Pitfalls in economic evaluation of OSH interventions

The objective of occupational health and safety (OSH) is to prevent work-related ill-health and injuries. In economic evaluation the health effects of these OSH interventions are related to the costs of these interventions such as in cost-effectiveness evaluation and cost benefit evaluation. This makes it possible to choose interventions that produce the biggest health effect for least money. Economic evaluation is thus a valuable technique that can help in making decisions about the most efficient use of resources. The technique is however fraud with pitfalls of which I would like to elaborate a few that are important to OSH.    Safe and healthy workplaces are realised by many different types of interventions such as regulation and enforcement, occupational health services and health care. When we discuss the contribution of occupational health services it is not always clear what the contribution of the other interventions is.    From cost of illness studies, it is evident that ill-health and injuries result in substantial costs for workers, employers and the society. However, this does not mean that we can reduce all these costs by preventive measures. There are very few interventions that are 100% effective.      Increasing productivity is a problematic objective for OSH professionals ethically.  Productivity increases when workers produce more or when they are less often off work. Increasing productivity by decreasing sick leave can go at the expense of sick workers. Moreover, evaluating an OSH project only in monetary terms makes it comparable to any other business project but ignores the inherent values of health and safety.    In economic evaluation, it is not always clear from which point of view the costs are evaluated. Business and societal points of view will often lead to different outcomes.    Fortunately, it has been shown that employers choose OSH measures for legal, moral and financial reasons.