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Three views on occupational health promotion

The development of occupational health promotion may be presented as a process yielding three different concepts (fig. 4). It must be noted, however, that this linear order concerns – as mentioned before – mainly the rhetoric, the theoretical thinking about occupational health promotion. In practice we will usually find a mix of all the concepts identified at different stages that will not always be dominated by the last one.

Fig. 4

The first of the analyzed concepts will be referred to as “working population health promotion”. Within general health promotion it is associated with the “population-oriented” strategy. It is addressed not really to workplaces, but rather to individual employees – if considered, workplaces are essentially treated as the area where health promoters (usually from outside of the company) have better access to the employees. The employees are treated more as typical representatives of the society rather than people with specific health problems associated with the work they perform. The employees of companies are subjected mainly to interventions related to disease prevention (diagnostics, vaccinations, consultations) and the traditionally understood health education (fliers, chatty lectures). The criteria for assessing the effects of these actions are usually the number of interventions, the number of diagnosed cases, the changes in behaviours that affect health or health status parameters of people subjected to interventions and the extent to which they acquire the presented information. In principle, this concept lacks reflection on the specific relations between the health status of employees and the work they perform, as well as between the initiated actions and the functioning of the company. All that counts is health and acting in support of it, which from the point of view of a typical enterprise is a rather insignificant or even strange objective.

The other concept, described here as “health promotion in occupational environment”, refers to the actions performed under the strategy described in general health promotion as “environmental”. Here the object of these actions is not the individual employee, but the entire workplace. To be more specific: the employees (or rather groups of employees exposed to certain hazards) and their material occupational environment (infrastructure, physical and chemical factors). What is omitted (or marginalized) are the cultural, socio-organizational and socio-psychical aspects of the environment. The main criteria for assessing the effects of the actions promoting health is the compliance of the achieved environmental parameters and behaviours of employees with the standard requirements applicable in this field. This is why the actions are not usually aimed at factors that were not precisely described in regulations concerning occupational health and safety (e.g. the problem of stress which is hard to measure). The main value from this point of view is no longer health itself, but rather the compliance with certain requirements. From the perspective of a typical enterprise health promotion understood in the way described above is important mainly to the extent to which it solves the problem of the employer’s legal responsibility for the health of the personnel. The health promoter plays mainly the role of an “engineer” who implements the required solutions.

The third concept, which has been developed in the recent years, is “workplace promoting health”. It describes actions that are in line with the “habitat” strategy under general health promotion. Here interventions are about stimulating the organizational development of enterprises towards “healthy environments” (mainly in psycho-socio-cultural meaning). The subjects of the actions promoting health are thus entire workplaces (including employees and various groups and organizations of employees, management, families of employees, customers). According to this concept the ultimate criterion for assessing the effects is not (or not only) the health status of employees or the status of health conditions or health care actions, but the effect of these phenomena on the basic area of the company’s functioning (its profit, market position, public image) and the functioning of its employees (their comfort, personal development, identification with their workplace). This is achieved mainly by extending the involvement of the personnel in various health-promoting actions within the company (that is why it is important to support and empower their capabilities) and the degree to which health-related issues are accounted for in different, harmonically associated internal organizational policies (e.g. concerning remuneration, employment, promotions, training, occupational health and safety, environment protection, information circulation, social fund utilization). Only through this are efforts made to make pro-health changes in the infrastructure and material environment, the behaviour and health status of the employees (which was important in the first two concepts).

This last concept is the closest to the mission of the European Network of Workplace Health Promotion [ENWHP]. It is also the closest to the current pathways of the development of occupational health concepts and rhetoric.

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