When in searching for solutions to health and safety problems, people increasingly rely on the internet and social media. Senior Consultant Dr Stephen Cowley discusses the consequences of reliance on uninformed or sponsored opinion versus evidence-based advice.
On what basis are health and safety professionals making decisions about the best risk controls? When we visit our GP and receive healthcare, we assume that the treatment and advice is evidence-based. Isn’t it reasonable for people in workplaces who depend on our advice to expect that advice to be evidence-based?
During our studies, we were taught to access the body of scientific literature to complete assignments. Information literacy enables us to distinguish fact and knowledge from supposition and uninformed opinion. But our consumption of information and thereby our absorption of knowledge, is changing. We increasingly expect and use “sound-bites” and our attention span is reducing. Simultaneously our trust in and respect for expert opinions is falling.
The University of Melbourne’s Vice-Chancellor, Duncan Maskell[i], speaks of a breakdown in public discourse, increasing ignorance and a heightened challenge to expertise, fuelled by the rise of social media. He says that the media are increasingly undermining a historical respect for the authoritative advice of experts and warns of the consequences of society deciding to not operate on the basis of knowledge.
In his book “The death of expertise” Tom Nichols[ii] talks of “a Google-fuelled, Wikipedia-based, blog-sodden collapse of any division between professionals and laymen, students and teachers, knowers and wonderers – in other words, between those of any achievement in an area and those with none at all.” He suggests that one of the reasons for this is, “To reject the advice of experts is to assert autonomy…”
We have been seeing this increasingly in everyday life; in political and public debates about matters such as climate change and vaccinations. The increase has been dramatic and stark during the COVID-19 pandemic. The debate about the extent to which expert medical advisors have been correct and to which their advice has been heeded continue to rage. The use of ibuprofen to reduce susceptibility to COVID infection and a test for infection involving holding one’s breath are just two of the many examples of “advice”, based on opinion and not evidence, that have been widely circulated via social media.
Doctor and British Medical Journal (BMJ) columnist, Abraar Karan[iii] says that social media, has democratised the generation of ideas and allows not only people who know what they are talking about, but also those who do not, to gain sizeable followings relatively quickly. Without information literacy, many observers of the political and social debates are ill-equipped to decide what constitutes “evidence” or to know it when it’s presented.
Sue Llewellyn writes in the BMJ that we are living through an “info-demic (or disinfo-demic)”[iv]. While the comment refers to the COVID-19 pandemic, we all know that in everyday, non-pandemic life we are inundated with ever increasing volumes of information and dis-information.
The internet makes answers findable with ever increasing speed. In our discipline, the H&S Professional must be equipped with the skills and knowledge to not only ask the right questions but also sieve the evidence out of the soapbox opinion. Professional knowledge is, after all, built on an evidence base that has been subject to peer review and not “everyone review” [v].
Without the informed consumption of peer-reviewed evidence, the H&S profession will struggle to make the improvements to the lives of workers and the community at large that we are morally and ethically required to.
While we are improving health and safety, we still seem to have a very high tolerance for humans harming each other. Workplace injuries and harmful exposures are not natural disasters[vi]. The International Labour Organisation estimates that around 2.3 million people succumb to work-related accidents or diseases every year; more than 6,000 deaths every day, worldwide[vii]. There are around 340 million occupational accidents and 160 million victims of work-related illnesses annually.
Work-related illness is at a level that if driven by other causes would not be tolerated. In the UK, around 12,000 deaths each year are caused by past exposures to harmful substances at work[viii]. This equates to the loss of all passengers on at least two 747’s every month. Would we continue to fly if this was the case?
In my day-to-day practice, in first world countries I am no longer surprised to see the recurrence of the same injuries resulting from the same hazards that I saw in the 1980’s when I first entered the profession. I see amputations and fatalities that result from unguarded machinery, from inadequate lifting equipment and techniques, and from unprotected work at height. The tide of hearing loss and hand-arm vibration syndrome claims does not seem to abate. The concept of safety by design continues to pass duty holders like a ship in the night[ix].
I see lumbar disc prolapses as a result of triple manual handling of hundreds of cartons per day or the manual lifting of large lumps of stone, and I see carpal tunnel release surgery required following daily repetitive assembly tasks. There is evidence that manual handling training has not reduced manual handling risk[x], and yet risk assessments that have identified manual handling injury as likely, point to training as the solution. Often, time spent on design improvements and the integration of mechanical handling equipment will have a relatively short-term return on investment.
I see money wasted on ill-informed designs. I recently visited a workplace to see a new local exhaust ventilation (LEV) system that had been installed to control airborne dust. The exhaust hoods (inlets) were 1 metre above the source of the dust. As a rule of thumb, if you measure the diameter of an exhaust hood and then move the equivalent distance away from the face of the hood, the air velocity will have fallen to 1/10th of what it was at the inlet. At 1 metre the airflow was barely detectable.
Bernard Fletcher of the HSE quantified this as long ago as the 1970s[xi]. In fact, HM Factory Inspector Thomas Legge and Dr Kenneth Goadby are reported to have identified as long ago as 1912 that hoods are generally “placed too far away from the source of danger”[xii]. The hoods I saw had to be used in conjunction with personal protective equipment (respirators) because of the inadequacy of the LEV, adding additional cost and administrative burden and discomfort for the workers.
The safe-place, engineering approach to risk control embedded in contemporary H&S legislation is continually under assault by advocates of the safe-person, behaviour-centred approach. Behaviour-based safety is often dressed-up in descriptions of causation, using some trendy language. It is supported through descriptions of the effectiveness of the latest behaviour-management strategies, none of which are based on any evidence or, at least, any evidence of lasting improvements. It often leads to increased training and PPE rather than the adoption of evidence-informed, reliable and cost-efficient engineering controls.
H&S Professionals need to advance the science of safety faster than we have been. We need to accept that access to and the consumption of knowledge are changing. The profession should not fight but embrace the sound-bite, social media and google driven dissemination of ideas to spread evidence-based knowledge.
Perhaps as H&S Professionals we should, as Sue Llewellyn says4, think about “contact tracing” when accessing knowledge: think about and identify who sent a message, what was the original source, and how do we know it is reliable.
Social media uses influencers and sound bites and pithy messages to move their followers on to their sponsors’ message and product. Perhaps in health and safety we should adopt the same technique and look for “knowledge activists that can take ideas and drive them home”[xiii].
Whether in-house or external consultants, professionals are obliged to ensure that the advice given is robust. This requires the judicious consumption of evidence and well as the responsible sharing of knowledge. Without this, opportunities for workplace improvements in productivity and efficiency will be missed and the unacceptably large number of workplace injuries and harmful exposures will continue.
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[i] Hunter, F. (2020) ‘The politicisation of knowledge’: Uni boss warns facts are falling victim to partisanship, The Sydney Morning Herald, February 7, 2020 https://www.smh.com.au/politics/federal/the-politicisation-of-knowledge-uni-boss-warns-facts-are-falling-victim-to-partisanship-20200207-p53ysv.html, Retrieved 10/02/2020
[ii] Nichols, T., (2014) The Death Of Expertise The Federalist, January 17, 2014 https://thefederalist.com/2014/01/17/the-death-of-expertise/, Retrieved 10/03/2020
[iii] Karan, A., (2020): Covid-19—on trust, experts, and the brilliance of everyday people March 26, 2020 https://blogs.bmj.com/bmj/2020/03/26/abraar-karan-covid-19-trust-experts-brilliance-everyday-people/
[iv] Llewellyn, S., (2020) Covid-19: how to be careful with trust and expertise on social media BMJ 2020;368:m1160 (Published 25 March 2020)
[vi] Takala, J. (2020) Personal communication, What about the workers? Symposium, Cardiff University 29 January 2020)
[vii] ILO (2020) World Statistic, https://www.ilo.org/moscow/areas-of-work/occupational-safety-and-health/WCMS_249278/lang–en/index.htm, Retrieved 12 March 2020
[viii] HSE Work-related ill health and occupational disease in Great Britain https://www.hse.gov.uk/aboutus/occupational-disease/the-facts.htmretrieved 23 June 2020
[ix] Cowley, S. (2020), A peer-reviewed journal: Anachronism or Professionalism?, Journal of Health & Safety Research & Practice, V10(1), pp 3-6
[x] See for example Clemes, S., Haslam, C. & Haslam, R. (2010) What constitutes effective manual handling training? A systematic review, Occupational Medicine, 60(2), pp 101–107
[xi] Fletcher, B., (1977) Centreline Velocity Characteristics of Rectangular Unflanged Hoods and Slots under Suction, Annals of Occupational Hygiene, V20, pp 141-146
[xii] Legge, T. M. & Goadby, K. W. (1912), Lead Poisoning and Lead Absorption. The symptoms, pathology and prevention, with special reference to their industrial origin and an account of the principal processes Involving risk, Arnold, London, p. 35.
[xiii] Owen, T. (2020) Personal communication, What about the workers? Symposium, Cardiff University 29 January 2020)