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Safeguard Magazine

Health, as well as safety

Most of us talk much more about safety than about health. CHRIS JONES discovers why, and offers a way out of this unproductive mental pattern.

Before I joined WorkSafe, I had another great role leading the occupational health and wellbeing strategy for the organisation that develops and manages the UK’s railway infrastructure. As with most safety-critical organisations, it was (and still is) passionate about the health and safety of the 130,000 people who work on the railways each year.

When I started with them I was keen to understand the health and safety risks that workers were facing and the approaches being taken to address them, so I made sure to spend time talking to various members of the leadership team, managing directors, health and safety staff, workers and their reps. I found their approach to be comprehensive and impressive.

Quite quickly though, I noticed something important and interesting: almost everyone I spoke to was talking about “health and safety” but each of them, without realising it, seemed to have forgotten the “health” part of the phrase. Rather than being a balance of the two issues, the risks, controls and indicators that they spoke about were all focused on safety, either as acute personal safety or potentially catastrophic events.

I’ve noticed something similar in many of my conversations and interactions in New Zealand. Given that a typical worker is at least ten times more likely to die of a work-related disease than a work-related safety incident, surely we would expect that most of our collective focus, effort and discussion would be weighted towards work-related health risks (or at least be on a par with acute safety risks)? Yet this clearly isn’t the case.


We all know there are a number of reasons why the health part of health and safety has historically received less attention. An interesting one that I’ve come to realise, though, is the way in which even our words and phrases might be unknowingly enabling this imbalanced focus, and that this has a lot to do with the way our minds work.

Over the past three decades behavioural economics and behavioural psychology have given us insights into how judgments and decisions are made. The book Nudge by Sunstein and Thaler brought these concepts to the masses. The authors describe two types of people: Econs and Humans. Econs are described as perfectly rational beings who make judgments based on coolly and calmly considering the full range of available facts, accurately weighing up the pros and cons of potential decisions, and acting accordingly to achieve the best outcomes. Think Mr Spock.

We Safeguard readers, on the other hand, are all Humans; we are influenced by a range of things that wouldn’t ever affect Econs, such as mental shortcuts (heuristics) and cognitive biases (drawing incorrect conclusions based on cognitive factors), all of which can lead to irrational judgments and imperfect decisions.

In his book Thinking, Fast and Slow, Daniel Kahneman says we all use these mental shortcuts to get us through the overwhelming number of conscious decisions we would otherwise need to make. Mental shortcuts occur due to the way our minds work; one part of our mind (System 1) works in a fast, automatic, intuitive and relatively effortless manner, while the other part (System 2) works in a slow, analytical and effortful manner.

Given that searching our minds for data, statistics and facts requires mental effort, and our mind’s aim is to minimise unnecessary effort, System 1 (fast, intuitive, low effort) has evolved to be always “on”, whereas System 2 only comes into play when activated by something.

Importantly, Kahneman argues that when we are asked questions, and as part of a tactic to reduce mental effort, System 1 has developed a cunning ability to mentally substitute hard-to-answer questions (that require mental effort to search for the true answers) for easier ones (that better suit what comes to mind easily) without us even being aware – so we can answer a question with something that sounds intuitively right, but is factually incorrect for the question we were asked.


Linking this to our roles, one mental shortcut that has a strong influence on perception of risk is the “availability heuristic” which proposes that our perception of risk (particularly the likelihood of something occurring) is influenced by the ease with which relevant examples come to mind. This can work, but there are many instances where this heuristic leads to important errors in assessment of risk. A classic example is the increased road death mortality that happened in the United States following 9/11 – the volume of media content focused on the plane crashes increased the perception of risk associated with air travel, leading many to incorrectly judge that travelling by car was a safer alternative despite evidence showing that not to be the case.

So, rather than making informed and rational judgments on what is most likely to lead to harm based on evidence (as an Econ would do), the availability heuristic can mean that we unknowingly focus our attention on those things that are simply most memorable or are in our consciousness more frequently.

Why is all of this important? Because the risks we think about, the controls we put in place, the conversations we have and the metrics we use to measure performance are all dependent upon what we judge to be most likely to lead to harm. Our natural tendency to be drawn mentally towards focusing on acute harm may contribute to a state in which we talk “health and safety”, but we think “safety”. After all, what’s more likely to come to mind quickest and easiest: the blood, noise and adrenalin rush when one worker fell from a ladder and broke his leg (acute), or the fact that five different workers on a dusty building site have all had nasty and persistent coughs for the past two months (chronic)? The availability heuristic would suggest it is the fall.

So when thinking about risks, our minds naturally divert to safety risks. When thinking about performance measures, our minds naturally divert to safety measures. How often do we read about a health and safety programme which contains almost exclusively safety-focused activities? Or a health and safety vision that only describes safety? Or a health and safety dashboard in which 90% of the measures are safety-focused? We plan to do safety walks and have safety conversations and assume that the health part will somehow take care of itself.


So how do we balance this natural tendency to drift towards focusing on acute safety with a focus on the less obvious chronic health risks? Kahneman argues that countering System 1 requires activating System 2 so that we actually consider and process information, rather than just respond automatically and intuitively.

One way to do this could be to develop a range of objective lead indicators that can be used to consciously raise the focus on health risk management, because processing facts and figures can be good at activating System 2. The recent Monitoring What Matters guide by the Business Leaders Health and Safety Forum has some good examples.

Another way could be to ensure a strong awareness campaign on work-related health risks, so they are in our minds more often.

But another quick and simple approach might be to change the way we talk about “health and safety” so that the emphasis we place on “health” is stronger and more explicit; maybe it’s time we recognise that “health and safety” could be more effective if we talk about “health, as well as safety”. It may sound subtle, but I have found it to be incredibly effective at sparking System 2 and making people consider both the “health” and the “safety” part of what they do. (Interestingly, the UK’s HSE was using the phrase “health as well as safety” back in 2014 as part of their construction initiative).

So the next time someone asks you about your approach to “health and safety”, remember your cunning System 1 and consider responding instead with “Why don’t I tell you how we approach health, as well as safety?”


Tversky, A., and Kahneman, D., (1973). Availability: A Heuristic for Judging Frequency and Probability.  Cognitive Psychology, 5; 207 - 232
Reiman, T., and Rollenhagen, C., (2011). Human and organizational biases affecting the management of safety.  Reliability Engineering and System Safety, 96; 1263 - 1274

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Chris Jones is WorkSafe New Zealand’s strategy manager.

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