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Traditional ideas about workplace wellbeing focused on occupational health and safety, which was appropriate because they arose in an era when most jobs were blue-collar and many workplaces were full of hazards.

Workplace hazards have evolved, however, from toxic environments and the risk of physical injury to the situation today in developed countries, with risks arising from sedentary jobs and stress. The greatest hazards for many are no longer hearing loss or accidents caused by machines, for example, but the onset of chronic diseases such as diabetes or burnout-linked depression. People spend between a quarter and a third of their waking life at work, making the workplace one of the most important environments for promoting and maintaining health.

In 2014, Singapore launched a national programme on total workplace safety and health (TWSH), integrating existing accident prevention initiatives with health promotion and disease prevention. The initiative involves the government, employers and workers. TWSH goes beyond traditional occupational health and safety initiatives to include a significant component on health promotion, focusing on interventions such as workplace ergonomics, weight management, smoking cessation and vaccination.

Before the national launch of TWSH, a pilot study was conducted in 2012, involving 30 state-run companies. This showed the more comprehensive approach of TWSH produced benefits, including wellbeing as well as health and safety. Compared with before the intervention, employees were 7.4 times more likely to be satisfied with their jobs, 4.4 times more likely to be proud to work for their company and 1.7 times more likely to report work-life balance.

Opponents of implementing TWSH initiatives frequently cite staff turnover as a reason not to invest in workplace health promotion. They point out that employers risk financial outlay with no benefit. Such a narrow-minded perspective overlooks collective benefits that can be enjoyed by all employers and employees if sufficient numbers participate.

As a leading proponent of TWSH, the School of Public Health at the National University of Singapore advocates and educates on balanced dietary intake, and provides influenza vaccinations for all staff. It also gives employees an incentive to exercise during working hours in the form of credits that can be exchanged for time off work. Members of the school’s senior management “walk the talk” by participating in these health promotion activities.

Staff have been motivated by the scheme, especially because time used for physical activity is taken from the working day. There has been no loss in productivity because staff end up working more efficiently.

To ensure the success of the scheme, senior management must get involved. Not only do they have to be seen to participate in the initiatives, but they also have to establish the framework for workplace health and answer the following sorts of questions. Are there any repercussions if an employee chooses not to take up an influenza vaccination? Should the office cafeteria subsidise healthy options and increase the prices of unhealthy offerings? What is the expectation on workplace health screening to provide early and regular indicators of health to the employees?

In Singapore, the government’s Health Promotion Board has a division that advises and guides the establishment of workplace programmes and “healthy workplace ecosystems”. The latter are facilities developed in collaboration with landlords of industrial estates or office blocks, for example, that provide centralised resources so the services are available for smaller companies. The initiatives aim to increase health literacy, provide health screenings, offer free exercise sessions, and ensure healthier food is provided at canteens.

More than 40 ecosystems, hosting in excess of 300,000 employees, have been established. The ecosystems, which are jointly funded by government and employers, are assessed by process indicators, such as the proportion of healthier meals sold and numbers of sign-ups for workplace screening (it is too soon to assess health outcomes). The scheme has been so successful that it is being expanded.

Chronic diseases can impair work performance and productivity, either through absenteeism or by affecting one’s ability to focus while working (termed presenteeism). An academic study published in 2016 estimated that diabetes cost Singapore S$1bn ($725m) in medical bills and lost productivity in 2010 and forecast that the economic burden of the disease would rise. The government launched a “War on Diabetes” in 2016 to try to combat the condition.

More needs to be done to demonstrate to governments and employers both the punitive costs of inaction on curbing the rise of chronic diseases in the workplace and the cost-effectiveness and long-term benefits of workplace health promotion programmes.

Otherwise, what awaits future governments and employers will be soaring healthcare costs that will be compounded by our rapidly ageing societies.

Yik-Ying Teo is the dean of Saw Swee Hock School of Public Health, National University of Singapore

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