt otU mlyr $18bn employers US cost to ported trsacigthe searching fter eo ea —a wd re eisa al e,who Rex, calls dce to ddicted as dse nd efo drug from ie et l trigt prcaei is it appreciate to starting nly mlrfate. imilar special ablets ity ttle et re dd calls a a han own asi spriual aln httecmayi “lining is company the that galling particularly is it says healthcar free as offering such by perks talent for compete to companies prompted war policies world freeze second wage the to during traced implemented be can and world elsewhere the unparalleled in is US of the scale in The coverage pockets. employer own their of out the or by government than rather employers by predominantly funded ar citizens of two-thirds to came them of 70 derive both ingredients Abuse; active Drug contain on Institute National the drug, to illegal according the to US prior the opioids in prescription users using heroin of cent per 80 Nearly n ag Semployer US healthcar large of one charge abuse in to executive lead An can addiction. that and pills painkiller the for paying up healthcar private of vagaries the of face which companies, US country any in ultimately and, their perform to ar they painkillers, prescription on ay however human a 16,000 attended of he conference 2010, In success. of degrees varying their on employers at at arrived has developed has that up Healthcare, the Axial in digits, is single disorder low abuse opioid an with people employed built. is country the which on foundation sector private the in working society American of ti nabsurdity an is It of true be would same The answers, with up come to interests employers’ in is It educate to tried has Rex died, brother his Since epewohv bsdoii-ae anilr are painkillers opioid-based abused have who People of the percentage indicate statistics official Although am ear .T uc efirst he hh ,ast ai Crow David ig ecii scsigte iloso dollars of billions them costing is crisis he he afi .B ,p re rr ro ttepolmi atclryauefor acute particularly is problem the ut gur ro sni biu:i okr ar workers if obvious: is ason is e effectively les ,n as ro ,n fitability. kofb eof8t tls nepoes htte end they that employers, on lost ot ei akigtecii,with crisis, the tackling in le tlatmdl-ls people middle-class least ot sino opioids. on ession ,w ap eini cmn eonaddicts. heroin ecoming oakdntt enamed, be to not asked ho re as o1 er itv healthcar dictive re nsur cn hleg because challenge econd —t as te hnpyrises. pay than ather ore rfsinl;just professionals; sources 2p df ,r ub epol ena the as seen people he nepasta are that plans ance rcent. er dcn productivity educing ro el ei st at mt neauecrisis abuse ance s ieyt eable be to likely ess nA cnlg start- echnology eopium he me ,w rica re ep hich ported eh .A latform, po ooked bout eat ppy. 1 painkiller b Abu methadone ro fhri addiction heroin of Re hrBl idfo a from died Bill ther se xB si fopioid-based of utler ncr 2 1 ea ,w ov e h risk the ses erdose hose 2 2

PHOTOS: KATHYRN GAMBLE;GETTY IMAGES It is an absurdity, not lost on employers, doctor visits and emergency room admissions tend to be the biggest factors,” says Tess Benham, NSC senior that theyend up paying forthe painkiller pills programme manager for prescription drug overdose initiatives. “People end up overdosing or they get that canleadtoabuse and addiction impaired and end up in acar crash.” The combined cost of lost productivity and the bill for caring for people with an opioid abuse disorder is difficult to quantify,but it is undoubtedly large. the pockets of drugmakers, and the doctors who write Castlight, aSiliconValley-based company that prescriptions that areunnecessary and borderline specialises in health data, estimates the total employer abusive —who arethrowing these pills out like they are outlay at roughly $18bn ayear,made up of $8bn in candy”. Yetthe cost of the tablets themselves is nothing extra healthcarespending and afurther $10bn lost to compared to the cost of what happens once aperson absenteeism and lower productivity. starts abusing them. Given the huge costs, and that the opioid crisis started Of all the types of substance abuse, from alcohol some years ago, it is perhaps surprising that so many to marijuana and cocaine, people who arehooked on employers arefailing to tackle the epidemic. Part of the opioids end up in hospital the most, according to the problem is denial. In asurvey for the NSC of human National Safety Council, anon-profit organisation resources specialists at morethan 500 employers, focused on workplace health and safety.“Outpatient fewer than one in four respondents agreed with the

FT.COM/HEALTH-WORK | 21 statement “misuse and abuse of prescription drugs is a ‘Alternativesliketherapy problem in my workforce”. 1to3 and massage could be made MoreAmericans nowdie The design of some employer-sponsored insurance from drug overdoses than plans is also exacerbating the crisis. In recent years, available at lowercopays’ in caraccidentsorfrom gun companies have cut healthcarebudgets to boost profits, violence put together in large part by pushing agreater shareofthe burden 4 on to employees themselves. The efforts weretacitly An overdose reversal agent that police in Philadelphia approved by the Obama administration, which wanted “Employers have areally important role in designing carrytodeploy to turn patients into price-conscious consumers who their benefit plans to ensurethat opioids arenot being in emergencies would pick cheaper drugs and treatments, and thus overprescribed, such as covering alternatives like reduce the nation’s soaring healthcarebill. About 50 physical therapy,acupunctureand massage —and 2 per cent of Americans arenow in “high-deductible” making these available at lower copays,” says Benham. plans, wherethey aresometimes forced to contribute Thereisawidespread reluctance among US employers thousands of dollars ayear towards their health costs to talk about opioid abuse, but some aretaking action. beforetheir insurance fully kicks in. One largeorganisation, whichasked not to be identified, When it comes to treating pain, however,opioid employs morethan 100,000 workers, and already offers

painkillers aremuch cheaper than alternative and safer them access to aphysical therapist at no personal cost. IMAGES

options such as acourse of physical therapy.The But the senior executive in charge of benefits says the TY differential is reflected in the patient’s personal “copay” group is trying to do moreand has decided to take a ET /G —afixed amount the patient has to pay towards an “dual-edged approach to the opioid problem”. AFP

insurance-covered healthcareservice.This might be $600 “The first is adiligent focus on people who are S:

for asession with an orthopaedic physical therapist already facing challenges. We areworking hardto TO

versus as little as $30amonthfor adailydose of opioids. identify these people and get them into the behavioural PHO

22 |FT.COM/HEALTH-WORK ‘If you’re an employer, 40% of your overall healthcarecosts aregoing to be attributable to that 8% with an opioid problem’

health system,” he says, referring to practitioners who treat pain and relatedconditions such as anxiety and depression without prescribing drugs. The executive says this drive is aimed particularly at those employees who arefrequently absent from work. Second, the company is “narrowing the networks” of doctors and hospitals to which it will refer employees in case of musculoskeletal complaints. That means workers aremorelikely to see professionals “who arecompletely awareofthe problem, and effective at managing pain and dealing with opioid issues”, the executive adds. Increasingly,the company is turning to sports medicine specialists who areused to treating pain in athletes, he says. Spotting employees who areabusing opioids, or who areatrisk of developing adisorder,isnot always 3 easy,and can be especially difficult in the fragmented US healthcaresystem. If aperson changes jobs, more often than not they will also switch insurance company, doctors or regularly switch their primary physician. The meaning their records end up in two places. Warning platform also tries to identify those who have not yet signs, such as aperson who is visiting multiple doctors developed an abuse disorder but areatrisk of doing so, to get multiple prescriptions, or who has been on the such as those in pain who aretaking long-term pills for morethan ayear,could be missed. medication for conditions such as depression or anxiety. Axial Healthcarebelieves its platform —a“predictive “If you’reanemployer,40per centofyour overall pain management system” —could help solve the healthcarecosts aregoing to be attributable to that 8per problem. Thecompanyhas signed agreements with many cent with an opioid problem,” says John Donahue, Axial of the biggest insurers to build adatabase of morethan chief executive. “You need to zeroinonthemand get 190m people that cuts across different healthcareplans. them to high-quality physicians who will be able to Algorithms mine the data to identify patients who might mitigate their behaviour and taper their opioid use down.” 1 be abusing opioids, such as those who visit multiple Axial also offers what it describes as a“cognitive decision support system”, which syncs with apatient’s electronic medical recordand automatically informs 4 doctors when they areconsulting with apatient who might be abusing opioids or is at risk of doing so. “The minute [a patient] walks in, then ‘bang’ —the physician receives an alert that tells them the person is being treated for complex pain,” says Donahue. The system then comes up with a“carepathway”, which might advise the doctor that the patient be referred to a behavioural or physical therapist, or switched to anon- opioid painkiller such as ibuprofen or naproxen. Yetsome believe employers need to stop workers ending up in pain in the first place, pointing to figures showing that rates of substance abuse arealmost twice as high in physically demanding occupations such as construction, compared with desk jobs. “Many of these people really areinextreme physical pain,” says Adrienne Abbate, executive director of acommunity wellness partnership in Staten Island, New York, wherethereisahigh rate of opioid misuse, reflecting the preponderance of people working in blue- collar jobs or the police or fireservices. Whereworkers aremoreprone to physical injury,employers “should have better safe workforce practices so people don’t sustain injuries on site in the first place”, Abbate says.

FT.COM/HEALTH-WORK | 23 Sleeping on thejob

Anap at work can result in ahealthier,more productive employee, so some companies are happy to provide facilities. By Neil Munshi

few years ago, White &Case, the international law firm, was renovating its Washington DC Aoffice when some of its younger associates made arequest for an amenity to be added to a proposed “wellness room” —sleep pods. “One of the other desired features of our new office was improved coffee, so this probably got both ends of the spectrum,” says Francis Vasquez, apartner at the firm’s Washington office, which acquired two pods last year. He says they have been well received by the 300 employees there, and they areused five to eight times 1 Dome-shaped nap rooms aday.“From our perspective, it’s giving our people at the Beijing headquarters of what they want. And happy employees make better Baidu, the Chinese employees, so we’rehappy to make them happy.” internet company The sleep pods, which cost about $13,000 each, have 2 been popping up in Silicon Valley for nearly adecade. AMetroNaps sleep pod in use at tech company MetroNaps, the New York-based company that makes Google’sheadoffice in the pods, counts among its other clients Nasa, the US 1 Mountain View,California space agency; Uber,the ride-hailing app company;

2 Samsung, the technology group; JetBlue, the airline, and Zappos, the online clothing retailer. “Wehave anumber of IT companies —Google, Cisco —it’s aquestion of companies that areinterested in attracting and retaining good-quality employees,”

LAMY says Christopher Lindholst, MetroNaps’ chief /A executive. “Wealso have moretraditional companies — [consultancies] PwC and KPMG, White &Case —it’s anyone out therecompeting for talent.” The law firm’s investment in the pods reflects agrowing trend in business, as sectors beyond AL GEOGRAPHIC technology,aviation and medicine, which have long had rules and initiatives around rest, focus on sleep as apart NATION of their wellness programmes and efforts to improve G; productivity.These range from flashy gadgets to more mundane screening for sleep disorders. “Until fairly recently,sleepwellness was missing BLOOMBER

S: from most wellness programmes —they tended to

TO focus on diet, weight, exercise and smoking cessation.

PHO That’s been kind of unfortunate because of the major

24 |FT.COM/HEALTH-WORK ‘Wecan easily trytosteal time from sleep.The net result is that we are tired during the day’

fitness-for-duty guidelines related tosleep disorders”. Sleep disorders areincreasing in prevalence, says Ana Krieger,medicaldirector of the Center for Sleep Medicine at WeillCornell Medicine and New York- Presbyterian Hospital. She blames factors such as our attachment to smartphones and the increased stress of being constantly connected to the office. For pilots or firefighters, whose errors can lead to loss of life, sleep disorders or disturbances areseen as critical, she says. “But wheredoyou draw the line?” she asks. “When someone is working in finance and makes abad decision because they arenot well rested, and that leads to acompany failing or an agreement failing and many people losing their jobs, what do you do then?” Another problem is that people try to chip away at the hours they need to sleep —betweensix and nine hours anight for the average adult. “Biologically and physiologically,weobviously need to breathe, eat and sleep,” says Krieger.“Obviously it’s hardfor us not to eat becauseweget hungry and breathing is more of a function that we don’t havevoluntary controlover,but we can easily trytosteal time fromsleep. Thenet result is that we aretired during the day.” In Switzerland, global accounting firm PwC has a flexible working hours system —employees can arrive and leave early,take midday breaks and generally design their own workdays so long as they complete their tasks and work all of the hours they arepaid for over the course of the year.Itstresses the importance of rest to keep its employees from “stealing” those working hours from sleep. Michaela Christian Gartmann, the firm’s human capital leader for Switzerland, says some of PwC’s bigger offices have sleeping rooms, but about two years contribution that sleep makes to health and wellness,” ago it stepped up its efforts to persuade employees says Lawrence Epstein, director of the sleep medicine to use them when it launched awellness programme fellowship programme at Brigham &Women’s Hospital focused on boosting employees’ energy.The idea, in in Boston and an instructor at HarvardMedical School. part, was to remove some of the stigma “sleeping on the “Moreand more,we’reseeing how sleep disorders job” might have with some employees. affect work productivity,healthcarecosts and workplace The firm “invited sleep experts to talk about good accidents,” adds Epstein, aformer president of the and bad habits, the importance of taking regular American Academy of Sleep Medicine. “The cost of breaks and how aquick snooze can work wonders”, insomnia in the US is estimated to be over $100bn when 29.6% she says. The flexible working system also makes it you add in reduced productivity,absenteeism and of employees sleep “easier to visit this room than if you wereinanother presenteeism [when employees areunproductive at less than 7hours working environment”. work].” per night and lose an But, she says, PwC has not yet tried to measure Programmes that screen for sleep disorders have equivalent of whether its napping rooms have boosted productivity. been shown to reduce healthcarecosts and workplace Speaking of the sleeping room in her premises, accidents, and increase productivity,says Epstein. 4.7 Gartmann says: “Wehave no quantifiable data. We He cites a2012 study by the Union Pacific Railroad have this room and people can useitorcannot use it. Employes Health System, apension and health fund productivedays What we know is that when we launched our energy manager,which found such aprogramme would save per year programme, this room was visited much morethan the organisation nearly $5m over two years. Union Source:VitalityHealth/Rand Europe before, and those people who go thereonaregular Pacific says it is “in the process of developing additional Britain’s Healthiest Workplace basis, of course, love it.”

FT.COM/HEALTH-WORK | 25 Thefight on flab

Acalorie-rich diet has made Singapore’s office workers prone to obesity and diabetes. Now the state is taking action. By Jeevan Vasagar

an Qing Lin drops into afighting pose and throws punches in time to the instructor’s Lrhythm. Battling apost-pregnancy tendency to gain weight, the office worker spends just over an hour aweek at aBodyCombat class, working through awhirl of boxing stances in time to music. “After along day,Ican punch out all the negative stuffinmymind,” says Lin, 36, who works in the corporate affairs department at Far East, aSingapore- based property developer.“After this, when Icome home, Ican be anice wife and daughter-in law.It’sme- time for aworking mum.” 1 Last year,Singapore’s health ministry declared “war on diabetes”. As part of abroader push to curb the rise of the condition, Singaporeauthorities have encouraged 2004 and 2010, according to government figures. employers and office landlords to host fitness sessions. Singapore’s Malay and Indian minorities weremore About 11 per cent of adults in Singaporehave prone to being overweight than the Chinese ethnic diabetes, according to official figures, one of the highest majority,according to the data. proportions in the world. The government estimates That means Singaporeoffers aglimpse of Asia’s that, if left unchecked, about aquarter of Singapore future. Its approach to tackling diabetes provides residents will have diabetes by 2050. Lin does not have clues for its giant neighbours, China and India, where diabetes herself, though her father-in-law does. She the disease is also on the rise as incomes grow and exercises because, like many Singaporeans, she has a populations shift rapidly from the countryside to cities. sweet tooth. “Weall love cakes,” she says. In acountry known for its paternalistic style Behind Singapore’s vulnerability to diabetes is its of government, acombination of nudging and extraordinary transition over five decades from a admonishment has achieved mixed results. “Educating developing nation to Southeast Asia’s most prosperous people will only go so far,” says Yoong Kang Zee, chief country.The calorie-rich diet that fuelled labourers on executive of Singapore’s Health Promotion Board. “We the docks, or workers on the farmland that once dotted just need to restructurethe environment they areliving Singapore, makes less sense for the current generation in, so thereisanew set of norms.” of city-dwelling, white-collar workers. Singapore’s One example of shifting norms has been the claiming lifestyle has changed but the dietary preferences of its of public space —fromparks to office atria and people —for bowls of white rice, fried noodles and shopping malls —for fitness programmes such as DAS deep-fried breads —has not. Zumba. “Wewill pay atrainer to go tothe park,” Zee Added to that is agenetic propensity to develop the says. “There’s no marketing, just atrainer and aboom- condition; people in Southeast Asia become diabetic at box and see what happens. The first day afew curious HANDRA alower body mass index than Europeans, according aunties start dancing. It’s ahandful by the second week. AC to the World Health Organization. Rising obesity has After three months it’s 60-100 people.” AMRIT

contributed to the wider prevalence of diabetes in the Authorities herepay close attention to the S:

country.The proportion of obese Singaporeans rose psychology of exercise, noting that small companies TO 2

from around 7per cent to nearly 11 per cent between tend to be moreenthusiastic about corporate PHO

26 |FT.COM/HEALTH-WORK ‘Educating people will only go so far. We need to restructure their environment’

walking challenges, for example, as the social ties are stronger.Larger companies have been able to harness similar social bonds by organising internal teams for sporting activities. At the BodyCombat session, Lin saysthe classes have encouraged her to broaden her circle of friends. “This is free for staff, and it’s quite good bonding time for me to meet colleagues from different departments,” she says. “Wehave now made friends and help each other at work.” The government’s public health agency has targeted office workers with free early-morning workouts at fitness studios across the .Ccity alled Sunrise in the City, this programme has now signed up 8,000 subscribers, up from 200 participants when it launched in 2013. “When Ilook at how many people of different age groups thereare out exercising [in Singapore] and comparethat to the UK, it is miles apart,” says Julian Sham, Asia-Pacific lead for health at Accenture, the consultants, pointing out that Singaporeans are exercising more. Singapore’s approach has emphasised flexibility, offering health screenings at car service centres as away of reaching taxi drivers, who have traditionally used such service breaks as an opportunity to eat acurry puff, the local version of ameat pie. These screenings werefollowed up with one-to-one health coaching. Apilot screening programme, also among taxi drivers, generated significant health improvements, the government says, with about half of participants who had unhealthy results at their screening seeing at least one improvement in ahealth indicator —suchasblood pressure, blood sugar levels or cholesterol —ayear later. Efforts to encourage Singaporeans to change their diet have been less effective, however.Office workers tend to go out for their lunch breaks, heading to hawker centres, or markets, wherestall-holders serve up traditional favourites such as chicken rice —adish of roasted or poached chicken with rice cooked in the stock —orlaksa, aspicy noodle soup. Hawker stalls areacentral part of Singapore’s social make-up, aplace whereall strata of society dine together and even the poorest can get afilling meal. “It’s fair to say that we have an attachment to our food,” Zee says. “It’s part of our identity.” Authorities in Singaporehave encouraged food outlets to offer lower-calorie options, to use healthier blends of oils for cooking, and to include whole grains, fruit and vegetables. Brown rice is now on the menu 1and 2 at bus drivers’ canteens. The emphasis has been on Fitness programmessuch making small dietary changes. “We’renot going to as BodyCombat arerising in popularity, as thecitystate’s get people to eat salad. We can’t change your char authoritiesencourage kway teow,” says the health agency chief, referring citizens to exercise to apopular dish of fried ricecake strips. “But we can change the oil that’s used for your char kway teow.”

FT.COM/HEALTH-WORK | 27

Intervention strategies

Illustrations by Scott Chambers

SCREENINGPROGRAMMESSHOW PREVENTION IS BETTERTHAN CURE

olvo, famous for its role in increasing driver safety with the introduction of the three-point Vseat belt in 1959, is trying to apply the same ethic to improving the health of its workforce. Since last year,the company’s UK arm has been offering regular health screening for its employees, including checks for common cancers as well as comprehensive physical assessments for management. “Thereare two ways of minimising the impact of an accident,” says Simon Eade, human resources manager at Volvo Cars UK. First, he says, thereispreventing the accident in the first place and, second, minimising the impact after the accident has occurred. “Health checks arelike preventative safety to avoid people having accidents,” he says. Volvo introduced its programme after along-serving member of the team at the company’s headquarters in Maidenhead, south-east England, was diagnosed with breast cancer.She survived the scare, but the incident highlighted how important health checks can be. Putting an exact number on the direct benefits of health screening is difficult, not least because its positive effects arehardtodistinguish from those resulting from other health initiatives, but those who aremonitoring such programmes say the benefits eear vident. “Wesee through our own engagement surveys that afitand healthy workforce is an engaged workforce that is moreinnovative, morecreative, and is going 67% to deliver better outcomes for your clients,” says of employees Tony Horan, head of human capital and diversity at havehad blood pressure AccentureUK, the consultancy,which offers health screening in the past12 assessments to its employees every five years. months Likewise, feedback from screening programmes can help employers to identify health issues across 26% the company and in roles that have differing mental of employees and physical challenges. “Weget trends and analysis remember their blood from the company that provides the health screenings pressurelevels so that we can target our [occupational health] Source:VitalityHealth/Rand Europe; education programmes,” says Hamish Watson, Britain’s Healthiest Workplace UK human resources director at Scottish Power.

FT.COM/HEALTH-WORK | 29 The UK utility company’s employees aresplit between office-based retail and customer service teams and a technical field operation. Pinpointing aproblem can help to manage risk and improve performance. “Because of the kind of jobs that some of our people do, it’s hugely important to us,” says Watson, who says strong powers of concentration areparticularly vital for some of Scottish Power’s employees. “That’s amajor safety issue [in the field]. We want to make surewe’ve given them every opportunity to be as fit and as able as they can be.” Companies’ understanding of their employees’ health on the job might soon be supplemented by information from wearable technology.Such devices could monitor anything, from heart rates to hormone levels, that may affect performance. However,their use raises ethical questions. Tesco, the UK supermarket HEALTHY EATING INITIATIVES chain, is conducting atrial of wearables on small groups HAVE TO BE MADE APPETISING of employees. Natasha Adams, people director for the UK and Ireland, says Tesco appreciates that there arequestions of privacy and that “therewill be fears around that”. imberland’s Victory Garden started as asmall In the US, privacy advocacy groups have plot in the front yardofits headquarters in protested against proposed legislation on wellness T New Hampshirein2008. Today,itconsists programmes that would allow employers to collect of four large raised beds where, each season, their workers’ genetic information. But Adams green-fingered staffproduce hundreds of kilos of fresh says that, unlike in the US, where companies are produce and flowers. allowed to impose financial penalties —such as While giving employees at the US clothing higher health insurance premiums —onemployees manufacturer and retailer the opportunity to volunteer for not participating in wellbeing initiatives, Tesco’s and spend time outdoors, the organic fruit and programmes arevoluntary.“We will understand more vegetables produced in the garden arealso sold to as we work through the trial,” she says. “But we have staff—and in the company café —and theproceeds no ambition to monitor colleagues for anything other donated to alocal charity. than to continue to support people being well at work.” “A large part of why VF Corporation [Timberland’s Sebastien Ash owner] chose to invest in wellness initiatives at both a global and brand level is the return on investment for the company and culture,” says Beth Reichl, human resources business partner at Timberland. In the case of the Victory Garden, $15,000 has been raised for the local food bank since its first harvest. At the same time, staffhave had the opportunity to use ingredients from the garden in quarterly cooking workshops with the company chef. When it comes to healthy eating, education is crucial, employers such as Timberland argue. Dun &Bradstreet UK would seem to agree. The data and analytics company has offered nutrition workshops for the past two years, including talks from specialists. The sessions teach the company’s 500 UK-based staffhow to use food “to influence how you’refeeling”. “Part of our focus on nutrition is to show how you can make sureyou feel properly fuelled so that you can be at your best when you need to be and, as you 3.5 go through your day,how you can keep yourself topped up,” says Julian Prower,Dun &Bradstreetchief productivedays human resources officer. ayearare lost by In an area as personal as food habits, thereisarisk of employees with poor diets. Reducing fat employers lecturing staff. “Wehaven’t gone down the intaketoahealthy road of saying, ‘You can’t eat this, don’t do that’,” says range reduces work Prower.“We wanted to go down the route of saying, impairment by ‘Let us give you the knowledge and the insights, so that you can make the right choice for you’.” 2.5 Beyond giving staffamoredetailed understanding of healthy eating, an increasing number of workplaces days per year areoffering employees morenutritious food options. Source:VitalityHealth/Rand Europe; At UK insurance services provider Phoenix Group, this Britain’s Healthiest Workplace has meant stocking alocally sourced menu —including

30 |FT.COM/HEALTH-WORK asalad bar,fresh fish and chicken —atthe restaurant in the company’s offices near Birmingham. Working with the local environmental health service, it promotes nutritional information and portion advice —for example, how long it would take to walk offthe calories from aparticular food. Last year,when popular foods such as chips were taken offthe menu on healthy eating days, staff complained, says Lucy Symonds, the company’s corporate responsibility manager.“This year when we took chips off, we offered alternatives such as sweet potato fries, which werepositively received,” she says. “Weare making surewhatweoffer is still appetising: ‘healthy’ doesn’t necessarily mean ‘bland’.” Tailoring initiatives to staffneeds is vital, says Liz Ellis, human resources director at the early-life nutrition business of French food group Danone. The company — which states that its mission is to bring “health through food to as many people as possible” —carried out a study that found ahigh percentage of people in the UK did not know their cholesterol levels, and indeed 90 per cent of its own employees did not know their levels limitations ensurepeople of all fitness levels are either. engaged. This prompted the company to launch its own “Weeducate the individual. Because the wellness healthy eating initiative by first offering free 30-minute centreisonsite,webuild alevel of trust. We work health assessments to staff. Its trained nutritionists now with employees in their comfort zones. If you’ve had offer bespoke eight-week healthy eating courses and past injuries, [we’ll] have you see aphysiotherapist,” encourage teams to dine together in the office. says Kalloo, explaining how access to facilities at work “Beforesetting up your healthy eating initiative, try means employees areless likely to call in sick. to get comprehensive insights into your workforce’s Iris Worldwide has achieved similar success. The habits,” Ellis advises. “You need to understand what marketing agency network formed wellbeing policies support they need and why.” that grew out of the recognition that having healthier Hannah Murphy employees means greater productivity. Led by fitness director Rebecca Cox, Iris has reinforced the importance of personalised care. All staff have access to one-to-one consultations to help develop HOWAFOCUS ON PHYSICAL FITNESS alifestyle plan based on everything from their commute to sleep duration. “People can train in groups specific to CANSTOPILLNESS IN ITSTRACKS their needs, whether it be arunning class or back care; there’s awhole timetable of things,” says Cox. The sessions give trainers at the company abetter uring the run-up to acharity swim held sense of other things taking place in employees’ lives, by Adidas UK, one employee developed a allowing them to take amoreholistic approach in Dfeeling of butterflies. However,she confessed understanding what motivates individuals to exercise. she had been having the uncomfortable Nomura, the global investment bank, has been sensation offand on forawhile. “The minute we put able to shrug offthe banking sector’s poor image her on the ECG to do her exercise stress testing, we on work-life balance to present itself as acompany discovered she had aheart problem,” recalls Tricia that champions the health of its staff. Ian Edwards, Kalloo, chief executive of Wellness International, a programme director at private healthcareprovider provider of occupational health and wellness services. Nuffield Health who heads the wellness services “The doctors told her if she proceeded with the event, it at Nomura, has emphasised the need to find atrue might not have been agood outcome.” measureofhealth risk. By using predictive models of The employee later had heart surgery to have stents 47% an employee’s health, Nomura was able to save £3m on inserted. Though she made afull recovery,early presenteeism —the cost to acompany of an employee of employees over intervention was made possible by the health and turning up for work but being unproductive —over 55 do not take wellbeing services put in place by Adidas’s partnership sufficient exercise. two years, from 2015 to 2016. The company runs acycle with Wellness International. The sportswear company Employees of all scheme used by 150 staffeach day and has an integrated has achieved particular success with its physical health ages canreduce fitness and medical centre. interventions. “Adidas has developed the concept that work impairment by About half of its workforce areactive members of the physical activity is just alifestyle,”says Kalloo. centre, Edwards says. “We’ve been focused on taking a It is 20 years since Adidas established its health and 3.2 proactive rather than reactive approach,” he says. wellbeing centreatits head office in Stockport, north- All three companies base their provision on the west England. Performance and testing labs provide days ayeariftheygo notion that thereisnosuch thing as not having enough employees with health markers such as their VO max from no exercise to 150 time to exercise. Iris promotes the idea of short, high- 2 minutes per week score, which measures oxygen consumption and gives intensity workouts to demonstrate this. “You don’t need an indication of improving fitness levels. Meanwhile, Source:VitalityHealth/Rand Europe; an hour at the end of the day to work out,” says Cox. bespoke programmes tailored to each individual’s Britain’s Healthiest Workplace Hasan Chowdhury

FT.COM/HEALTH-WORK|31 support of Mental Health Awareness Week and found ENDING THESTIGMAAROUND that it was quickly oversubscribed. MENTAL HEALTH BEGINS AT THETOP Thereisgrowing recognition globally of the psychological and social costs of mental ill health. This momentum has shifted employees’ expectations, says Ed Thurman, managing director of financial institutions hen international law firm Gowling WLG at the UK’s Lloyds Banking Group. “Ten or 15 years marked Britain’s Mental Health Awareness ago, we werehanding out subsidised gym memberships WWeek in May last year with aseries of to keep people physically fit,” he says. “Today,[our events in its UK offices, one employee told graduate population] expect to be looked after in terms organisers he had been reluctant to attend —incase of overall wellbeing. They expect apackage.” doing so gave the impression that he himself had a He says companies should try to give managers the mental health problem. latitude to shape these packages according to the needs “Our hearts sank when we heardthat sort of of their teams. “What works for our London trading feedback,” says Lorna Gavin, head of diversity, floor might not work for an operationseo centr ut in inclusion and corporate responsibility at the 3,500- Reading [south-east England] because they have different strong firm. “Because that was the living embodiment of profiles in terms of people and working patterns.” the stigma [around mental health]. That’s what told us Many companies offer employee assistance we needed to break the stigma down.” programmes to help with personal or work-related For employers, raising awareness of mental wellbeing 33 problems, often including occupational health support, —and supporting staffwho suffer from ill health — private medical insurance that covers wellbeing or productivedaysare lost requires both sensitivity and openness. The potential per year to moderate counselling, and even massages. Some organisations benefits ecar ompelling: in the UK, nearly 11.5 percent to severe depression by also train stafftorecognise when colleagues have a of sickness absence in 2016 was mental health-related, the 5.6% of employees problem and how to manage that. according to the Office for National Statistics, while the who suffer from it.They But employers should also fashion “proactive” and canreduce their work OECD puts the cost of mental-ill health in the UK at impairment by preventative interventions on top of their “reactive” some 4.5 per cent of GDP through lost working days, programmes, says Philip Gibbs, director of organisation lower productivity and increased healthcarespending. and people analytics at GlaxoSmithKline, the For Gavin, the employee’s comments reinforced her 31 pharmaceutical group. “Given today’s cultureof belief that senior figures, in particular dmboar embers, back-to-back meetings, emails throughout the day and days if theynolonger need to be avisible part of any workplace mental health suffer from depression phones next to the beds, employees need aperiod of initiative to lend it credence and ensureother stafffeel ‘recovery’ and this is what we want to push,” he says, comfortable participating. This year,she made sure Source:VitalityHealth/Rand Europe; citing recent legislation in France that allows employees senior staffpromoted the programme organised in Britain’s Healthiest Workplace to ignoretheir work email after they leave the office. He points to “Time for aMoment”, GSK’s new online course, which teaches participants mindfulness and one-minute meditation techniques. “It’s about how to ensuresustainable performance,” he says. Indeed, targeted campaigns can be effective, many employers argue. Gowling WLG introduced an initiative recently around domestic violence and mental health that included training “domestic violence champions” to spot the signs and provide initial support. However,“the biggest difference came from putting posters on the back of loo doors”, Gavin says. These outlined different domestic violence scenarios with the strapline “Help is closer than you think”. More than adozen people came forwardfromevery level of the organisation and wereable to get help. “It’s practical, tactical things as much as it is big rhetoric coming from the organisation,” says Thurman. Hannah Murphy

32 |FT.COM/HEALTH-WORK

th Br 34 By workers. diseases their lung among industrial for account to held Africa’sm South |F T. COM/H es ou EA 1 LT H- WORK S ac h eti h So Europe. or US the in best the match npoverty in pdmc hyhv enwdl rtcsdfrtheir for failur criticised widely been have they epidemic, their for praised been have companies mining Africa’s South While wellbeing problems. and health to vulnerable particularly is a Gini index, the by measur defined as world, unequal the most in the societies of one as consistently scored has AngloGol industry mining the in than evident worker did cause okdsne16 n eeoe h iess n the and diseases, the developed and have 1965 who since miners worked former and current includes that suit average. national the times four is miners of among incidence TB the estimates, some to According disease. tuberculosis —s contracting them to from led workers that protect conditions to failed also companies the that silicosis. failur from their workers for protect mines, gold operate to continue operated or have which companies, 29 against lawsuit ($35m inin ‘W ght ttesm ie mor time, same the At nMrh21,mnn opne nl American Anglo companies mining 2016, March In Nowher h w ae ar cases two The Mor ur lcsssfeesar sufferers ilicosis no ogtbenefit get to et db en )i hl the while ta es sw elh aeyadwlbigpoiin that provisions wellbeing and safety health, workplace with companies working multinational lives for privileged enjoy cities its in people is Africa outh eof gc op nt yi dm giiatfrteidsr is the industry for ignificant dA oa ,a ho eist ro hln fin nhaling ee income tlia it crigt the to ccording etwresaantln diseases. lung against workers tect ompa shanti rs ocompensat to trust ha a tr fcnrsigfrue more fortunes contrasting of story hat dc daq bili in Jenkins Siona eb nrce silicosis ontracted fa distribution. ybtare to agreed but ty ag ac ighear eing ed re ep ed utyo otat.Many contrasts. of ountry isar nies y’ et us riual unrbet the to vulnerable articularly iksettlement uick a aftepplto lives population the half han t—at as re re Wo pnet h HIV-Aids the to sponse et As stop da l ak ot Africa South Bank. rld tlemen to et tl ali still ce work. cn utcharges suit econd eclaimant he sas pa ,w eb —al ac yuptoR tw ingl oeworkforce hose Th la eo it un ec ss-action ec eing h4 gd la ve’ ompanies s. ,4 ple ss-action 464m 00 isease eto mine and fe exposur after mor health 120,00 industry mining the in employers organisation an Mines, of South Chamber the African shrinking, is sector the Although Africa. TB.” and silicosis is thing them only with the have home they back come Africa they South When in years. been for have men “These says. he people,” of death and breadwinner illness their the by poverty into thrown families diseases. centr specialist no had infrastructur health Africa, minimal South has by encircled South is in which mines Lesotho, the Africa. left had who workers of thousands country his that in says decades families, for their and miners former assists which Agency, Development Mineworkers the Lesotho-based of manager country Salae, Puseletso affected. died. already have who those of dependants Silicosis over well back goes mining Gold ar Lesotho neighbouring from Mineworkers 0p ol ar eople The —i et et han re etfe as dentified oa utwstn ftosnso mining of thousands of tens was sult ee ac .“ pp mplo h ie aejs xlie our exploited just have mines The nuyago entury ear et .Ina ot ye ,t at re dint her llowing ra omn workers’ mine to hreat tocptoa lung occupational at ew —c ecutysgl sector. gold country’s he ea ,e sn olwu fthe of follow-up no as nd ntk 03 years 10-30 take an tmtsabout stimates ac th ,u nuyi South in entury ec ntil asato suit lass-action re re presenting cently, ea lso 2

PHOTOS: AP;AFP/GETTY IMAGES; REUTERS;EPA ‘The mineshavejust exploited our people. 4 When theycome back home the only thing theyhavewiththem is silicosis and TB’

3

Fine defends the mining companies’ records on employee wellbeing, pointing out that those the working group represents wereamong the first organisations in South Africa to provide anti-retroviral treatment (ART) for employees with HIV. They began offering ARTin2002, contradicting the policy of the South African government, which under president Thabo Mbeki denied that the disease was caused by avirus and refused to provide the treatment. According to the working group, ARThas also helped reduce TB rates. Companies nowoffer regular TB screening and treatment as part of their employee healthcareservice, although they admit thereare “challenges regarding former mineworkers, particularly those living in ruralareas”. In recent years the companies have also begun taking action on occupational lung disease. In 2003, they committed to aMineHealth and Safety Council (MHSC) goal of no new cases of silicosis among mineworkers who had not been exposed to the disease before2008, but because silicosis takes so long to appear,itwill be many years beforethey know whether they have been successful. They have also pledged to meet new 2014 MHSC guidelines on significantly reducing dust levels in mines and making investments in improved anti-dust measures in drilling, ventilation, filtration and blasting, among others. The improvements have been acknowledged by many involved in theclass-actionsuit. But when asked why,given the link between mining and silicosis, the companies did not implement better measures to protect workers sooner,Fine says: “South to go ahead in May last year,the High Court judge said 1 Africa has along and troubled social and political hundreds of thousands of miners mayhave beenaffected. Afemale South African history and the mining industry was part of that.“ mine worker South Africa has had amodestcompensation 2 As the court process continues, the working system for morethan 40 years, but it has been criticised Adoctorexamines an group and lawyers for the mine workers aretrying as inadequate. “It is well known that the lung disease X-rayofaminer’s silicosis- to agree asettlement for the class-action claimants. compensation system has over the past number of years affectedlungs Several companies’ most recent financial results show 3and 4 become very badly administered, which has meant provisions to settle the claims. Minersprotest in 2015 in very long delays and agrowing backlog in payments to supportofcolleagues who But the clock is ticking. RichardSpoor,alawyer eligible claimants,” says Alan Fine, spokesman for the had filed alawsuit against specialising in occupational health and safety and a Working Group on Occupational Lung Diseases, which their employers forfailureto member of the team representing the miners in the was formed in 2014 and representssix of the largest protectthem from silicosis class-action litigation, says about 4per centofthe South African mining companies. The group aims to miners in the suit aredying every year.“Thereisa strengthen the compensation scheme, bolster prevention general consensus that we need to achieve asettlement measures and improve medical carefor occupational quickly and get benefits to people while they’restill lung diseases in mining. alive. It’s in everybody’s interests.”

FT.COM/HEALTH-WORK | 35 fmi of Me “C aB an product of head chance dul numbingly re because ca their from mor promises eye an hit to want don’t “We’r body: the of zones” work will to people machines alongside getting instance, For says. she space,” be envision to to important able very “It’s Science. Computer of School Ve allow mor Ever pl thv aeti mor this to made how have on it imagination apply and technology the both in limits ar dangerous these less straining, made less or or augmented, work be your to “If about wellbeing: truly worker is of way the in gained be ther agrees interaction, human-robot about By judge. to of harder on thewellbeing is workers its impact but benefits ar have them enable that harmless off.” head least your at cut but won’t collaboration, they much do don’t “They says: he of Institute Massachusetts Mindell, David says underwhelming, if humans. with interact machines’ to the ability of improved colleagues their on effects the consider ar designers their packaging, or handling 36 petitiv ep stesoftwa the As thesoftwar design to been has job first The idl,ato of author Mindell, ml,light Small, safe been has technology new this stages, early its In oo edo ahn eriga angeMellon’s Carnegie at learning machine of head loso, os |F ro o-ae maker ton-based as ro gr fca of imple ost prt ntehmnwrd asManuela says world, human the in operate to bots ea th T. ammed —t er ction COM/ re ge egular etra efrigtsssc smaterial as such tasks performing get at ascobots better But to automate. difficult too considered previously work into inroads collaborative or obots”, esnosan sensors he efl radvance er an ov la s. am re st ds xbemachine exible er “W o“u to nd to ei a strai hat be HE ride dm bl creatur obile lo ro shu e’ osg okr to workers consign com wm re u oos Ourselves,a2 Robots, Our oscan’t bots ego ve et AL nd tliettcnlg a la business clear has technology ntelligent of :if reiga ehn Rob Rethink at arketing quir td —ane ment erstand” smo es et oos hs often These cobots. eg TH- ah oving own. nh dm Te yn omodel to rying eanu tp o hns”Bth asthat says he But things.” ood ep mngt to gets uman chnology mnlms ar limbs, uman ,h WORK ol on job doing eople cielann software achine-learning lb re em ,c st ro do wi esimportant.” less is ow es drtnigo “safety of nderstanding ohsiae,it sophisticated, bt ar obots iethan mise ha th ays. vn rudi our in around oving t”sy Ji says it,” eir tc ing nd ro .Oft nbe an en os ar bots, jo ap eg vironment oc swt no with bs eh ap ecobots, he eism ro em re re oe they lose, enerally em in vn to aving mL erson. st esrat fessor ality. leased otics, volve 1 book 015 em dl to odels oday ind- awton, c to uch aking You s? ihr Waters Richard ieto h ahn saott oein move to about is machine the direction on image (an ro be to have machines the mor that is One machines. working the of with experience human the improve to overcome sokdpol” esays. he people”, “spooked wher valley” “uncanny the into Moving condescending”. and machines wer the thought people Lawton: says opposite, hmse mor seem them its on mouths smiling putting with har they find intelligence of level whose machines alongside to says. he people,” with befor go to a way has long still world science computer “The processes. about like been humans largely treating has automation of history the that take will people 2 o ild et h ae twl e”sesays. she be,” will it safer the next, do will bot ehn’ nwrhsbe ogv its give to been has answer Rethink’s Ve At between interactions complex Designing re es eu uetesneo erns o epeworking people for weirdness of sense the duce oosy ther says loso as ikn tte,adfudte “arrogant them found and them, at mirking drtnal.“h mor “The nderstandable. dt ml ee,mkr fcbt ar cobots of makers level, imple oj er de ehn,frisac,experimented instance, for Rethink, udge. at bt tr ocp uastoclosely too humans copy to start obots e“ hum be optr htidct the indicate that computer) ablet ac ea human” ag nmnst esy,adding says, he mindset, in hange eith re ro os oftit automated into fit to bots, hu an as rd .T ac le he st u bu o odeal to how about lue re eh ha utwsthe was sult tw mn ne hta what infer umans ro ost make to bots l aet be to have ill ew ro os“eyes” bots —a orking ro osand bots sim ple 1 AR La altt tablet with gvnadcnevda a as conceived and ngevin ro ethink de InMoo bot ve ‘e oi ,d omn plat lopment ye mo nd Ro esig v, s’ ve ic a3 displa botoc at 2 1 ments ne eit D- dbyG printed ye si sm nt dona fo ac ended rm aël hine,

PHOTOS: AP ‘ALGORITHMSTOOKOUR JOBS’

TomGordonwas 45 fourth industrial when his lucrative revolution is that we career as an oil don’t have the trader suddenly social institutions faced anew threat. that arefacilitating Electronic trading, and enabling the which originally had transition,” says been introduced Ravin Jesuthasan, to expand trading managing director capacityovernight, at Willis Towers wasnow operating Watson, and leader head-to-head with Gordon and of the consulting group’s research his colleagues on the floor of the area,“FutureofWork”. exchange during the day. Research on the threatof Gordon, pictured, says he used automation paintsacomplicated to handle between 500 and picture. A2016 OECD report 750 trades aday.Inhis nearly found an averageof9per cent 25 yearsasatrader he recalls of all jobs acrossthe 21 countries recording only twomonths of the research coveredcould losses. But even the high volumes be automated, given current that asuccessful trader like technology.Areportbyconsultants Gordon could handle were quickly McKinseyputsthe global figureat overshadowedbythe volumes less than 5per cent. electronic systems were capable of Manyresearcherssuggest processing. the morenuanced effectofthis ForGordon, working alongside transition will be on the handful ‘The computer scienceworld the electronic market waslike of tasksacrossall sectors that still has along waytogoon being hit by atruck.“Isaw the areroutine and repetitive. transition wascoming and knew According to another howtodeal with people’ [traders] were going to get run McKinseyreport, morethan over,” he says. He eventually left 70 per cent of tasksperformed and retrained as asocial worker. by workersinthe food service way to preparepeople around them that they areabout He waswisetodoso, because and hospitalitysectorcould to do something, says Lawton. afew yearslater,in2016,CME be carried out by machines. Another key is to design aform of robot-human Group,which owns the NewYork In manufacturing, nearly 60 symbiosis in which each helps the other achieve its goal, Mercantile Exchange (Nymex), per cent of tasksinjobs such says Veloso. That will mean teaching people to respond closed the lastofits remaining as weldingand maintaining to requests from the robots, or to anticipate their needs, commodity-trading pits. equipment areatrisk. as much as the other way around. As interactions like Gordon says some of his former Higher-paying jobs arenot this become moresubtleand machines take over more colleagues have struggled to cope immune from the disruption. work alongside people, the long-term impact on the in their newlives. “Somehavedone McKinseyfound that up to 50 wellbeing of human workers is hardtopredict. Against quitewell, but formanyofthe per cent of tasksinthe financial the obvious benefits of taking dangerous or tedious people it really broketheir lives and services industrycould be work away from people, theremay be unexpected side- their spirit.” automated, as could about athird effects. “When people invented keyboards, they weren’t Losing ajob to amachine of jobs in healthcare. imagining carpal tunnel syndrome,” Veloso points out. or algorithm carries aunique Jesuthasan says this refocusing As moreautomation creeps in, theremay be subtle psychological burden, says Marty of taskscan givepeople the but far-reaching effects on the way work is designed. Nemko, apsychologistand career space to do moremeaningful Thereisafear that the iterative process improvements counsellor. work.“Leavingbehind all of that areaproduct of lean manufacturing —constantly No training exists that canhelp those routine things [creates] a learning and implementing better ways of working ahuman match the speed and huge emphasis on creativityand —may be threatened, says Lawton. If existing work efficiency of artificial intelligence. empathyand care,” he says. processes areautomated, the result could be an “Thereisaninevitabilityof[one’s] Afterwitnessing his original job ossification that prevents this steady improvement. inferior abilitythat accrues,” Nemko as atrader vanish, it is perhaps Like much technology whose benefits ecar lear in the says. no surprise that Gordon has short term, even if their long-term effects on human TimLeberecht,aconsultant on found himself engrossed in wellbeing arehardtojudge, the advance of the cobots is business leadership,agrees: “If we work requiring these human unlikely to be slowed. People arelikely to take to their lose our jobs due to automation characteristics. “I want to do new robot colleagues as enthusiastically as they took to and can’tget back intothe my part,”hesays. “Will Imakea their smartphones, saysMindell. “Peoplehavetheir fears workforce, then thereisthis huge difference?Idon’t know,but I’m —insome ways, they arelegitimate fears,” he says. “At void of purpose and meaning.” going to giveitashot.” the same time, they areaddicted to their technology.” “The big issue with this Aimee Keane

FT.COM/HEALTH-WORK | 37 Rewardsfor thetaking

If companies can be persuaded of the financial benefits, they might take greater responsibility for workers’ wellbeing. By Sarah Neville

orman Lamb may have surrendered his the health and wellbeing of their staff, to help reduce ministerial redbox when the UK’s experiment some of the pressureonhis own strained departmental Nin coalition government ended in 2015, but the budget. former health minister is energised by anew The mental health commission came up with mission: to persuade employers to play afar bigger role the idea of a“West Midlands workplace wellbeing in keeping their workers healthy. commitment”, avoluntary agreement to aplanof In those countries whereemployer-funded insurance action, which it is encouraging private and public sector forms amajor part of health provision, companies have employers to sign. The goal is to commit employers to asubstantial incentive to keep their staffhealthy.In “a standardofbehaviour towards employees”. the UK, however,most bosses will not bear the cost of Some big employers have agreed to take part, staffsickness in the form of higher premiums because including carmaker Jaguar Land Rover and the West their employees arecovered by the taxpayer-funded Midlands fireservice, but local organisers aspireto National Health Service. attract 200 employers over the next two years. Lamb, aLiberal Democrat MP and former minister Lamb knew the commission’s ideas wereinline for community and social care, is determined to shift with those of Simon Stevens, chief executive of NHS perceptions about whereUKemployers’ responsibilities England. The plan contains acommitment to evaluate lie. Interviewed in his office in the Palace of the proposal Lamb is most excited about, the “wellbeing Westminster in London, the MP radiates excitement premium”. Awarethat Stevens had championed the and enthusiasm about the prospect of employers idea of fiscal incentives, Lamb and his team came taking active steps to keep their workforce healthy. up with aproposal to offer businesses adiscount Although he represents the North Norfolk constituency on their business rates —local authority taxation — in eastern England, the testbed for his approach will provided they implemented specific interventions be morethan 100 miles inland in the West Midlands, that wereknown to work. The proposal has been put which has become hospitable terrain for this kind of out to consultation. innovation following the region’s successful application The plan of action was launched at the end of January for devolved powers from Westminster. as part of the wider programme developed by Lamb’s In 2015, Lamb, whose ministerial responsibilities commission. Outlining measures that participating included mental health, was appointed to chair amental businesses might be expected to implement in return for health commission in the West Midlands after the the discount, Lamb says better training of line managers region’s 18 constituent local councils identified poor has been one of the most effective ways of improving mental health and wellbeing as asignificant driver wellbeing in the workplace. of demand for public services, which in turn had a “If you’ve got line managers who treat their team negative impact on the economy. better,who aremoresensitive and effective at handling Lamb explains that originally he was asked to sickness absence or underperformance because of stress produce only aset of recommendations. “I decided or anxiety [and] who avoid abullying culture, then you thereare so many reports with recommendations that get welcomed and then ignored [that] Igot them to ‘If we just keep pleading agree to an action plan and got all of the relevant bodies in the West Midlands to sign up to it, which gives us a forcompaniestodomore, degree of accountability to try and make things happen.” He was also keen to see employers moreinvolved in some will but most won’t’

38 |FT.COM/HEALTH-WORK Strong conviction have apositive impact on wellbeing of that workforce. which he describes as an internationally evidenced and Norman Lamb believeshis Youreduce sickness absence; you reduce presenteeism intensive programme for people who areout of work scheme will be so effective that companies will continue —peopleturningupatwork who aren’t performing and have severeand enduring mental ill health. with it out of ‘enlightened —and, potentially,you reduce the number of people The programme prepares people to re-enter the self-interest’ falling out of work because of ill health,” he says. workforce and supports them for aperiodafter Acknowledging that to approve the tax incentive they have found what he calls “real jobs” rather proposal, tax authorities would need to be convinced than “supported workshop-type employment”. The that the savings would justify the initial outlay,Lamb commission has been given about £8.5m by the work cites the potential fruits of his approach as “reduced and health unit to runatrial, which he hopes will pave benefit payments, potentially improved tax revenues, the way for the scheme’s wider adoption. reduced use of the NHS and improved productivity”. Implementing the mental health commission’s ideas Nor,hebelieves, would an ongoing public subsidy be is vital if employers aretotake their place in the front required. The MP envisages the rates discount would line of employee health, Lamb argues. “Exhortation last two years and believes the scheme will prove so on its own won’t work; if we just keep pleading effective in keeping staffhealthier and happier that for companies to do moreoreven demanding that “enlightened self-interest” will persuade companies to companies do more, some will but most won’t.” continue with it thereafter. But if companies invested in improving training or He is hopeful that both Whitehall’s work and the ergonomics of office tasks, forexample, they would health unit —staffed by civil servants from the health see apositive impact on their bottom line, he suggests. AKMEN department and work and pensions department —and “And once you’ve lifted their horizons and got them to GA NHSEngland will contribute money to ensurethe see the benefits of doing these things, then you don’t OL

:T scheme gets offthe ground. need to continue apublic subsidy.For the sake of £2m

TO The action plan also proposes aseparate scheme to or £3m [the estimated cost of the rates discount pilot],

PHO implement individual placement and support (IPS), that seems to me to be well worth it,” he adds.

FT.COM/HEALTH-WORK|39 Burning problem

Workplace smoking remainswidespread in China but local initiatives arestarting to turn the tide. By Tom Hancock

orking at astate-run hotel in China’s making smoking in offices, restaurants, hotels and Sichuan province in the 1990s, Wu Luorong hospitals punishable with fines. Businesses that fail to W recalls cigarette smoke filling the lobby, rein in smoking on their premises can be fined up to restaurants and corridors. “Wecouldn’t Rmb10,000 ($1,530) and repeat offenders can have their say anything even if we didn’t feel happy with people licences revoked. Individual smokers can be penalised smoking in the office,” she says. Rmb200. Ahotline was set up for public complaints, Now ahospital administrator,Wu, 49, says things and teams of inspectors wereenlisted. have changed. “Thereisasmoking area for staff Many weresceptical about enforcement when and patients’ families. Especially in the respiratory the law came into effect, citing the difficulties of department, we tell smokers to go there,” she says. changing long-entrenched habits. But ayear later, China is home to some 300m smokers, more than any BernhardSchwartländer,head of WHO China, said the other country; about half of men areregular smokers. enforcement had “exceeded expectations”. The city said However,thereisalack of national legislation to ban it had collected morethan Rmb1m in penalties. smoking in workplaces. The World Health Organization Groups of smoking workers arenow acommon sight estimates that acomplete nationwide ban on smoking huddled outsideoffice buildings in Beijing, Shenzhen in the country’s workplaces would reduce prevalence and Shanghai —the latter two cities having followed of smoking among Chinese men by 13m, averting 6m suit with similar laws in January and March this year. prematuredeaths. “You can only smoke on the platform outside on But Wu’s experience reflects anational trend: the second floororonthe ground floor,” says Stella local campaigns arebeginning to turn the tide Sun, who works at abrokerage in the Shanghai World against workplace smoking, experts say,even while Financial Center,a101-floor skyscraper in the city’s enforcement remainsuneven. The statistics arestartling: Pudong district. “Thereare smoke detectors everywhere morethan 54 per cent of Chinese people who work in the building,” she adds. indoors witnessed smoking in their workplaces in 2015, Dressed in asharply ironed white shirt and naval- according to agovernment survey.But that number style hat emblazoned with China’s national emblem, represents afall from about 60 per cent in 2010. sanitation inspector Zhang Jun is one of the officials Likewise, nearly 40 per cent of people surveyed in tasked with enforcing the rules in Shanghai. Ablack 2015 had witnessed smoking in government buildings, satchel holding abadge and abundleofpapers for and morethan 35 per cent had seen smoking inside handing out fines bounces around his waist. hospitals. But that was an improvement on 2010, when “Sanitation department, herefor an inspection,” he the figures were55per cent and 37 per cent respectively. says, flashing his badge at areceptionist in the lobby Public health observers say that even though a at ahospital. Zhang walks through the corridors, national ban has been delayed —apparently because of checking that no-smoking signs areproperly displayed, the influence of the Chinese tobacco industry,amajor sniffing the air for smoke and peering into bins for tell- source of government revenue —therehas been ashift tale cigarette butts. in attitudes, with greater opposition to smoking. “Therewerealotofcalls to the hotline at the This has been driven by aggressive public health beginning after the law went into effect,” Zhang campaigns highlighting the risks of second-hand smoke, explains. “But the number has decreased now,” he and by individual cities launching legislation aimed at adds, attributing the drop to greater self-regulation. National habit reducing smoking indoors. “Usually when asmoker sees us in our uniforms, they About half of In 2015, Beijing’s municipal authorities passed the will put out their cigarette. In that case we will just men in China are toughest anti-smoking legislation in China’s history, give them awarning.” regular smokers

40 |FT.COM/HEALTH-WORK ‘Some doctorswillsmoke in non-smoking areas,but once the leaderscome, theywill move to asmoking area’

But inspectors areoverstretched, with just five to cover apopulation of tens of thousands, Zhang says, adding that they have additional duties, such as checking water quality in swimming pools. “Wehaven’t given out many fines since March, to be honest, because often by the time we get to aplace wheretherehas been acomplaint we aretoo late,” says Li Yuna, another inspector. Enforcement is even less reliable in the 20 or so other cities that have introduced various laws against indoor smoking. Shenzhen, Beijing and Shanghai have very strong laws, but we don’t see that across the whole country —itreally depends on the locality,” says Kelvin Khow Chuan Heng, of the WHO’s Tobacco Free Initiative, aglobal programme to reduce death and disease from smoking. “A lot of the problem with these laws is that they don’t have resources put into enforcement,” he says. “Westill struggle with some venues, especially entertainment venues, karaoke bars —these arealso workplaces. Those venues we definitely find much moreproblematic.” Even hospital worker Wu says that enforcement can be lax in the small city of Mianyang whereshe is employed. “Some doctors will smoke in non-smoking areas —like, offices —sometimes, but once the leaders come investigating, they will move to asmoking area,” she says. State-owned tobacco companies remainaninfluential group, hindering efforts to introduce anational smoking ban. Adraft law circulated last year was watered down, public health observers say,allowing for “smoking rooms” in offices. Some initiatives by individual companies have helped. Internet giant Baidu committed to smoke-free office environments in 2011, thereby protecting the health of some 40,000 employees. Chinese and US health authorities launched ajoint initiative in 2012 to promote smoke-free workplaces in China. The programme to educate the public and promote cessation services at workplaces follows earlier efforts that have also targeted workplaces. “One thing is legislation and the other implementation. What an enterprise can contribute is vital,” said Wang Ke’an, head of the Research Center for Health Development, a think-tank and one of the Chinese groups involved. Thereisalso space for bottom-up pressurefrom employees. Newspaper illustrator Zhao Liang says his attempts to give up smoking werehampered by IMAGES colleagues who have turned parts of the workplace TY

ET into a“smoking centre”. “If Iquit smoking, Iwon’t /G be able to tolerate anyone smoking in my office ever FP

:A again,” he adds. TO

PHO Additional reporting by Wang Xueqiao

FT.COM/HEALTH-WORK | 41 Danger signals

Suicide is acomplex, personal matter but employers and colleagues cantake steps to try toprevent it or at least alleviate the ensuing distress. By Emma Jacobs Illustrations by Nanette Hoogslag

ichael Mansfield finds that addressing employers about suicide prevention is a Mway of “channelling the feelings, the anger”. The eminent English barrister’s daughter, Anna, committed suicide in 2015. “I can’t get to grips with it,” he says. Thereasons for suicide arecomplex and personal. But Mansfieldbelievesemployers should do more to help employeesatrisk. Thereis“acollective responsibility”, he says. In hisdaughter’s case, her mental health deteriorated aftershe was made redundant. While Mansfieldknowsthathis daughter’s decision to take her ownlifewas complicated — Anna also had two young childrenwithhealthproblems — he believes that employers should be vigilant about trying to detect signs of distress in employees,whethertheyaresecureintheir role or about to be made redundant. “Companies arenot alive to personnel issues,” he says. “Employees require a place where they feel comfortable talking about their difficulties. [People with mental health problems] worry that if they reveal vulnerabilities to line managers they will get chucked out.” Louise Aston, wellbeing director at Business in the Community,aUK charity, agrees. She says few companies feel comfortable talking about suicide. This means they areneithergoodattalkingtothose who may be at risk nor do they know how to care for the workforce if an employee kills him or herself. “The biggest mistake is that companies are reactive,” she says, whereas she believes they should have policies in place in such circumstances. If an employee takes his or her own life it is not necessarily asignthey worked for a bad employer, she says. “But aresponsible employer... should have mental health policies embedded into the organisational culture.” This is particularly important because people with suicidal thoughts arenotnecessarilyintouchwith mental health services and might continue to turn up at work, even as their feelings intensify. Talking about mental health is less of a taboothan it was, but the stigma around suicide is still strong,

42 |FT.COM/HEALTH-WORK ‘I’veheard mental health discussed as partofcorporate policy but rarely suicide. We need moreopenness’

says Aston. Rachel Suff, employment relations take their own life. It could, however,bethe first step adviser at the UK’s Chartered Institute of Personnel towards prevention. and Development, agrees: “I’ve heardmental health Thereare some occupations that experience higher discussed as part of corporate policy but rarely suicide. suicide rates than others. The Office for National We need moreopenness.” Statistics (ONS), published areport earlier this year, To improve matters, some suggest companies need to that showed that between 2011and 2015 the suicide 4% tell staff, particularly line managers, what signs to look rate in England among males aged between 20 and 64 for (see box, page 45). Poppy Jaman, chief executive years was 18.9 deaths per 100,000. Men working in the of employees would not be willing to discuss a mental of Mental Health First Aid England, amental health lowest-skilled occupations, had a 44 per cent higher risk healthissuewithanyone training provider, believes colleagues and managers of suicide than all men. should be trained to observe changes in people’s In Australia, according to Mates in Construction, an behaviour. In a recent report, she wrote: “We teach organisation that looks at mental health in the industry, 21% people that if they are concerned about someone, not to construction workers are six times more likely to die ofthoseemployees be afraid to ask the question, ‘Are you having suicidal from suicide than from an accident at work. havemoderatetosevere thoughts or feelings?’, because if they are, then they A study published in Psychological Medicine (2013) depression can be supported to access the right professional help found that socio-economic forces are a major determinant and quickly.” Contrary to popular mythology, she says, of high occupational suicide rates in Britain. It identified Source:VitalityHealth/RandEurope; talking about suicide does not encourage people to those in mainly manual occupations, such as Britain’sHealthiestWorkplace

FT.COM/HEALTH-WORK | 43 merchant seafaring,labouringinbuilding trades and their fathers and the moreprogressive, open and window cleaning,asbeing particularly at risk. Those individualistic generation of their sons”. sectorsofthe labour markethad “undergone major Thereisadifference between the genders. The contraction andreconfiguration,particularly during authors of the study in Psychological Medicine wrote: the1980s, resulting in the loss of traditional patterns of “Moreofthe high-risk occupations among women than employment in some communities, which may have men wereprofessional or non-manual rather than affected suicide rates forthese occupations”. The authors 11.6% manual, which suggests that socio-economic forces area suggested thehighsuicide rateswerepartly due to stronger determinant of occupational suicide rates of people aged difficulties adjustingtochangeand handling stress. among men than among women.” The ONS found that 18-20 suffer from As employment has become moreprecarious, depression among women the risk of suicide was highest in artistic, organisations might also need to consider the mental literary and media occupations. wellbeing of contractors. “The structureofthe Employers should think not just of prevention of workplace is changing. If you areatadistance from the suicide but also so-called “postvention” —strategies office, organisations need to think about how to assess 2.1% to support employees if acolleague has died through people’s mental health,” says Suff. suicide. “My estimation is not many employers have Samaritans, the UK charity,said in a2012 report that of people aged protocols in place,” says Aston. 56-60suffer from middle-aged men from disadvantaged socio-economic depression The impact of suicide on co-workers may be backgrounds werehighest risk because they wereless profound. “It can be ashock. People who kill themselves likely to talk about their feelings. Source:VitalityHealth/Rand Europe; may not have shown signs. People will feel deep guilt Britain’s Healthiest Workplace “Problems with relationships and employment about what they could have done to prevent it,” says during mid-life areexperienced intensely,because by Aston. She stresses that the reasons someone might this life stage people have typically invested agreat decide to kill themselves arevery complex. “Suicide is a deal in work and relationships, and the possibilities for making changes in these areas arelimited,” the report ‘Problems with employment said. It identified the current generation of men in their during mid-lifeare mid-years as “the buffer generation —caught between the traditional silent, strong, austeremasculinity of experienced intensely’

44 |FT.COM/HEALTH-WORK feeling of unbelievable pain.” The reasons that someone SIGNSTHATSOMEONE chooses to die “can never be fully known”. IS SUFFERING WITH Suffsays that if asuicide happens to acolleague, it “can be completely devastating” for their peers at THEIRMENTALHEALTH work. But if employers have aframework in place and can support employees, the distress can be somewhat alleviated. Changesinproductivity Employers will need to be mindful of employees’ 1. Deterioration in performance at work divergent ways of reacting and perhaps try to decrease 2. Lethargy in apreviously energetic person workloads, and allow time off. Asuicide prevention 3. Newpatternofunexplained lateness or absences “toolkit” published by Business in the Community, 4. Recent inabilitytoconcentrateonwork acharity supporting ethical business practices, and 5. Recent inabilitytocompletework Public Health England suggests managers should make Changesinsocial functioning themselves available to employees, including those who 1. Deterioration in social functioning work remotely. It gives guidelines on memorial services, 2. Withdrawal from colleagues, isolation advising employers to commemorate the life of the Changesinpersonalityorbehaviour deceased rather than dwelling on their death. 1. Extreme mood swings Line managers might be particularly affected and 2. Acting anxious or agitated become the target of recriminations from colleagues, but 3. Showing rage, uncontrolled anger managers can also be role models, talking of their 4. Behaving recklessly methods of coping, occupational health experts say.The Increased alcohol or drug use importantthing istocommunicate.Ifthe workforcefeels valued in the wake of asuicide,itcan help them Changesineating and sleeping patterns manage their own feelings but also foster trust in their Signs of (self-inflicted) physical harm leaders. Avacuum can have the opposite effect, destabilising the workforce and destroying trust. “It is a Source:Business in the Community/Public Health England, crisis,” says Suff. “You have to try to manage acrisis Reducing the Risk of Suicide:AToolkit forEmployers and support colleagues.”

FT.COM/HEALTH-WORK | 45

Escaping debt

Helping workers deal with financial difficulty improves their wellbeing and their productivity.ByNaomi Rovnick

nJanuary,when 29-year-old Matthew Dreiling joined on weight, says Hafner,who says his findings are the US arm of professional services group PwC as an controlled for other variables that may affect Iassociate, he was delighted but alittle anxious. His respondents’ wellbeing, such as childbirth or starting salary was high, but not enough to stop chronic illness. him fretting about his $90,000 of student loans. “I Morethan two-thirdsofworkers who would revisit this topic pretty constantly in my report financial difficulties show at mind, and analyse it, and try and figureout least onesign of poormental health, how Iwas going to pay it off,” he says. “I accordingtothe Moneyand Mental wouldn’t say it was ahealth concern, but it HealthPolicy Institute. “Our was definitely aworry.” qualitative research shows that He was lucky.Last year the US division financial difficultiescan also affect of PwC became one of the first of a relationships with colleagues, growing number of companies that help motivationand likelihood of pay staffers’ education loans. Dreiling sickness absence,”Evans says. She gets $1,200 worth of such assistance a addsthataround half of workers in year.“That goes along way to covering financial difficulty say they achieve the interest and, over time, helps reduce the lessatwork or work less carefully. burden of that debt,” he explains. Anglian Water’s Purbrick says As consumer indebtedness rises, employers that while employers arekeento arebecoming awareofthe impact of financial stop such situations developing, large stress on employees’ productivity and mental financial services organisations have yet health, and how to do something about it. to respond to this need with products and “This is the hot new thing among HR and wellbeing solutions that help staffsave or escape problem professionals,” says Sally Purbrick, head of rewardat debt. “Therejust isn’t alot in the market,” she says, Anglian Water,aBritishutility company that helps adding that the bank that runs theAnglian scheme to employees to save and to consolidate their loans. In agreement is Jennifer Hanson, head of associate ‘Financial worriescan affect experience and benefits at Fidelity Investments, another large employer to offer student loan reimbursements in motivation and sickness absence’ the US. “After we launched [in January 2016] we had phone calls with about 100 other employers wanting to know about what we weredoing. Now it is popping up help employees save part of their salaries was forced to in benefit programmes all over the place.” adapt its employee sharesave programme to carry out Employers’ focus on debt is growing. “One in six the function. Britons is over-indebted and 16.8m people in the UK do For loan consolidation, Anglian is in partnership with not have morethan £100 put aside,” says Katie Evans, Neyber,aBritish fintech start-up that lends to employees head of research at the Money and Mental Health Policy through the payroll, with repayments deducted from Institute, aBritish charity.Inthe US, household debt 48% salaries. Monica Kalia, Neyber co-founder,says her has surpassed its pre-crisis peak as rates of arrears on customers have usually borrowed on credit cards student and car loans also rise. of employees charging around 20 percentannual interest. Refinancing Financial illhealth costs companies time and money, indicatetheyhaveat £10,000 of such debt at Neyber’s mid-rate of 6.9 per cent surveydata show.According to Rand Europe, which leastsome financial would save customers £101 amonth, she says. concerns and lose surveyed 30,000 Britons this year for the Britain’s Borrowers range from those “just about managing” to IMAGES an average of Healthiest Workplace project, problem debt directly the relatively affluent: 5per cent of those who apply for TY

ET affects employees’ productivity.“Around half of people debt consolidation earn morethan £50,000 ayear. /G we surveysay they have financial concerns, and this 6 PwC’s Dreiling says he is aprime example of makes them less productive,” says Marco Hafner, research “someone who earns agood amount but still has to NE SUB leaderatRand Europe. “Theylose on average six days days of productivetime budget around debt repayments”. However,hesays TO at work each year

:S per year more,inabsenteeismand presenteeism, than the $1,200 ayear from PwC has gone along way to

TO someone who does not have financial concerns.” Source:VitalityHealth/Rand Europe; ease his stress. “It is nice to know I’m not alone in these Britain’s HealthiestWorkplace PHO The financially distressed also sleep less and put repayments. It feels moreofamanageable burden.”

FT.COM/HEALTH-WORK | 47 fi Ou I agru ciiyi hc taymmn o could you moment take any at which in activity dangerous employers. their for priority workforce motivated and healthy physically maintaining makes This threat. face guards security private commonplace, In itself. Brazil in companies security private-sector facing challenge years. two past of the out over operating Brazil gangs by depots and trucks security crowning re fir on cars approach set others while safes, the raided the the guards, ro subduing After rifles. assault and to Prosegur belonging depot armoured-truck an attacking was By life-saving. potentially security, ac as such industries dangerous In armed that.” know staff] Protege, Grupo of 48 fir of line the in also orderonthe law and streets ofmaintaining in charge officers police military so-called country’s the year. same the in US 100,000 per murders far 4.9 this the context, exceeds some number this give rates, to homicide but their compile to criteria different use mor 100,000 or per 2015, 29 in about people at world, the in rates murder otdwstebgethiti aauyshistory, Paraguay’s in heist biggest the was ported br blew bbers rzl wk otesudo uoai gunfir automatic th of sound the to awoke Brazil, del Ciudad of nt In Oratvt soeo ihrs.It’s risk. high of one is activity “Our the highlight attack this of violence and scale The media Brazilian what in $40m with escaped They Ther hl uho hsvoec ae lc between place takes violence this of much While eb eeryhuso h onn hsApril, this morning the of hours early he ab |F as ultur ea —a rin ro aigo a alarms. car of laring cene le, asMroBpit eOier,tehead the Oliveira, de Baptista Mário says ullet,” ,aS T. bbery re ro as ddu ag,piaescrt ursare guards security private gangs, drug nd COM/H d oboktepolice. the block to ads no tagtoto Hollywood, of out straight re fmltr-tl tak against attacks military-style of eries aihscrt company security panish ah ,b eoft ac re Es l ntebidn ihdnmt and dynamite with building the in ole tBai a n ftehighest the of one has Brazil ut dl vial ainlsaitc on statistics national available adily utyi hc armed which in ountry ac te, eint EA tofthe meio fProsegur of ompetitor ac et LT ann n upr is support and raining it a 900dah.Countries deaths. 59,000 han ewraantcrime. against war he yon gl H- WORK aauysbre with border Paraguay’s am nal and entally re ,u —t otdi the in ported ah ac igexplosives sing ro ighly efront-line he iia gang riminal eont .“ ac br is bbery ap ine hy[our They re onstant sidents articular he ea o Leahy Joe nd ag rvt euiycmaissyte ar they say companies security private large death”. of “highway the dubbed been attacks has for it notorious that so become has and gangs, drug favelas between passes airport, international its Linha the on unit Ve escort armed an was driving he while which shot in incident an describes Santos, dos member union workers’ One security unions. private to according work, to unable can attacks have Such daylight. broad driving in while motorways even down or premises, clients’ leaving while or smaller in attacked capital. cane sugar Ribeirão Brazil’s in Preto, inland South further Santos, and nearby port, in largest as America’s well as Paulo, São an from about hour hub technological and industrial important an Campinas, in occurred have companies security-truck 1 To ar officers security private But on raids large-scale similar years, two past the Over mla h highway The rmelha. prep ad vsaigefc nemployees, on effect evastating ar ee poesfrsuch for mployees ro bre,smtmsa hi depots their at sometimes bberies, ,w ihlnsRod Janeir de Rio links hich ,L i lui Antônio Cláudio uiz ec ah ntnl being onstantly igh-ri re kprofession, sk drn them ndering er ig ru orous oto nby 2

PHOTOS: AP;REUTERS 3 ‘Our training means our recruitsare not just those guys who were at aloose endwith no other options’

At Protege, all employees, from cleaners to managers, must complete an opening course on integration into the company.“No new functionary will receive an entry pass [for the front gate] until they have completed the obligatory integration module. From that the worker will know the rules, the history of the group, the group’s clients and moreabout the post for which he or she was contracted,” Baptista de Oliveira says, adding that thereare morethan 100 modules that employees can complete as their careers progress. about recruitment and provide the carefully selected 1 Founded by Baptista de Oliveira’s father 46 years employees with training and generous benefits. While Brazil’sdrug gangs ago, Protege today has 18,000 employees deployed largely fight with the police, In Brazil, those wishing to enter the security industry privatesecurityworkersare throughout Brazil. The company has made efforts to must first pay out of their own pocket for an obligatory also targeted by criminals give employees and their families asense of belonging, security guardtraining course that is certified by the 2 helping to keep staffturnover low and maintain a federal police. Protege has anetwork of such schools The scene of the security motivated workforce. depot raid in Ciudad del Este, that account for half of those trained in the city of São The key to this is the company’s “personal Paraguay, this April Paulo, according to Baptista de Oliveira. 3 development” section, ateam of 20 people who run Training is provided for employees at all levels, In Brazil, securitystaff at programmes in employees’ residential areas to foster from doormen to armed guards. For those working all levels, including armed skills among the spouses of workers and their children. in armoured vehicles thereisadditional training in guards, undergo obligatory “Wehave put together classrooms to promote digital police-certified training personal security and defensive driving techniques. inclusion, teaching them [children of staff] how to use “This means by naturethat our recruits arenot just Excel and PowerPoint and the like,” Baptista de Oliveira that guy who was at aloose end out thereand had says. noother options than to work in security,” Baptista When atraumatic event such as arobbery occurs, de Oliveira says. Protege and Brink’s say they have psychologists Another critical aspect for security companies is to on hand to help employees and their families cope. develop astrong culturesothatemployees understand The importance of such interventions cannot be what is expected of them in any given situation, from underestimated. operational discipline when working in the field to Santos, the armed guardshot in Rio, says: “The personal integrity.Vera Lúcia Tavares, director of colleague who was with me [during the attack] is human resources at Brink’s Brasil,anarm of the US- still suffering psychologically.Iamtoo. Iamstill based security company,says the company surveys staff traumatised today.IfIhear any kind of banging sound, annually to check on “their engagement with the values Ithink it is ashot. Istand theregluedtothe spot, unable of the organisation”. to move.”

FT.COM/HEALTH-WORK|49 1 Behind thecurve

The great disrupters of Silicon Valley have been less revolutionary in the thinking behind their headquarters. By Edwin Heathcote

he tech titans of Silicon Valley never seemed to caretoo much about architecture. Their mythical Torigins wereinsuburban garages, their actual offices wereingeneric business parks. Now all that has changed. Suddenly they appear to have realised that to attract workers they need to create places that feel good to be in and they have hired architecture’s biggest names to see what they can do. Apple’s new Norman Foster-designed headquarters (with areported price tag of $5bn) in Cupertino is slowly opening its doors. Facebook hired Frank Gehry, the architect of Bilbao’s Guggenheim museum, to design its new Menlo Park headquarters and Google has commissioned probably the hippest young architect, Bjarke Ingels, alongside Thomas Heatherwick to design its Mountain View offices. So what does disruption look like when it is applied to the slowest of the arts, architecture? The answer, perhaps surprisingly when you consider the huge piles of cash being spent, is not really that disruptive at all. If thereisachange, it is asign of an acknowledgment that the office might not be enough —whatgoes on outside might count too. To understand why,weneed to switch our minds back to amoment, not that long ago, when the internet was supposed to mean the end of the office.

1 EUTERS ;R ARTNERS +P OSTER /F UNG YO

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50 |FT.COM/HEALTH-WORK From now on, went the schtick, everyone would be working from home in their pyjamas. The grind of the daily commute would remainonly as an urban myth. The office was over. It didn’t happen. People, it turns out, quite like to be around other people. Coffee shops appeared as the fabled “thirdspace” and freelancers and coders started lounging around lattes as the enchantment of being able to work anywherebegan to be realised. But the office survived. The much-heralded revolution in working turned out to be acollection of childish tropes borrowed from ad agencies —the foosball and ping-pong tables, the breakout spaces and cafés in caravans, the nagging feeling that you wereinanadult kindergarten rather than aplace of serious thinking. The giants of Silicon Valley have added pretty much nothing to the way we work other than making it possible to be working all the time —inthe hotel, in the airport, at home. The effect of the internet was not to make the office redundant but to make everywhere apotential office. Tech’s ultimate impact on office life has not been its end, but its endlessness. Apple’s Norman Foster-designed office appears to be at the top of the pile for architectural ambition. Its sleek new ring is aremarkable building, but the new Apple HQ appears to be an object as much as it is architecture. Steve Jobs’ last public appearance on June 72011was his pitch to Cupertino city council to build it. “It’s a little like aspaceship landed,” he told the meeting. And it is. Thereissomething of the boyish sci-fi fantasy in this great UFO. Thereare huge curved glass doors that open the café up to the landscape. “There’s not astraight piece of glass in this building,” said Jobs. Thereisapassive ventilation system which allows air to trickle in beneaththe eaves. The windows do not open, of course, as that would interferewith the smoothness of the curve. This building is, like the iPhone, aclosed system. It does not allow adaptation and cannot be extended if the company needs to grow or change. When it is fully populated therewill be 12,000 people inside. Therewill be 9,000 parking spaces outside. There will also be 9,000 trees. Yetfor all its green credentials and its undoubted elegance, Apple’s new HQ is still asuburbanbusiness park, acampus in the mould of 1950s corporate planning for afossil-fuel age. Mark Zuckerberg’s association with his big-name architect, Gehry,has had arather different outcome. The 88-year-old did something rather different with Menlo Park. It might not sound particularly revolutionary but when Gehry was outlining the designs just beforethe building was completed in 2015, he said: “Look, this is the largest open-plan office building in the world!” He was clearly enthused. Unlike Apple’s HQ, Gehry’s is abit of adeliberate mess. “Wewant our space to

FT.COM/HEALTH-WORK | 51 52 1 mkhuebreu shack barbecue Smokehouse Fa on nutilifune at influences Industrial rprn uc tthe at lunch Preparing |F cebook’ Fa cebook’ edoffice head T. COM/H sM 2 1 sc enlo ampus Pa rk EA LT H- WORK tdoadtecetv eso narchitectur an of mess creative the and studio advertising youthful self-consciously the loft, urban is This volumes. chaotic a make to quirky mass-produced the and industrial assemblage the hoc of ad an architecture, Angeles Los early ar is offices that Facebook’s But it. location. about suburban their is it HQs new time.” on and budget Under cheap. said. was Gehry it over-designed,” “And it want not did He space. matter-of-fact unassuming, an wanted Mark statement. world.” the connect ther to left you much want how we feel buildings, our enter you “When time. like feel t oue ar volumes Its am re Vi the on and, parking encounter serendipitous of ar stairs affording boxes and booths by ia fte16sielof ideal 1960s the of vival wi oehn ifrn gi.I is It again. different something is ew fther If emphatically Gehry said not,” is “It h QGol spann o tefi Mountain in itself for planning is Google HQ The egastructur ,u es eisa aw np aiu n frequent and pacious re r npors, adZuckerber said progress,” in ork itbelnsaewt oldn,slightly colliding, with landscape dictable simil ec er niuu n uebtboe up broken but huge and ontinuous oof rt ewe pl n Facebook’s and Apple between arity ro —a of, eistobe as lwn lxblt and flexibility llowing ag .A prszdms-po the of mash-up uper-sized af arden. ea tg re al ro —i es do hobc oGehry’s to throwback ittle n ee ther level und aebeneath pace ei u iso to mission our in ne tne sspaces as ntended ,“ privacy ak ag n of ind addesign rand gatt .T es he chool. eis he emninvto htwas that innovation a German landscape), (office Bürolandschaft the with 1950s no. be: to seems answer The work? we the which change in will places that anything done have they buildings, we work way we the way and the consume, and communicate we way construction by updated be earlier said Ingels year to,” this want they if hack actually can demands as adaptation 2 h atmjrcag nofc cultur office in change major last The the altered fundamentally have tech of titans These ,“ mor ea li ve okhpta nofc,aditcould and office, an than workshop .T eqeto swhe is question he ch ne I’ pc htanyone that space “It’s ange. ro ar bots.” ato oterigid the to eaction ea ther rr ive ,w di t these ith nt he 1

PHOTOS: NICK OTTO/THE WASHINGTONPOST/GETTY IMAGES; JESSICABRANDI LIFLAND/POLARIS/EYEVINE Amazon’s vast warehousesare every 4 bit as much the workspaces of the digital economyasthe flagship HQs

regimentation of Nazism through the creation of a non-hierarchical open-plan interior intended to foster collaboration. Between then and the launch of Facebook not that much has happened. Perhaps thereweremore rubber plants then,moresoft-play areas now,but that is about it. To underline how little has changed, we might also want to consider the spaces where, for instance, many of Apple’s products aremade —Foxconn’s factory in Shenzhen, China. Apple may boast of accommodating 12,000 people in one beautiful building but the company that makes its products has perhaps 450,000 workers labouring under afierce regime in its plant. Similarly, we could look at Amazon’s vast warehouses populated by workers struggling to meet strenuous targets and having to runbetween the high-stacked shelves to keep up. These areevery bit as much the workspaces of the digital economy as the flagship HQs. Back in Silicon Valley,the biggest change in the wake of these huge projects appears to have been asudden and returning to live in the cities, the companies that recognition that the office is not enough. The landscape want to attract the best of them arestuck in the suburbs. is as important as the interior.Facebook has hired Today’s youngsters want to be urban. They shun cars architects OMA to design anew “village” beside its in favour of bikes, eschew taxis in favour of Uber.Their 3and 4 Menlo Park campus. The renderings show generic relentless search for authenticity keeps them in coffee Atent-likecanopyispart parkland but also an attempt at building streets and shops with barebrick walls and naked lightbulbs —city of the BjarkeIngels and Thomas Heatherwick design even housing. structures stripped back to the barebones. The dream forGoogle’snew Mountain But these token efforts might not suffice. Just as of aperfect industrial modernism is stuck in an infinite View offices millennials areshunning their parents’ flight to suburbia loop (which is also, coincidentally,the address of Apple’s current HQ). Residents of San Francisco —the magnet all young 3 techies seem to be attracted to —are annoyed by the extra traffic and the property-price inflation. Why, you might ask, arethese companies not building in those areas of cities that aredesperate for regeneration, using the existing fabric of factories and derelict buildings as askeletonfor their vision? Imagine the boost they could have given to nearby cafés and restaurants if their staff left the office, and walked or cycled to nearby outlets to buy their lunch instead of having free buffets inside. Could the technology giants not build whole new cities rather than isolated corporate campuses? If thereisa resentment towards them it is because they do not seem to give back to society.The companies’ transnational naturemeans they pay their taxes wherethey arelowest and they feed offcities like San Francisco without feeding anything back in. Health in the workplace is as much about ahealthy city as an ergonomic office chair. This includes the spaces to walk to and from work, the parks to runinoreat lunch in, and the other features of public infrastructureofeverydaylife. The big new headquarters werethe perfect opportunity to show that the technology titans could contribute. They could have built places that were at least in part open to the public rather than private fiefdoms. They could have built streets and squares, the 4 seeds of new cities. So far,that has not happened.

FT.COM/HEALTH-WORK | 53 Chain reaction

Companies with dispersed supply networks arerecognising the need for consistent health and safety standards. By Hannah Murphy

hether you areridingabike or amotorbike, 1 helmets in India arenot the “done thing”, Protesters and relatives of the victims of the Rana says Matthew Rae. For Vodafone’s director W Plazadisasterdemand of health, safety and wellbeing, dealing compensation with the safety and wellbeing of workers across the 2 group’s supply chain means he often encounters local Helmetless moped riding in the Indian practices that aredrastically at odds with the standards cityofAhmedabad he is tasked with maintaining at the FTSE 100 telecoms 3 company’s London head office. Agarment factoryin In India, whereVodafone has thousands of suppliers Bangladesh; such businesses and alarge logistics operation, the company responded arekey supplierstowestern clothing retailers 1 five years ago by requiring all staffand contractors on two-wheelers to wear helmets —several years before the authorities tightened regulation on the same thing. 2 Managing those nuanced cultural differences requires “perseverance and consequence management”, says Rae, adding that the group has developed strict procedures to guide supplier behaviour if things go awry. Multinational companies such as Vodafone face considerable challenges to ensurethe health and wellbeing of their wide network of staffand suppliers. Some 40 per cent of senior business leaders surveyed by the Economist Intelligence Unit say adverse events associated with their suppliers arebecoming more frequent. Risks range from suppliers being involved in criminal activity to breaches of regulations on human rights, they say. Many developing countries find it dthar oachieve compliance with international standards. Research suggests that only 10 per cent of the working population in developing countries is effectively protected by health and safety laws. “Globalisation means thereare increasingly complex and extended supply chains,” says RichardJones, head of policy and public affairs at the UK’s Institution of Occupational Safety and Health. “A big driver in this area now is reputation,” says Therehas been some progress in recent years. For Jones. “There’s this corporate desirefor maintaining example, clothing retailers made efforts to improve a‘social licence to operate’ that can help companies health and wellbeing among their suppliers in the to attract and retain talent in their workforce, [and] to wake of the 2013 Rana Plaza disaster,when agarment secureinvestment.” factory in Bangladesh that supplied overseas companies Beyond reducing accidents, thereare proven collapsed, killing morethan 1,100 people. business benefits to improving supply chain safety

54 |FT.COM/HEALTH-WORK ‘It’s fundamental that we don’t see safetyasa competitive element but as ashared goal and value’

3 IMAGES

TY workers wereeating takeaway food late at night, then

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;C “aligned safety,health and wellbeing —and was away of demonstrating to the workforce that we really did careabout looking after them”, Waterman says. REUTERS

S: Getting that right boosted other areas of collaboration,

TO he says. “At London 2012, by working cooperatively

PHO with the construction companies on health, safety and workforce wellbeing, it made co-operation in all sorts and wellbeing. Research by Tufts University for the of other areas, like logistics, so much easier because International Labour Organization shows that garment the relationship had been built up,” he says. “There factories in the global supply chain whereworkers was trust there.” report better working conditions and better compliance Sometimes small changes can make abig difference. on health and safety aremoreproductive and more UK utility company Thames Water says one initiative profitable. In contrast, the research found, putting that has had asurprisingly positive impact was its suppliers under too much pressuretocomplete jobs requirement that workers in the supply chain wear quickly and the threat of penalties for late deliveries can protective equipment but also drive vehicles bearing result in greater stress among supervisors, which in turn the company logo. “The family has been branded,” can increase verbal abuse in the workplace. says Karl Simons, Thames Water’s head of health, “It’s fundamental that we don’t see safety as a safety,security and wellbeing, of the company,which competitive element… it’s something we see as a has 10,000 supply chain workers. “Above all, it shows shared goal and value,” says Vodafone’s Rae. The they areworking in compliance with our standards company has established its own safety forum where and expectations.” four times ayear it meets with global suppliers that Karen McDonnell, occupational health and it believes represent the highest risk of falling below safety policy adviser at the UK’s Royal Society for safety standards. the Prevention of Accidents, agrees. “Successful Workers in other industries arealso affected by organisations should have very clear values and time and cost pressures. Lawrence Waterman, who monitor the supply chain —asopposed to over- oversaw health and safety for the Olympic Delivery managing them —toensuresome kind of cultural Authority during London’s 2012 Olympic Games, says transference,” she says. the “most powerful programmes” around supply chain On top of acareful selection process when bringing health arelinked directly to the job the contractors suppliers on board, companies should carry out have been asked to do. regular audits of their existing supply chain to identify During construction of the venues Waterman noticed strengths and weaknesses, she says, then work with an uptick in the number of minor accidents in the them to raise their standards whereneeded.Training morning involving building workers —incidences of offered to coreemployees should be rolled out to the fainting, for example. He soon discovered that many supply chain wherepossible.

FT.COM/HEALTH-WORK|55 Theprice of success

Asia’s economies may have prospered but the health of the region’s workers is in somewhat poorer shape. By Andrew Jack

conomists have long marvelled at the Asian economic miracle, but such productivity is Ecoming at amuchhighercost than they might realise, asurveyacross four nations in the region shows. The AIA VitalityHealthiest Workplace research found that in Hong Kong the average amount of time lost per employee per year because of absence and presenteeism (when employees turn up to work but areunproductive) amounted to nearly 71 days — 1 two to three months’ worth of lost time. Employees in Malaysia and Singaporelost an average of 66 and 54 days, respectively.This compares with 45 days in Australia but only 30 days in UK. ASIA’S WASTED WORKINGDAYS “The most striking factor was the high level of mental health issues and the stigma associated with them,” says Christian van Stolk, home affairs and social policy Time lost to absenteeism and presenteeism everyyear research head at Rand Europe, the research consultancy that analysed the data collected in Asia and compared them with data from Britain’s Healthiest Workplace. “The other trend was the very high number of days lost to productivity: people areworking very hardbut to no 65.6 54.3 effect, while doing harm to themselves.” days days In Hong Kong and Malaysia about 12 per cent of Malaysia Singapore respondents reported symptoms of depression — around double the proportion in Australia, Singapore and the UK. Meanwhile, rates of bullying in the workplace in Hong Kong, Malaysia and Singaporewere almost three times the UK’s level of 6.6 per cent. 45.1 Yetvan Stolk says thereislittle sign employers or days governments in the region aretackling mental health Australia problems. He adds that thereare also relatively few 70.6 support services, such as counsellors and psychiatrists, days for those who do want to seek help. “Asians were Hong Kong taught to be reticent and reserved in expressing any emotions, so they keep their feelings to themselves. Plus, mental health resources and services arenot as 30.4 readily available as in western countries,” says Winnie days Mak, professor of psychology at the Chinese University UK of Hong Kong. The AIA VitalityHealthiest Workplace survey polled morethan 100 employers and 10,000 employees from Sources: AIA Vitality/VitalityHealth/Rand Europe

56 |FT.COM/HEALTH-WORK 2

employees who did not eat at least five portions of fruit and vegetables per day.They werealso less physically active, with fewer than 40 per cent reporting at least 150 minutes aweek of exercise. In Australia, as in the UK, about 65 per cent of employees took that much exercise. The Asian results need to be viewed in their context. Basic safety concerns remainsignificant factors in many Asian workplaces, with particular concerns around poor prevention and physical safety risks for accidents on construction sites. Certain companies in the survey performed very well, however,including Announcer,anAustralian financial services business. Anna Smallfield, digital marketing manager says the company offers programmes such as flexible working and givesft staf he option of working BLOOMBERG one day aweek from home. This allows them to cut S; down on the stress of long commutes and spend one

IMAGE day in amorerelaxed and less disruptive environment.

TY The company also promotes physical exercise by

ET allowing stafftotake two hours out of the office each /G day to participate in afitness activity of their choice. AFP

S: “Wehave low sick leave rates,” she says. “We

TO measurethe results of our health and wellness

PHO programme on how happy staffare —and the results areoutstanding. Alot of our team have been with Hong Kong, Malaysia, Singaporeand Australia. The 3 Announcer for 10 or moreyears and that is atestament data werecompared with the Britain’s Healthiest to the culturethat has been created.” Workplace research, amuchlarger survey of nearly For the future, the company is exploring stronger 32,000 employees and morethan 165 organisations that forms of mental health support. “Working in financial is now in its fifth year. services and so closely with our clients means we are The large amount of time lost in Asian countries close to their lives and can be asupport pillar for any should be balanced against the longer hours those issues that may arise. That is why we want to further employees spend at work. While staffwerecontracted our support of our staff,” she says. to work from 28 hours aweek in Malaysia to 36.5 in Yi Mien Koh,medical director at insurer AIA in Hong Hong Kong, they worked far longer in practice: from Kong which funded the research, says: “Organisational nearly 44 hours in Malaysia to morethan 48 in Hong 1 cultureand practices have asignificant impact on Kong. This compares with an average contracted The work catches up with employee job satisfaction and morale. Clear and atraderatthe Malaysia stock working week of just over 35 hours in the UK and an exchange in Kuala Lumpur transparent workplace policies that areimplemented actual total of about 39. 2 fairly contribute to mental wellbeing at work.” She says That focus on work may help explain why about half Residential blocksinHong employees in different countries favoured different of employees reported problems with sleep in Hong Kong: around half of workers interventions that companies could make to improve in the territoryreport Kong, Singaporeand especially Malaysia, where56per employee wellbeing: in Australia respondents said they problems sleeping cent said they slept less than seven hours on average a 3 would like fitness trackers; access to fresh fruit and night. In contrast, this was the case for only 26 per cent Mass yoga in Singapore, vegetables was valued in Hong Kong; healthy canteen of Australians and 30 per cent of workers in the UK who where7%ofemployees options in Malaysia; and participation in volunteering replied. Asian respondents also produced some signs of surveyedwereobese —less or charity work in Singapore. than half the rate in the UK superior health metrics. Hong Kong employees on VanStolkargues that in Asia, with its rapidly average werethe leanest, with only 3per cent reporting ageing population, employers and policymakers will abody mass index of 30 or above —astandardmeasure need to pay increasing attention to wellbeing in the of obesity.This compares with 7per cent in Singapore, workplace. He also highlights one area for optimism: 13 per cent in Malaysia, 15 per cent in Australia and 18 the receptiveness in the region to digital health per cent in the UK. interventions, such as the use of apps to track health Respondents across the region drank less alcohol than in initiatives. Embracing new technologies could help the UK, especially in Hong Kong, Malaysia and Singapore, moreenlightened companies leapfrog those in the UK but those countries also had afar higher proportion of and elsewhereinthe developed world.

FT.COM/HEALTH-WORK | 57 PETERSIMPSON Chief executive, Anglian Water Thinking holistically

Employee wellbeing is not just about safety but about improving people’s lives as awhole —anapproach from which everyone benefits

appy,healthy and engaged employees aremoreproductive It has been ajourney —and oneweare still on. By fundamentally and less likely to leave, or be offsick. So far,soobvious, but at changing our approach, we have halved spending on private medical H Anglian Water thereisabigger prize for championing care. Sickness absence rates have reduced to just four days per employee employee wellbeing. Understandably for acompany with from 5.5 days lost on average in 2012. Our goals of improving service public health at its core, health and safety is whereour wellbeing journey and productivity have been met. This has made it easier to recruit good began. In 2005, private medical cover was costing us £2m per year,and people and has attracted praise from independent sources too. Anglian was forecast to rise by 10 percent everyyear.Wecould see aclearline to Water was recently named Responsible Business of the Year 2017 by a£4m bill, with sickness levels averaging10days per employee per year. Business in the Community. We had achoiceofreducing the cost of the medical cover by changing We’renow in amorematureposition when it comes to wellbeing. benefits, or thinking differently to keep people well and at work. We focus on the “whole person” —westillspend on safety,but not The evidence for afocus on wellbeing was compelling. Sickness exclusively.Wehave provided nutritional advice from John Briffa, the absence due to mental ill health costs the UK economy morethan £8bn per year,according to the Centrefor Mental Health charity,while the cost of reduced productivity from those suffering from mental ill health ‘Work canhaveapositiveeffect who turn up to work is afurther £15bn every year.The question was on colleaguesthat will repay not, “Why should we take aholistic approach to wellbeing?” but rather, “Why wouldn’t we?” We set aclear ambition, now enshrined in our thebusiness manytimesover’ company charter.Ithas movedusfrom, “Great,wehaven’t hurt anybody today”, to, “Excellent. You’rehappier and healthier than you were”. Once committed to wellbeing, we had to define it in away that well-known health writer.Thousands of staffhave attended wellbeing resonated in the boardroom. We turned to the Workwell Model from roadshows on ending the stigma around mental health as well as on Business in the Community,the UK-based charity and business administering CPR in the workplace. Ipersonally teamed up with lobbying group. The model allies corporate experience with academic Mind, the mental health charity,pledging to support its Time to Talk best practice. We integrated it into our business plan to identify gaps campaign. And we have partnered with Neyber,the fintech platform, and to signpost our intention to give equal consideration to mental to offer financial advice and loans through employer partnerships. and physical health. The model put employee wellbeing at centrestage Feedback from colleagues has been fantastic. in boardroom discussions. It helped improve employer brand and One of the most important tools we have developed allows us to customer engagement. It reduced staffabsence and raised productivity. quantify the bottom-line impact of wellbeing initiatives. Working We weresoon able to demonstrate the benefitconsistently outstripped with Philip Gibbs at GlaxoSmithKline, the pharmaceuticals company, investment —for every £1 we spent, we got £8 of benefit back. we have developed a“wellbeing calculator”. This tracks the shift in The focus on wellbeing has also helped to improve safety standards spending from reactive to proactive. The tool shows that over the past across our workforce. Last year,directemployees, and those employed four years we have reduced reactive costs by eight times the amount we by contractors, partners and other affiliated businesses, worked 1.24m spent on proactive, preventative measures. hours and recorded zeroaccidents —afirst for Anglian Water.In2009, Our goal is to implement ways of working that improve the whole for example, the company recorded an accident frequency rate of 0.37 life of our employees. This is afar moreambitious vision than simply per 100,000 hours worked. keeping them safe at work. Ireally believe work can have apositive Our managers areleading this. Three years ago we partnered with effect on colleagues that will repay the business many times over. performance consultants Lane 4totransform the way we lead our As the benefits become clearerand easier to quantify, more companies people. Run by Adrian Moorhouse, the former Olympic swimmer,our will see the merits in promoting the wellbeing of their workforces.As programme helps leaders to try to create aculture of genuine careand chair of Businessinthe Community’swellbeing taskforce, Ihope to help concern. It focuses on supporting others, and being seen to be doing so, galvanise small andmedium-sizedenterprisesinto action, so that they thereby creating what we call the “shadow of the leader”. too canreap the benefits of having healthier andhappieremployees.

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