Aftermath: using research to understand the social and economic consequences of workplace injury and illness.

• Author: Butcher, Frances

Abstract

Evaluation research, when assessing something like the impact of workplace illness and injury, often isolates one area or perspective to study, such as clinical, functional, psychological or financial outcomes. Any attempt to identify, separate and quantify the impact of policies is made more challenging by interconnected policies and the complicated effects they have on people's lives. This article describes one example where innovative methods were used to illustrate the complex impacts of health-and-safety and injury-prevention policies, where the majority of costs and consequences remain hidden and borne by society, and therefore not part of official calculations. Aftermath: The Social and Economic Consequences of Workplace Injury and Illness explored both quantifiable and non-quantifiable costs by presenting 15 case studies of social and economic consequences. The findings humanised and personalised the burden of occupational injury and illness on society. These findings have been used for a range of health and safety initiatives, including training, media promotion, and providing client-based supporting evidence for new government initiatives and workplace insurance partnership schemes. The Aftermath study is one example where the full costs--both positive and negative--of policies are illuminated to provide a complete picture of policy impacts.

INTRODUCTION

In 2000 the Department of Labour and the Accident Compensation Commission (ACC) began a mixed-method research project called Aftermath involving 15 case studies of injured or ill employees. These case studies identified and illustrated the visible as well as the hidden costs and consequences of workplace accidents, from a range of perspectives, to help policy makers and the wider community understand the total cost. Understanding the consequences for people involved in workplace accidents, and for their families, is one example where research can be used to inform policy development from client-based evidence.

This paper explores some issues around using in-depth case studies to evaluate and measure policy outcomes. It does not discuss in detail the findings and conclusions from Aftermath, but instead explores some implications of these findings as an example of how research is used as a tool in the policy process. (2) Firstly, current gaps and debates in policy evaluation are briefly discussed. The paper goes on to outline the aims and findings of Aftermath, which used imaginative methodology to take a situation, complicated by inter-relationships between work and non-work arenas, and look at it from a range of perspectives in order to provide a full overview of the various impacts on people's lives. It concludes by discussing how providing a truer account of the impact of policies--both positive and negative--can help create a basis for rethinking the premise on which policies are based.

Although these findings are from a study looking at the impact of health and safety policies, the conclusions are relevant for many different areas of government policy, such as crimes, smoking, drug misuse, alcohol abuse, domestic violence, different diseases and injuries, and traffic accidents.

CURRENT KNOWLEDGE: GAPS AND DEBATES

Evaluating health and safety policies involves determining the purpose of the particular policy being studied, and selecting an appropriate method that provides the information needed. This is a complex and challenging task due to a lack of thorough and rigorous incidence and cost information, debates around cost and value, and the inter-connections between work and other areas of people's lives.

There is ongoing debate about the terms under which policies should be evaluated and judged a success or failure. For health and safety policies, this is further complicated because there is no clear definition of the costs of injuries and illnesses at work, and the value of prevention programmes. What are usually debated are the financial costs of red tape, bureaucracy and complying with legislation.

Some costs are less visible than others. These are the costs--financial, emotional and social--that are typically borne by the employees themselves and their family, friends and community, and are estimated to be up to seven times the amount of visible costs (Health and Safety Executive 1997). Policy evaluation can become very removed from the individual impacts. Often, what really matters to people cannot be easily measured in economic terms, and it requires imaginative techniques to capture the range and depth of complex outcomes for ordinary people of policy programmes and legislation (Dembe 2001, Kiel et al. 2000). In the case of incidences of injury and illness, we do not know how big the problem is, and unless we have experienced an injury or illness at work ourselves it is difficult to imagine what it is like.

Outcome research commonly uses statistics as its data source--administrative data or validated scales. The study population offers evidence from one perspective, and the cost information collected is usually limited to one type of cost. Because employment outcomes both affect and are affected by different areas of society, the information collected is limited and frequently underestimates the true range and depth of effects. In the literature, costs are generally divided into direct (visible or tangible costs that appear on the accounting balance sheet, and are compensated and identifiable) and indirect (invisible or intangible costs that are real, but have no dollar value assigned to them, and are incalculable and subjective). (3)

For "total cost" studies, as well as smaller, discrete population-based studies, the methodology depends on whether the purpose is to measure functional, clinical, psychological or financial outcomes. These studies illuminate certain outcomes by isolating and magnifying consequences for a particular segment of the total population, but although they retain the minute detail required to allow for individual outcomes, they do not use standardised methodology and so are not comparable. In addition, they often use clinical measures, such as validated scales, that miss the depth of qualitative information required to provide a full picture of all the consequences.

Most importantly, there have been scarcely any studies that combine a range of perspectives on one case. Because no one person sees, experiences or accounts for the full range of consequences of policy outcomes, including workplace injury or illness, the full depth and breadth of consequences are often not measured or recorded in any official statistic. Different areas view these outcomes from a range of perspectives, and it is rare that one area learns about or appreciates the experiences of another. (4) This is often the case with subjective experiences, because factors that are unique to the individual affect the type and extent of an injury's social consequence. Dembe (2001) comments that:

Characteristics such as the injured worker's age, gender, race, ethnicity, nationality, education, and socio-economic status could influence the responses of the worker, employer, insurer, and medical provider. Isolating and measuring the impact of employment policies is particularly complex because work affects many other areas of our lives. This means that identifying, separating and quantifying the various...