Chapter 4: International definitions of work-related harm
4.7 International comparison and analysis
As apparent from this review, none of the countries examined has an overarching definition of related harm or a comprehensive method for collecting work-related harm data. The review shows that definitions of work-work-related harm around the world are generally developed for specific purposes, which may not be complementary. The systems most likely to provide broad coverage for rehabilitation and compensation purposes by not requiring work-relatedness to be established, such as the Netherlands, do not have compensation schemes that provide an excellent source of data on work-relatedness (as defined by the scheme). Finland and Australia, both dependent on establishing work-relatedness for rehabilitation and compensation purposes, generally have broader definitions of work-related harm than New Zealand in this regard.
This section compares and contrasts the countries examined in this chapter with the concepts of work-related harm discussed in Chapter 2 and New Zealand’s definitions, discussed in Chapter 3.
4.7.1 Purpose
It is clear from the international review that having multiple definitions and mechanisms for recognising work-related harm is common, and the difficulties experienced as a result are widely acknowledged internationally. None of the countries examined has an overarching framework with the sole purpose of identifying all types of work-related harm.
The legal frameworks for recognising work-related harm in New Zealand and the five other countries examined generally fall into three categories:
1. OSH notification systems that define work-related harm for regulation and prevention purposes.
2. Workers’ compensation systems that define work-related harm for rehabilitation and compensation purposes.
3. Operational classification systems that may or may not use their own definitions of work-related harm or may draw those from categories 1 or 2.
The best reporting mechanisms can be seen where there is a workers’
compensation scheme with broad coverage and high uptake, as in Finland. Where there is a high incentive to claim compensation and broad coverage that recognises a broad spectrum of work-related illness and injury, there will be a clearer picture of size and nature of work-related harm. Generally, all workers’
compensation schemes based on an insurance model have limitations, however, and surveys and other supplementary tools are increasingly used to improve information on work-related harm.
4.7.2 Who is included
Chapter 2 highlighted the importance of definitions of work-related harm clearly identifying the specific groups of people who are included or excluded. The international research discussed in Chapter 2 has given particular attention to
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clearly identifying work-related harm among the following groups: workers, including the self-employed and contractors, bystanders, commuters, and volunteers and students in work-like situations. There is also increasing discussion of how older workers are covered, given the ageing workforce.
Internationally, there is considerable variation in how these groups of people are recognised for occupational safety and health regulation purposes, for compensation purposes and in reporting and classification systems for work-related harm. Compared with the other countries examined in this review, New Zealand’s coverage of particular groups of people other than those in a traditional work environment is broad. In this regard, New Zealand’s current definitions appear well placed to face the changing nature of work in terms of providing cover and enforcement for people in non-traditional work situations. As identified in Chapter 3, however, there are still gaps that could be improved.
Table 4.1 summarises the general coverage of OSH regulation, Table 4.2 summarises the coverage of OSH reporting requirements and Table 4.3 summarises the coverage of workers’ compensation schemes in the jurisdictions examined in this review. The tables highlight the difficulties of making international comparisons without specifying definitional differences and the importance of transparency when discussing what is meant by “work-related harm”.
Table 4.1: OSH coverage of particular groups for general regulation purposes
Contractors Self-employed
Bystanders Commuters Volunteers Students
NZ ! ! ! X ! !
Victoria, Australia
! ! ! X X X
NSW, Australia
! ! ! X X !
(Apprentices)
The UK ! ! ! X X X
The
Netherlands
! ! ! ! ! !
Finland ! ! ! ! X X
The US
OSH Act
only.
X X X X X X
Table 4.2: OSH coverage of particular groups for reporting purposes
106 Contractors
Self-employed
Bystanders Commuters Volunteers Students
NZ ! ! X X X X
Table 4.3: Workers’ compensation coverage of particular groups
Contractors Self-employed
Bystanders Commuters Volunteers Students
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4.7.3 Identifying work-related acute and chronic injury and disease
The different approaches to identifying or distinguishing acute and chronic conditions are summarised in Tables 4.4 and 4.5 below.
Table 4.4: OSH reporting coverage of acute and chronic injury and
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The UK ! ! ! !
The
Netherlands
! ! ! !
Finland ! ! ! !
The US ! ! ! !
In summary:
• In Victoria, under workers’ compensation law, acute injuries and illnesses, and gradual process (chronic) injuries must simply arise out of or in the course of employment. In contrast, employment must be a significant contributing factor in the case of chronic illness and disease. Under OSH law, Victoria requires the notification of acute injuries only.
• In New South Wales, under workers’ compensation law, employment must generally be a “substantial contributing factor” for both acute and chronic injuries and illnesses. Exceptions to this general rule include travelling for work purposes, which explicitly includes commuting and recess claims. Under OSH law, New South Wales requires the notification of acute and chronic injuries and illness.
• While the UK’s system does not create distinctions between acute and chronic injuries and illness for the purposes of income support or compensation, in practice, the process of getting cover through employers’ liability insurance for chronic injuries and illnesses, and acute illness, is much harder than for acute injuries. Under OSH law, the UK requires notification of acute and chronic injuries and illness.
• In the Netherlands, there appear to be no definitional distinctions between acute and chronic injuries and illnesses for health care and income support purposes. Generally, everyone has a right to health care, covered by compulsory health insurance, and everyone has a right to 70 percent of their income to be paid for the first two years by their employer. The eligibility criteria for benefits depend on the extent of the illness or disability rather than its origins. Under OSH law, the Netherlands requires notification of acute injuries and occupational diseases.
• Finland has broad coverage of acute and chronic conditions. It covers chronic injury and illness within a list of occupational diseases. Finland requires notification of acute and chronic injuries and illness.
• Coverage in the United States differs between states. Some states require that work be a major or predominant cause of the disability or eliminate compensation for the aggravation of a pre-existing condition or for a condition related to the ageing process.Some states have additional requirements such as the disease may not be “an ordinary disease of life” or even characteristic of or peculiar to a worker’s occupation. Under federal OSH law, there are requirements to record and gather statistics on both acute and chronic injuries
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and illness. While the definitions are broad, the methods of collecting the data are often inadequate.
4.7.4 Classification and surveillance
There are a vast array of methods and systems for collecting and/or classifying information on work-related harm used internationally. The NOHSAC reports Methods and systems used to measure and monitor occupational disease and injury in New Zealand110 and International review of methods and systems used to measure and monitor occupational disease and injury73 have set out in detail methods and systems used to measure and monitor occupational disease and injury in New Zealand and internationally.
The international review of systems for classifying work-related harm above focused on the two major methods for collecting work-related harm data:
compulsory notification requirements and workers’ compensation data. Nether of the two major methods of collecting work-related harm data are adequate for compiling an accurate picture of the size and nature of work-related harm. The review also highlighted a number of other research approaches that are being used to supplement the traditional methods, such as the voluntary reporting schemes for occupational physicians in the UK, analyses of hospitalisation data and attributable fraction analyses for occupational disease.
Classification systems need to be developed and utilised in such a way that robust surveillance of work-related harm is possible. Ideally, systems recording work-related harm would use identical or compatible classification systems internationally. The ICD has the greatest potential in this regard as it is broadly used and continues to be developed with greater improvements in the ability to identify work-related harm.
The European Agency for Safety and Health at Work reports on OSH monitoring systems. It notes that no single data source can provide a complete and adequate description of occupational safety and health. There are a wide variety of approaches towards monitoring occupational safety and health in the European Union aiming to describe the situation at different levels, from the company level to a national overview. It has become a very dynamic area with a number of new models and strategies.111
The different approaches chosen for monitoring OSH at a national level include monitoring health outcomes, describing the workplace environment and describing the infrastructure and the level of prevention at national and at enterprise level. The traditional data collection approaches, based on outcome factors such as accident and diseases data, have been complemented by some new initiatives that combine data sources and monitor the infrastructure and resources at different levels. All these initiatives strive to reach the goal of having as complete a picture as possible of occupational safety and health at the level chosen.111
The Australian studies led by Driscoll have highlighted the usefulness of coronial records for identifying work-related fatalities.14 New Zealand’s changes to the coronial system hold promise for an improved source of information on work-related fatalities if the system is able to determine work-work-relatedness for all deaths
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investigated. Fatalities investigated by the coroner are, however, only the tip of the iceberg, and information on non-fatal injury as well as disease are vital to understanding the nature of work-related harm. As discussed earlier, a number of studies have stressed the importance of using multiple sources of data and types of studies to obtain a better understanding of work-related harm.13,14,33,58,59,60
These studies have predominantly used ICD-10-AM to identify injuries as well as work-relatedness. In the absence of a clear international model for identifying work-related harm from a single source, this approach holds weight, but demands a clear framework of definitions for work-related harm.
4.8 Chapter conclusion
The international review highlights that the kinds of problems identified in New Zealand are experienced internationally and emphasises the potential difficulty of establishing a common framework for defining work-related harm. In particular:
• none of the countries examined in this review has an overarching definition of work-related harm
• with the exception of Finland, none of the countries examined in this review has a comprehensive method for collecting work-related harm data
• all of the occupational health and safety systems examined suffer from under-reporting of work-related harm, particularly work-related disease/illness, which indicates that they are unlikely to be a useful tool for surveillance, although they have other useful purposes, particularly for investigations and other prevention activities such as education
• all of the countries examined face challenges in the attribution of chronic conditions to work due to the difficulties of identifying causation where there has been long latency, the often poor knowledge of general practitioners and/or the lack of relevant research.
In comparison to the countries examined in this review, New Zealand:
• is similar in its division of occupational safety and health regulation and compensation functions
• generally has broader coverage of particular groups of people other than those in a traditional work environment for compensation and regulation purposes, notably the self-employed and those in non-traditional employment relationships. However, reporting requirements are generally not as broad.
There are, however, a number of areas where, in light of the principles for defining work-related harm set out above, New Zealand could learn lessons from the countries examined. In particular:
• all of the countries examined, with the exception of the United States, provide for more straightforward criteria for rehabilitation and compensation cover of work-related chronic injury and work-related chronic disease and illness
• several jurisdictions provide for clearer, more explicit reporting requirements, with broader coverage including for example, near-misses – this may reduce confusion for employers, which would increase notification and may help focus investigations on preventative action
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• each of the countries examined provides compensation for work-related mental harm, albeit with some limitations
• the Netherlands, Finland and several states in Australia recognise commuter accidents as work-related
• Australia, the UK, Finland and the United States all provide examples of data collection methods that draw on multiple sources to provide more accurate data on work-related harm than single sources alone.
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